Evaluating Risk and Updates on Coronavirus

Preventing coronavirus infection and minimizing risks with Dr. David Perlmutter.

I’m seeing the damage that’s happening in the United States economy and people losing their jobs from the coronavirus epidemic and yet we’re worried about the potential risks of returning to normal. All actions have a potential risk, but how do we determine the least risky path to move forward. I invited Dr. David Perlmutter to have a conversation about how we should proceed to minimize the risk of coronavirus spread.

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How Do We Reopen With the Risk of COVID-19?

We all want to know how we’re going to get our lives back to some sense of normal or whether we should stay home to minimize coronavirus cases. How do we contextualize this, and help people understand the relative risk of coronavirus deaths to other causes of death?

Dr. Perlmutter said, “The conversation has been framed as: ‘Do we do everything we can to isolate and contain virus spread so it will run its course? Or do we open up the floodgates and say, ‘you’ve got the right to go back to work and you need to have an income, so let’s get the economy back on its feet.’ I think that these are not mutually exclusive concepts.”

“The answer, as I see it, is that both groups can be satisfied. Each side has to give a little.”

Coronavirus Testing Reduces Risk

Perlmutter said, “I think that we really need to be very aggressive about getting people back to work provided that we can give people coronavirus testing and determine that they are safe to return to work. We need to know if they’ve been exposed and have antibodies or not, with the hope that having IgG and IgM antibodies is an indication that they have some degree of protection.”

Minimizing COVID-19 Infection for Higher-Risk People While Reopening

Low-risk populations eventually have some contact with higher-risk populations, and that makes infection prevention one of the biggest challenges to navigate. I asked Dr. Perlmutter how we minimize person-to-person risk for the most vulnerable?

Dr. Perlmutter said, “I think the strategy must be dynamic, and we have to be able to accept the idea that our plans will change with time.”

“Once we can test and determine who’s able to go back to work, then by all means, we can get the economy back on its feet. [Then we can] more comfortably await the development of a coronavirus vaccine, or watch the development of passive immunization via plasma, or other techniques that can allow us to reach a threshold of people infected.”

But he offered this caveat: “It’s okay for people to make decisions about their own health [however], younger people in relatively good health need to consider that it isn’t just about them.”

Mitigating COVID-19 Risk from Travel & Visiting Family

I asked Dr. Perlmutter how we can visit our families or safely travel, knowing that coronavirus vaccines, effective treatments, and herd immunity are some time away.

He shared some “inconvenient truths”.

“So for those who want to visit their parents, you have to be willing to make that 14-day investment in self quarantining when you get there. That gives you about a 96% chance to manifest symptoms or to become positive with mild symptoms once you’ve been exposed. Then you’re able to see them.”

“It is certainly not a viable solution for many and it’s certainly not attractive, but these are the public health rules of engagement today and these rules of engagement have shifted compared to three months ago, in the most dramatic ways we never could have imagined.”

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How Do We Get to Dependable Minimized Risk?

Dr. Perlmutter shared the current options being explored to reduce the risk of coronavirus spread, severity, and infection.

• “Convalescent plasma is being studied right now around the country. Mayo [Clinic] is doing a multicenter study of that.”
• Coronavirus Vaccines, but it’s not clear yet if it will be effective, because coronaviruses may mutate too quickly. About vaccines, he said, “The reality is that the flu vaccine is only about 20 to 40% effective every year. Most people who have received a flu shot have not derived benefit from it because of its relatively low effectiveness.”
• Repurposed antiviral treatments are showing promise to minimize infection severity. These include remdesivir, arbitol, lopinavir, and ritonavir.
• Ivermectin, antiparasitic medication: “We use this here in the US to treat head lice, and it is remarkably effective against other viral infections…Published research showed in cell culture that it dramatically reduced the virus 5,000 fold in 48 hours.” But in vitro research doesn’t necessarily translate to humans, so we’ll have to wait for more research.

Comparison of Mortality From COVID-19 vs. Other Causes

How lethal is COVID-19 really compared to ordinary levels of mortality? The data have been quite confusing, and some data may suggest that our current death rates are the same now as before coronavirus. I asked Dr. Perlmutter his thoughts on this. He said, “You know, there was a time when we were told [there was] 3-5% mortality, because that’s the death rate that was calculated based upon people who had confirmed cases in Wuhan, China. I think we’re going to see with time that the death rate is significantly lower.”

“But that said, for [those] who do end up having severe disease…If they survive, we’re now seeing evidence that there may be some long-term sequelae that persist after infection that involves the brain, heart, kidneys, and certainly that may involve the lungs.”

Rejuvenate Immune System Function for Reduced COVID-19 Risk

There are a lot of integrative approaches to coronavirus prevention being promoted. I asked Dr. Perlmutter if there were a few that worth focusing on.

He said, “There’s a lot of discussion about how we can enhance the NRF-2 pathway, for example, through interventions like turmeric, sulforaphane, broccoli sprouts, caloric restriction, aerobic exercise, et cetera. I think that it’s a little bit of an extrapolation to assume that [this will work].”

He suggested that what we should really be focusing on is why the immune system becomes dysregulated. He said that because chronological age appears to increase the risk of having the over-responsive immune system and the cytokine storm we see in severe coronavirus cases, this is the best place to focus.

Dr. Perlmutter recommended we explore the lifestyle choices that support healthy immune system function.

Lifestyle Choices Impact COVID-19 Severity

Dr Perlmutter: “Sometimes it’s not as sexy to talk about foundational principles, but the biggest arbiter of our health are the choices that we make on a day-to-day basis. We see there’s a lot of very powerful shifts happening when you do simple things like fasting or reducing stress. This is all the more reason not to overlook these fundamentals.”

“This infection is specifically selecting out those individuals who made bad lifestyle choices…with physical activity, sleep, and certainly in terms of diet.”

“Hopefully it will rattle some cages for the people who’ve maybe been sitting on the fence and get them to reprioritize what things they do in their lives.”