Treating My First Covid Positive Patient with Dr.Karen Fraser August 2020
It has been my privilege to be a part of team of physicians treating a Covid case over the last few weeks, and I wanted to share the experience as we haven’t had many cases on Vancouver Island to discuss. In order to protect the identity of the patient, a few details about her background and location have been changed. Please note that all correspondence was directly with the patient and not with the other health care team members. All information in this case is specific to this patient being treated and would not necessarily fit the treatment plan for all Covid positive individuals, or our local medical protocols. The research is constantly evolving as more is understood about the infection. The following is my summary and interpretation of this patient’s case and may not reflect my treatment views nor the views of all team members.
The patient is a 45 year old primary care practitioner in a hospital in another country that I will call L.F. She had no pre-existing conditions, fit, healthy eater, normal body weight, but was exposed to Covid-19 through her work. Her country has an average number of cases, but they were doing Covid testing near her office. She was told that the chance of acquiring Covid within their health care setting is estimated to be about 20%.
Covid is being broken down into stages and I will go through these here as they pertain to her case:
This is where we look at trying not to have one of the pre-existing conditions. The CDC has finally now included some diet and lifestyle comments in their online material. The preventative phase also includes the physical distancing, wearing of masks, hand washing, barriers and all of the recommendations that have been made since March. The preventative phase should also include trying to manage and reverse any underlying conditions if possible as the majority of the Covid death rates occur in patients with pre-existing conditions such as Type 2 Diabetes. From a naturopathic perspective, the preventative phase should include nutrients or protocols that have been shown to benefit the immune system. This might include optimizing vitamin D, zinc, vitamin A, vitamin C, sleep, stress, and a consideration to take other plant products that have shown benefit for keeping the immune system healthy such as Reishi or other mushrooms. There is little research on prevention at this point, but some articles are showing vitamin D deficiency may be linked with increased cases. However, not only do we not want Covid, but we do not want ANY symptoms, as all symptoms are presumed Covid until we know otherwise from being tested. This poses the threat of being quarantined until symptoms resolve as well as financial and stressful scheduling issues with work, children or school even if it turns out to be the common cold. In this preventative phase, L.F. was as diligent as the rest of her coworkers, but had an unlucky (and unknown) interaction with an infected person.
The virus may be asymptomatic or very mild at first. The 3 most common symptoms are: fever, cough, shortness of breath. We also now know that there are a multitude of other symptoms including: fatigue, rashes, loss of taste and smell, body aches, cognitive decline, stomach cramps, diarrhea, vomiting, purple/”Covid” toes, peeling skin, headaches, sore or raw throat, runny nose, pink eye, chills, post nasal drip, blood clots. L.F.’s initial symptoms were fever and cough. She had an X-ray at the same time as the Covid nasal swab test due to her work. Both came back positive and she was diagnosed with “Covid pneumonia” July 14th. On a chest X-ray and more so on a CT scan, there are little white crystal shapes called “ground glass opacities”. These are areas of lung inflammation that are visible with Covid as well as other lung viral infections. Usually they take a few days to show up post the onset of symptoms so chest X-rays and CT scans are used to track the progression of the virus as well as to help make the diagnosis. L.F. was given referrals for a CT scan, blood work, pulmonologist, ECG, cardiologist and the beginning of her home quarantine started.
L.F. was able to remain active with gentle but regular walks on a treadmill at home and continue light activity as well as a small amount of work from home. Walking or light exercise within the quarantine setting, around bedroom etc. is recommended in order to keep the blood flow going. This is thought to help prevent blood clots and prevent the pneumonia from settling into the lungs further as the lung tissue is able to expand more when we are in a prone or upright position and with movement. L.F. had a pulse oximeter at home to monitor her oxygen saturation. Optimal is 97-99%. Compromised is 93% or less. L.F. hovered around 94-95%.
She immediately began the anti-viral drug oseltamivir (aka Tamiflu), the steroid prednisolone as a strong anti-inflammatory, and 2 different antibiotics to prevent secondary infections. Hydroxychloroquine was considered, but the ECG showed bradycardia (slower heart rate) and so this prescription was not used.
The naturopathic part of her treatment included IV vitamin C, glutathione, zinc, vitamin A, vitamin D, the plant andrographis, quercetin, oral liposomal glutathione, infrared saunas, nebulized glutathione,
After 7 days, the cough and shortness of breath and lung sounds were improved. A follow up ECG was ordered and diagnosed with Covid in the SA node of the heart. Heart rate was slow, but no treatment needed unless the L.F. were to feel faint. The other area of the heart that Covid can affect is to cause ischemia in the heart muscle and thereby increases the risk of heart attack and heart complications. L.F. had this ruled out. Plant products and some supplements were stopped when symptoms improved. The following day, the fever resumed, new rash on chest and back, diarrhea. It is unknown which symptoms were from Covid and which may be side effects of medications.
After 14 days, L.F. was feeling better again and attempted a work out. This caused an immediate drop in her PO2 (oxygen). Steroids were resumed. The common asthma drug monteleukast (aka Singulair) was introduced to inhibit post Covid symptoms. A second swab was Covid negative and L.F. was able to come out of her quarantine.
Post Covid Syndrome and Auto-immune Phase:
By around day 18, oxygenation was varying from 94-97% and the fever resumed. L.F. went for a third swab and it was also negative, but she received a new diagnosis of an ear infection by her pulmonologist. This infection was presumed present due to being on the prednisolone which can cause immunosuppression. She began her 4th antibiotic and fever subsided within 24 hours. She was counselled to be very cautious about acquiring secondary infections. Supplements and the nebulized glutathione were maintained. By about day 22, symptoms included fatigue, restless sleep, night sweats and glutathione cream was introduced. These symptoms improved within 24 hours. L.F. is still recovering. Important things to note were that some of her symptoms could have been side effects from the medications, and some symptoms into the 3 week timeframe were related to the secondary infection. She is not likely to have a major setback at this point and is expected to continue to recover. If possible, I will update her case at a later date to see if she was left with any symptoms or if she makes a full recovery.
Dr.Karen Fraser, ND