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MedCram Video Recap | COVID-19 risks of infection and early treatment recommendations

February 1, 2024

In this video, Roger Seheult, MD, of MedCram examines the risks of infection and gives early treatment recommendations for COVID-19. Dr. Seheult is board-certified in internal medicine, pulmonary diseases, critical care medicine, and sleep medicine through the American Board of Internal Medicine.

Video length: 17 min., 59 sec.

COVID-19 Risk Factors

Dr. Seheult discusses a 2023 cross-sectional survey study performed in Greece involving 5,197 community-dwelling older adults age 65 and older that found certain sociodemographic, anthropometric, and lifestyle risk factors for COVID-19 that persisted after multiregression analysis. These factors included the following:

• urban residence (vs. rural residence)
• regular smoking
• elevated BMI
• abdominal obesity
• depression
• poor health-related quality of life score
• inadequate sleep quality
• anxiety
• stress
• lack of exercise
• low adherence to a Mediterranean diet

Early treatment COVID-19 recommendations

What can be done if one comes down with COVID-19? Dr. Seheult provides an overview of early treatment COVID-19 recommendations below.

Although the recommendations are outlined in no particular order, Dr. Seheult notes that sunlight and hydrotherapy are interventions that he always recommends as they can be easily accessed without fear of a supply chain shortage, require no prescription, and won't interfere with existing medications.

1. Paxlovid. This oral medication can be taken early on to reduce incidence of hospitalization and should be considered especially in older patients, in patients with comorbidities and/or those are concerned about potential hospitalization. Downsides: Can interact with other existing medications, can cause a metallic taste in the mouth, may result in a rebound after one stops taking it.

2. Sunlight – 20 to 30 minutes. A number of studies have shown that sunlight improves outcomes and mortality in COVID-19. Unfortunately most people contract COVID or the flu in the wintertime when sun levels are at their lowest. However, just by being outside, infrared radiation either directly from the sun or via reflected light can penetrate deeply into one's body even through clothes. So while it's ideal to get patients in direct sunlight, as long as they are outside, they don’t need to be directly in sunlight to experience the benefit.

3. Hydrotherapy – 20 to 30 minutes. Hydrotherapy was used 100 years ago during the flu pandemic. Hydrotherapy involves either heating up the body in a sauna or spa or using hot fomentations. It typically ends with about one minute of cold therapy, usually in the form of a foot bath. Dr. Seheult explains that hydrotherapy increases interferons. A recent article in the New England Journal of Medicine showed a single injection of interferon subcutaneously reduced hospitalization rates for COVID-19 by 50%. Hydrotherapy is something can be done very early on, is inexpensive, and in most cases, very safe. He goes on to say that hydrotherapy is useful not just for COVID-19, but also for the flu.

Caution: It's important to make sure that patients can indeed tolerate elevated temperatures because their heart rate will go up (eg, patients with cardiac arrythmias). So it's recommended that hydrotherapy be done in the presence of someone that can render aid if needed.

4. NAC (N-acetylcysteine) – Some studies have shown that NAC is associated with improved outcomes in COVID-19 as well as the flu. Evidence suggests that NAC works because of its ability to cut sulfite bonds, the mechanism used in polymerization of von Willebrand factor and blood clots in the pulmonary vascular circulation. Although risk is low, Dr. Seheult cautions that there's some concern that taking NAC chronically at high levels could increase cancer risk (in animals), so he recommends taking it only seasonally (at a dose of 600 mg PO bid).

5. Zinc – Zinc has been shown to be beneficial in reducing cold symptoms. Although there’s very low evidence that zinc is harmful, it's important not to ingest more than 40 mg zinc daily, as doing so might reduce copper levels. Quercetin is also a supplement that Dr. Seheult recommends that has very low risk for adverse effects.

6. Vitamin D3 – Dr. Seheult takes 5,000 IU daily and has had his levels tested. Some health experts also recommend taking Vitamin K2. Both can be beneficial, but before taking either Vitamin D3 or Vitamin K2, Dr. Seheulet recommends getting levels tested.

7. Hydroxychloroquine (HCQ) and ivermectin (IVM). Dr. Seheult says he was a big proponent of both HCQ and IVM very early on in the pandemic, before there were any studies, but there was a clear pathophysiological mechanism for how they might work—as a zinc ionophone that allows zinc to enter cells and via inhibition of RNA-dependent RNA polymerase. This seemed to be supported by some retrospective data at the time. However, today Dr. Seheult doesn't think there's enough evidence for efficacy of either HCQ or IVM in the form of large, randomized placebo-controlled trials.

Any views, thoughts, and opinions expressed in this recap are solely that of the host and guests and do not reflect the views, opinions, policies, or position of epocrates and athenahealth.

Source:

Seheult, Roger. (2024, January 12). MedCram. COVID-19 Risks of Infection and Early Treatment Recommendations. https://www.youtube.com/watch?v=1-ddS47V8bY