Dr. Cook: Everything you need to know about viruses right now!

Hi, my name is Dr. Matt Cook. Today I'm gonna talk about the Covid 19 viral outbreak. I'm gonna talk about the history and biology of pandemic infections. And I'm also gonna talk about some approaches to staying healthy and some integrative strategies that we use in our practice for patients with wellness.

I'm also gonna talk about some approaches that we've used to taking care of patients with complex vi viral infections over many years. I'm here to educate and inform, and I don't want to recommend any particular treatment. There are many scientific trials and case studies going on all over the world.

I'll be referencing some of this work. It's a rapidly evolving Problem. And I think some of the research is gonna be rapidly evolving and I'm just gonna be having an academic conversation pointing in direction of some, some some small successes and potentially some future options for care as well.

I'm gonna be discussing some things that are not FDA approved. The FDA and the FTC have a position that the only treatment right now is supportive care, although I think that based on some early evidence that's gonna come out, it may be that there are some. Some antiviral drugs that that will be approved.

They've sent warning letters to a number of companies. And so I just want to be explicitly clear that I'm not recommending any specific treatment, but just trying to start an an intellectual conversation that is hopefully constructive. I've been interested in viruses for 25 years. I actually did a, a research project in college in a virology lab, and we were studying the feline immunodeficiency virus, which is a model for hiv.

I ended up going into anesthesiology and I have a practice in interventional pain management and also have a functional, integrative and wellness practice. I'm probably well most well known for doing ultrasound guided injection into joints in the spine, and doing nerve hydro dissection for peripheral nerve pain.

But I had an evolving and interesting experience in functional and integrative medicine because I had a lot of patients who had chronic pain, but who also had chronic infections. The most common was Lyme, but we've, we've had a lot of patients with viral. Illness that complicated their pain.

And because of this, I ended up really digging into that and getting interested in that. And so I've, I have a long experience of taking care of patients with viral infections on a weekly basis for years and years. And have found it quite interesting is I'm gonna share some of my personal experience in, in this space.

And know that I'm speaking, speaking generally, and, and this is a rapidly evolving science scientific experiment that's going on across the world. And so know that I'm not in any way trying to influence you to, to buy any product or, or seek out any treatment because I don't think we know quite yet what the best treatment is.

But at least we can begin to talk about it. These these infections the flu is always going around, but probably every a hundred years one will come around. That's just a lot worse than, than the average. The average flu the, the, the, the biggest one that hit the world in recent times was a hundred years ago.

In 1918, there was an influenza pandemic and it was caused by H one N one influenza virus. And it, it absolutely swept all the way around the world. And the thought is that it infected about 500 million people. It was in Europe it included the Pacific islands that went to the Arctic.

And it had a death toll that was somewhere between 17 and 50 million. But it may have been as high as a hundred million people Now that, that pandemic actually happened during World War I. And the, the wartime sensors didn't wanna scare people, and so they kind of put their head in the sand and they didn't allow the press to report on it.

And so the only press that was able to report on it was the, the Spanish press. And so it, it became known as the Spanish flu, even though it was happening all over the world. And I think this is just a interesting point that I think it's important that The press is free to talk about and discuss these, these problems and, and get as much information out there so that people can make the best decisions.

So when we look back at that epidemic from 1918 people, sometimes people ask, well, what happened? Was it a, was it some form of a perfect storm that created the possibility for that that pandemic? And certainly there may have been because the war, the, the ravages of war were going on, there was large camps of pigs, sick and injured people.

There were large numbers of birds and pigs and other animals in, in those camps. And so it may be that there was a, a number of different circumstances that combined to, to. Enhance the, the probability of people getting and, and ensuring a, a infection. However even though that may have been a perfect storm probably there was also something called a cytokine storm.

And I, I'm going to go into this a little bit later in de in more detail. But the, the thought is, is that sometimes a virus can trigger something called a cytokine storm. And what, what that means is it triggers and a very extreme. Activation of the immune system, that that causes inflammation.

And that inflammation starts in one place, often in the lungs, but then it starts to spread all over the body. And it's actually the cytokine storm, which can lead to something called sepsis that is actually what does more damage than the virus. And so, we'll, we'll talk about that. And so there was probably a perfect storm and a cytokine storm that, that led to that pandemic.

And we, we are probably looking at something similar to that. But now, and so, and I will go into what I mean by that, the, the 1918 pandemic, interestingly Had a predilection towards killing younger people and younger adults. And it may be that older patients had been exposed to a similar flu, the Russian flu 20 years prior to that.

And so they may have had some immune protection from it. Or it may be that the pan, the pan that pandemic had a real strong predilection towards causing this extreme inflammatory immune activation. And that was the problem that, that affected and, and caused that pandemic to be affecting more younger people.

This is probably gonna be a similar situation, although it's, it's different in, in, in that there's a predilection in this one for the, the people who get most affected and the people who get affected by the cytokine storm to be a little bit older to be immunocompromised or to have other problems.

And, and we'll talk a little bit about this. Since then we've had two other recent big viral infections that were respiratory. One was the SARS virus and one was the Mers virus. And these were both coronaviruses that were probably not quite as contagious as as this one but had a higher fatality rate.

So the sars had a 9.6% fatality rate, and I think the mers had a 34.4% mortality rate. The current fatality rate in for the covid 19 infection is, is, is unclear. And, but it, the ranges that we've seen are between, between 0.6 and three or 4%. So a lot of people ask me, well, what is this virus? And so it's the coronavirus.

And in the coronaviruses there's a whole bunch of different ones and they cause about 25% of the flu.

And this, this virus, SARS COV two cause causes the illness COVID 19. So viruses are very small, and so we, we with our eyes can't see a single bacteria. And I heard an expression that if bacteria had eyes, they wouldn't be able to see. Viruses. So viruses are, are really, really small and they're a protein shell with either DNA or rna and some enzymes that replicate.

So it has a genome. But it can't replicate without help. And so what they do is they infect cells and they, they bind onto a cell and then they insert them into the cell. And then what they do is actually get the cells to copy their genome. And then they, they turn that cell into a kind of a zombie that makes a whole bunch of viruses.

Those viruses get released, and then once they get released, then they try to duplicate that process and infect other cells. This this virus started in bats and then it went into Pangolins as an intermediate host before coming into humans. And it seems to go through the eyes and the nose and the mouth.

And it causes respiratory symptoms fever, cough, and shortness of breath. But some people can then progress onto the more dangerous complications such as a R d s, shock and, and sepsis. Now, by far the most important strategies are prevention. Avoid traveling to infected places.

Careful hand washing. And this goes especially for healthcare practitioners. Avoiding touching the T zones because our hands can pick up respiratory droplets that came off of an infected person. And then obviously avoiding crowded areas. So right now, the most people are not going into any crowded areas at all.

So the question, the next question, well, how is it spread? And it's not that interpersonal transition transmission is primarily from respiratory droplets and contact trans transmission. But there may be some fecal oral transmission as well. And there was some situations where there was buildings that did not have good venting and, and it, it probably is in the stool.

And so there was fecal, some, there's been fecal, oral transmission and, and in some of these buildings that didn't have good ventilation people in different parts of the building got, got infected because of it was able to transmit up up these these lines, which is kind of concerning.

I want to emphasize that the majority of cases are relatively mild, kind of, kind of a flume, and that's positive. But, but there are and, and that's probably 80 to 85% of people are gonna have mild cases, but 15 to 20% of people can have quite significant and complex problems. And so that's why everybody's so worried about it.

A fever at a dry cough are the most common presentations. Some people had shortness of breath and fatigue. Some people have had muscle pain, confusion, sore throat. Some people can have gastrointestinal symptoms. People have had diarrhea and, and vomiting as a presentation. And there, there have been a, a real number of people who presented without any fever.

I wanna really emphasize how important before we get into treatments, hand hand hygienists and cl cleanliness and even in the, in your home and at other areas wiping down the areas around where you are and making sure everything is clean, I think is, is gonna be quite important. And risk management from this perspective is gonna be is gonna be very important.

There are, are guidelines that are gonna be are, are and are continue to be released from healthcare organizations. And, and we're gonna try to post these guidelines both from a perspective of cleaning, from a perspective of taking care of someone who's been quarantined and at home.

And then from the perspective of taking care of people in a clinic and a hospital. I wanted to go through a little bit about the time chorus. Most people are gonna have a mild infection. The, the people who get real sick. Sepsis in one study developed median of nine days after the illness. A r Ds.

I developed a 12 days as a, and cardiac injury happened at 15. I'm gonna go into why, why this seems to affect a diffuse and, and broad set of organ systems. People developed acute kidney injury at 15 days and a secondary infection at 17 days. I found one real interesting study that they did with monkeys who were inoculated with the sars covid virus.

And they found that the older monkeys had a stronger host in eight response than the younger ones. And what that did is it affected how they responded to infections because they preferentially created a lot of inflammation. They had less T-cell and B-cell function, and they had more cytokines and that set them up for the cytokine storm that I'm gonna go into in just a second.

I've been having a lot of people ask me, why does the flu come in the winter? And somebody, somebody told me, well, the flu loves winter. In the Northern Hemisphere, it typically happens between November and March, but in the southern hemisphere happens from May to September. So viral outbreaks typically happen in the colder months, and sometimes in, in the, in the summer, things get better, but sometimes they can go from the northern hemisphere to the southern hemisphere and that, that may be what's gonna happen here.

In general the tropics probably have less much less in the way of flu infections than colder areas. And, and there's some evidence that even animals who are kept in a cold environment are, are less susceptible to, to viral infections.

So let's get into it. What is, what is the cytokine storm? This virus, the, the primary target is probably respiratory epithelial cells. So these are cells that line the line your airway, and they are the choreographers of cytokine application during infection. So I told you that when virus comes in, the virus can't replicate itself without going into a cell.

So it, it comes in and it gets into a, a cell, one of these epithelial cells, the cells that line your airway, and then they recruit that cell to make a whole bunch of copies. And and that's how it replicates itself in response to that the human body. Says, well, let's make a whole bunch of chemical messengers that will create an inflammatory response.

And the goal of that inflammatory response is to get a whole bunch of immune sys immune cells to come in to fight that infection and, and fight that virus. The way, the way that it happens is, is that the, we, the, the first thing that happens is that the, the pro-inflammatory cytokines are produced and they act like an alarm belt.

They drive cells of your immune system to come in and then fight the infection, and then after that acute, very inflammatory response, then there are some anti-inflammatory cytokines that calm everything down, and generally your immune cells were able to fight the virus, and then everything is cool.

What, what happens in a cytokine storm is that the inflammatory process goes outta control, and it goes so far outta control that the anti-inflammatory process doesn't ever get to take effect. And we get runaway inflammation and it was all targeted to kill something, but the, the virus actually is not nearly as bad as the over inflamatory response that the human body had in trying to fight it.

And the analogy I had was, imagine there was a bunch of kids and maybe a whole bunch of kids that were in a grocery store, shoplifting. Well, that'll be bad and probably we need to do something and, and get them. But one thing that you could do is you call it a drone strike that takes out the grocery store.

And that's kind of like what's happening here as, as, as an analogy. I'm just gonna give you a little bit of science and there's a, a couple names and you'll, you may be hearing some of these names in the press. There's a whole cast of characters of the inflammatory cytokines and then the whole cast of characters of the anti-inflammatory ones.

There's one called tumor necrosis factor alpha. TNF Alpha is often maybe the first one to initiate this fire alarm. And it typically will promote the generation of another one called interleukin one. And interestingly, the, the fact that these are, we have older patients who are more susceptible.

Some of them may have some genetic susceptibility. They may they may make a little bit more of these inflammatory cytokines. Or it may be that their immune system is somewhat weakened because of a variety of factors. And so as a result, instead of being able to rely on their cells to come in and do what they need to do, the they're, they're relying on an inflammatory response, but that inflammatory response goes out of control.

Now, what happens in this setting of this extreme inflammation is that those cells can undergo a process called apoptosis and they can die. And then when those cells that are lining your airway tracts start to die because of this inflammation, then That can cause all kinds of swelling and inflammation in the tissues where that's happening.

When that causes swelling and inflammation in the tissue of the lung, we call that a pneumonia. Often when this happens, it leads to a pneumonia and because it's it's systemically happening, it, it doesn't happen just on one side, it happens on both sides, and that can progress onto an acute lung injury or a R d s.

Now as, as a mechanism of healing, the first thing that happens with inflammation is it leads to vasodilation of the blood vessels. And the reason we try to vasodilate the blood vessels is this so that immune cells can start to go in and get out into the tissues where there's, that's happening. And so I like to give an example.

Let's say I was walking around and I bruised my leg. Well, the first thing that would happen is I might create that inflammatory response that we're talking about. So some cytokines come out and they create inflammation, they create swelling, they create heat, and then some immune cells come in. And what happens is when those immune cells come in, they're gonna choreograph healing.

And then what they do is they start to send more messages, which are anti-inflammatory, and then a coordinated response happens that calms everything down in the case of an acute lung injury that is progressing into a rds. What can happen is, is the, the, the inflammatory mediators that were causing vasodilation to.

Hopefully heal the lung, start to get into the systemic circulation, and then they start to cause a drop in blood pressure in, in the whole body. And so then this is one of, this is how sepsis starts to happen. There was inflammation in the lungs, but then all of a sudden there's inflammation everywhere in the body.

And then what happens is you have somebody with very low blood pressure. They also have not enough oxygen because because of all the swelling, the lungs can't exchange oxygen well enough. And so now we we're, we're having systemic collapse. And that's, that is physiologically what's happening.

The, the other thing that can happen is, is that this virus appears to have an effect of being able to bind onto some receptors called ACE two on the cell surface of cells in different tissues in the body. And, and so there are an, an ability for this virus to affect the lungs, but also it can then begin to affect and infect cells in the heart and the kidney.

And that's why we're, we're having a diffuse group of other problems that happen in, in addition to just traditional septic physiology. So I'm hopefully beginning to give you the idea that a little bit of an. Inflammation's a good thing, but when it's outta control, it's a bad thing. We have molecules in the body and, and proteins and regulators that at all times are either driving inflammation up or driving inflammation down.

And, and in general, this is the nature of life. Where we're we, we turn something up to initiate a healing response and then turn it down. We go into fight or flight to, to meet an event, but then we come back and to rest and relax. And so we're perpetually in some form of a yin yang cycle. The, one of the, the biggest drivers of of inflammation is a, a protein called nuclear factor kappa b.

And it turns out that activation of it is a, a central thing that can lead to sepsis. It also is broadly implicated in a, a whole host of illnesses and, and medical problems that are expressions of outta control, inflammation and, and sepsis, higher levels of nuclear factor CFA beer associated with a higher mortality rate, and and worse clinical outcomes.

And I think that it may be that some of these older patients that we're seeing who are either immunocompromised or have other contributing factors that make them more susceptible. One of the factors may be that they have greater levels of NF capa B or That is one of the only strategies they have cuz something else isn't working.

No. There's from a septic physiology perspective an approach to tr trying to inhibit NF CAPA b activation. But it's a also a, a fairly well known strategy that's used broadly in, in integrative medicine as there are a, a number of supplements and, and strategies that inhibit NF capa B.

And so I'm gonna go into this a little bit Now, the other, the other side of that coin so I've got inflammation. The other side of the inflammatory coin is a transcription factor called NRF two. And this is the master anti-inflammatory switch. And so we are able physiologically in our body to either turn up inflammation or turn it down.

And so there are gonna be strategies with vitamins and things like that that can turn down NF capa B. There are also strategies with vitamins and things like that that can turn up NRF two. If you wanna pneumonic to remember this, I think NF kappa B is nuclear factor kappa bad, and then NRF two.

I just remember that Nerf Nerf is good. So now I'm gonna go ahead and start to talk about some of the different treatment options that are out there. Now for those with mild illnesses, I think by far the most important thing is containment. And so avoiding other people, avoiding transmission, avoiding transmission to other family members having great respiratory hygiene, environmental cleaning limiting movement, limiting exposure, and staying away from other people so that you don't get infected.

Because if we do a great job with that 80%, then we have a hope to get this contained. And so it's like by far. The, the most important thing to think of in that category. Then with that being said as, as I go through the treatments treatments that may be beneficial in general could be also beneficial for these mild cases.

But then in addition to those cases, there's people who have cytokine storm and, and septic physiology and some of the severe things we were mentioning and above. So we'll, we'll talk about some of those strategies. If this is a fundamentally a model of runaway inflammation, then you begin to think, well, maybe something that would be anti-inflammatory.

And in Western medicine, one of our. Great ideas in terms of turning inflammation down is to use corticosteroids like prednisone. The good thing about corticosteroids is they are quite good at turning inflammation down. The downside is, is when when we give them sometimes they blunt how well the immune system works.

And in the previous coronavirus outbreaks systemic steroids was found to not give benefit and, and may have caused some harm. So unfortunately that one's probably not gonna be a useful, useful strategy for us.

And so then the next, the next, and I think most obvious and and rational thing is gonna be to look at the antiviral medications. I think the most exciting of these medications is there's one called Rimes Avir, and it's a small molecule that mimics one of the components used during the production of the replication of this the virus's rna.

Th these are RNA viruses, and when it's incorporated the, the, the replication of the viruses is halted. And early investigations have shown some promise for rimes avir in treating MERS and sars which were both coronaviruses. And it also had some benefit in Ebola. And it sounds like There's a, a, a fairly broad ability for Rees vir to affect a wide different variety of coronaviruses including the two bad ones that we've seen.

And a number of clinical trials looking at a, at its use in any Ebola. The the other drug, there's a drug that goes by the, I think the brand name Altra. It's K e l a t r a. And that's ritonavir and Vir. And this is a a drug that has been u used in Asia in a couple different countries to, to treat this infection.

And, and it sounds like there's some early evidence that this, this may have some value. We don't know how effective it is. It's been just crazy in terms of the inability to get supplies and get things right now. But I was able to, to, to get a small amount of this and so we'll be anxiously watching to see what the results are in terms of how effective it is.

There are another, a number of other antivirals. And as far as I can tell none of those are showing much effectiveness, although there are some people looking to see if Tamiflu combined with, with potentially the ritonavir is effective. And but, but Tamiflu well by itself, it, it sounds like was not one thing that's being looked at, looked at as therapies that are anti tnf.

So if TNF is this inflammatory cytokine that is starting the whole process, there is the idea of. Giving something that would decrease the, the, the TNF alpha. And I'm not aware of, of anything that has shown that much merit in this regard. Although there's, there's a lot in that space.

However it, it may be that ozone therapy, which I'm gonna discuss a little bit later may have an ability to, to lower some of the pro-inflammatory cytokines and in particular TNF alpha. So, so one idea is back to this theme, turn the bad guys off. TNF Elephant Ozone Mate may have Some ability to do that.

And then the other thing is to turn on the good guys to turn up the inhibitory cytokines that would normally come in and calm things down. One of those is something called TGF beta. And another one's called i L 10. And I'm gonna foreshadow where we're gonna go here a little bit. But the, it turns out that ozone, which is a modality that is one of the integrative strategies that is used in some parts of the world may not only decrease NF CAPA B, but it may actually increase NRF two.

So it's kind of interesting. And so when, so this kind of brings me to the, the idea of functional medicine. I, I've referenced that earlier. And so if you said, well, what is functional medicine? I think functional medicine is a, a system approach to looking at the whole body and diagnostically doing testing and trying to figure out how the whole body is working and seeing if there's things that can be done to optimize each component, each system to get the whole thing working together better.

Play-Doh said that The part can never be well unless the whole is well. And I would say that is true whether we're a person or society or the whole planet. I think this is, this is an example where what we're trying to do is improve each individual's total wellness. But, but then to go further to, to, we have to look, we really have to band together to help everybody.

It may be the thing to do that, to help other everybody more than anything else, is just gonna be, to make sure that people who are infected or exposed or isolated so that this stops as, as, as soon as possible. But this, the functional medicine idea is kind of interesting and entertaining to, to begin to think about because it's has some useful applications for wellness in life.

As an example A typical conversation in functional medicine. If we break down the different systems, we have immunology, we have neurology, we have the cardiovascular system, the pulmonary system. The I'll give an example that I, I see a lot which is, is that people will have a fairly significant problem in their gastrointestinal tract.

And so they may have bacteria 11, the small intestine that's called small intestinal bacterial overgrowth. They may have a bi, a biofilm there that has yeast in it as well. They could have mycotoxins there as well. Or they could have a parasite infection, small intestine. They could have any of those in the large intestine as well.

And then that inflammation and infection can start to lead to inflammation in the wall, in the, in the wall of the intestine. And that can start to lead to leaky gut. And so when that happens toxins from the gut can start to get into the bloodstream and sometimes little bits of undigested food can get into the bloodstream and then the immune system can start to have an inflammatory response that will come in and start to attack the wall of the intestine.

But it can also create antibodies and allergies to foods and, and other problems. And then this has the effect of making the immune system somewhat dysfunctional and, and not work quite as well. I. When I see people with real complex infections, usually there's four or five things going on. And so if somebody comes in fairly debilitated with Lyme disease, they don't come in with a perf, nobody come, nobody that's sick comes in with a perfect gut.

They all come in with a whole bunch of things going on and, and I generally think that that is an initiating factor that causes the immune system to get dysregulated. And then because of that, then their immune system's not working that well. And that's what set them up to be susceptible to the infection in the first place.

Because I'll see people who've had a blood test that show they were exposed to, to ly quote unquote, but they are totally fine and they're super successful and they have no problems at all. But then I'll see somebody else that has exactly the same testing, but. From a systems perspective, they've got four or five problems.

And, and because of that, the whole, the whole body can't work very well together. And so there's a problem and it's kind of like if there was a company and the company had a problem in marketing and a little problem in strategy and a little problem in operations, well that's a big problem. If all they had was just a small problem in marketing, They just bring a consultant and fix that marketing problem and then they're back to the races.

But if there is problems going on systemically in the company, then what's gonna have to happen is a strategic implementation of approaches to fix all of those problems. Cuz if we don't begin to, in, in, in broad terms, focus on the problems these people don't get better. And so when I, a lot of times when I talk to people, I, I say I'm, I'm thinking like I'm a McKinsey consultant, trying to go in and, and optimize.

Each system. And I think from a wellness perspective as we, we sit here and try to get ourselves as well as we possibly can in anticipation of this pandemics, we sweeping through the less toxins we put in ourself, the, the healthier we get, our intestines and our heart and our lung, and the more we sleep and the lower our stress and the, and the more we exercise and we, we ha we're doing everything to get our, our, our immune system and our biology working well.

Then that has potential to be a long term strategy of preventing infections. And I would say that has been born out in my clinical experience. And so when, when We use strategies to, to optimize our biology. A lot of that is lifestyle modification and a lot of that is just making great choices.

But then there's some interesting things on the supplement front that can be helpful and that'll relate to some of the biology that I've discussed as we're going through here. And the, one of the big ones is vitamin C. So there's some, some studies that have shown that vitamin C when it was given intravenously decreased mortality and prevented organ system failure in patients with sepsis.

Now, It kind of makes sense. And I think it's rational because I said that sepsis is runaway inflammation and vitamin C is an antioxidant. And so and the runaway inflammation is, is this overreaction to the body, the, the runaway inflammation is carpet bombing the grocery store in response to some kids that were just shoplifting.

And so in that sense, vitamin C I think has a, a, a good, a good logic. And I know that there's some trials that are looking at using IV vitamin C to treat this, this infection and, and and patients with a sepsis specifically from the, the covid 19 virus. I think it's also, IM important to, just to keep in the back of your mind, IV vitamin C is like super cheap.

And so I think it's a provocative tool that could be used as, as an adjunctive treatment to calm inflammation down in, in patients with septic physiology with this problem at a low cost. And my suspicion is that the. Most important thing that we're gonna be able to do to help people is gonna be with medication.

My suspicion is that if we could combine things in particularly from kind of a, from a cost perspective, if we could combine cheap things to put in a stack along with some of the traditional therapies, it may be that we, we would have more success. And so I'm, I'm real interested in, in the vitamin C for that, for that reason.

The next one would be vitamin D. They've, they've called it the pro survival molecule. And it can be it's felt to be helpful to the immune system in, in states of Excessive or chronic stress. It has an anti-inflammatory potential. But it may also help yourself kill bacteria, viruses.

Now, the other side of that coin, kind of from a functional medicine perspective is, is that if. Vitamin D is low, that may lead you to higher susceptibility, to to problems. And so then and, and vitamin D deficiency may actually be considered a risk factor for sepsis and inflammatory disorders. And so this is one of the things that we do what we, we check the vitamin D levels with the blood test.

And so then the goal is to try to keep your vitamin D level in the range of 50 to to 80. There can be problems if it gets too high. So we're looking to, to begin to think about supplements and, and some of these strategies in terms of optimizing biology and finding that sweet spot of, of where, where your levels are not too high or too low.

One of the, one of the more famous supplements that people hear about that's anti-inflammatory is curcumin which has been found to inhibit the nuclear factor Kappa kappa b and it's been studied. It's been studied broadly in sepsis and in some animal models of sepsis as well.

Another, another similar to curcumin quercetin is another supplement that also inhibits NF capa B and has been studied in, in models of sepsis as well. And so then I'm since I'm doing the podcast by myself, I'll ask myself the question, well, would, would taking some supplements that turn off the inflammatory pathway.

Be prophylactically a good idea. And the answer to that question is a, as that, I don't know, but it's I think it's an interesting question. I think to, to go back to to go back to what I was talking about before, I think the primary, the primary thing that's gonna be helpful in the situation is gonna be the drugs.

I think number two is, is gonna be some adjunctive things that we put in the stack. And then I'm, I'm gonna wonder, and I'm gonna go through some other ones is would it be helpful to start to layer in supplements that could begin to e modulate in general the immune system or to modulate inflammation?

I can tell you that I, as my personal strategy, I've been, I've been doing this and so I've been taking. It's some Kaku Cetin Tyler who works in our office and is amazing found a product. And so we just ordered, I took it for the first time this morning called x environment. It comes from Apex Energetics.

It's has a whole bunch of ingredients that are designed to boost immune function and vi fight viral infections. And so there's vitamin C, vitamin A, zinc, astragalus eia Miki mushrooms. And so whole bunch, whole, whole bunch more in there. Is that, is that the, the one to take? I have no idea.

I think that there's probably hundreds and hundreds of different products in the market and I think that they, there would be Hopefully supportive of the immune system from a wellness perspective. And, and that's how I would be thinking about these rather than I would not be thinking of them as, as something that would cure cure a big problem.

And if you've ever been in an ICU or an operating room trying to take care of somebody who is septic you will realize that it's, it's something to face indeed. And it's and probably we're really gonna need the full spectrum of, of Western medicine to begin to face some of the end, end, end stages of, of, of what this on this is.

Now another, another one is that, that we, we, we had to. Search high and low to get these, and, and I feel like I got the last bottle of it. But there's these life extension has these enhanced zinc lozenges and zinc's an antimicrobial product. But it helps to prevent the replication of viruses.

And I really like if you can get a hold of these zinc lozenges, then send me, send me a bottle cuz we only have one. But they, they if you're the first place where people get infected is. It could be in the eyes, but as, as mostly in the nose and the mouth. And so maybe a, a droplet was on a door or it came onto your hand and then you touched your mouth.

And so we try to keep our hands away from, from those areas. But the nice thing about these lozenges is these lozenges are being dissolved, and they're right there at the area where the the, the, the virus is coming in. Another one Tyler found is from a company called Designs for Health. And so we just ordered this a, a quercetin.

A corba. So it's combining two things that I think have a, a, a nice rational ideas of vitamin C and of Carcin. And, and Quercetin may have some specific antiviral effects in, in, in addition to its effect on NF kappa B. And so I think that that's quite exciting. There's some probab there's problems with a poor absorption.

And I'll probably go into that in another podcast one. One of the, probably the most famous supplements that you've heard of is glutathione, which is the master anti-inflammatory antioxidant particularly in the liver. There's a company called Quicksilver, and they have a liposome, a liposomal glutathione complex.

And glutathione it turns out, will help combat, combat the, the, the reactive oxygen species that are produced by the virus and may have a, a benefit on helping the inflammatory cascade. And then on top of that glutathione may may actually have some inhibitory effects on coronaviruses.

And I think I, I do like the idea of taking the liposomal glutathione because you're, you're, that's in your you're putting that in your Your upper airway, your, your, your throat. But then we know that this infection can go into the gut and and, and travel all the way through the intestines.

And so having some glutathione there from our perspective is, is probably beneficial from a wellness perspective. And so could it be, could it be somewhat helpful from as a prophylactic maybe? But once again, we just don't know. But I'm just kind of going through some of, some, some, some functional medicine strategies.

The next one's, vitamin A vitamin A, it turns out, has a, a whole diversity of ways that it can improve immune function. In addition to improving immune function, it probably increases the lacto basal species in large colon which can improve the balance of good and bad bacteria in the gut.

Vitamin A is also like vitamin D. You you definitely need to have some of it, but you don't wanna have too much. But when you take 'em together they can be synergistic. So I think that's a good one to pay attention to. Now I'm gonna interrupt and so my, my team just came in while I'm recording this.

We just found some. Press releases that are coming out that are suggesting that chloroquine phosphate, which is an anti-malarial drug has may, may have some benefit. And so experts are discussing adding that as a possible a possible drug that may be beneficial on, on the treatment guidelines.

And so we're gonna be posting about, about this. But it's, it's positive to me that that was placed on the list because it's been used for 70 years and has been tr. Been used to treat people all over the world. So I think it has a good record and a safety profile that I think is gonna be helpful.

And so then, like I said, these supplement things I think are helpful, but I think that they are, I, I, I'm thinking of them as supportive wellness things that you can do that I would wrap around good science and, and a good medical approach with drugs that are scientifically proven to, to be antiviral to, to this virus.

In terms of an overall wellness supplement, I would say the Chris Shade over at Quicks over made. He said if there was only one. Supplement I was gonna take, it would be one that he calls the one. And it was developed to increase cellular energy production within the mitochondria. And so it is, is helping your actual cells be healthier.

And they, they put in a couple things. One is PQQ and another one's resveratrol, which are designed to turn NRF two, the master antioxidant switch on. And there's some other some other things in there. There's some adaptogens that can help you feel good and respond to stress as well as as well as to tocotrienols from the Vitamin E family, which are antioxidants.

Now as a, as a. A concept of taking care of people, either A, who are healthy, or b, who are super sick. There's a, a concept of, of trying to, IM improve the, the health of the mitochondria. And so if you're, if you don't know what mitochondria are in every cell there are some little tiny baby cells that are inside, they're called mitochondria.

And the mitochondria are responsible for making all the energy in our body. And so when in life, basically the process of life is, is that we breathe oxygen in and then we eat food, and then that food goes into cells and then we burn that food. It gets broken down, sugar gets broken down, and, and eventually it gets, part of the process of breaking it down happens in the cytoplasm, and then part of the process of burning, it happens in the mitochondria.

And so one general strategy is, is that if we can get those mitochondria to make energy more efficiently, then the, the cells, wherever they are, may function better. And so the products like the one that have s strategies to improve mitochondrial health we're using with a lot of patients who have complex illness.

We're also using strategies to improve another molecule that can be beneficial towards driving mitochondrial health. And you may have heard me talk about which is called

N

A D. If you want a deep dive, I did a a podcast with Joe Mercola. And right around that time, he also did a podcast with Dr.

Sinclair from Harvard. And Who's, who's a great thought leader in, in this field. And so our experience has been when we give Patient's supplementation with strategies that will improve n a d Sometimes we see their immune function go up. Now with this one it's extremely nuanced and I think you have to be careful.

But it's been We've had a very positive experience with it. There's a, a product from Quicksilver called n a d Gold that has nmn which can drive basically the salvage cycle of recreating n a d in your body. If you see a doctor that works with a compounding pharmacy, you can actually get N A D and it, it can be given subcutaneously or as an iv.

You can do n a d nasally. There's patches. It's I think it's a, a provocative tool for, for wellness because it's a, it's a, a molecule, it's a co-factor that drives the assembly line of biochemistry. It's actually a version of vitamin b3. But the levels decreased by 90% from age one to age 90.

And so we're beginning to see that. The, the people who are susceptible to this, this epidemic or pandemic are older people whose bodies may not be functioning as optimally as they can. Part of that may be general dysfunction, but I think most of it more specifically is, is they have other coexisting diseases.

But sometimes I think underlying complex illness, sometimes underlying a cardiac problem, may be a mitochondrial problem in those cells in the heart. And so n e d I think is a useful wellness tool. I, I would not, I would not in any way think of it as a therapeutic, but for, for an infection, but I think is an interesting molecule to think about from a wellness perspective.

Another vitamin that we've been working with, with people is an extract of olive of leaf called the lupin. And it, it apparently has some antiviral effects broadly as a phenolic compound. And that also has some antimicrobial effects against bacteria and has been shown to be helpful to some respiratory viruses.

Despite that, I would continue to think of everything in the supplement front as being designed or with thematically to be from from, from a, a wellness perspective and not so much as a therapeutic. But is there a preventative role in any of those? I think that that is going to be determined o over time.

But I would be, I would be hopeful that there was, and, and I'm certainly interested in it, and I'm doing some of those strategies myself. And so, we'll, we'll just be watching for, for what the, the, the data says over time. The, the next therapy that I foreshadowed a little bit, that I wanna talk a little about is ozone therapy.

And ozone therapy is, is interesting. It's been in clinical practice for over a hundred years. It's it's an allotrope of oxygen and it's, it's three oxygen molecules. And so ozone is oh three. And so when when oxygen is exposed to electricity sometimes that that creates The O three molecule.

And so if you've ever been on a lightning storm, you probably smelled it. And but you can there are generators that can generate ozone that can be used for medical use, and they generate they generate a gas that has ozone and it has it at, at concentrations that go from zero to a hundred micrograms per milliliter.

And there are a wide variety of ways that doctors around the world use ozone. Nikola Tesla patented the first commercial medical that was on generator in 1896. And So and so we've been, we, we have been quite impressed with our experience using ozone in some of the complex patients that, that I've seen.

And I think it's provocative to, to think about the ozone because it may have an effect of, of calming down some of the pro-inflammatory cytokines like TNF and interleukin one. And there's some references for this and I'm gonna try to cite these. And then it also may have the ability to up-regulate NRF two.

Interestingly, you know, I, I, my background is anesthesia, so we're always thinking about the physiology of, of, of blood and, and oxygen and pulmonary physiology. And so ozone actually has a whole bunch of beneficial effects. If, if it's in the blood it increases something called two three dpg.

It shifts the oxygen hemoglobin disassociation curve to the right and allows you to get more oxygen to the tissues. And but, but most importantly, ozone is known to be antiviral, antibacterial, anti parasite and antifungal. So it kills a lot of the things that can come and affect us.

And ozone is used broadly around the world to treat in the, in the integrative medical space complex illnesses particularly with in, in the setting of Lyme disease. So, so then you may be asking yourself, well, how do, what do people do with this gas that is, has some ozone and let's say some oxygen?

Well you can't breathe it into the lungs because the lungs don't are very sensitive to oxidation reduction reactions, and they don't have an ability to deal with that. And so ozone is actually toxic and you can't breathe it into the lungs. However other parts of the body like the blood has a, a, a mass of buffering capacity.

And then also in the, in the colon, there's a, a big buffering capacity as well. And so one way that a lot of people will do ozone therapy is that they'll actually stick a catheter. Into the rectum and, and give them an enema. But instead of doing an enema with a liquid, they can do an enema with the ozone gas.

And then what can happen is some of that ozone will dissolve across the wall of the colon and then get into the bloodstream. And then when it gets into the bloodstream, then it begins to have some of these beneficial effects that may affect cytokines and then may have an antimicrobial effect on in, in the case of infections.

It turns out that there's a whole bunch of other ways that you can do ozone. So, for example, you can inject ozone subcutaneously. You can inject ozone into joints. You can take water and ozon eight water with a, a medical device, and then drink that water. And then when that water is absorbed in the small intestine then some ozone comes with that.

And so you can get some systemic ozone from from water. And there's companies that make ozone generators that can make water. There is another strategy where you can bubble ozone through olive oil. And then the ozone makes ozon that are ozonated oils. Oil molecules and those can be quite helpful for, for some skin infections.

But there are some people who are promoting the idea of putting the ozonated olive oil in, in, in your nose because that's, that, that may, may have some preventative strategies in, in this case, which I have no idea if that would be helpful. There are machines that can bubble ozone through olive oil making it less toxic.

And then there are some strategies where that can be breathed into the Into the nose. And, and, and we, we've had many people buy these machines and have told us that it helped them with nasal biofilms and, and, and chronic sinus infections. And so that's another strategy. There is some strategies where very low concentrations of ozone can go through a stethoscope and, and, and can affect the timatic membrane.

But, but the, the big guns on the ozone therapy world is, is that there's some strategies where ozone can be mixed with blood. And so the, the, the, the oldest and most famous was something called Major auto hemotherapy. And what happened with that is, is that some blood was withdrawn into a bag from the body.

And then and then the ozone gas was injected in and mixed with the blood. And so then the, the, the blood goes back into the body. And so that was called major auto hemotherapy. So no gas went into the body, but the gas was mixed with, with blood outside the body. There's some companies from Germany that have machines that have a vacuum and they actually pull blood out and mix the, the blood with the ozone and then push the blood back in.

And these are regular licensed European machines. And the, the, the. Term for this is high dose ozone therapy cuz it's you can do that one time or you can do that five times, you can do that 10 times. The term for doing that 10 times is called the 10 pass. If, if, if they did that five times, they call that five pass about 200 to 250 ccs of blood as ozonated with each pass.

So you can imagine if you did four passes, that would be about a liter of blood. And we have a fairly robust experience of seeing people with chronic infections particularly ly and mold who have done quite well with ozone therapy and both with both with the low dose intermediate dose and high dose therapy.

I don't really believe in any one of those against the other ones because Some people are very fragile, and we, we tend to start very low with them and carefully, and then work our way up. The, the, the final strategy of using ozone therapy IV is a term called ozone dialysis, where blood is taken out and it's run through a dialysis filter and pumped back in.

But the, the blood is mixed ozone with ozone during this process. And so this process is called ozone dialysis. And we found that of, of everything that we've done in ozone, this probably been the most profound modality that we found to be helpful for for, for treating chronic infections and the, our, our experience.

Has been in dealing with people who have often, often multiple infections. Sometimes they will have Borrelia, basia, Bartonella, and then often they'll, they'll have high viral levels of a couple different viruses when they come in. And so then we've, we've employed all of these ozone strategies.

And it was a little shocking to me coming from anesthesia to learn about these things. But I found it's the, the most valuable and impactful therapies that I have had in my career for dealing with these chronic infections and chronic Chronic Lyme disease in particular. But there's a, there's a, a very interesting theme of viral infections complicating Lyme, Lyme illness.

And, and, and so it's an interesting model to to think about when we're thinking about like a viral pan pandemic. Now, given, given that given that we now have a number of strategies of giving ozone, it could be just a rectal ozone. It could be an IV therapy. Then the question is, how is ozone going to be helpful?

What would it do theoretically for a virus? And one is, and we'll have a reference, there's not a lot of reference in this, but one is, is that the. These viruses need to attach the cells and insert them into the cell to get this whole process started. There's a theory that the way that they do that is with sulf hydro groups.

And those sulf hydro groups need to be in a reduced state for them effect to effectively insert themselves into a cell. It turns out that ozone has an affinity for these sulf hydro th groups and can oxidize them. And when they're in the oxidized state then it, it renders them unable to be able to get into a cell.

We we have no idea if ozone would be helpful for this for this outbreak, but it's, it's. I think it, it, it has the possibility of being provocative and is interesting. Number, number two, ozone may have some immunomodulatory effects in terms of calming down some of the inflammatory cytokines.

And number three, there's a, a, a concept of oxidative preconditioning. And so the ozone experience creates an oxidation in the body. And then the response of the body is to, to turn around and have an anti-inflammatory effect. And, and so this anti-inflammatory effect and, and the, in turn, the activation of NRF two and some of these other biochemical pathways may, may have some beneficial effects for patients.

And so it's provocative to, to think about ozone a from a treatment perspective, but, but also from a prophylactic perspective. A friend of mine Dr. Rowan went to the Ebola outbreak a number of years ago and treated a, a number of people, a number of doctors actually who had Ebola and.

Based on their data, the mortality rate in the people he treated was significantly lower. It was, it was small numbers. The other thing is, is that after the Ebola outbreak, there was a, a whole bunch of complications in terms of pain and, and arthralgias and other things that didn't happen in his group.

There was also in, in that experience they didn't have support from the government in terms of treating people in mass. And so they're basically running around just trying to find people and treat 'em and see if they could help 'em. Which I, I have to say I was kind of like super impressed by, but there was, there was some.

Some communication in terms of letters that they gave ozone generators to some people and, and and those, those people were treating some of the patients who were in the Ebola outbreak with rectal ozone. And there's a suggestion in, in, in an article that I read that the, the death rate in in that group may have been lower by, by more than 20% from some, from some other groups.

And that the, that data is super weak. But I just think it's, it's, it's provocative and, and, and ozone is a is something because of our experiences I think is useful. And, you know, and another thing that to just wrap your head around how, like I'm thinking about this, We have, we have seen a lot of, we see a lot of people with herpes outbreaks.

And so we'll, if somebody has a her an acute herpes outbreak, we will obviously treat them with an antiviral. But just over, over 10 years, my experience of treating people with, with complex viral outbreaks is that if we give them ozone on the first or

second

day the, their symptoms are, are dramatically less than if I just gave them the antiviral.

And so I. And, you know, at the ozones, not even regulated by the fda, but the, a lot of the medical boards in different states in the United States have a little bit of a don't ask, don't tell policy with, with regard to ozone. And I basically have found it to be so helpful that I have done it, but I've never really talked about it on podcast much.

And I've never never even really let anybody know that I do it. But it's been so helpful for, for people with chronic infections as a tool that I'm just coming out and saying it. And I think that in the future I'm gonna be pre-teaching other clinicians about this. Now another, another category that I think is a, is sort of the, the new kid and maybe the most exciting kid on the block in, in integrative medicine is the category peptides.

A peptide is a, a sequence of amino acids that's bigger than amino acid, but smaller than a protein. And. Proteins, as you know, if you take a protein and eat it, it's gonna get broken down into amino acids and then it'll be absorbed, but you wouldn't get the effect of that protein. And that's the same thing with peptides.

It's a whole bunch of amino acids and maybe 50 or a hundred. And so then if you took that peptide it wouldn't have any effect. The most famous peptide that you've probably heard of is insulin. And insulin is a peptide. And so since we can't take it as a pill or a sublingual we have to inject it.

And so people are well, and you're probably aware of people that have diabetes that inject insulin. Well, it turns out that there are hundreds and hundreds of peptides in addition to insulin that are in our body that have all kinds of different effects. And this is a rapidly emerging area of medicine that has potential to be quite beneficial.

And so some of those peptides are anti-inflammatory. One of the most famous ones in that category is something called B bpc, which stands for body protection Compound 1 57. The other famous one that you may or may not have heard of is, is called LIMUS and beta four which can be helpful for pain.

And we've used for patients with peripheral neuropathy. But the thymus gland is the center, one of the centers of the immune system, and there's a peptide called thymus and alpha. And it's been shown to increase the production of some cytokines, but can be quite helpful in terms of helping NK cells, which are natural killer cells, which are a critical part of the immune system to go out and attack and, and kill infections.

And really, they're kind of like our first line of defense. And if NK cells are appropriately working, then they're gonna come in and attack that virus that's attacking us or that bacteria and mop it up. And then because of that then we do good. And, and the, the process never really gets outta control.

And there may be an inflammatory response, but it's self-limited. One thing thematically that I see with a lot of patients with, with, with real complex illness, and especially people who've had complex illness for a long time and, and chronic infections, is that they will have very low levels of NK cells.

And I think that that puts them. At a slightly greater reliance on using cytokines as a strategy to to, to initiate an immune response. And it may be that that's underlying some of the susceptibility of some of the older patients to this, this illness. There's a, another peptide that is interesting from a infectious disease perspective called LL 37 that ca apparently has some, an antiviral effects.

And we've used both of these in in Lyme patients and Lyme patients who have viruses, but not, not the coronavirus and, and or not this one anyways. And so so I, I think that long term, some of these peptides may be very provocative and they may be helpful as part of a stack of supporting immune system function.

But I, I still think that it's, it's, we, I'm thinking holistically around a, a, a, a stack of things that's is gonna help the immune system. But in this pandemic, we're, we're still looking for a drug. Now speaking of speaking of drugs the next thing I'm gonna tell you about is exosomes and exosomes are small small vesicles that are secreted by stem cells.

And, and it turns out that a, a stem cell and the, the inventor of the stem cell ha, came out and said he doesn't even want the word stem cell to be used anymore because he says a stem cell's not a stem cell. A stem cell is a medicinal signaling cell that sends signals to the other cells and coordinates healing responses.

And the way, one of the ways that a stem cell can communicate is by secreting different cytokines. And another way that a stem cell can communicate with other cells is to secrete small

little

liposomal vesicles that are full of growth factors. And those growth factors can have a variety of different effects.

I think that over the next five or 10 years, exosomes may be the, the most exciting and impactful. One of the most exciting and impactful tools to come onto the scene in medicine in years and years and years. I think that they will have a potential to be used in a variety of ways. There are are doctors around the world who are injecting them into joints injecting them around nerves nebulizing them into the lungs and using them topically for skin.

They seemed to be very, very safe. Unfortunately in 2019, there was a company that had a bad batch and there was some infections. And so there was a very strong letter from a reg regulatory perspective from the FDA that came out cautioning people. And I think part of the problem is, is because when there's a, a sexy new kid on the block, then people on the marketing side start to really market a tool.

And that's quite unfortunate because Generally, I'm just against that. And then second, because it, it potentially drives people to, to a therapy that might not be the best therapy for them, but it was marketing driven. And that's, I think, systemically a problem in our healthcare system. But then I think it's also negative because these are quite interesting molecules.

And I've talked to five or six very smart PhDs in the last couple weeks about exosomes. And there's some evidence that they

can

have some antiviral effects. I've, I have talked to a, a, a number of Clinicians and scientists who've used exosomes, both intravenously and nebulized to treat C O P D, which is, is kind of like a model of A R D S, which is a part of what's happening as an antecedent to sepsis in, in in, in this, in this pandemic, I am aware of some preclinical studies on mesenchymal stem cell exosomes as a therapy for a R D S.

And and I think it, it is provocative and it needs to be studied more. I'm aware also that there's a an ability to give these exosomes Into the lung system. So they could be nebulized, they could be injected through a bronchoscope, and they have growth factors that can they tend to be extremely anti-inflammatory.

They have TGF beta in them. They, and the experiences when we, whether we inject them around or clinicians inject them around nerves or wherever they're placed, they tend to lower inflammation. And so I've never treat, I'm not treating and have not seen anyone with this with this viral epidemic.

But I, I do think that if there is someone taking care of people who are hospitalized it's, it's. Provocative to start a conversation with some of the the nano vesicle scientists, the x M scientists out there, because there may be a role for, for these for these vesicle to be used as part of a strategy of calming down the acute lung injury and pneumonia and a R d s.

That happens right before people get super septic. Now exosomes are secretions of stem cells, and so they are the, they're the way that stem cells do their healing. Now Generally, the way that exosomes are made is this, that stem cells are grown in a lab, and then stem cells when they're healthy and happy, they secrete exosomes, which are these little nano vesicles that are full of growth factors.

And so there's an original article in aging and Disease that came out just a couple days ago. And what they did, and this, this was in China and then they treated a small number of patients, seven patients, I think, where they transplanted stem cells into some patients who were sick and with pneumonia in the hospital.

Now, interestingly, these stem cells were had the same receptor. The a c e two that I was talking about, they don't have that. So these were stem cells that were a c e two negative. Now, scientifically, it appears that this new coronavirus what it, what it does is it binds onto these ACE two receptors on cell surfaces.

It, it's, it's going for the lungs, but once it gets into the bloodstream, then it can act and bind onto other cells that are expressing this protein. And it turns out there are cells with those receptors in the, in the heart, which is why people can get myocardial injury from this virus as well as an irregular heartbeat or something called an arrhythmia.

There are Cells that have that receptor in the kidneys and in multiple other organs, and so they can get dysfunction broadly. And so this, this may be related to the, the the pathology of sepsis that is above and beyond the typical sepsis that people experience. Mm-hmm. Apparently what happened with this study is that the inflammatory markers started to go down C reactive protein, another marker of inflammation started to go down and the patients ended up doing quite well.

I mean, this is a tiny study in a, a just was received for publication at the end of February of this year. And so then you ask yourself the question, well, what, what What did these stem cells do when they were put in the body? So they were put in intravenously and in stem cell medicine, one of the things that happens is, is that the stem cells are floating around the vein and they go up and they go into the right side of the heart and then they go to the lungs.

A lot of times those stem cells actually can get stuck in the lungs. And so there's a, a conversation a lot of people have in a regenerative medicine. They say, well, y if you give people IV stem cells, they're never gonna make it past the lungs because they're gonna get stuck in the lungs. So let's say if you were trying to treat someone with dementia, there's a conversation on one side that says if you give the stem cells iv, they're never gonna make it to the brain.

They're gonna get stuck in the lungs. But it may be that that's. Very beneficial in this, in, in this specific study. And the reason being is, is that when if you remember earlier in the podcast, I was talking about let's say I bruised my leg. And there's a bunch of inflammation. The next thing that would happen is, is that I would have cells start to migrate out and modulate that inflammation.

And so it may be that the stem cells are gonna migrate into the tissues that are inflamed in the lungs where there's an acute lung injury, and then start to try to heal that or try to modulate that inflammation. How are they gonna modulate that inflammation? They may modulate it by secreting cytokines and mediators acting as medicinal signaling cells.

But they may also secrete exosomes which may also have some beneficial effects that are anti-inflammatory as well as potentially antiviral. And I have been personally quite interested in the physiology of stem cell medicine. And I I have I, and it's a full disclosure, I actually have a company and have a, a, a long experience of, of using stem cells systemically not in the United States, but overseas.

And so I was, I was quite interested when I I saw this it is Obviously way too early, but, but I think is quite provocative as a, as a concept. It never occurred to me to, to, to use it in a setting, setting as grave as acute lung injury and potentially sepsis. But the fact that it the fact that it is this trial came out and was this positive I think is, is an indication the stem cell medicine is something that we may want to think about.

I would strongly encourage people not to Do umbilical cord blood or some of the regenerative things that are being offered and sold as quote unquote stem cell therapies that I think are unproven and could, could, could do harm. And so I think we need thoughtful leaders to help us navigate this.

But so then, so then where do we go from here? It's just gonna be evolving every day. A I think we have to learn from the past. In the past we haven't fostered conversation. We haven't. That was what happened in 1918. And, and there was no communication. So I think getting communication going and getting that out there, I think is, is, is important.

I think that you see, I just got interrupted in my talk just to find out that

something

else a new drug is working. And I think that as we, we watch that, I think that's gonna be the, the primary therapy primary prevention is going to be isolation and preventing this from getting worse.

I'm sure that there's gonna be people who are gonna be working on the vaccine side and will look forward to that. The, there, there was an idea that the world was, was for sure gonna go bankrupt from polio, but then they came up with a polio vaccine. And so I'm hopeful that technology will be Will be helpful in overcoming this, and then hopefully, and we have to, we have to think towards the future.

Hopefully what will happen is the side effect of that technology will have all kinds of benefits that will make us better. That's, that's, that will be, that will be our goal. And so then how do we deploy these this technology and, and what are the appropriate stacks of things to put together? I think there, as you begin to now think of, there's ways to turn inflammation up and down in the body.

And I brought up a, a couple things that could be regulators for this, but there's, that's just the, the, the tip of the iceberg. And, and so then now it's good to, to know that there are supplements and lifestyle strategies that can optimize. Inflammation in the body. We know that there are some provocative new kids on the block, like peptides that I think are very early and, and, and may not be studied in this outbreak.

But I think they're provocative and they're interesting to think about. And the they're a genre of, of helping that may be supportive to the drug-based therapies that, that we have and may be helpful for people who are allergic to those drugs and for the, for, for that don't have access to those drugs.

And so I think that's an intriguing category and And then I would not have really anticipated this, I would say a month ago, but that there are some, some tools and strategies on the regenerative medicine side both from exosomes and stem cells that have may be, may be helpful and beneficial.

And, and so I guess my prayer for 2020 is that the best clinicians and scientists on the planet get together and share this information and that something good for the planet in humanity comes out of it. And so my thoughts are with you.