More than just hand washing and social distancing: What you can do now to prepare for a COVID-19 exposure.

For the past few weeks, I’ve haven’t been on social media much. Mostly because I was taking the time to slow down and tend to my health. In March and April, I was scheduled to travel almost every week and in preparation for that travel, I had multiple work projects that needed completed. On top of that, Ben, our eldest son, decided he wanted to finish 8th grade in public school in preparation for high school in the fall. Thus, I was expecting a very busy spring. So I started my normal wellness routine, to settle down and get back to my roots.

And then COVID-19 hit the US.

Now, my travel has been postponed until further notice. My work has slowed because I can now easily prioritize what really needs done. And since public school in West Virginia is cancelled for at least the next two weeks, we are finishing up the home-school year as planned. Amid the chaos, we’ve been given the gift of a slower pace and much needed time at home. And I’m thankful for that.

But, I’m also acutely aware that this is not the case for so many others.

Many of you are now dealing with educating your children at home, managing new and changing work situations, preparing for shortages at the food markets, dealing with the stress and anxiety of an ever evolving and uncertain situation and asking what you can do besides hand washing and social distancing to ward off this potentially life-threatening illness if you should have an exposure.

For those of you in healthcare, this is amplified by the fact that every day, you put yourself at risk simply to do your job. I deeply understand the tug of war you must be feeling. Questioning whether you should stay at home to protect your family or continue to serve those in need and work alongside your colleagues as this virus engulfs us. Although I’m no longer working on the front lines as a nurse, I remain deeply committed to the healthcare community and sincerely want to offer my support to you.

If you need someone to talk to, want to brainstorm what’s working or not working in your institution, or are simply looking for advice as to how to protect yourself, please reach out. I may not have any answers, but I can at least listen and be there as a sounding board as you navigate this unknown territory.

Given we know so little about this infection, there is little evidence to support specific recommendations for how to prepare yourself for a potential exposure. However, these past few days I felt compelled to look at the evidence supporting common preventative measures for the flu and common cold, because I know there is more we can do to prepare for COVID-19 than what we are hearing in the media. I’ve taken the liberty of sharing them here in the hopes that it resonates with you in some way and may even help to keep your immune system strong and healthy in the event that you should be exposed. I offer these suggestions as only suggestions based on the evidence. Most of what I have reviewed has little to no side effects or risks, but please reach out to your healthcare provider for specific treatment advice, especially if you have an underlying medical condition or fall into an at-risk or vulnerable population.

As a holistic nurse and mom of four, wellness is the way I live and practice. So, I’m doing everything I’ve written about here to prepare myself and my family. In addition to the specific tips below, please follow the Centers for Disease Control and Prevention (CDC) recommendations to stay home and avoid crowds, wash your hands regularly and do not touch your face, eyes, or mouth to avoid spreading the virus. https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html

Most importantly take this seriously. We have never seen anything like this, and although I am hopeful it will settle in a few weeks, I’m prepared for things to get much worse before they get better. And taking the steps now to protect my health and the health of my family.

We fight fear with faith; but faith comes from action. Do what you can today.

Support your immune system now, before a potential exposure

1.      Consider adding Vitamin C and Vitamin D supplements and Probiotics to your daily wellness routine

Vitamin C has been shown to decrease the incidence of the common cold (viral infection) in physically active people as well as to prevent pneumonia, in those who get the cold. 1 In children Vitamin C may even reduce the duration of upper respiration tract infection (URI) and has very little side effects. 2

Vitamin D is known to have an antiviral effect,3 and in a recent meta-analysis (many studies evaluated together) Vitamin D supplementation was deemed safe and protected against acute respiratory illness. 4  

Probiotics are live gut microbes that support the health of the gut microbiome, from which 70% of your immune system comes. Thus, a healthy stomach is the key to fighting off viral and bacterial infections of all kinds. Those who take probiotics and eat prebiotic rich foods (high in fiber, green leafy vegetables) have a lower risk of getting the flu or upper respiratory tract infection.5 In those who get the flu vaccine, probiotics enhance your response to the vaccine, protecting you even more from getting the flu.6

The gut microbiome is extremely complex, and I am not an expert in this area, but to put it simply: when you overload your diet with sugar, hard to digest flours and red meats, the good bugs in your gut die, allowing the bad bugs to grow out of control. These bad bugs do nothing to support your immune system and may contribute to poor immunity and things like autoimmunity (the body turning on itself) and inflammatory conditions. But taking probiotics is only half of the equation: To re-populate your belly with good bugs, you must support those good bugs with good food or else the probiotics you take will be taken in vain. Fill up on green leafy veggies and fiber, and your belly (and immune system) will thank you for it!

2.      Manage your stress and breathe, often

 I know you’ve heard it, but do you really understand why you need to manage your stress? Probably not. When you feel anxious, frustrated or uptight (ie stressed), your brain sends chemical signals coursing throughout your body in preparation for a fight. In the long term, these chemical signals (most notably cortisol) wreak havoc on your liver, kidneys and blood vessels. If you don’t take regular action to turn to slow the signals and turn them down, to calm your brain, you set the stage for chronic health issues and poor immunity.

But how do you this when in a stressful environment? First and foremost, take a deep breath and deep breathe often. Deep breathing is a highly effective way to decrease cortisol, decrease blood pressure, improve concentration and create feelings of overall calmness and peace.7,8

This right here is exactly why I advocate so deeply for a regular yoga practice. The root word of yoga means to unite---in yoga we unite breath with movement. Yoga teaches you how to breath and that is why it is so effective in managing stress and anxiety. Depending on the type of yoga you practice, you can get a cardiovascular workout, or you can practice restorative poses to relax when feeling ill. There are many forms of yoga, but all of them focus on breathing. Find an advanced yogi to show you how to start slow, find a practice you like and stick with it!

3.      This brings us to exercise (sorry, there’s no getting around this one!)

Exercise is a necessity. Our bodies were meant to move. When we don’t, we get achy and arthritic. When it comes to exercise, the best thing you can do is stay active throughout your day and add walking multiple times a day to your routine. If you can also add in short bouts of moderate intensity to sweat a little, even better. This combination of staying physically active all day combined with short bouts of moderate intensity exercise has been shown to be the most effective in boosting the immune system, reducing inflammation and preventing the common cold and flu.9   

4.      Get plenty of sleep

In challenging times, it’s hard to sleep. We stay up worrying about all the what ifs, and if we are lucky enough for sleep to finally find us, we find ourselves waking up multiple times throughout the night or way too early to get in the recommended 7 to 8 hours each night. But now, more than ever, sleep needs to become a priority. Sleep has a positive impact on the immune system, is associated with a reduced risk of infection, and improves infection outcomes.10  

If you have trouble sleeping, and do not have a nightly sleep routine, then make tonight the night you start. A nightly sleep routine or good sleep hygiene is an easy way to calm your mind and prepare your body for sleep. Start at least an hour before bedtime, eliminate electronics, and do things to support your body to slow down: Like taking a warm bath or shower, drinking a hot herbal tea, practicing deep breathing or mediation, and restorative yoga poses. Good sleep hygiene has been shown to decrease insomnia in post-menopausal women 11 and does wanders for your immune system.

5.      Do what you can to avoid isolation

In healthy aging studies, scientists have found places in the world where people consistently live beyond 100 years of age. These areas have been called the Blue Zones and there’s a lot we can learn from these communities. Most notably, those who live to an old age are those who stay connected to others and their community through a sense of purpose and belonging.12 It seems isolation has a negative effect on not just your life expectancy, but your ability to ward off infections.13 Loneliness affects your cortisol and decreases your immunity, making it harder for you to fight off an infection. So, in the midst of social distancing, stay connected to your people and your community. Video call those you can, pick up the phone for those you can’t; join online discussion groups and participate in the conversation. Stay connected. And if you don’t have a community join ours at Deep Roots Healing! https://www.facebook.com/Deeprootshealing

In addition to the 5 things listed above, you may want to consider decreasing overall inflammation in your body, which is especially important for those of you with underlying inflammatory conditions, like heart disease, diabetes, obesity, and arthritis. Since I have an underlying heart condition, I do my best to follow an anti-inflammatory diet (high in vegetables, healthy grains and fats, and low in animal fats, sugars, and white flours), but often fall short of my best intentions. After taking note of how I feel when I follow this diet, I have to personally recommend this to anyone who wants to improve their overall health and well being. Many common chronic conditions, like heart disease and diabetes, stem from issues with the gut microbiome, thus targeting your diet is a sure fire way to get these conditions under control.14  When food enters your mouth, your immune system is activated, and immune responses to food and microbial antigens can cause inflammation and exacerbate underlying conditions. And this isn’t just people with food allergies. All of us have a reaction to our food. During this time, we should be extra careful about what we are putting in our mouths. We truly do become what we eat.

If you want to go beyond an anti-inflammatory diet, you can consider adding herbs like Holy Basil (Tulsi), which has been shown to not only enhance immune function but improve mood. 15 And add garlic and turmeric (curcumin) to your meals to help decrease blood pressure, regulate cholesterol and boost immunity. 16,17  I’ve got lots of other herbal remedies I’ve tried over the years, so if you are interested in learning more, send me a note, I would love to give you specific feedback.

If or when you get sick or have a known potential exposure

The foundation of an integrative approach to decreasing the severity and duration of symptoms lies in the appropriate use of nutrition and botanicals. The combination of proper diet with Echinacea, Vitamin D, Vitamin C and Zinc has been shown to improve symptom severity and duration for the common cold. 18 Although the data on Echinacea for prevention, has shown to have minor benefit in large meta-analysis, 19 , there are mixed results to support its use in prevention. 20 However, drinking Echinacea tea at the earliest onset of symptoms reduces overall symptoms.21 If you are tea lover, then you can even mix echinacea with holy basil for an added beneficial effect.  

Zinc supplementation is another potential addition to your routine, but there are mixed opinions of its effect in the medical community. Zinc is a known antiviral prescribed for herpes simplex and the common cold, 22 and when taken within 24 hours of first signs and symptoms it reduces the duration of the common cold. 23 But it can cause nausea and leave a bad taste in your mouth, so it doesn’t come highly recommended.

Although we are not dealing with the common cold, self-care that works for the common cold, should be the mainstay of treatment until a vaccine or treatment is made available. Unless you have severe symptoms, per the Centers for Disease Control and Prevention (CDC), stay home, get in touch with your doctor and take care of yourself by focusing on nutrition, staying well hydrated and if you feel inclined to do so, supplement with Echinacea, Vitamin D, and Vitamin C. If your symptoms worsen, or you have trouble breathing, experience pain or pressure in your chest, are confused or unable to be aroused or awakened, or have bluish or pale lips or face, seek emergency treatment right away. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

And don’t forget supportive care. This includes things like detox baths, massage oil back rubs, and plenty of warm snuggles and prayer. These little things go a long way in helping you through any challenging time and are a great way to support your children when they are sick. You can read an earlier post I wrote specifically for sick little ones here: https://www.deeprootshealing.org/supportive-care-sick-little-ones/

Although, this is not an exhaustive review, and I’m certain there are mixed opinions regarding these non-pharmaceutical measures, I do believe much of what I present can help if you take the time to implement them correctly and with care. Too many of us have forgotten how to take care of ourselves, especially when there is no treatment. This crisis is reminding me how critical it is to advocate for the importance of getting back to our roots.

I pray for the health and safety of everyone in the front lines, as well as their families who are feeling the pressure of the profession to go when called. May you come out of this stronger, healthier and even more committed to your work than ever before. For those of us on the sidelines, do what you can to support those on the front lines.

We are all in this together.

References:

1.      Hemila, H. Vitamin C and Infections. Nutrients. 2017 Mar 29;9(4). pii: E339. doi: 10.3390/nu9040339.  

2.      Vorilhon P, Arpajou B, Vaillant Roussel H, Merlin é, Pereira B, Cabaillot A. Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children. Eur J Clin Pharmacol. 2019 Mar;75(3):303-311. doi: 10.1007/s00228-018-2601-7. Epub 2018 Nov 21.

3.      Teymoori-Rad M, Shokri F, Salimi V, Marashi SM. The interplay between vitamin D and viral infections. Rev Med Virol. 2019 Mar;29(2):e2032. doi: 10.1002/rmv.2032. Epub 2019 Jan 6.

4.      Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC, Grant CC, Janssens W, Jensen ME, Kerley CP, Laaksi I, Manaseki-Holland S, Mauger D, Murdoch DR, Neale R, Rees JR, Simpson S, Stelmach I, Trilok Kumar G, Urashima M, Camargo CA, Griffiths C, Hooper RL. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis. Health Technol Assess. 2019 Jan;23(2):1-44. doi: 10.3310/hta23020.

5.      Zhang H, Yeh C, Jin Z, Ding L, Liu BY, Zhang L, Dannelly HK. Prospective study of probiotic supplementation results in immune stimulation and improvement of upper respiratory infection rate. Synth Syst Biotechnol. 2018 Mar 12;3(2):113-120. doi: 10.1016/j.synbio.2018.03.001. eCollection 2018 Jun.

6.      Lei WT, Shih PC, Liu SJ, Lin CY, Yeh TL. Effect of Probiotics and Prebiotics on Immune Response to Influenza Vaccination in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2017 Oct 27;9(11). pii: E1175. doi: 10.3390/nu9111175.  

7.      Perciavalle V, Blandini M, Fecarotta P, Buscemi A, Di Corrado D, Bertolo L, Fichera F, Coco M. The role of deep breathing on stress. Neurol Sci. 2017 Mar;38(3):451-458. doi: 10.1007/s10072-016-2790-8. Epub 2016 Dec 19.

8.      Manandhar SA1Pramanik T. Immediate Effect of Slow Deep Breathing Exercise on Blood Pressure and Reaction Time. Mymensingh Med J. 2019 Oct;28(4):925-929.

9.      Simpson RJ, Kunz H, Agha N, Graff R. Exercise and the Regulation of Immune Functions. Prog Mol Biol Transl Sci. 2015;135:355-80. doi: 10.1016/bs.pmbts.2015.08.001. Epub 2015 Sep 5.

10.  Besedovsky L, Lange T, Haack M. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev. 2019 Jul 1;99(3):1325-1380. doi: 10.1152/physrev.00010.2018.

11.  Duman M, Timur Ta?han S. The effect of sleep hygiene education and relaxation exercises on insomnia among postmenopausal women: A randomized clinical trial. Int J Nurs Pract. 2018 Aug;24(4):e12650. doi: 10.1111/ijn.12650. Epub 2018 Mar 23.  

12.  Buettner D1 Skemp S. Blue Zones: Lessons From the World's Longest Lived. Am J Lifestyle Med. 2016 Jul 7;10(5):318-321. doi: 10.1177/1559827616637066. eCollection 2016 Sep-Oct.  

13.  Campagne DM. Stress and perceived social isolation (loneliness). Arch Gerontol Geriatr. 2019 May - Jun;82:192-199. doi: 10.1016/j.archger.2019.02.007. Epub 2019 Feb 22.

14.  Yap YA, Mari?o E. An Insight Into the Intestinal Web of Mucosal Immunity, Microbiota, and Diet in Inflammation. Front Immunol. 2018 Nov 20;9:2617. doi: 10.3389/fimmu.2018.02617. eCollection 2018.

15.  Jamshidi N, Cohen MM. The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature. Evid Based Complement Alternat Med. 2017;2017:9217567. doi: 10.1155/2017/9217567. Epub 2017 Mar 16.  

16.  Ried K. Garlic Lowers Blood Pressure in Hypertensive Individuals, Regulates Serum Cholesterol, and Stimulates Immunity: An Updated Meta-analysis and Review. J Nutr. 2016 Feb;146(2):389S-396S. doi: 10.3945/jn.114.202192. Epub 2016 Jan 13.

17.  Li C, Miao X, Li F, Adhikari BK, Liu Y, Sun J, Zhang R, Cai L, Liu Q, Wang Y. Curcuminoids: Implication for inflammation and oxidative stress in cardiovascular diseases. Phytother Res. 2019 May;33(5):1302-1317. doi: 10.1002/ptr.6324. Epub 2019 Mar 4.  

18.  Rondanelli M, Miccono A, Lamburghini S, Avanzato I, Riva A, Allegrini P, Faliva MA, Peroni G, Nichetti M, Perna S. Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds-Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds. Evid Based Complement Alternat Med. 2018 Apr 29;2018:5813095. doi: 10.1155/2018/5813095. eCollection 2018.

19.  Karsch-V?lk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;2(2):CD000530. Published 2014 Feb 20. doi:10.1002/14651858.CD000530.pub3

20.  Ross SM. Echinacea purpurea: A Proprietary Extract of Echinacea purpurea Is Shown to be Safe and Effective in the Prevention of the Common Cold. Holist Nurs Pract. 2016;30(1):54–57. doi:10.1097/HNP.0000000000000130

21.  Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327–334. doi:10.1089/10755530050120691  

22.  Read SA, Obeid S, Ahlenstiel C, Ahlenstiel G. The Role of Zinc in Antiviral Immunity. Adv Nutr. 2019;10(4):696–710. doi:10.1093/advances/nmz013

23.  Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev. 2013;(6):CD001364. Published 2013 Jun 18. doi:10.1002/14651858.CD001364.pub4