Coronavirus Patient Information

Dear Patients,

As you know, we continue to face evolving stages of the of the Coronavirus (COVID-19) outbreak pandemic. As a result, our office has changed its policies from in person appointments to a combination of in-person and telemedicine. We have been doing this successfully for over a month and will continue to do this until the pandemic is over, which may be several months or even years. Our telemedicine platform (doxy.me) is completely HIPAA compliant and secure. We do require that all patients provide Dr. Marra their vitals (blood pressure, pulse, temperature and weight) during their appointments over video or telephone. For in-person appointments, patients are required to wear an N95 mask during their appointment. With this in place, we are prepared to continue servicing your needs, while ensuring that everyone remains safe from inadvertently contracting COVID-19 virus. Dr. Marra is a member of several physician groups who discuss this pandemic, and she attends several webinars to remain current with research and treatment options for the COVID-19 virus.

Heather and Dr. Marra are frequently disinfecting all surfaces in the office with Briotech. It’s an all natural solution of HOCL (hypochlorous acid) that is also a natural part of our immune system’s defense, produced in white blood cells. It has excellent antimicrobial activity and quickly inactivates pathogens such as viruses, fungi and bacteria that dwell on surfaces. Please go to www.briotechusa.com/science for more information on this natural disinfectant.

Coronavirus Pathophysiology:

ACE-2 – How the virus enters your cells:

The Coronavirus attaches to a cell surface protein called ACE-2 which is an enzyme. When the Coronavirus binds to ACE-2, it becomes inactive which produces “ACE-2 exhaustion.” This exhaustion may be responsible for pneumonia that is associated with COVID-19. Supplements that enhance ACE-2 include Resveratrol, Curcumin, and Alpha Lipoic Acid.

mTOR – Replication and Proliferation of Coronavirus:

Once the virus has entered a human cell, it begins replication by hijacking a ubiquitous protein called mTOR. The body then uses special proteins called Sirtuins to control mTOR activation. Therefore, nutritional activation of Sirtuins can inhibit mTOR and inhibit viral replication. Nutritional modulators of mTOR include Resveratrol, Quercitin, curcumin, apples, and onions.

Following is a list of foods that are high in Sirtuins that you might want to
increase in your diet at this time:

Proteases: Coronavirus mechanism of spread:

Once the virus particles have multiplied, Coronavirus causes human cellular damage by producing an enzyme called 3CL protease. Some dietary flavonoids like Quercitin can inhibit 3CL protease that helps minimize the infection. Elderberry and Houttuynia are both herbs that have been shown to inhibit the viral 3CL protease and viral activity in the cell.

Inflammasome: Activation of Proinflammatory Cytokines:

Inflammasomes are an elegant feature of our immune system because they “sense” pathogen danger. Activation of the inflammasome causes the release of a variety of proinflammatory cytokines, which stress the alveolar cells in the lung, and this results in respiratory distress. A weakened immune system therefore, is likely to precede severe illness. The Coronavirus may have intrinsic mechanisms evade the human immune system, just as we see in bacterial stealth infections like Lyme disease.

Melatonin produced in the pineal gland and vitamin C, both potent antioxidants, inhibit inflammasomes and scavenge free radicals produced by inflammation. Both of these supplements are highly recommended during this Coronavirus outbreak.

Nutrients to Prevent a Cytokine Storm:

• Turmeric (by EcoMedica)
• White willow bark (Saloxicin)
• Boswellia (Pure Encapsulations)
• MSM (Orthomolecular Products)
• Fish Oil (EFA Sirt or Arctic Ruby)
• Resveratrol (Rersveratrin by Zymogen)
• Quercitin (D-Hist by Orthomolecular)

The doses for these nutrients vary depending on age and weight, so please check
with your healthcare provider for appropriate use.

General Wellness Behavior During the Coronavirus Outbreak:

1. Wash hands with soap and water frequently throughout the day for at least 20 seconds, especially as you transition into and out of places. Use Briotech to disinfect all high contact surface areas.
2. Gargle twice daily with either warm lemon water or apple cider vinegar to keep the throat area clear of germs.
3. Social distance yourself and your family by standing 6 feet away from others. During this allergy season, make sure to cover your nose and mouth when you sneeze and cough. Wear a mask when you go to the grocery store, the pharmacy, gas pumps and any other essential needs.
4. Eat a balanced diet with lots of fruits and vegetables, especially garlic, which has antimicrobial properties.
5. Drink plenty of water throughout the day to stay hydrated (1-2 liters/day depending on body weight).
6. Get at least eight hours of restful sleep/night.
7. Only go to places with many people and crowds, i.e. grocery store, when you absolutely have to. Use gloves when touching produce.
8. Completely limit travel at this time (plane, train, bus).
9. Humming for 5-10 minutes a day can clear your throat so that the Coronavirus can not stick and increases nasal nitric oxide.
10. Hug your family and pets during this trying time and remember, this too shall pass. Find the joy in your life and milk it for all its worth.

If you get symptoms of fever and dry cough, call your Primary Care Provider immediately and get tested for Coronavirus. Self quarantine and avoid the hospital if you can.

Begin treatment by using herbs and nutritionals until you have a positive test.

Example of Natural Combination Preventive Treatment:
– Quercetin
– Green Tea
– Curcumin
– Melatonin
– B Glucan
– Elderberry
– Zinc
– Astragalus
– Andrographis

DISPENSARY:

If you need supplements, our dispensary will remain open during the Coronavirus (COVID-19) outbreak. Please call us at (206) 299-2676 to place an order and we will mail your supplements directly to you.

LABS:

All patients are still required by law to do routine lab work if they are on medication, especially pharmaceuticals. Please use a mask over your nose and mouth, and hand sanitizer upon arrival and departure. Take your mask off as you exit the building and throw it away or put it in a plastic bag.

If you would like to use a mobile phlebotomist to come to your home to draw blood, please call Elite Phlebotomy at (360) 784-0748 or email them at scheduling@elitephlebotomy.com. The charge is $50.00 per visit draw.

VIRAL SUPPLEMENT SUPPORT:

During this stressful time, there are a number of nutritional and antiviral supplements that can help support your immune system. You may purchase them by calling my office. If you would like a viral treatment plan designed for you, please call my office and make an appointment at (206) 299-2676

1. Vitamin C – buffered vitamin C has long been used to support immune function during the winter months. It has antiviral properties and is a very strong antioxidant. Dosing varies by age and weight. Please contact your healthcare provider for instructions on how to dose Vitamin C.
2. Vitamin D – 1,000-10,000 IU/day is an immunomodulator. For some patients you will also need to take Vitamin K and the supplement K Force by Orthomolecular Products.
3. Vitamin A – (not for use in pregnant women) is a potent antiviral at 100,000 units/ day for 7 days. Please consult your healthcare provider for proper dosing instructions.
4. PHP Colloidal Silver – has shown effectiveness against H5N1, and we use it frequently for the viral component (EBV, CMV, HHV6) of tick borne disease. The colloidal silver dose is 1-20 drops in water twice daily but please consult your healthcare provider.
5. Beyond Balance IMNV III – this is a blend of antiviral herbs that shows great promise against viruses. Dosing is 1-20 drops twice daily but please consult your healthcare provider.
6. Researched Nutritionals Multiimmune is a blend of antiviral nutritional and herbs. The dosing is 2-4 caps twice daily but please check with your healthcare provider.
7. Monolaurin (lauricidin) is a nutrient derived from coconut that has many antiviral properties. Dosing can be 300mg twice daily but please check with your healthcare provider.
8. Skullcap tincture (Scutellaria) has some antiviral properties but is most nutritive to lung tissue. This would be especially useful during the Coronavirus outbreak that targets the lungs. Dosing can be 1-20 drops in water twice daily but please check with your healthcare provider.
9. Elderberry (Sambuca) has a long history of immune boosting properties and is very high in antioxidants. Dosing does depend on weight and we use gummies because they have a great taste.
10. Biocidin spray is a great blend of antiviral herbs that can protect the throat, which is known to harbor and incubate the Coronavirus. Dosing varies depending on the patient so please consult your healthcare provider.
11. Houtynnia cordata is an herb native to Southeast Asia that shows promise against the Coronavirus. Dosing depends on the individual so please check with your health care provider.
12. Quercitin is a bioflavonoid and polyphenol found in many fruits, vegetables, seeds and grains. It also suppresses the replication of Coronavirus and minimizes the spread.
13. Melatonin is an antioxidant that is produced in the pineal gland of the brain and inhibits inflammasome activity. Dosing is 1-40 mg but please check with you healthcare provider for individual dose.
14. Resveratrol is a bioflavonoid found in grapes and red wine that enhances ACE-2 activity and suppresses the replication of Coronavirus.
15. Andrographis is an herb that decreases viral replication and enters the cell easily by passive diffusion. It also has anti-inflammatory properties.
16. Sulforaphane which is found in broccoli has excellent immune protection properties and we use Oncoplex by Zymogen. Please speak with your health care professional for dosing.
17. Zinc picolinate prevents viral replication and decreases complement over activation. However, it is difficult to get inside the cell so use zinc with Quercetin and/or Green Tea.
18. Licorice in the form of glycyrrhizin inhibits the Coronavirus replication but it is also contraindicated in patients with hypertension. Please consult with you health care provider for dosing and appropriate use.
19. B Glucan is a nutrient that is very June supportive, especially in combination with Sulforaphane and Maitake mushrooms. Please speak with you healthcare provider about use and dosing.
20. Gargle with warm lemon water or apple cider vinegar twice daily to keep the throat clean from any Coronavirus invasion.

Lastly, some of you may want to purchase an in home ozonator to clean the air from any viruses, bacteria or fungi. You can search through ozonators online, but the one I recommend is:
Airthereal MA10K-PRO Ozone Generator 10000mg/h High Capacity O3 Ionizer machine- Fireproof Tested by SG ($120.00.)

You can safely use this in your home provided you remove people, pets and plants from the house. Otherwise O3 can suffocate living O2 breathers. Turn it on when you leave for work so that there is plenty of time before you return to your own home. Otherwise, ozone can irritate mucous membranes and cause burning.

I hope all of you can remain calm and stay safe during this difficult time. This is a time to reflect on all the things in your life that you absolutely love and shower them with gratitude. I am grateful for the information I have obtained from other ILADS doctors to formulate this alert for you. It is the most comprehensive and current information on the Coronavirus (COVID-19) that I am able to obtain at this time.

Sincerely and with best wishes to stay healthy and stay safe,

Dr. Susan L. Marra

References:

1. The role of ACE-2 in COVID-19 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088566/
2. Resveratrol and ACE-2 – https://www.ncbi.nlm.nih.gov/pubmed/29407880
3. Resveratrol vs. the MERS coronavirus (MERS does not us ACE-2 for entry into cells, so this study demonstrates other anti-coronavirus actions of resveratrol. The authors recommend resveratrol as treatment for MERS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307780/
4. Curcumin and ACE-2 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651552/
5. No association between prior use of ACE inhibitors or ARBs and severity of COIVID-19 https://www.ncbi.nlm.nih.gov/pubmed/32120458
6. Coronavirus disease is not increased in immunosuppressed patients https://www.ncbi.nlm.nih.gov/pubmed/32196933
7. Angiotensin 2 is directly related to viral load and severity in Chinese patients with COVID-19. This is the only paper that supplies actual evidence, not speculation. The authors call for the use of ARBS to ameliorate COVID-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088566/
8. ARBs protect against ARDS and may be good for COVID-10 patients (opinion) https://mbio.asm.org/content/11/2/e00398-20.long
9. A role for ARBs in the body’s defense against COVID-19 (opinion) v
10. In vitro effectiveness of hydroxychloroquine vs chloroquine against COVID-19 https://www.ncbi.nlm.nih.gov/pubmed/32150618 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078228/
11. Open label study of hydroxychloroquine plus azithromycin on viral load. Study was recently expanded to 90 patients (not published). https://www.ncbi.nlm.nih.gov/pubmed/32205204