SHOW NOTES

Review of Dr. Pastore’s qualifications [0:20]

• PhD Biomedical informatics, nanomedicine and clinical informatics from Rutgers University, School of Health Professions
  • Expertise is understanding biomedical sciences, human genetics & RNA mechanisms, disease processes & systems, nanomedicine, drug discovery
• Graduate degree in Human Nutrition, Certified Nutrition Specialist

All of the information today is backed by science [3:00]

What is the coronavirus, what is COVID-19 and how does this compare to SARS [3:45]

• Coronavirus - simply type of virus, under microscope has pointed structure looks like it wears a crown
  • Been exposed to coronavirus for a long time - cold, mild upper respiratory tract infection where bodies fight back - no cure
  • 200+ different types
  • “Novel” coronavirus = newly identified coronavirus type, no resistance against it
• SARS 2003-2004 [6:20]
  • Severe acute respiratory syndrome, caused by a novel coronavirus at the time
  • Jumped from animal kingdom to humans, which is what is believed to have happened with the new 2019 coronavirus
• COVID-19 [7:05]
  • The upper respiratory infection some people develop after contracting the novel 2019 coronavirus (hence the name COVID-19)
    
• You can be exposed to the coronavirus, be a carrier of the coronavirus, potentially exhibiting zero symptoms ever, transmit the virus to someone else and they can develop COVID-19 symptoms [7:30]

• Coronavirus is spreading faster than SARS in 2003 [8:00]
  • Less severe of an illness in the majority of those infected when compared to SARS
• Those with strong immune systems may only ever feel incredibly mild cold/flu symptoms or nothing at all, yet are giving the coronavirus to others with weaker immune systems [9:40]
  • There are some individuals who do not feel sick, infect others, and then  develop COVID-19 symptoms

What makes the coronavirus so dangerous? [10:50]

• Spreading faster than any other virus in history
• Those that have passed away from COVID-19 experienced a “cytokine storm” [11:30]
  • Mutli-factorial hyper-inflammatory process
  • Over-stimulates the immune system factors, causing the lungs to shut down the normal process of breathing
• Genetic polymorphism (genetic expression) in gene ACE2 can allow COVID-19 to get deeper into the lungs, greater chance of developing cytokine storm requiring hospitalization & ventilation [13:25]
• As of April 9, 2020, 25% of people walk around asymptomatic (constantly changing) [17:00]
  • was 17.3% March 20th, 2020
  • People need to behave like they have the infection

Less-known or more rare symptoms of the coronavirus beyond cough/fever/chills/aches [18:00]

• 3% of carriers present with pink-eye, can be the only symptom
• Diarrhea & other gastrointestinal/digestive complaints can be your only symptoms, don’t assume it’s a stomach bug or bad food
• Loss of taste or smell
• Sudden confusion - potentially caused by reduced blood-oxygen levels

What causes the more common symptoms [22:05]

• Dry “barking” cough, fever, chills, body aches, headache, shortness of breath, congestion
• Virus interacting with immune system
• Virus is replicating within body [22:45]
  • Virus is RNA strands that fool your own cells into reproducing the virus (making your body “photocopy” the virus to take over more of your body) and then bust out of cells & take over nearby healthy cells
• Replication of virus + immune system response causes the common symptoms

Immediately notify your physician if these symptoms arise, get immediate medical help if you have trouble breathing or pale/bluish skin [24:30]

How long does it take to show symptoms? [25:15]

• 2-14 days from time of exposure, if at all
• Some reports of people being sick/developing symptoms beyond that
• Learning more about how long virus can survive.
  • can live 3 days on stainless steel, 24 hours on package delivered to your door [26:25]

Who’s most at risk? [27:00]

• Those with pre-existing conditions like diabetes, heart disease, lung diseases
• Immuno-compromised individuals - HIV, autoimmune diseases, undiagnosed or newly diagnosed celiac disease patients that are sIgA deficient

Recovery [29:15]

• Some feel fine after 3 days, some passing away - why?
  • Genetic ACE2 polymorphism
    • Some have the ACE2 polymorphism that better prevents the coronavirus from infecting the body
  • Pre-existing conditions, those with poor health
• Body produces surfactant chemical that makes lungs sponge-like [31:05]
  • Genetic polymorphism that lowers surfactant production, makes lungs less sponge-like and makes breathing more challenging with COVID-19

What can we do? [32:15]

• Pretend you have the coronavirus
• Social distancing - use technology to virtually connect with others
• REALLY wash your hands - scrub & sing “Happy Birthday” twice
• Hand sanitizer - minimum 60% alcohol
  • Other types are NOT designed to kill novel/new viruses
• Stay home as much as possible - 6 feet from others is not enough
• Wear a mask when going out
  • To protect others from you
• Don’t touch your face before washing your hands
  • Study showed even trained, educated medical professionals touch their face 23 times per hour
• Clean & disinfect all surfaces that could have been exposed (groceries, counter where you rested groceries, car surfaces)
  • Alcohol-based surface cleaners need to have at least 70% alcohol
• Strip off & wash your clothing in hot water, warm shower with soap as soon possible
  • So far, we know virus can live on cloth for 3 days

How is COVID-19 treated? Current research shows…. [45:00]

• No FDA/CDC/WHO approved medical treatment
• Hospitals are practicing palliative care, symptom treatment
• Ongoing experimental medical trials around the world (approx. 60 so far)
  • NYU hyperbaric oxygen therapy - putting COVID-19 patients in more oxygen-rich environment, previously used to treat lung damage
• Repurposing FDA-approved drugs to treat COVID-19 [47:15]
  • Scientists are using drugs that have already been approved for other conditions and are currently being studied on effect to combat COVID-19 & slowing the spread within the body
  • Limits the virus spread so your own immune system can battle it
• DRUG TRIAL: Remdesivir
  • Believed to inhibit the action of RNA polymerase, intravenous delivery
  • Targets how coronavirus replicates
• DRUG TRIAL: Galidesivir
  • Viral RNA-polymerase binder, intravenous delivery
• DRUG TRIAL: Camostat
  • Transmembrane protease, serine 2 inhibitor
  • Blocks penetration of coronavirus to get into cell
• DRUG TRIAL: Favipiravir
  • Selective viral RNA-polymerase inhibitor, delivered orally
• Two HIV drugs being studied right now
  • DRUG TRIAL: Darunavir and Cobicistat, delivered orally
• DRUG TRIAL: Fingolimod
  • Sphingosine 1-phosphate receptor modulator, delivered orally
  • Class of drugs used as immunomodulators and are used in conditions such as multiple sclerosis.
  • Calms the immune system/cytokine storm to prevent it from attacking your own cells
• DRUG TRIAL: Plaquenil, better known as hydroxychloroquine
  • May inhibit the terminal glycosylation of ACE2 of this virus

These drugs SHOULD NOT be taken as a prophylactic / to “prevent” the coronavirus [51:00]

• All medications have side effects
• Pharmacogenetics - study of genetic reaction to drugs  (99.999% accurate)
  • Based on an individual’s genetics and polymorphisms, some may have opposite reaction and worsen health
  • Can not respond to a drug
• Won’t be one specific drug to treat it
• Instead, a polypharmacy - multiple options to treat based on genetics and other pre-existing medical conditions

Testing accuracy & false negatives [57:25]

• NIH estimates weeks away from a finger-prick test with almost 100% coronavirus diagnosis accuracy
• Current testing of throat swabs 87.3% accurate, at best
  • 13 of every 100 people that have been tested are given a false negative and are out in public infecting others

Vaccination? [60:00]

• Over a year out, but trials are underway
• Using plasma of those that have recovered from the virus
• Cell-surface receptor to suppress cytokine storm (keep immune system calm to prevent degrading of lung function)
• When vaccine is available, celiacs should get tested to ensure vaccine is effective (often times they do not)

The future evolution of the coronavirus [63:20]

• Hard to determine next 6 months, constantly changing
• Hoping to flatten curve - signs are showing improvement
  • Less infected, more time to react
  • The faster everyone does their part, the faster the curve will flatten
• Drug trials to conclude in a few months - more answers to what drugs work for certain categories of people

Conclusion [66:30]

• Do your part - stay home
• www.drrrobertpastore.com
• @drrobertpastore

LINKS:

EPA Disinfectants for Use Against SARS-CoV-2

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

CDC Cleaning and Disinfection for Households

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html