Coronavirus Sars-Cov-2: useful information and advice for prevention of the infection

English translation – Vicki Ann Holder (Revised 10th April 2020)

At the moment, we are inundated with alarming health warnings, which essentially engender fear in the minds of ordinary people who are without the necessary knowledge and data to fully comprehend the situation.

Fear is the root cause of much that may cause harm, including: a lack of trust, denial, conflict, rejection, escapism, compulsive shopping or eating and a great many other such emotional reactions and behaviours, depending on individual character.

Fear of disease can even trigger disease and illness, as it creates both tension and stress, and prolonged stress may expose and aggravate our latent vulnerabilities. Fear may cause an increase in blood pressure, irregular heartbeat and can upset sleep and digestion-related processes. An already fragile balance can be upset, which is particularly true for the elderly or for those suffering from chronic illnesses. In the end, fear can undermine the immune system.

This is precisely what we have to avoid at all costs in the current situation!

Therapy should be based mainly on three essential pillars:

A healthy physical lifestyle, in order to optimize all our biological functions which, working well, can protect us from any germ or pathological event (obviously within the limits of human capacity);
A healthy psycho-spiritual lifestyle, based on reasoning, common sense and an optimistic vision of the future which includes trust in the laws of creation;
The awareness, which arises from the knowledge of what can harm us, but also of what helps us and keeps us balanced.

The suggestions contained in this article only aim to act as stimulus, for deeper reflection, that everyone will then need to personalize. It begins with technical information concerning the Coronavirus SARS-CoV-2 infection and it continues by analyzing the main factors that facilitate the onset of the illness. It then goes on to explain ways in which it may be possible to prevent the disease, or at least to limit its impact as much as possible, in order to prevent it from harming the body too much. The secret, of course, is to do everything possible to strengthen our immune system and that is what the article aims to explain.

So let’s get to know this novel Coronavirus infection, and establish what can rightly be done in this predicament, in light of the current situation in Italy, and around the world.

Indice

1. What science says about Coronaviruses
2. How the infection is transmitted
3. Why the number of cases of infected people is multiplying
4. The symptoms of Coronavirus SARS-CoV-2-infection
5. Evolution and duration of the infection
6. At the first symptoms one wonders: am I infected with Coronavirus?
7. Main differences with seasonal viral syndromes
8. Mortality for Coronavirus SARS-CoV-2
9. People most at risk
10. Prevention of Contagion
11. Fever management in common viral infections
12. Conclusions
Bibliography

1. What science says about Coronaviruses

Coronaviruses encompass a large family of positive sense single-stranded RNA viruses, which affect the respiratory system. Their diameter measures approximately 80-160 nm (1 nanometre is a millionth of a millimetre) and their genome is among the longest of the RNA viruses (around 30,000 nitrogen bases).
The name ‘coronavirus’ is derived from their appearance under the electron microscope, where the bulbous-shaped proteins create a crown like image on their external surface. These same proteins enable the virus to attach itself to the cell membrane of the cells it will infect. Subsequently, the virus penetrates the cells and forces them to encode the virus’ RNA, the proteins of the external envelope and therefore the whole virus once copied will leave the invaded cell in order to go on to infect other cells (1).
Common Coronaviruses are responsible for pathologies in mammals and birds, in which they cause diarrhoea (cows and pigs) or diseases of the respiratory tract (chickens).
In humans, common Coronaviruses cause respiratory infections, these are often quite mild, such as the common cold, and in some cases, they may cause non-severe viral pneumonia (about 20% of all viral pneumonia are associated with coronaviruses). Only rarely do they trigger a Severe Acute Respiratory Syndrome (SARS).
As has happened with other viruses in the past, some animal-specific Coronaviruses that would normally not infect humans can make an ‘inter-species jump‘. This means that they are transmitted to humans, causing very severe and occasionally life-threatening pneumonia.
In this case, the severity of the pathology is due to the novelty of the virus. Since our immune system has never encountered it before, it does not know it. Therefore, it cannot defend itself and suffers an attack that may become particularly violent and dangerous in immunologically debilitated or immunosuppressed individuals. This is particularly true for the elderly with severe chronic diseases, or for people with debilitated immune, cardiopulmonary, renal or metabolic systems.
So far, seven human Coronaviruses have been identified. The first four viruses (also known as ‘common cold viruses’) listed below are very common and were identified in the 1960s. The last three have been identified much more recently:

Human Coronavirus 229E (Coronavirus alpha).
Human Coronavirus NL63 (Coronavirus alpha).
Human Coronavirus OC43 (Coronavirus beta).
Human Coronavirus HKU1 (Coronavirus beta).
SARS-CoV (Coronavirus beta which caused the Severe Acute Respiratory Syndrome of 2002, an epidemic that originated in China and infected about 8,100 people, with a mortality of 9.5%).
MERS-CoV (Coronavirus beta which caused the Middle East Respiratory Syndrome of 2012, an epidemic which originated in Saudi Arabia and infected about 2,500 people with a mortality of 35%).
Coronavirus SARS-CoV-2 (A new Coronavirus which was identified in late 2019, causing a severe acute respiratory syndrome leading to death in a small minority of cases. The outbreak started in Wuhan, a city in China, where it infected about 150,000 people with an estimated mortality of 2.1% so far: about 3,200 deaths out of 150,000 confirmed Chinese cases) (2) (for updated world data see bibliography (3) and for updates of the Italian data see bibliography (4)). However, the virus subsequently spread to other countries in Asia and almost immediately after reached Italy, which became the second country in the world per number of cases in only a matter of weeks. The virus has now spread rapidly all over Europe, indeed is now rapidly spreading all over the world, and has caused a real pandemic.

Coronavirus SARS-CoV-2 is referred to as the ‘novel Coronavirus‘, because it is a new strain of Coronavirus which has never been identified in humans before. The virus is associated with an outbreak of pneumonia cases recorded in the city of Wuhan (central China) starting from the 31st December 2019. It seems – but it is not certain – that most cases were initially believed to have an epidemiological link with the Huanan Seafood market (Southern China), a wholesale market for seafood and live animals.

In fact, Coronavirus SARS-CoV-2 is 96% genetically identical to a known Coronavirus of bats and 86-92% to a pangolin Coronavirus. Therefore, the transmission of a mutated virus from animals to humans is the most likely cause of the appearance of the novel Coronavirus.

2. How the infection is transmitted

Human Coronaviruses are transmitted from one infected person to another mainly by direct contact through saliva, coughing or sneezing (to be infected, you must be within a range of about 1-1.5 metres). The virus probably also spreads by direct contact with the nasolabial mucous membranes or from the hand of an infected individual (who is likely to have contaminated hands, since people tend to touch their nose or cover their mouth with their hand when coughing or sneezing) (5).
In fact in China, the highest rate of infection (78-85%) was recorded within families, mainly due to aero-transmitted droplets from those infected by the virus, in close contact to other members of the household. Transmission from airborne droplets at distances of 1.5-2 metres or more is not a significant cause of contamination, especially in large indoor spaces or out in the open air (6). There is a risk of being contaminated via transmission from direct (skin) contact, for example by touching the hand of an infected person, only if you put your hand in your mouth or if you touch (the mucous membranes of) your nose or eyes before washing your hands thoroughly.
Anyone who is infected, can spread the virus not only during the symptomatic phase of the disease but – like in any viral infection – also during the 5-6 days preceding the onset of clinical symptoms (in fact probably during the preceding 15 days), long before the infection is detected.
Initially the virus seems to be located in the throat of an infected person. There it rapidly multiplies and when it reaches a sufficient quantity, it enters the blood stream and invades the whole body, in particular in the lungs via inhalation. For this reason, as a preventive measure, it is important to use mouthwashes that are able to inhibit the local increase of the virus (see section 10.c). This is all the more vital at the onset of the very first symptoms.

3. Why the number of cases of infected people is multiplying

As already stated, this virus is new to the human organism and moreover along with other cold or flu viruses does not have a short incubation period. Therefore a person may have become infected and have been spreading the virus for several days before the symptoms of the infection become apparent. Furthermore, although the data is still uncertain, it would appear that there are many healthy carriers who have overcome the disease with very few symptoms or without even realizing that they have contracted the virus. These people therefore continue to involuntarily infect others.
This is why the first and foremost rule for limiting the spread of this infection is to stay at home, limit contact with others and use a mask to protect both yourself and other people.

4. The symptoms of Coronavirus SARS-CoV-2-infection

According to the WHO (6), the symptoms of the SARS-CoV-2 infection are not specific and the presentation of the disease can vary from no symptoms (an asymptomatic subject) to severe pneumonia and death.
More often than not, to begin with, this infection is a challenge to diagnose, as starts as if it were a common flu syndrome with symptoms such as those of the common cold or of a simple pharyngitis. The duration of these symptoms varies, depending on the strength of an individual’s immune system.
If the subject is immunologically weak, the infection intensifies, local symptoms become systemic (as the virus extends throughout the whole organism) and a fever appears. Given that this virus seems to have a particular affinity for lung tissue, in weaker, elderly and/or immunosuppressed subjects, it induces basal or disseminated pneumonia that occurs with respiratory difficulty, persistent dry cough and high fever. In some subjects this symptomatology becomes particularly serious and can lead to death.
More specifically, beginning on February 20th 2020, based on the study of 55,924 Chinese subjects who obtained confirmation of the infection with a pharyngeal swab, the most common signs and symptoms of the virus were the following:

fever (87.9%),
dry cough (67.7%),
exhaustion (38.1%),
mucous expectoration by coughing (33.4%),
difficulty breathing (18.6%),
sore throat (13.9%),
headache (13.6%),
muscle pain (14.8%),
chills (11.4%),
nausea or vomiting (5.0%),
nasal congestion (4.8%),
diarrhoea (3.7%),
bloody sputum (0.9%),
conjunctival congestion (0.8%).

Two other studies (7, 8) have shown similar symptoms.
In addition, there is almost always a marked reduction in lymphocytes (typically 500-600/mcl) and in most patients the concentrations of c-reactive protein (CRP), lactic dehydrogenase enzyme (LDH), ferritin, liver transaminases and serum amyloid A protein (acute phase protein) are elevated (9).

5. Evolution and duration of the infection

It is known that approximately 80% of those infected develop only a mild disease. Only in the most severe cases can the infection cause basal pneumonia, usually bilateral, with severe acute respiratory difficulty and, rarely, death (10). In fact, 10% of cases are so serious that patients need to breathe highly concentrated oxygen (and not just for a few days, more often for 2-3 weeks), while the most serious cases of all (around 8 – 13% of people) need ICU admission as they require assisted breathing. According to the aforementioned WHO document (6), the duration of the disease from its symptomatic onset to recovery is on average 2 weeks in previously healthy patients who had only mild symptoms during the disease. The disease lasts from about 3-6 weeks in serious and critically ill patients, those who have the more serious form of the disease because they were already ill or immunosuppressed for various reasons.

6. At the first symptoms one wonders: am I infected with Coronavirus?

Since the Coronavirus infection initially expresses mild symptoms, such as those of the common cold or simple pharyngitis, in the beginning a person may underestimate their symptoms and do nothing about them. This can happen to anyone: anybody could, at any time. We might catch a cold with mild fever and general malaise and therefore be concerned as to whether it is a normal seasonal virus or the beginning of a mild-moderate Coronavirus infection?

These are the questions it is natural to ask ourselves:

What should I do?
Do I need the pharyngeal swab?
Do I have to go to the emergency room?
Do I need to quarantine?
What about contact with family members?
And work?

It is important to state that it is not recommended to go to the emergency room if there are no important symptoms (such as high fever with evident respiratory difficulty) which would suggest a lung involvement (the virus causes interstitial pneumonia with important respiratory difficulty). It is easy in this situation for the sick patient to feel abandoned at home, above all because Doctors can also catch the infection, some have actually become ill and therefore doctors too, are afraid of becoming sick.

The result is that many patients, especially those who live alone, risk staying at home without treatment… and then their fear increases!
Obviously, if the fever remains high for a long period or if breathing difficulties should appear, a patient should not delay going to the hospital immediately for the appropriate treatment.

7. Main differences with seasonal viral syndromes

It is therefore important to understand what the main differences between the Coronavirus infection and a common and non-dangerous seasonal viral infection are. If only to reassure people and to explain what they must do for those particularly at risk and with uncertain initial symptoms!
It has to be said that differentiating these two pathologies is sometimes difficult. It requires medical competence and the analysis must be personalized to the individual case.
However, given the emergency of the moment, I think it is important to provide some parameters to people who may experience particular anxiety during this period.
It is specified that the precise diagnosis of the type of infection is possible only with a microbiological examination of a sample taken with a pharyngeal swab that uses the PCR (Polymerase Chain Reaction) technique. This is an examination that provides a result in a few hours.
Unfortunately, even this test can be mistaken in some cases (both false positives and false negatives are always possible) and therefore it should be repeated a second time for greater security.
As for how to distinguish the Coronavirus infection from a common and non-dangerous seasonal viral infection, the studies published since the appearance of the current Coronavirus outbreak and some WHO documents (11) certainly allow us to provide some important information.
For example, it seems to be certain that SARS-CoV-2 rarely makes young people under the age of 18 ill and, if they do become ill, it induces only a mild flu-like disease in them (7): depending on the weak points of the affected subject. It can present the symptoms of a catarrhal cold with nasal secretion or the symptoms of a rhino-pharyngitis or a rhino-sinusitis (usually frontal) which in some cases evolves into laryngotracheitis with hoarseness and an altered tone of the voice.
Furthermore, preliminary data from studies conducted in China indicate that children affected by the virus have been infected by adults, rather than vice versa, while in the case of the flu virus the opposite occurs: children are an important vehicle of community transmission of the flu virus and it is they that infect adults.
Another element that enables us to distinguish the SARS-CoV-2 virus from the viruses of the flu syndrome, that affects the upper respiratory tract, is that the first one has a longer incubation than the flu syndrome and therefore it spreads a little less quickly. However, in the end, SARS-CoV-2 involves a greater number of people because many think they are well and therefore do not use precautions and spread the virus when coming in contact with healthy people.
This is why it is important to ask everyone to “Stay at home” in order to limit the peak of the epidemic and to reduce the number of contacts each person has, and therefore also of the number of infections.
SARS-CoV-2 is practically never expressed only with the symptoms of a common cold, such as sneezing and nasal discharge (6, 9). These symptoms may be present, but only at an early stage and subsequently the infection may evolve further in one of three different ways:

The symptoms intensify, change rapidly and the respiratory symptoms typical of the Coronavirus SARS-CoV-2 worsen. Therefore it is said that the patient now has this pathology (this usually happens in immunologically weak subjects or in the elderly);
The symptoms remain those of a common cold that the affected person recognizes as his usual symptomatology, one that the individual has already presented with at other times and that resolves in a few days as is normal for this person (this means that the person has not been infected by the virus SARS-CoV-2);
The symptoms of a cold or pharyngitis or pharyngo-laryngotracheitis tend to last many days (generally 7-10 days) without improving or worsening. This means that the organism is likely to have come into contact with the SARS-CoV-2 virus, but the organism is strong enough to contain the infection by preventing it from spreading and causing the organic damage it could cause (usually this happens in young adults or elderly adults who still have a fairly good immune system).

So, if you have a simple symptomatology of rhinitis, rhinosinusitis or nasopharyngitis (i.e. little more than a common cold), if it is accompanied by a fever, if these symptoms do not rapidly deteriorate accompanied by persistent dry cough and difficulty in breathing, but remain for 7-10 days and then they gradually decrease probably you have had a mild form of the SARS-CoV-2 infection. In this case you might be pleased to have had the infection and acquired a state of immunity!

The important recommendation in all these cases, until you are sure of the diagnosis and therefore until you are completely better, is to stay indoors avoiding all close contact with others.

In general, however, the SARS-CoV-2 infection has its own clinical characteristics which, especially when the infection is of a serious form and according to the data provided by the aforementioned WHO document (6), enabling it to be differentiated easily enough from common seasonal viruses (colds, rhinosinusitis, nasopharyngitis, laryngotracheitis, flu syndrome, etc.) (Table 2).

It is necessary to consider Coronavirus mortality carefully, so as not to run the risk of falling ill and dying more often from the consequence of fear, rather than from those of this new virus.

8. Mortality for Coronavirus SARS-CoV-2

In China, mortality from SARS-CoV-2 was around 2.1% and therefore much lower than the current world rate of around 5.8% and in particular that of Italy at around 12.8%. Clearly, as long as this pandemic is ongoing, precise estimates cannot be made. However, it is important to consider that, as this virus is particularly dangerous in the elderly, if a country has an elderly population (where the average age of the population is high), it is likely to have a higher rate of mortality. In fact, the average age of the Chinese population is low (about 37 years of age), while the average age of the Italian population is higher (about 46 years old). So it is understandable that Italy has a higher mortality rate than China.
It must be said however, that it is still far too early to draw conclusions. We do not have definite data; there are only provisional statistics, since the exact number of people infected with Coronavirus SARS-CoV-2 is not known. In all likelihood, the number of infected people is high (many people have hardly any symptoms and therefore fail to be recorded; moreover, mortality is calculated on the total number of those infected, but if the whole population does not have a pharyngeal swab [which is unthinkable] we will never know how many people have been infected with this virus and therefore mortality will always be overestimated).
Therefore it will be necessary to wait some months for more accurate data to become available. In the meantime we are currently witnessing this infection spreading around the whole world and it is likely that it will kill tens of thousands of people for many more months.
Based on the data currently available it appears that Coronavirus SARS-CoV-2 mortality is strongly influenced not only by the age of affected patients and by his/her pre-existing pathologies but also, by the assistance that the patient receives from the National Health System.
The condition of a country’s health care system plays an important role, in dealing with the virus. In China, 20% of infected patients required hospital treatment for several weeks (6), but most hospital beds were already taken by other patients, who had been admitted for unrelated pathologies. In fact, SARS-CoV-2 patients with severe symptoms have a higher mortality rate if an insufficient number of intensive care beds are available. Consequently, the first and most imperative measure is to aggressively contain the spread of the virus, in order to reduce the number of severely-ill SARS-CoV-2 patients and to also increase the number of available intensive care beds (including medical supplies and medical staff) as much as possible (something the Italian government has been trying to do since the start of the outbreak).

9. People most at risk

Viruses can enter and multiply inside anyone with whom they come into contact, though their impact is not necessarily the same in every individual. In the case of Coronavirus SARS-CoV-2, the data available so far shows that this infection can cause very different symptomatic profiles in those affected, and that this essentially depends on the condition of their immune system (2, 3, 12).

The real risk of the Coronavirus SARS-CoV-2 infection depends on the condition of the immune system:

a. A group of people we do not yet know how to quantify are those who, may present with an asymptomatic or mild infection, with symptoms that do not attract the attention of the subject. It is difficult to say how many people might be affected because, as with all viral infections, some subjects are asymptomatic or have ailments similar to those of a common cold or a mild and transient pharyngitis. These people are usually not elderly, have a very robust immune system and generally do not even undergo medical checks because they do not think they have the infection. However, it must be said that, according to the WHO’s experts (6), many infected people sooner or later develop symptoms.
Consequently, potentially, we are all at risk, because any one of us may find ourselves ‘momentarily’ in a ‘temporary’ condition of increased risk due to certain factors causing imbalance and weakening of our immune system. Among the main causes of imbalance are essentially the following:

Prolonged and very intense psycho-somatic stress, especially when causing agitation, anger and fear;
A radically altered nutrition-pattern (often referred to as ‘junk food’ consumption);
Quantitatively altered nutrition consumption (too scarce or excessive);
Consumption of products with altered nutritional value (i.e. deprived of nutrients that are essential to our organism’s vital processes: oxygen, water, essential amino acids, essential fatty acids, vitamins, minerals);
Severely reduced fluid intake, especially for prolonged periods of time;
Excessively sedentary lifestyle, especially for prolonged periods of time;
Severe sleep deprivation, especially for prolonged periods of time;
Chronic exogenous intoxication (excessive consumption of drugs, alcohol, coffee, smoking, pharmaceutical drugs).

If exposure to the conditions which risk unbalancing the immune system are not severe, intense or too prolonged, and if the individual is fit, healthy and not elderly, in 80% of cases the SARS-CoV-2 infection will only cause mild symptoms. In this situation it is enough to remain in isolation/quarantine for approximately 15-20 days.

b. However, 10-14% of infected individuals may develop severe symptoms as a result of pre-existing chronic pathologies aggravated by the aforementioned conditions, debilitating the immune system to such an extent, as to require immediate hospitalization in conditions of isolation. In fact, the Coronavirus SARS-CoV-2 infection is generally aggravated by the presence of several factors:

Old age (over 65-70 years of age);
Severe chronic immune pathologies: immune-deficiencies or immune imbalances of various types, such as those expressed with recurrent infections, HIV infections, etc.;
Severe chronic respiratory diseases: bronchial asthma, chronic bronchitis, bronchiectasis, respiratory infections, respiratory failure, etc.;
Severe chronic cardiovascular pathologies: advanced ischemic coronary artery disease, atrial fibrillation, dilated cardiomyopathy, heart failure, etc.;
Severe chronic metabolic diseases: decompensated diabetes mellitus, chronic pancreatitis, intestinal malabsorption, severe obesity, cachexia, etc.;
Severe chronic kidney diseases: decompensated renal failure, etc.;
Severe chronic neurological conditions, especially myopathy associated with respiratory failure, etc.;
Oncological pathologies at advanced stages, namely with involvement of vital organs and vital centres, etc.;
Acute or chronic treatment with immunosuppressives (corticosteroids, non-steroidal immunosuppressants, oncologic chemotherapy, major surgical procedures under general anaesthesia, etc.).

c. About 8-10% of those infected, due to pre-existing, precarious immune system conditions, can enter a highly critical state. Some even face death from multi-organ failure despite advanced technology and the vigorous therapy available in intensive care units. These patients are those who are so weak that they are unable cope with the disease, they usually experience bilateral basal pneumonia (75-79% of these cases) which is characterized by intense dyspnea with a respiratory rate of about 30 acts/minute, saturation of 90% oxygen (measured by an oximeter on the finger of one hand) or by partial pressure of oxygen in the arterial blood of 50-60% (measured with blood gas analysis). And there will also be lung infiltrates in more than 50% of the lung field even within 24-48 hours (the most affected lobe seems to be the lower right one) (13); if they do not receive assisted breathing (intubation), these patients risk succumbing to respiratory failure, septic shock and multi-organ failure over a highly variable and subjective time frame (14). According to data published by a study (15), among critically ill subjects, only 11% did not experience fever until 2-8 days after the onset of symptoms, the average time interval from the onset of symptoms to the radiological confirmation of pneumonia was 3-7 days and that from the onset of symptoms to admission to the Intensive Care Unit was 7.0-12.5 days.

I’d like to ask: why the reasons some individuals die from the Coronavirus SARS-CoV-2, whereas others survive the infection, are not being explored a little more?
This is the question that, we doctors must strive to answer. Understanding why some people become very ill or die, and why others make a full recovery could help to lay the foundations for a more effective and targeted preventive medicine.

10. Prevention of Contagion

Although no virus is able to live and reproduce outside of a living organism (human or animal) indefinitely, viruses are known to survive a short amount of time in an external environment. (The Coronavirus SARS-CoV-2 is believed to be able to survive no more than a few hours outside its host. Data thus far are still unverified, due to the novelty of the virus and the lack of sufficient studies. In fact, some claim that the virus is able to survive up to one day inside residential buildings).

The actual prevention of contagion depends on the probability that people be exposed to viruses, released by either sick individuals or healthy carriers. (Healthy carriers refers to individuals who have been contaminated with the virus, but who are either asymptomatic or have not developed symptoms yet, or individuals who will never show any symptoms, because their body is able to eliminate the virus efficiently).
The rules for the prevention of contamination with the Chinese Coronavirus SARS-CoV-2 are practically the same that apply to all viruses (16, 7, 18) and are summarized in the paragraphs below.

a. Adopting a lifestyle that reinforces our defences against infectious diseases in general

Examining the list of people at risk and Table 2, it quickly becomes evident that the first measure of prevention is preserving a strong and well-functioning immune system. This approach is fundamental and applicable to the prevention of any pathology, whether it is infectious or not.
Therefore, the first and most effective form of prevention is always to have the right lifestyle!
The human organism is almost always able to overcome an attack caused by any virus, bacterium, fungus, or germ. This remains true whether or not it already exists or has yet to develop, provided that we maintain good health and protect ourselves adequately.

I believe that the most important advice is the following:

Reduce the consumption of animal-based food products (i.e. meat, milk and other products derived from these sources) and industrially processed food products, as much as possible. (By reducing our consumption of meat, we are also indirectly fighting against intensive animal farms, where animals are kept in very poor conditions and treated worse than worthless objects. In fact, these animals live under such stressful conditions, that they become more prone to infections, which require the constant administration of antibiotics. Consequently, this promotes the onset of viral infections which eventually create the conditions that enable pathogenic germs to make the ‘inter-species jump’ from animal to human.)
Maximize the consumption of vegetables, especially fresh vegetables, whole cereals with low glycaemic index, pulses and fresh as well as dried fruit.
Drink approximately 1.5-2 litres of water per day, preferably slightly alkaline and with a low fixed residue.
Take necessary measures to normalize your body weight: by eating less (smaller quantities) if you are overweight and chewing the food adequately in order to facilitate and speed up digestion.
Engage in some physical activity every day (for example, at least 30 minutes of brisk walking in the open air, surrounded by nature).
Sleep a minimum of 7 hours, if not 8 hours, a day. Sleep in a dark, quiet room, without background noise and if possible far away from sources of electromagnetic fields.
Give up your addictions at once if at all possible or if not gradually (smoking, coffee, alcohol, drugs, the unnecessary consumption of pharmaceutical drugs, as well as the excessive use of mobile phones, computers and television; also give up any kind of addictive and/or detrimental behaviour).
Use probiotics, some supplements or nutraceuticals depending on individual nutritional deficiencies, especially when related to nutrients that are considered essential for our body (nowadays, deficiencies are increasingly frequent due to the pollution of the environment and of the food chain). The most important supplements with antiviral functions are vitamin A, C, D and mineral salts based on copper and zinc (see below).
Reserve some time every day for reading and/or meditation as well as other forms of leisure that are both relaxing and gratifying. If possible, in the period of greatest risk of infection, It is recommended to:
– avoid crowded areas,
– arrange Sunday outings to places where you can breathe good air and reinvigorate yourself: in the mountains (above 800-1000 meters or at the most convenient altitude appropriate to the condition of your general health), at the seaside (even in winter, walking a few hours along the beach can be beneficial, especially for children and the elderly, provided they are adequately dressed for cold weather). Obviously, in the event of an emergency and an obligation to minimize travel from your home, this cannot be done.
Avoid conflict and any other circumstances leading to increased stress that can be avoided. (However, it is also important to try to do something to help the resolution of conflicts that do not depend on us personally).
Adopt a positive and peaceful state of mind to minimize both personal and inter-personal stress (obviously, not everyone is born with such a predisposition, but we can all try to improve ourselves).

b. Strengthening our antiviral defences in critical periods and when we are in a high-risk situation

When the goal to achieve is a fairly rapid immune-stimulant effect, in order to activate a nonspecific antiviral response as fast as possible, it is imperative that all advice is carefully considered and personalized. In fact, if a person meets one of the health risk conditions listed in Table 2, he/she very likely needs a personalized immune-stimulant treatment, that only his/her physician is qualified to prescribe.

Bearing in mind that in the present article any advice can only be generic, during a period of increased exposure to infection risk, to adults I would recommend following guidelines in order to achieve a rapid immune-stimulation:

Commit to integrating a habit of periodic fasting (at least one day a week) in order to compensate for deregulated eating patterns, and with that minimize the accumulation of toxic substances as well as catabolites that weaken the immune system. With the exception of children, people older than 80 years of age, and those with particular pathologies, this advice is beneficial for everyone:
– overweight or obese individuals;
– people with metabolic pathologies affecting the abdominal organs;
– people who are aware of an excessive amount of food habit (we are all familiar with our own weaknesses with regard to food consumption!);
– people who crave simple sugars or refined flours; or who eat a lot of animal-based products (especially meat and dairy).
There are several ways of fasting, but I would recommend a simple personalized manner of periodic fasting. It is enough to stimulate the reactive-defensive processes of the body and enable it to react efficiently in many unfavourable conditions. Animal studies using laboratory guinea pigs have widely demonstrated that, if fed on alternate days (as opposed to every day), thus subjecting the guinea pigs to frequent forced fasting, their lifespan can be extended by as much as 30% and morbidity reduced, even without losing weight (19,20).
Based on my own clinical experience, my advice is to fast once a week (preferably over 2 days for those who need it most) and to drink only water (or herbal teas) at will (about 2.5-3 litres) during the fast. Those who are unable to fast can start by drinking plenty of water in between or before meals, consuming only cooked and/or raw vegetables seasoned with lemon and/or balsamic vinegar at lunch and/or dinner.
Remember that, generally speaking, experiencing a little hunger is good for the body and mind!
Those who feel that they can safely fast for a longer period, might try what I like to call the ‘15-day diet‘. It is based on the sole intake of liquids and vegetables in moderate quantities, throughout that period:
– 1st and 2nd day: only water or purifying herbal teas;
– 3rd and 4th day: centrifuged vegetables, vegetable extracts or only cooked and/or raw apples;
– 5th-15th day: vegetable broths, vegetable soups, soups, cooked and raw vegetables, some pulses, two or three seasonal fruits, lemon juice and a spoonful of olive oil a day.
Take high doses of vitamin C (ascorbic acid) in powder: it is commonly known that vitamin C stimulates the immune system. In fact, a deficiency of vitamin C results in decreased immunity paired with increased susceptibility to infections, whereas the integration of vitamin C seems to prevent and treat many respiratory and systemic infections (21). However, it is important to note that to achieve acute and intense immune stimulation, high dosages are required (22), for example 2.5-5 grams of vitamin C (i.e. half or a teaspoonful) per day for several days (maximum a month. If you want to assume high dosages over a longer period, it is desirable to have a 15 day-break free from taking any vitamins). The aforementioned dosages of the vitamin must be dissolved in a litre of water and consumed little by little over the span of the day. This is necessary in order to avoid diarrhoea, as result of increased osmolality (our bodies are only able to absorb small quantities of vitamin C at a time, thereby leaving the remaining ‘unused’ vitamin C in the intestines, which is discarded by attracting water.) If it is not possible to keep the bottle in the dark, it is preferable to prepare half a litre in the morning and the other half in the afternoon, in order to avoid prolonged exposure to light. In case of fever, the dose of vitamin C can be increased up to 10 grams per day or even higher doses.
Take a teaspoon of baking soda with a little water every night before going to bed (or alternatively some alkalizing salt tablets).However, induced alkalization may still have a positive metabolic impact, since under circumstances of acidosis our enzymes are not able to function adequately and I thereby increase the body’s susceptibility to inflammation and illness.
Take parenterally administered Glutathione: do so by administering a single 600 mg ampoule every 5-7 days during the critical period of exposure to risk; in the case of fever, every day for 7-10 days. Glutathione is one of the most powerful antioxidant substances our bodies produce, and in this case is important in defending the body from inflammation caused by free radicals. In fact, it is known that viruses, particularly Coronavirus SARS-CoV-2, cause interstitial alveolitis with the production of free radicals, which can also contribute to cell necrosis. Therefore, glutathione is an important preventive weapon and an additional means of support in the case of pathology. It is a natural substance without any known side effects.
External use of essential oils (EOs): EOs are powerful antibacterial, antifungal and antiviral agents, the beneficial action of which has been proven over many years (23, 24, 25). They are generally selected based on their aromatograms (these are laboratory test to assess the sensitivity of a germ towards a specific EO). In the case of viral infection, the following EOs can be used in combination with one another: Ravensara (a member of the Laurel family) EO, Eucalyptus EO, Rosemary EO, Lemon EO, Cloves EO, Cinnamon EO (though be mindful of its slightly irritant effect), Peppermint EO, Mountain Pine EO and Thyme EO. All of these EOs have antiviral properties. It is not necessary to use them all, but I would recommend preparing a blend of at least three or four of them. A single drop of such a blend – made up of equal parts of the chosen EOs – can be applied to the outside of nostrils or the front of the neck. It is important to note that EOs are for external use only. A blend can also be diffused indoors, by using an electric diffuser (generally 1 drop of the blend is used for every square metre of the room), or used to fumigate a closed space (use 2-3 drops in a pan of boiling water, and inhale the steam from the pan, with your eyes closed, while bending carefully over the pan and covering your head with a towel). You can also use 2-3 drops directly on a handkerchief to be sniffed frequently or put a drop inside a protective mask. In order to purify a room, proceed as follows: fill a normal small pressure sprayer with 100 ml of a solution of 40% alcohol and add 70-80 drops of an appropriate EO blend. Shake the solution well and spray it into the air 3-4 times a day. You can also spray it onto your hands, and then rub it gently onto your face for disinfection, or also onto a cloth which you can use to disinfect door handles and other frequently used surfaces and objects. Finally, besides having an antiviral and antibacterial effect, EOs also release a very pleasant fragrance in rooms where they are used.
Do not to touch your eyes if you have EOs on your fingers! EOs are not suitable for young children (under 3 years old), since they may cause bronchospasms. Some adults may be hypersensitive to EOs; therefore, it is important to test one’s reaction before use, by putting a drop on the forearm: in the case of a red skin rash, wash thoroughly with soap and water. For hypersensitive individuals, dilute the EOs by mixing 5 drops of the mixture with a teaspoon of olive oil, and keep the mixture in a small, tightly closed glass bottle.
Supplements: other than vitamin C, (which has already been discussed in this section), there are other important nutritional supplements that assist in the prevention of viral infections. The most important are:
– Vitamin A: a deficiency compromises both innate and acquired immunity. It compromises innate immunity by reducing the functionality of neutrophils, macrophages and Natural Killer lymphocytes and a deficiency also compromises acquired immunity by affecting the role it normally plays in the development of Th1, Th2 and B lymphocytes (26). Doctors may consider a dosage of 50,000 IU / per day for a period of 7-15 days followed by 10,000 IU / per day.
– Vitamin D: vitamin D deficiency, which is extremely common nowadays, is associated with an increased risk of acute viral respiratory infection. Meta-analyses of clinical studies on vitamin D supplementation have demonstrated its protective effect against viral infections (27, 28). In fact, vitamin D has numerous immune-stimulatory effects, but for fast action, an intake of daily high dosages is required, for example 10,000 IU/day for a period of 2 months (in emergency cases, a dosage of 100,000 IU/day may be taken for 4-5 days). Switch to 5,000 IU/day afterwards. Bear in mind, that the intake of vitamin D should be accompanied by the ingestion of about 1.5-2 litres of water per day.
– Copper: it is essential for the uptake of vitamin C; it contributes to the normal functioning of the immune system and inhibits viral growth (29). A doctor may consider prescribing dosages of around 1.5-2 mg per day (ingested on a full stomach, reduced to half the original dosage in the case of nausea).
– Zinc: it promotes the normal functioning of the immune system against viral and bacterial pathogens; zinc is also required for the good functioning of the thymus, the leukocytes, and especially T lymphocytes (30). Recent studies have shown that zinc is a powerful and selective inhibitor of interferon-lambda signalling pathways, which are important pro-inflammatory cytokines in acute and chronic viral infections (31).
– Probiotics: the efficacy of many probiotics in the prevention and treatment of viral infections has long been known (32). In fact, recent studies have also shown that viruses are eliminated by interferon, the production of which is stimulated by probiotics (which work through the activation of dendritic cells). For this reason, probiotics should feature among the additional rational options for the treatment of viral diseases (33). There are numerous probiotics to recommend in the prevention and treatment of respiratory infections. My personal advice is to use at least two different probiotics per day, or alternatively, take two to three types following a rotation scheme in the case of an elevated risk of infection. The most documented species in scientific literature include Lactobacillus rhamnosus GG, Lactobacillus paracasei, Lactobacillus plantarum L-137, Lactococcus lactis JCM5805. Other probiotics are also an option.
A strictly personalized homeopathic treatment: in my view, homeopathy is an extremely powerful medical approach with an immediate impact on acute pathologies, when the remedy administered is suitable for the characteristics of the person in question, i.e. when there is a strong similarity between the psycho-physical symptoms of the subject and the homeopathic characteristics (‘Materia Medica‘) of the administered medication. For this reason, it is almost impossible to list which remedies can be recommended to prevent or treat an infection or other pathologies. None the less, as Homeopathy operates by similitude and not by patient/remedy equality, based on 200 years of clinical experience, it is still possible to provide some general advice on which remedies have proved to be the most suitable for any viral pathology (known or unknown to medical practitioners). For those who accept the use of homeopathic medicine, I recommend that you contact your homeopathic doctor, who is certainly able to provide you with an effective (personalized) treatment and pertinent advice.

Lastly, it must not be forgotten that the immune system is strongly influenced by: our central nervous system (and therefore by psycho-somatic stress); our diet (if unbalanced, deficient and/or polluted); our degree of fatigue or a sedentary lifestyle; the presence of relapsing or chronic inflammatory processes; the pharmaceutical drugs we use; and by the degree of tension we experience in our daily lives.
These factors determine our ability to defend ourselves not only against Coronavirus SARS-CoV-2, but also against any virus, bacterium or germ. In fact, in the case of any disease!
Therefore, it is indisputable that an appropriate lifestyle is essential to the normal functioning of our immune system.

c. What a healthy person can do to try to avoid contact with viruses

The most common recommendations for avoiding direct contact with Coronavirus SARS-CoV-2 are the following:

Avoid direct or close contact (i.e. a distance of less than 1.5-2 metres) with people who are ill, anyone who has suspected respiratory symptoms or people who are simply at risk of the disease (i.e. those who in the last 15-20 days may have been in contact with people who later got sick).
Wash your hands frequently with soap and water, rubbing your hands together for at least 20 seconds, or use antiseptic solutions (34); (be aware that if an infected individual has touched the tap that we turn on in order to wash our hands, by touching it again afterwards [i.e. after washing our own hands], we will become re-infected. Therefore, handwashing where an infected individual has recently washed himself can actually facilitate infection, unless we take certain precautions, such as drying our hands with paper towels from the dispenser in public lavatories, and using them to turn off the tap and to touch the door handle when leaving the room, so as to avoid any contact with our newly washed bare hands).
Gargle with a suitable mouthwash when you suspect you may have inhaled pathogenic viruses, or think that they have been in contact with your mouth (35). Gargling is even more effective, if powerful natural antiviral substances such as Thyme, Eucalyptus or Ravensara Essential oils are used. Place a drop of one of these directly into the mouth, in order to become accustomed to its taste and slight irritant effect. Then use two drops placed directly into the mouth 3 times a day. If this is difficult, simply add a splash of water to the drops and use this to gargle with. This precautionary measure is particularly important, since the virus initially settles in the throat and multiplies there during the first days, and only later, does it invade the whole body.
Avoid touching your eyes, nose or mouth with unwashed hands (especially if you have touched people who are or may be infected or surfaces and objects that may be contaminated).
Protect your nose and mouth with a surgical mask or anything that can act as a physical barrier to the entry of the virus into your body. A mask should be used when you suspect you may have contracted the infection (so as not to contaminate others), or when coming into contact with people suffering from, or suspected of, having respiratory problems, or when there is an epidemic in your city or surroundings.
Protect your hands by using disposable gloves.
Clean all surfaces that may have been infected, by using chemical disinfectants capable of eliminating the Coronavirus SARS-CoV-2 (bleach-based products [sodium hypochlorite] or other chlorinated solutions, peracetic acid [even at low concentrations] or 75% ethanol).
Limit as far as possible anything that may unbalance or weaken the immune system (such as stress and the consumption – voluntary or involuntary – of toxic substances). Reinforce immune-boosting actions (such as maintaining a correct lifestyle and taking multi-vitamin and multi-mineral supplements at double dosage).

d. What to do in case of infection

If in the past 15-20 days you have been in close contact with people who have then become ill with SARS-CoV-2, or with people who are suspected of having been infected and who are expected to become ill in the near future, and if you start to experience mild flu-like respiratory symptoms, the following additional measures to the ones aforementioned are recommended:

Stay at home and contact your GP (general practitioner), who will evaluate the clinical situation and therapeutic measures to be taken.
Sneeze and cough into a disposable handkerchief or into your bent elbow (these measures prevent contamination of the environment and of your hands).
Refrain from touching your nose and mouth with your hands (so as not to contaminate yourself and facilitate the spread of the virus).
Wear a surgical mask and throw used paper handkerchiefs into a bin and close it immediately afterwards.
Sanitize your surgical mask with a few drops of an essential oil blend (see section 10.b) several times a day.
Take elevated dosages of vitamin C (up to 5-10 grams per day), vitamin D, glutathione, copper, zinc, in other words the supplements (see section 10.b).
Do not use antibiotics and only use paracetamol in the case of a very uncomfortable fever. It is widely known that a high fever activates our immune defenses, blocks viral duplication and facilitates its elimination.
If the symptoms are limited and you have no sign of respiratory problems, DO NOT go to Emergency services of the hospital, keep your General Practitioner (GP) informed instead.
People living alone, beside their GP, should inform at least also a family member or a friend, and keep them updated on their state of health.
Rest and try to sleep as much as possible.

11. Fever management in common viral infections

Digressing only briefly to explore the question of fever in more detail, it is important to note that these days, whenever a flu syndrome appears, in the broadest sense of the term, it seems that the most widespread and pressing concern is that of lowering body temperature.
This is a serious error, liable not only to prolong the duration of the illness, but also, in some cases, to increase the risk of complications. In fact, a Canadian study from 2014 suggests that in the United States, the suppression of fever increases by 5% the expected number of flu infections and flu-related mortality in the case of seasonal flu (36).
The fact that fever is a very important defence mechanism should not be overlooked:

Fever kills germs (all viruses and bacteria are temperature-sensitive, and an increase in temperature from 37 °C to 38 °C can reduce viral multiplication by more than 90%, whereas a temperature of 39 °C blocks the growth of any virus altogether);
Fever stimulates the body’s immune response, mobilizing the defence mechanisms that can contain, fight and kill any pathogen.

The use of antipyretics (i.e. paracetamol) or any non-steroidal anti-inflammatory drug (NSAID) (37) facilitates the transmission of common germ infections. This is because it inhibits the rise in temperature and, with it, all the benefits of activated inflammatory mechanisms at the site of infection, which enable the body to either stop or kill germs (38).
Therefore, it is not desirable to lower body temperature too early. In fact, if there are no particular contraindications and if the individual can sustain it adequately, we should allow the fever to follow its course and drop spontaneously, since this signals that the organism is immunologically stronger and is winning its battle against the increase of germs.
When necessary, pharmacological intervention with an antipyretic is possible, if after 1-3 days of fever, the organism shows signs that it cannot sustain a state of fever any longer or if the individual suffers from some pre-existing pathology (appropriate options should be discussed with and agreed by a Medical Practitioner).
It is important to underline the fact that, as is the case with any viral infection, antibiotics are not useful. They can be prescribed in the event of bacterial superinfection, e.g. in the case of a non-viral bronchitic or pulmonary complication.

During the initial period of illness, many natural forms of support can be used and in particular homeopathic treatments. These contribute not only to reinforcing our immune defences, but also to reducing the risk of complications, shortening the duration of disease and avoiding relapses (39). The guidance of a homeopathic practitioner is required, because this kind of therapy must always be tailored to the requirements and condition of the individual patient. Standard treatments should only be applied when personalised therapy is not available.

12. Conclusions

In the current situation, it is advisable not to circulate news that generates fear, but to instead encourage the dissemination of constructive information, which can contribute to limiting the spread of the virus and strengthen immune response in individuals and the population as a whole.
The message being that the most effective prevention is both personalised to individual needs and implemented well in advance of an emergency, when people are well!
True prevention of viral infections, or indeed of any disease, takes place from conception until the final breath. True prevention cannot be in the form of large-scale standardised treatment. Generalised therapies which are imposed on everyone will always yield one of three outcomes: some people will benefit from them, some people will be harmed, and others will not respond to the standardised treatment.
Governments are providing a lot of information on the Coronavirus SARS-CoV-2 on their websites. The general public need to be urged to consult these websites, and more importantly, be encouraged to adopt a healthy lifestyle.
Our organism obeys a very important physiological law that may be called: “The whole supports the part” (40). The whole human body, when it is well, and is therefore properly nourished and respected through the adoption of a healthy lifestyle, has the capacity to protect all its constituent parts. The body defends the parts it is built from and does not fear the Coronavirus SARS-CoV-2 or any other pathogenic condition. However, the question is whether we nourish and look after ourselves psychophysically as we need to or not?
It is possible to immediately take steps to adopt the right approach to our lives, and to become aware that for all of us, action can be taken that will improve our overall health.
In fact: