COVID-19: Reducing incidence and severity

We all know that Covid-19 is one of the worst pandemics in history. It began in late December 2019 and an enormous number of lives are being lost to it every day.

Published: 28th August 2020 07:10 AM  |   Last Updated: 28th August 2020 07:10 AM   |  A+A-

Health workers rest during at a COVID-19 testing centre. (Photo|PTI)

Health workers rest at a COVID-19 testing centre after duty. (File Photo|PTI)

We all know that Covid-19 is one of the worst pandemics in history. It began in late December 2019 and an enormous number of lives are being lost to it every day. There is a dire need for a comprehensive approach to keep the virus at bay until a proper vaccine is available.There are two determinants in the development of any infectious disease, be it bacterial, fungal or viral, and SARS-CoV-2 is no exception. One is the person’s immunity level and the other is the infective load to which the person is exposed to. By reducing the viral load to the bare minimum and improving immunity to the maximum possible extent, we can keep Covid-19 at bay.

Viral load reduction: A person is assured of non-exposure to the virus, and therefore, non-occurrence of Covid-19, only if they stay at home, as in a strict lockdown, with other members in the family too unexposed to the virus during the preceding 30 days. Now, for various reasons, the lockdown has been relaxed, we have come out. Because of infected people, the virus is there in the air. As we breathe in the contaminated air, we get exposed. 

But the number of viral particles entering individuals may vary widely depending upon the density of the virus in the inhaled air, the quality of the mask used and other precautionary measures. Let us look at the precautions. Face mask: Wash your hands before touching the mask. Ensure it is dry and clean. Make sure it covers the nose, mouth and chin. Ensure there is no gap between the mask and the skin. Change the mask after eight hours.

If it is a cloth mask, wash it once daily in hot water using soap or detergent. Don’t touch the mask in between; if needed, touch only its border. While removing it, do so from the back and away from the face. After proper disposal, wash your hands. Ask non-mask wearers to wear a mask. Social distancing: A minimum of six feet, if there is only one person. Add a minimum of 10 feet if there are more people. Avoid close contact. Avoid crowding. Minimise social gatherings. Minimise travel. Conduct meetings in an open space. Work in open spaces wherever possible. Keep the doors and windows open.

Hand hygiene: Frequent washing with soap and water. Use alcohol-based sanitisers, if a facility for washing is not available. Don’t touch your eyes, nose and mouth without washing hands. Eyes: Use goggles. Respiratory hygiene:

1) After every meal and drink, rinse your mouth thoroughly. Keep the nose and mouth always clean.

2) Local viricidal measures: Hot water, turmeric (curcuminoids) powder, and saline gargling every time back home after work and before going to bed help. Practise steam inhalation, plain or medicated, once daily. One can also chew about 10 tender fresh neem (azadirachtin) leaves, like chewing betel nuts, for half an hour once daily in the morning on an empty stomach. Don’t spit, don’t swallow and rinse the mouth with clean water after half an hour.

 3) Breathing technique: It is done in the leaning forward standing position, with the neck partially extended. Following gentle deep inspiration, the individual breathes out with moderate force as long as possible, five times during every spell, and this is to be repeated six times in a day. This will facilitate washing out the inhaled virus, if any. 

All the above measures are meant to prevent the entry of the virus, and reduce the number of viral particles, if any, so that the individual doesn’t develop Covid-19. Now what about the susceptibility factor in Covid 19? Will tracing it help control the disease?

Though the majority of people who succumbed to Covid-19 are elderly, almost all of them had some underlying co-morbidity such as diabetes, obesity, hypertension, coronary artery disease, chronic kidney disease and cancer. Do all these diseases have a common aetiology? Is there a common denominator that also explains the occurrence of Covid-19 in children and young adults? If yes, it is likely insulin resistance (IR)—in simple terms, this means resistance to the action of insulin at the cellular level.

Most of the 50 trillion cells in our body, especially of the muscles, liver and adipose tissue are then less sensitive to the action of insulin. To make them sensitive and to carry out their functions, there is compensatory overproduction of insulin. IR is the world’s biggest killer. Approximately 85% of the world’s population is insulin resistant with a high level of insulin in their circulation.

This is toxic to almost all organs and tissues in the body. IR, with its compensatory hyperinsulinemia, is the master culprit and the cause central for almost all the non-communicable diseases (NCDs) in human beings. People who have normal sensitivity to the action of insulin comprise only 15% of the total world population. This population is the one free from the clutches of almost all of the above-mentioned NCDs. They have good immunity and easily qualify for the centenarian and super-centenarian status. 

Now, with regards to Covid-19, in what way does it matter if the individual is insulin resistant or not? IR makes the individual prone to developing Type 2 Diabetes. Of the 85% of the world’s population who are insulin resistant, 15% of them develop both diabetes and pre-diabetes. Increased blood sugar status provides a platform for micro-organisms including SARS-CoV-2 to thrive.

It enhances the action of angiotensin, a well-known proinflammatory molecule, very crucial in the development of a cytokine storm in Covid-19. IR is also responsible for the increased number of ACE2 receptors in the lungs, as in smokers, and in other parts of the body. ACE2 accords SARS-CoV-2 a red-carpet welcome. IR is responsible, even in the absence of diabetes and other diseases, for keeping the immune system including the innate cell-mediated and the complement-mediated immunities in “sleep mode”, making the way easy for SARS-CoV-2 to thrive and proliferate.

This may explain why children with no obvious co-morbidities also develop Covid-19. In addition to warding off Covid-19, improving insulin sensitivity might also help reverse NCDs in people. Here are some insulin sensitisers/immune boosters: 1) Universal health diet: Low-sodium, zinc-rich, low-fructose, high-fibre, anti-inflammatory, alkaline, calorie-optimised diet (Healthy natural fat 55%, complex carbohydrates 30%, protein 15%), preferably whole food plant-based; 2) Vitamins and minerals: Vitamins C and D, zinc, magnesium, chromium, selenium; 3) Natural sensitisers: curcumin, berberine, CoQ10, fish oil, etc.; 4) Healthy lifestyle, yoga and exercise.

Dr N Murugesan
Chairman and Chief Nephrologist, East Coast Hospitals, Puducherry. Views are personal

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