Eat Food – Antivirals are found in common foods.

Chloroquine medications are dangerous, many medications are dangerous especially if taken in too large a dose. Chloroquines are typically used to treat malaria, a condition caused by a parasite. The mechanism of action is that the chemical can hold onto the mineral zinc and carry it into an infected cell where the zinc disrupts the replication of proteins, causing less virus replication. (6) It has been mentioned as a medication that potentially may be helpful for treating patients with the novel coronavirus that is currently causing a pandemic.

The chloroquine medications are also used by autoimmune patients and supplies of the drug are limited. Increasing production is a goal but will likely take some time. (7) There are other safer alternatives available in foods or phytonutrient extracts (1, 8, 9) that have an immune modulating effect – promoting removal of infected or damaged cells while also inhibiting an overactive immune response.

People with a heart condition may also be at more risk of dangerous side effects if taking chloroquines. The medication also needs to be given with zinc to be as effective as possible. The food or phytonutrient alternatives would also need to be used with zinc in the diet or added as a supplement. (1, 8, 9)

***** ONLY TAKE PRESCRIPTION MEDICATIONS THAT ARE PRESCRIBED FOR YOU BY YOUR OWN MEDICAL PROFESSIONAL *****

***** ONLY EAT FOOD *****

Someone is dead because they consumed a household product containing chloroquine because they thought it might protect them from coronavirus infection, (10), – dead is not infectable by a virus, but dead is also dead.

Quercetin plus zinc is also an antiviral that works as a zinc ionophore, (1), however it is readily available in some common foods or as a supplement and is nontoxic to cells. (1, 2) The zinc is disrupting protein replication within the infected cell so the virus can not be replicated to spread to other cells, for more replication, more infecting other cells, more replication, etcetera.

Onions are the richest source of quercetin (4) and citrus peel is also a very rich source. (3) Pumpkin seeds are the richest source of zinc in a vegetarian diet and is commonly available in meats in a non-vegetarian diet.

Pomegranate peel extract or the inner white membrane of a pomegranate is also a source of quercetin and another phytonutrient that acts as a zinc ionophore (epigallichatechin-gallate). (1) It also would be nontoxic to healthy cells and low risk compared to the chloroquine medications. (2) However it can have some side effects, acting as a diuretic and has COX2 inhibition activity. (recent post, older post) A tablespoon or two of the liquid extract or inner white membrane can be enough to provide some health benefits for an adult. (G13: Preparation & Benefits of Pomegranate)

Onions, citrus peel, pomegranate peel – we have choices, safe choices, to help our body’s own defense system stop the coronavirus. Chloroquines do not kill coronavirus – it helps our own defense system do its job – but with more risk to healthy cells, and normal function than onions, citrus peel or pomegranate peel or quercetin supplements. Zinc is a trace mineral which we need in small amounts, a larger dose taken for a week or two would be unlikely to build up to toxic amounts but please be aware that in large doses a zinc supplement could become toxic.

Eat food – that is what our body is designed for. If the GI tract is inflamed and the idea of eating food is no longer appealing due to pain or constant diarrhea than please see the recent post: ACE2, Diarrhea, & COVID19 – it gets complicated. and try to eat small servings of something that might help heal and stop the inflammatory reaction in the intestinal tract.

If nausea and vomiting are also symptoms, hold off on the food and just sip water that has a dash of lemon or lime juice or apple cider vinegar. Those all have a type of acid that is similar to stomach acid. In cases of severe nausea even plain water can be unsettling and larger amounts of anything can be a problem. Start gradually with small sips of the lemon water, or a lime or lemon popsicle may be soothing and not cause more vomiting.

Once feeling better some of the mucilaginous or hydrolyzable tannin foods mentioned in the recent post (ACE2, Diarrhea…) can help replace the mucous lining that coats the intestinal tract during times of health. It also serves as a defense system, helping to prevent entry of virus or other pathogens into the body between intestinal cells. And white blood cells patrol the area and actively defend against pathogens.

Pomegranate peel also provides hydrolyzable tannins if the white membrane is used in prepared foods like a bean soup (G8: Cookies & Bean Soup/recipes) or sweet potato dish. Pomegranate peel and citrus peel and onions (less so) are also sources of vitamin C which also helps our body’s natural anti-viral defenses. (5)

Addition: Table of drugs and phytonutrients that are being investigated for use as a COVID19 treatment, (@rubbersoul23,Eric/table) based on A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing, March 23, 2020, (biorxiv.org)

Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.

Reference List

  1. Husam Dabbagh-Bazarbachi , Gael Clergeaud, Isabel M Quesada, et al., Zinc Ionophore Activity of Quercetin and Epigallocatechin-Gallate: From Hepa 1-6 Cells to a Liposome Model. J Agric Food Chem, 62 (32), 8085-93 2014 Aug 13. https://pubmed.ncbi.nlm.nih.gov/25050823/
  2. Houston DMJ, Bugert JJ, Denyer SP, Heard CM. Potentiated virucidal activity of pomegranate rind extract (PRE) and punicalagin against Herpes simplex virus (HSV) when co-administered with zinc (II) ions, and antiviral activity of PRE against HSV and aciclovir-resistant HSV [published correction appears in PLoS One. 2017 Nov 20;12 (11):e0188609]. PLoS One. 2017;12(6):e0179291. Published 2017 Jun 30. doi:10.1371/journal.pone.0179291 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493292/
  3. Shafiya Rafiqa, Rajkumari Kaula, S.A. Sofia, et al., Citrus peel as a source of functional ingredient: A review. J of the Saudi Society of Ag Sci, 17;4, Oct. 2018, pp 351-358 https://www.sciencedirect.com/science/article/pii/S1658077X16300960
  4. Quercetin, Pharmacology, Toxicology and Pharmaceutical Science/Quercetin, ScienceDirect.com, https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/quercetin
  5. Kim Y, Kim H, Bae S, et al. Vitamin C Is an Essential Factor on the Anti-viral Immune Responses through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection. Immune Netw. 2013;13(2):70–74. doi:10.4110/in.2013.13.2.70 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659258/
  6. Xue J, Moyer A, Peng B, Wu J, Hannafon BN, Ding W-Q (2014) Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. https://doi.org/10.1371/journal.pone.0109180 https://journals.plos.org/plosone/articleid=10.1371/journal.pone.0109180
  7. Eva Schrezenmeier, Thomas Dörner, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 16, 155–166 (2020). https://doi.org/10.1038/s41584-020-0372-x https://www.nature.com/articles/s41584-020-0372-x
  8. Wang T1, Men R1, Hu M, et al., Protective effects of Punica granatum (pomegranate) peel extract on concanavalin A-induced autoimmune hepatitis in mice. Biomed Pharmacother. 2018 Apr;100:213-220. doi: 10.1016/j.biopha.2017.12.110. Epub 2018 Feb 9. https://www.ncbi.nlm.nih.gov/pubmed/29428670
  9. Hou L, Huang H. Immune suppressive properties of artemisinin family drugs. Pharmacol Ther. 2016;166:123–127. doi:10.1016/j.pharmthera.2016.07.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035609/
  10. Anne Flaherty, Sophie Tatum, Man dies after ingesting aquarium product containing chloroquine: Hospital network. March 23, 2020, abcnews.go.com, https://abcnews.go.com/Politics/man-dies-ingesting-chloroquine-prevent-coronavirus-banner-health/story?id=69759570

ACE2, Diarrhea, & COVID19 – it gets complicated.

The reason lung edema and diarrhea and other digestive symptoms (30) are potential symptoms of the novel coronavirus, (SARS-CoV2, also called COVID-19), and not infrequent as a way for the symptoms to start, (13); is because the virus is infecting cells by entering at ACE2 receptors. ACE2 receptors seem to have a role in cardiovascular health and they are more prevalent within the lungs and in the duodenum of the GI tract. ACE2 receptors also tend to be present in more quantity in men, in smokers, (people with excess weight will also have more, due to having more adipocyte/fat cells which also have ACE2 receptors, (32, 33)), and in people taking one of two different groups of medications.

It has also been confirmed…SARS-CoV-2 uses the same receptor, the angiotensin converting enzyme II (ACE2), as the SARS-CoV [11]”  “a 3D structural analysis indicated that the spike of SARS-CoV-2 has a higher binding affinity to ACE2 than SARS-CoV [23]

Xiaolu Tang, Changcheng Wu, Xiang Li, et al., On the origin and continuing evolution of SARS-CoV-2. 29-Feb-2020. (academic.oup.com/nsr/advance-article/doi/10.1093/nsr/nwaa036/5775463)

The ACE Inhibitors (list) block an enzyme involved in the chemical pathway and Angiotensin Receptor Blockers (ARBs, list) inhibit the ACE2 receptor in addition to inhibiting Angiotensin Receptors. Angiotensin is involved in the chemical pathway which gets complicated – watch the video: Coronavirus Pandemic Update 37: The ACE-2 Receptor – The Doorway to COVID-19 (ACE Inhibitors & ARBs). (1) (And for more information: an overview article on the ACE2/Angiotensin chemical pathway. (6))

Part of the complicated part is also the question of what to do about those medications while there is risk of infection – the consensus is, more information is needed. While having been on one of them may increase the risk of infection due to there being more ACE2 receptors than usual, stopping abruptly wouldn’t immediately get rid of the extra ACE2 receptors and the medications, particularly the ARBs which block the ACE2 receptors may have a protective effect once exposure to the virus occurs. (1)

As the viral infection advances in severity – more and more virus have been replicated and many cells are infected – the patient’s symptoms tend to become similar to genetic knockout mice bred to have zero ACE2 receptors. The mice don’t do well over time, developing cardiac problems and other symptoms similar to COVID19 patients with more severe cases. (1) If the viral load was very large than the patient’s ACE2 receptors might all have been filled with virus – making the patient phenotypically similar to a mouse with zero functional ACE2 receptors.

ACE2 enzyme is also present in the body in a free floating form, not just as a receptor embedded within cell membranes. A potential treatment possibility early in exposure would be to give the patient large amounts of the soluble ACE2, (7), – the free floating enzyme would attract virus to lodge into the enzyme but it would have no cell to enter and it is our cells, or another infected species cells in which virus are replicated. The viral design takes over our own gene replicating processes within the cell and set our own body to work making many many copies of the virus. When a cell is maxed out on replication of the virus the cell bursts and the many, many virus are free to circulate looking for more cells with ACE2 receptors to enter and set to more replication.

Symptoms include chest pain, difficulty breathing, a feeling that a breath isn’t really getting oxygen (because it isn’t, lung function is significantly reduced, requiring a ventilator or other breathing support). With more severe illness, all those infected cells that burst to release virus are dead and the area would have inflammatory damage from the cellular debris. Some patients who recover have been found to have continuing decreased lung function by ~ 20-30%, enough to leave them winded, short of breath, after minimal exercise such as walking. Reinfection also seems to be possible as the antibodies against the virus don’t seem to last very long. (4) Which suggests that pinning our hopes on a vaccine or herd immunity would be foolish.

Addition: As many of half of patients who tested positive for CoV-19, in nations that have been doing mass testing, have been found to have no symptoms or only very mild cough or fever, or even oddly, a loss of the sense of smell or taste – the virus may be affecting the olfactory bulb area of the nose and brain, which may be blocking nerve signals from the nose or mouth to the brain. (27) The brain has ACE2 receptors also, the significance of this symptom to long term health of the brain is unknown at this time. (29)

Of the patients testing positive two studies have shown an average of 17.9% had no symptoms and over half of people became infected in contact with some who had not developed symptoms yet. (28) This is why we need more testing to help stop spread of infection by people who don’t realize they are infected. In the meantime it would be cautious for everyone to practice Universal Precautions – avoid body fluids and respiratory droplets from everyone.

Diet tips that might help inflammatory GI symptoms.

Now, change of topic, what to do about diarrhea and other digestive symptoms? The digestive symptoms may include stomach pain/nausea, vomiting, and intestinal pain after eating, particularly after some types of foods. Inflammatory digestive conditions can be helped by eating foods that are similar to the layer of mucus that lines the intestines during normal health.

Foods that are mucilaginous – a little sticky and gooey – include:

  • the vegetable okra and the powdered sassafras leaves used in Creole gumbos known as Gumbo File.
  • Slippery Elm Powder is an ingredient in some herbal teas designed for use with a sore throat. Marshmallow Root Powder is very similar in healing benefits and a little less expensive than Slippery Elm Powder (and yes, marshmallows were originally made from Marshmallow Root Powder, now marshmallows are just another corn product).
  • Flax meal powder (21) when mixed with boiling water and stirred for two minutes will become mucilaginous and can be used as an egg replacer as it can act as an emulsifier. Gumbo File can also be mixed with boiling water and used in place of eggs as an emulsifier. It has a stronger flavor than flax meal powder but is a finer grind. Golden flax meal is slightly less gritty in texture than regular brown flax meal. Flax seeds are very tough and will not be digestible or chewable unless ground before use.
  • Egg replacer ratio that I use- 10 tablespoons water, bring to a boil and quickly remove before over-evaporating, stir into a bowl with pre-measured two tablespoons of Golden Flax Meal or Gumbo File. Stir for two minutes until thickened and the flax meal would turn the water from clear into an opaque creamy white color. Gumbo File is greenish and dark, and would be least noticeable in a chocolate brownie type of recipe.
  • Gelatin, bone broth, Jello (TM), are all mucilaginous from the collagen/gelatin from animal products. Agar is a vegetarian gelatin substitute made from seaweed and Irish Sea Moss can also be used to make gelatin like desserts. Tapioca starch can also be used to make a gelatin like dessert that is slightly more dense in texture than Jello (TM). The Gumbo File could be used to thicken fruit juice or fruit also for a gelatin dessert like effect but the flavor again might be more noticeable than if Agar, Tapioca Starch or traditional animal derived gelatin were used.
  • Psyllium Husk powder is a mucilaginous fiber sold as a fiber supplement and stool softener. (21) All of these mucilaginous foods could help with constipation by increasing moisture content of the bowel movement or help with diarrhea by helping absorb water content of the bowel movement as well as by reinforcing the mucus like lining of the intestinal tract.
  • chan (Hyptis suaveolens L.), chia (Salvia hispanica L.), or basil (Ocimum basilicum L.), all belonging to the Lamiaceae family, are applied to drinks or food with beneficial health effects. ” (21)
  • Aloe, cactus, Lotus Root, Chinese yams, See: Word of the Day: Mucilage.
  • Artichoke hearts/artichoke leaves are a better source of insoluble fiber (thedailymeal) which adds bulk to a bowel movement so it isn’t too watery and helps everything move along a little faster. A diet that has little fiber and more processed foods, refined grains, and meat and dairy products can take many days to pass through, increasing risk of cancer and constipation pain and hemorrhoids.
  • Jerusulem artichoke, carrot, turnip – (1850) These root vegetables would be a source of soluble fiber. Sweet potato and oat bran are also good sources of soluble fiber. (Mucilage/ScienceDirect) Black beans and other beans, nuts, seeds, broccoli, pears, nectarines, apricots, apples, guava, barley, figs, (Top 20 Foods Rich in Soluble Fiber)

Hydrolyzable tannins along with gelatin like foods can also be soothing during a diarrhea illness. (8) They help reduce inflammation by reducing the amount of the inflammatory chemical lipo-polysaccharides. (16) An excessive amount, an overly large serving of hydrolyzable tannins may increase irritation of mucus membranes so the rule holds: dose makes the poison, dose makes the cure. Hydrolyzable tannins are tannins that can bind with water and other molecules and form large complexes.

Condensed tannins don’t bind with water and are even more prevalent in leaves, making up as much as fifty percent of the tannin content within leaves of most plants. (12) Plants tend to make either condensed tannins or hydrolyzable tannins, but not both. The plant makes more in response to hotter sunny summer days, and in response to insect damage – the plant’s protection against cancerous effects of UV light, and a toxin if eaten in quantity by the insects. (17) See the Reference list for a longer list of plant sources of hydrolyzable tannins. (18)

Hydrolyzable tannins may help protect against cancer cells and other damaged or infected cells by promoting apoptosis (9) – the killing and engulfing of debris or a damaged cell by white blood cells. They have antiviral capability. (31) They also act as antioxidants and help reduce levels of oxidative chemicals. (19) Hydrolyzable tannins also act as COXII inhibitors (20) as do other antioxidants (last post).

Tannins are typically found in tea (tea leaves) and other tree leaves such as Sassafras leaves made into Gumbo File or Bay Leaves that are added to a soup broth at the beginning of cooking and removed before serving the food. Condensed tannins don’t bind with water and are even more prevalent in leaves, making up as much as fifty percent of the tannin content within leaves of most plants. (12)

Oak leaves are also a source of tannins, and are traditionally used to “tan” hides – with the tannin rich oak leaves. The initial soaking process with the tannin rich leaves prepares a deer skin so the hair can be scraped off the leather hide more easily – it still is a lot of work to tan a hide in the traditional way. Oak barrels are used in the aging of wine and liquors possibly because of the gradual addition of tannins to the aging alcohol product.

Walnuts also have hydrolyzable tannins and the binding of water and other nutrients is visibly noticeable when walnuts are cooked with sweet potatoes in a casserole – the dish can turn brown in color instead of the pretty orange color of sweet potatoes. It has not turned bad, it has hydrolyzed the tannins. The hydrolyzed tannins bind with other nutrients too and can slightly reduce nutrient availability for absorption out of the intestines , (15), – however if the goal is to heal inflamed and painful intestines than having more nutrients stay in the intestines may be part of the benefit – literally reforming the mucus lining of the GI tract that would be continually lost when severe watery diarrhea is an all day problem.

A larger quantity of tannins can also be obtained from pomegranate peel. The white inner part of the peel has slightly less than outer peel which makes it less bitter in flavor and less of a diuretic. Tannins have a diuretic effect and a larger serving of pomegranate peel products can have too much of a diuretic effect. I use a vegetable peeler to remove the outer reddish-purplish rind and then I separate the white membrane from the seeds and trim away any bad spots from the white membrane and remove any discolored or spoiled seeds.

The white membrane of the pomegranate peel can be minced and added raw to a salad or added to a soup. In foods that are acidic the color of the membrane and the dish you are preparing will become more reddish in color or might turn brownish if the tannins are hydrolyzing with other ingredients and the water content. In foods that are alkaline the color will turn brown. This is least noticeable in black bean soup, white beans will have a brown broth and greenish split pea soup looks odd (warning – foods are chemistry and this is kind of fun).

The red part of the peel can be used in tea or to make a liquid concentrate that is used in small amounts but it is too bitter to eat and the diuretic properties can be potent – have the extract or tea early in the day and drink plenty of water throughout the day to help it pass through before you hope to sleep through a night. Why would you bother then? Pomegranate peel has a long list of medicinal benefits potentially including cancer treatment or prevention. It is antimicrobial, anti-worm, etc, a long list, see this webpage for health benefits, preparation and menu ideas: G13: Pomegranate. A bean soup recipe using dry beans is the last recipe on page, G8: Cookies and Bean Soup.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Roger Seheult, MD, Coronavirus Pandemic Update 37: The ACE-2 Receptor – The Doorway to COVID-19 (ACE Inhibitors & ARBs). March 16, 2020, MedCram.com, https://youtu.be/1vZDVbqRhyM
  2. ACE Inhibitors Drug Class Side Effects, List of Names, Uses, and Dosage, MedicineNet.com, https://www.medicinenet.com/ace_inhibitors/article.htm
  3. List of Angiotensin Receptor Blockers, (ARBs), (Angiotensin II Inhibitors), drugs.com, https://www.drugs.com/drug-class/angiotensin-ii-inhibitors.html
  4. Menachery, V., Yount, B., Debbink, K. et al. A SARS-like cluster of circulating bat coronaviruses shows potential for human emergence. Nat Med 21, 1508–1513 (2015). https://doi.org/10.1038/nm.3985 https://www.nature.com/articles/nm.3985
  5. The ASCO Post Staff, Pulmonary Pathology of Early COVID-19 Pneumonia Identified Retrospectively in Two Patients With Lung Cancer, ascopost.com, March 5, 2020 https://ascopost.com/news/march-2020/pulmonary-pathology-of-early-covid-19-pneumonia-identified-retrospectively-in-two-patients-with-lung-cancer/
  6. Carlos M. Ferrario, Jewell Jessup, Mark C. Chappell, et al., Effect of Angiotensin-Converting Enzyme Inhibition and Angiotensin II Receptor Blockers on Cardiac Angiotensin-Converting Enzyme 2. Circulation. 2005;111:2605–2610 https://doi.org/10.1161/CIRCULATIONAHA.104.510461 https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.104.510461
  7. COVID-19 Science Report: Therapeutics, NUS Saw Swee Hock School of Public Health, March 12, 2020, https://sph.nus.edu.sg/wp-content/uploads/2020/03/COVID-19-Science-Report-Therapeutics-13-Mar.pdf
  8. Frasca G, Cardile V, Puglia C, Bonina C, Bonina F. Gelatin tannate reduces the proinflammatory effects of lipopolysaccharide in human intestinal epithelial cells. Clinical and Experimental Gastroenterology. 2012 ;5:61-67. DOI: 10.2147/CEG.S28792. http://europepmc.org/article/PMC/3358810
  9. Hydrolysable tannins had cytotoxic effec on leukemia cells, caused apoptosis https://books.google.com/books?id=uRHwlkQVS2QC&pg=PA764&lpg=PA764&dq=Blastocystis+hominis+hydrolysable+tannins&source=bl&ots=CKm1JLwdhj&sig=ACfU3U11YQo6Plk3wjd-KsihXREUtNwjIg&hl=en&sa=X&ved=2ahUKEwjNiaKL7PHnAhUDP6wKHcsBByIQ6AEwGHoECAsQAQ#v=onepage&q=Blastocystis%20hominis%20hydrolysable%20tannins&f=false
  10. Punicalagin – an overview, ScienceDirect.com Punicalagin – ScienceDirect.com
  11. Neuroscience/Punicalagin, ScienceDirect.com www.sciencedirect.com › topics › neuroscience › punicalagin
  12. Tannin, Wikipedia.com, https://en.wikipedia.org/wiki/Tannin
  13. Study Suggests Digestive Symptoms May Be Associated with COVID-19. drugtopics.com, March 18, 2020, https://www.drugtopics.com/latest/study-suggests-digestive-symptoms-may-be-associated-covid-19
  14. Word of the Day: Mucilage, Nov. 2, 2011, FoodRepublic.com, https://www.foodrepublic.com/2011/11/02/word-of-the-day-mucilage/
  15. Anti-nutritional Effects of Condensed and Hydrolyzable Tannins, 1992, https://link.springer.com/chapter/10.1007%2F978-1-4615-3476-1_40 
  16. Frasca G, Cardile V, Puglia C, Bonina C, Bonina F. Gelatin tannate reduces the proinflammatory effects of lipopolysaccharide in human intestinal epithelial cells. Clinical and Experimental Gastroenterology. 2012 ;5:61-67. DOI: 10.2147/CEG.S28792.  http://europepmc.org/article/PMC/3358810
  17. Erick Paul Gutiérrez-Grijalva, Dulce Libna Ambriz-Pére, Nayely Leyva-López, Ramón Ignacio Castillo-López, José Basilio Heredia Review: dietary phenolic compounds, health benefits, and bioaccessibility. ALAN 66:2 2016 https://www.alanrevista.org/ediciones/2016/2/art-1/ *Hydrolyzable tannins “In the case of tannins, hydrolysable tannins are characterized by a restricted taxonomic distribution and are mainly associated with dicotyledonous plants; it has also been observed that most of the plants that can synthesize hydrolysable tannins are unable to synthesize condensed and vice versa (100).” Tannin production is increased with more UV radiation to the plant and in response to some insect damage. (Note to self, 5, in this doc)
  18. Susan G. Wynn, DVM, Barbara Fougere, Veterinary Herbal Medicine, Elsevier Health Sciences, Nov 29, 2006 https://books.google.com/books?id=iLbZDzumqt0C&pg=PA327&lpg=PA327&dq=sassafras+leaves+hydrolyzable+tannins&source=bl&ots=qSTuWQ1XbN&sig=ACfU3U0cgrerOFCe7IFXq2xp49NPrgXKuQ&hl=en&sa=X&ved=2ahUKEwjC5u73rZ_nAhXBB80KHQEXAXUQ6AEwDXoECA4QAQ#v=onepage&q=sassafras%20leaves%20hydrolyzable%20tannins&f=false Sassafras leaves book page – Agrimony (Agrimonia eupatoria), Tormentil, (Potentilla tormentilla) , Blackberry, (Rubus fructosis), Cranesbill, (Geranium maculatum), Artichoke, Bayberry, Bilberry, Black cohosh, Blue Flag, Borage, Cascara, Cassia, Chamomile (German), Cinnamon, Clivers, Comfrey, Cornsilk, Elder, Ephedra, Eucalyptus, Eyebright, Feverfew, Gentian, Hawthorn, Hops, Horse chestnut, Juniper, Marshmallow, Meadowsweet, Nettle, Pilewort, Plantain, Poplar, Prickly Ash, Raspberry, Rhubarb, Sage, Sassafras, Saw palmetto, Skullcap, Slippery elm, St. John’s Wort, Tansy, Thyme, Uva ursi, Valerian, Vervain, Willow, Witch Hazel, Yarrow, Yellow Dock. book page
  19. Proanthocyanidins and hydrolysable tannins: occurrence, dietary intake and pharmacological effects. https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/bph.13630Tannins exert several pharmacological effects, including antioxidant and free radical scavenging activity as well as antimicrobial, anti-cancer, anti-nutritional and cardio-protective properties. They also seem to exert beneficial effects on metabolic disorders and prevent the onset of several oxidative stress-related diseases.” “
  20. Hydrolyzable tannins as COX2 inhibitor, dif book page 
  21. José Manuel Cruz-Rubio, Renate Loeppert, Helmut Viernstein and Werner Praznik, Trends in the Use of Plant Non-Starch Polysaccharides within Food, Dietary Supplements, and Pharmaceuticals: Beneficial Effects on Regulation and Wellbeing of the Intestinal Tract. Sci. Pharm. 2018, 86(4), 49; https://doi.org/10.3390/scipharm86040049 https://www.mdpi.com/2218-0532/86/4/49/htm
  22. H. Panda, Handbook on Drugs from Natural Sources, Asia Pacific Business Press Inc., Oct 1, 2010, https://books.google.com/books?id=2qRaAgAAQBAJ&pg=PT115&lpg=PT115&dq=sassafras+leaves+hydrolysable+tannins&source=bl&ots=uX153bFwL_&sig=ACfU3U3ZFst6bHi2I7YIePs1AUF8kA0Cag&hl=en&sa=X&ved=2ahUKEwiZi9TgxJ_nAhUUG80KHepcAXYQ6AEwF3oECAsQAQ#v=onepage&q=sassafras%20leaves%20hydrolysable%20tannins&f=false
  23. Christian Kogler, Why You Should Be Eating Artichoke Hearts and 9 Ways to Cook With Them. Feb 18, 2016, thedailymeal.com, https://www.thedailymeal.com/healthy-eating/why-you-should-be-eating-artichoke-hearts-and-9-ways-cook-them
  24. Mucilage, ScienceDirect.com, https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/mucilage
  25. Keith Imray, A Popular Cyclopedia of Modern Domestic Medicine: Comprising Every Recent Improvement in Medical Knowledge, with a Plain Account of the Medicines in Common Use, Gates, Stedman, 1850 https://books.google.com/books?id=8-QrAQAAMAAJ&pg=PA122&lpg=PA122&dq=artichoke+mucilaginous+food&source=bl&ots=F88wll8DOg&sig=ACfU3U31lUeCt3WobMiO6M8TmMULu-iyMQ&hl=en&sa=X&ved=2ahUKEwjvwZCgzKnoAhVSS6wKHa5vBBAQ6AEwCnoECAwQAQ#v=onepage&q=artichoke%20mucilaginous%20food&f=false
  26. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1–23. doi:10.1007/978-1-4939-2438-7_1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/
  27. Ryan W Miller, There’s a new symptom of coronavirus, doctors say: Sudden loss of smell or taste. March 24, 2020, usatoday.com https://www.usatoday.com/story/news/health/2020/03/24/coronavirus-symptoms-loss-smell-taste/2897385001/
  28. Bruce Y Lee, Study: 17.9% Of People With COVID-19 Coronavirus Had No Symptoms. March 18, 2020, Forbes.com https://www.forbes.com/sites/brucelee/2020/03/18/what-percentage-have-covid-19-coronavirus-but-do-not-know-it/#10bd1c187e90
  29. Abdul Mannan Baig, Areeba Khaleeq, Usman Ali, and Hira Syeda, Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host−Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem. Neurosci. https://dx.doi.org/10.1021/acschemneuro.0c00122 https://pubs.acs.org/doi/pdf/10.1021/acschemneuro.0c00122?ref=vi-chemistry_coronavirus_research
  30. Lei Pan, Mi Mu, Pengcheng Yang, et al., Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Preprint. https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf?utm_source=yahoo&utm_medium=referral&utm_campaign=in-text-link
  31. Pietro Buzzini, Panagiotis Arapitsas, Marta Goretti, et al., Antimicrobial and Antiviral Activity of Hydrolysable Tannins. Mini Reviews in Medicinal Chemistry 8(12):1179-87 · December 2008 https://www.researchgate.net/publication/23319589_Antimicrobial_and_Antiviral_Activity_of_Hydrolysable_Tannins
  32. Jia, X.; Yin, C.; Lu, S.; Chen, Y.; Liu, Q.; Bai, J.; Lu, Y. Two Things about COVID-19 Might Need Attention. Preprints 2020, 2020020315 (doi: 10.20944/preprints202002.0315.v1). https://www.preprints.org/manuscript/202002.0315/v1
  33. Sanjum S. Sethi MD, MPH@sanjum· Thread with observations about obesity and renal deaths due to COVID19, https://twitter.com/sanjum/status/1249374582110408712?s=20

NSAIDs are COX1 and COX2 Inhibitors, while Antioxidants are COX2 Inhibitors

The mechanism involved in why NSAID medications like ibuprofen have been found to not help with treatment of COVID19 and may worsen the patient’s health instead has not been stated, however it likely involves COX1 and/or COX 2 inhibition.

NSAID medications (like ibuprofen and aspirin) or phytonutrients that act like NSAID medications (like wintergreen berries which contain methyl salicylate, chemically similar to aspirin, (3)) can be a cause of edema due to the COX 1 and COX2 inhibition effects of the drug. (1) The COVID19 virus is known to cause lung edema even in the early stages of the infection process before the symptoms are obvious. (2)

*Addition, an CDC/MedCram Update: Coronavirus Pandemic Update 40: Ibuprofen and COVID-19 (are NSAIDs safe?), trials of HIV medications, (7), includes the mechanism and controversy. Ibuprofen’s inhibition of COX2 would lead to a reduction in antibody production which wouldn’t help fight an infection, but it might also inhibit viral replication – net result, not sure whether to recommend using or not using it. Too large a dose might increase risk however. Aspirin has more activity than COX2 inhibition so it might be more of a risk for causing lung edema, especially if taken in large quantity. In the flu pandemic of 1918 a large increase in death rate occurred shortly after aspirin, a new medication at the time, was being recommended and in doses that are far larger than would be typically used now. (7)

(I was eating wintergreen berries in quantity,* 1/8-1/4 cup when I had problems with leg edema. They are botanically related to cranberries and are similar in tanginess and texture but taste like wintergreen/mint when raw. The wintergreen flavor isn’t retained after being cooked. *Don’t try this at home. ;-)

Antioxidants can also be COX2 inhibitors (4) which can also be a cause of edema. Larger doses of a NSAID medication or phytonutrient would be more likely to cause fluid and sodium retention by the kidneys and lead to swelling due to edematous fluid build up in extracellular areas of the body. Non-selective NSAIDs inhibit both COX1 and COX2 and selective NSAIDs were developed that only inhibit the COX2 enzyme. (5)

We do need extra antioxidants during stress and infectious processes because the body is using them in greater quantities. We would also likely not be able to make as many of our own internally because our bodies would be dedicating more effort to making inflammatory cytokines to fight the infection. Too many inflammatory cytokines can become a problem though and providing extra antioxidants in the diet can help protect the body during conditions of infection such as a severe influenza. (6)

Dose makes the cure, dose makes the poison.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Reference List

  1. J. Depew, Pomegranate extract update – has similar mechanism to NSAIDs, Aug 3, 2018, transcendingsqure.com, https://transcendingsquare.com/2018/08/03/pomegranate-extract-update-has-similar-mechanism-to-nsaids/
  2. The ASCO Post Staff, Pulmonary Pathology of Early COVID-19 Pneumonia Identified Retrospectively in Two Patients With Lung Cancer, ascopost.com, March 5, 2020 https://ascopost.com/news/march-2020/pulmonary-pathology-of-early-covid-19-pneumonia-identified-retrospectively-in-two-patients-with-lung-cancer/
  3. SpinSolve, Traditional Undergraduate Experiment: Synthesis of Aspirin. magritek.com, http://www.magritek.com/wp-content/uploads/2015/03/Lab-Manual-Synthesis-of-Aspirin-web.pdf
  4. Laube M, Kniess T, Pietzsch J. Development of Antioxidant COX-2 Inhibitors as Radioprotective Agents for Radiation Therapy-A Hypothesis-Driven Review. Antioxidants (Basel). 2016;5(2):14. Published 2016 Apr 19. doi:10.3390/antiox5020014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931535/
  5. Raymond C. Harris and Matthew D. Breyer, Update on Cyclooxygenase-2 Inhibitors. CJASN March 2006, 1 (2) 236-245; DOI: https://doi.org/10.2215/CJN.00890805 https://cjasn.asnjournals.org/content/1/2/236
  6. Liu Q, Zhou YH, Yang ZQ. The cytokine storm of severe influenza and development of immunomodulatory therapy. Cell Mol Immunol. 2016;13(1):3–10. doi:10.1038/cmi.2015.74 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711683/
  7. Roger Seheult, MD, Coronavirus Pandemic Update 40: Ibuprofen and COVID-19 (are NSAIDs safe?), trials of HIV medications. CDC/MedCram.com https://youtu.be/dT6mHi_8V5E

Immune support against viral infection.

The concern about the Coronavirus outbreak is valid as the infection seems more dangerous than a winter flu season. People who smoke or have a chronic lung condition, or are elderly or have other chronic conditions, or who are obese, may be at increased risk of having a more severe case of Coronavirus.

*This blogpost is continued in a longer podcast / transcript, Fear and Immunity.

Symptoms can be non-noticeable or similar to a cold or mild flu. Digestive symptoms might occur in addition to lung symptoms, dry, non-productive cough, and chest pain, hot and cold feverish chills, and extreme tiredness. Smoking increases risk of lung symptoms developing into pneumonia. Recovery seems to take longer than for a cold or flu with some people needing hospital care for weeks with a ventilator for breathing. (World/national Coronavirus Statistics) Approximately 2-14 days from exposure to symptom onset, gradually developing symptoms with a cough and chest discomfort, fever, and shortness of breath/difficulty breathing being common symptoms. (Graphic by Robert Roy Britt)

Some people may be infectious without having developed symptoms yet, or at all possibly for the 20-29 year old age bracket based on South Korea’s more extensive testing of their population. (graphic-South Korea & Italy rates of COVID-19)

People seem to be most contagious before symptom onset and in the first week of illness. (link) Twenty days infectious is average and generally is reduced by the time coughing symptoms are over. Thirtyseven days infectious is the longest measured. (Zhou et al., 2020) Wearing a face mask while infectious might help protect others but is generally not recommended as necessary for people who are not sick. A Public Service video about reducing rate of infection by hand washing, staying home, focusing on not infecting others while we don’t know who might be contagious but not showing symptoms yet. (@thejuicemedia)

Contagion risk also seems worse than the flu or a cold as the virus can survive on surfaces longer than average, possibly a week or more. Respiratory droplets may be the usual route of infection however there also may be a risk of infection from an infected person’s bowel movement. Thorough hand washing with soap and plenty of water is more likely to disrupt the cell membrane of virus and remove them physically than depending on hand sanitizers which are designed for bacteria not virus.

Alcohol in the hand sanitizer may also be drying to the skin which also can increase risk of open sores which can allow infection to enter the body more easily. Moisturize with a hand lotion while the skin is still damp to seal in some of the water. Hand lotions don’t replace moisture, they add to an oily coating on the skin that helps prevent moisture loss.

Strengthening Immune Function – food and nutrients, rest, and water, cut down on sweets, increase positive thinking & stress coping habits.

*Nutrition is not a guarantee of not becoming infected with something but it can increase the likelihood of not becoming infected or not developing as severe symptoms, as seen in the Ebola outbreak (see embedded link) and with research on vitamin D and respiratory infection rate (see video link).

  • Sugar and high fructose corn syrup generally reduce immune health and may provide simple calories that support infectious microbes more than our own health. (Defeating the Coronavirus with Immunity & Hydrotherapy, Dr. Eddie Ramirez, Youtube)
  • Sleep helps the body recover and cope with healing or fighting infection.
  • Water is essential for the body to be able to have a thin protective layer of mucous in which white blood cells can more easily find and remove infected cells.
  • Positive feelings of hope and love are more likely to support health than fear and anxiety. Doris Day’s attitude in the song lyric may be more helpful, “Whatever will be, will be, que sera sera,” along with common sense health habits.
  • Vitamin C and/or zinc lozenges may be soothing for the throat and help immune function. Elderberry is also rich in antioxidants and may also be available in immune supporting lozenges.
An orange peeled so the white pith remains.
The orange zest layer of the orange peel can be trimmed to leave the white pith to be eaten with the sweet orange wedge. The white membrane is a source of nobiletin.
  • The white pithy membrane of an orange peel has beneficial phytonutrients and is also fairly mild like the inner peel of a pomegranate. Use a vegetable peeler or sharp knife to trim off just the outer layer of orange zest and then the sweetness of the orange sections will taste okay along with the white membrane.
    • The orange peel pith contains a phytonutrient, nobiletin, that may help with weigh loss too. (Orange Juice Molecule May ‘Drastically’ Reduce Obesity, Arterial Placque, slashgear.com)
    • Nobiletin is a chemical that promotes our circadian cycles and may be protective against metabolic syndrome. Genetic studies on animals suggest that differences in the CLOCK circadian protein can cause symptoms of metabolic syndrome – obesity, high blood lipids and blood sugar, low insulin levels, fatty liver, and respiratory uncoupling. (He, et al, 2016) Respiratory uncoupling changes the way mitochondria produce energy and if the changes continue for long may lead to worse dysfunction of the mitochondria which may lead to cancer (Seyfried, et al, 2014), or other chronic health problems. (Ruiz-Ramirez, et al., 2016) Research with nobiletin as a cancer treatment suggests that it stops cancer growth by deactivating cancerous genes. (plantmedicines.org)
    • Orange peel extract has also been studied for use against Coronavirus and it helped reduce replication of the virus. (Ulasli, et al., 2014)
    • Chen Pi, dried tangerine peel, is a traditional Chinese medicinal product sold as an anti-viral and digestive support. (alibaba.com/Chen Pi) Improving bioaccessibility of nobiletin with peanut protein nanoparticle encapsulation, for anti-cancer potential as a medication: (Ning, et al., 2019) Chen Pi is traditionally used as a digestive aid and for respiratory conditions that involve too much thick mucous. Chen Pi is thought to help thin the mucous and promote a more productive cough. (esgreen.com/Chen Pi)
  • Other immune supporting nutrients that may help against a Coronavirus infection include Nrf2 promoting sulfarophane and resveratrol. Elderberry is a good source of anthocyanins and other antioxidant phenols, blueberries and black beans would also be rich sources. Zinc and selenium are minerals with antioxidant function. (selenium sources) Having adequate Vitamin A and D is essential for immune function. NAC and lipoic acid are antioxidants. Nrf2 pathways increase our own internal production of antioxidants. (Other foods: Nrf2 Promoting Foods)
  • Both high dose vitamin C and zinc are listed as potential therapeutics for treatment of patients with COVID-19 and Chloroquine, the anti-malarial that was found helpful for treatment of the infection in China, is a zinc ionophore. (14) Zinc ionophores help with autophagy and apoptosis – the killing and engulfing of infected cells by white blood cells. (15)

Cytokine Storm Syndrome & Vitamin C Infusion, — webinar for medical professionals.

An over-reaction of the immune system called Cytokine Storm Syndrome or sepsis shock can be the cause of death from COVID-19 infection rather than the breathing problems and pneumonia symptoms. Some people may be more genetically at risk of having the inflammatory over-production of cytokines. (Cytokine Storm Syndrome/genetics) They are involved in killing infected cells but an excess can cause organ failure and lead to death. Intravenous Vitamin C Infusion can be safe and nontoxic for treating sepsis shock (Fowler 2014) and may improve survival rates (ScienceDaily) and is a strategy that was used in Wuhan, China for COVID-19 patients. (Video update by Dr. Cheng) (Clinical Trial/Peng) (Protocol used in China for Vitamin C Infusion IV treatment) A free webinar for medical professionals is being offered March 26 regarding Intravenous Vitamin C Infusion for COVID-19 treatment, see this for registration information. The webinar is now available as a video that can be viewed at any time, see the website: isom.ca. The Vitamin C Infusion technique is being used for COVID19 patients in a large hospital chain in New York, based on the improved survival rate seen in Shanghai China, (NYPost)

Patients from Wuhan with COVID-19 who were in the ICU had more cytokines, (“IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα.”, (Huang, et al, 2020)), than patients who weren’t sick enough to be admitted to the ICU. Other possible guidance to check for cytokine storm besides the cytokine levels is C-Reactive Protein and serum ferritin levels. (Teachey 2016) The medication Anakinra may be treatment. (comment)

From a nutrition care perspective – the Nrf2 promoting foods also tend to inhibit the inflammatory NfKb pathway which leads to increased production of TNFalpha and other cytokines.

Chloroquine phosphate, 500 mg BID, was used as a treatment in China per a comment on a medical site. (Detailed document with specific recommendations, may be helpful medication as a preventive or treatment.) It is an anti-malarial drug. and the virus seems to be interfering with heme in red blood cells, a little similar to malaria taking over red blood cells. ( Dr’s summary; and his ref list) Artemisinin is an extract of the herb woodruff that is used to treat malaria. It is available as an herbal supplement. (nobelprizemedicine/pdf)

With a new strain of virus we are learning how to treat it and how it spreads and being brand new, no one has immunity against it. Being a coronavirus puts it in the same group as colds and flus which can mutate slightly and we can catch the illness more than once.

The COVID-19 may also be able to be infectious to people who already recovered. (LATimes) The cases of reinfection may also be the same infection in the patient seeming to get better and then relapsing again.

Prevention is safest. Wash hands and surfaces thoroughly and regularly. Soap, water, and scrubbing physically helps break down virus membranes and remove the virus from skin and other surfaces. Hand sanitizer is not more effective than thoroughly washing with soap and water. antibacterial ingredients are designed against bacteria, not virus.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

“Supplements thought to be useful in the prevention of coronavirus infection include NAC, elderberry, spirulina, beta-glucan, glucosamine, selenium, zinc, lipoic acid, sulforaphane, resveratrol, vitamin D, Bifidobacterium bifidum strain probiotics and sporebiotics. ”

– Dr. Joseph Mercola (Essential Nutrition to Protect Yourself from Coronavirus) *

Origins – not a bat in China, genetically traced to the US around Aug/Oct 2019.

*That link includes some speculation about origins of the current Coronavirus strain – supporting the immune system and reducing infection rate and severity of disease is necessary whether the strain was from bats in the wild or a lab or from a lab manipulation of a strain from bats – saving lives needs to be a goal now.

(statement from Robert Kennedy Jr) “He [Taiwan Virologist] demonstrated that only the US has all the five known strains of the virus (while Wuhan and most of China have only one, as do Taiwan and South Korea, Thailand and Vietnam, Singapore, and England, Belgium and Germany), constituting a thesis that the haplotypes in other nations may have originated in the US. Korea and Taiwan have a different haplotype of the virus than China, perhaps more infective but much less deadly, which would account for a death rate only 1/3 that of China. [*so infection rates from South Korea may not be represent the risk for all ares] Neither Iran nor Italy were included in the above tests, but both countries have now deciphered the locally prevalent genome and have declared them of different varieties from those in China, which means they did not originate in China but were of necessity introduced from another source. It is worth noting that the variety in Italy has approximately the same fatality rate as that of China, three times as great as other nations, while the haplotype in Iran appears to be the deadliest with a fatality rate of between 10% and 25%. (7) (8) (9)” (globalresearch.ca) (news stories). (transcript of a video) There seems to be at least two strains, more information is needed to understand the significance of that (abcnews.com).

Reference List – incomplete, see links within the blogpost also.

  1. Protocol used in China for Vitamin C Infusion treatment for COVID19 , translated from Chinese on Google Translate – https://docs.google.com/document/d/1f21o4uqO0QmrF8e1d8JKMhE6NU7k8im5bVKqwROreTc/edit?usp=sharing
  1. Vitamin C for the Treatment of Coronavirus (COVID-19), free webinar scheduled for March 19, 2019, International Society for Orthomolecular Medicine, https://isom.ca/vitamin-c-coronavirus/
  2. Wen-Bin Yu, Guang-Da Tang, Li Zhang, Richard T. Corlett. Decoding the evolution and transmissions of the novel pneumonia coronavirus (SARS-CoV-2) using whole genomic data. https://www.dropbox.com/s/se41lvl8esbr40l/202002.00033v2.pdf?dl=0 
  3. Xiaolu Tang, Changcheng Wu, Xiang Li, Yuhe Song, Xinmin Yao, Xinkai Wu, Yuange Duan, Hong Zhang, Yirong Wang, Zhaohui Qian, Jie Cui, Jian Lu, On the origin and continuing evolution of SARS-CoV-2, National Science Review, , nwaa036, https://doi.org/10.1093/nsr/nwaa036 https://academic.oup.com/nsr/advance-article/doi/10.1093/nsr/nwaa036/5775463?searchresult=1
  4. Jon Cohen, Wuhan seafood market may not be source of novel virus spreading globally. ScienceMag.org,  Jan. 26, 2020, https://www.sciencemag.org/news/2020/01/wuhan-seafood-market-may-not-be-source-novel-virus-spreading-globally
  5. Other links until I complete this list are in the post Immune Support Against Viral Infection, https://transcendingsquare.com/2020/03/12/immune-support-against-viral-infection/
  6. The ASCO Post Staff, Pulmonary Pathology of Early COVID-19 Pneumonia Identified Retrospectively in Two Patients With Lung Cancer, ascopost.com, March 5, 2020 https://ascopost.com/news/march-2020/pulmonary-pathology-of-early-covid-19-pneumonia-identified-retrospectively-in-two-patients-with-lung-cancer/
  7. Chloroquine guidance for COVID19, as preventive or treatment of infection, https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub
  8. expert reaction to reports that the French Health Minister recommended use of paracetamol for fever from COVID-19 rather than ibuprofen or cortisone, March 16, 2020 https://www.sciencemediacentre.org/expert-reaction-to-reports-that-the-french-health-minister-recommended-use-of-paracetamol-for-fever-from-covid-19-rather-than-ibuprofen-or-cortisone/
  9. Fehr AR, Perlman S. Coronaviruses: an itoverview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1–23. doi:10.1007/978-1-4939-2438-7_1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369385/
  10. Roujian Lu, Xiang Zhao, Juan Li, et al.,  Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. January 29, 2020, https://doi.org/10.1016/S0140-6736(20)30251-8 https://www.cdc.gov/coronavirus/2019-ncov/downloads/genomic-characterization-of-2019-nCoV-Lancet-1-29-2020.pdf 
  11. Diagnostic detection of Wuhan coronavirus 2019 by real-time RTPCR. https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf 
  12.   http://www.aabb.org/advocacy/regulatorygovernment/Documents/Impact-of-2019-Novel-Coronavirus-on-Blood-Donation.pdf
  13. Sy Mukherjee, China’s high smoking rate may be exacerbating the coronavirus outbreak,  Feb. 19, 2020, Forbes.com, https://www.google.com/amp/s/fortune.com/2020/02/19/coronavirus-china-smoking-rate-men/amp/
  14. COVID-19 Science Report: Therapeutics, NUS Saw Swee Hock School of Public Health, March 12, 2020, https://sph.nus.edu.sg/wp-content/uploads/2020/03/COVID-19-Science-Report-Therapeutics-13-Mar.pdf
  15. Xue J, Moyer A, Peng B, Wu J, Hannafon BN, Ding W-Q (2014) Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. https://doi.org/10.1371/journal.pone.0109180 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109180