COVID-19 – Coronavirus
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Introduction to COVID-19
-Updated: 26 May 2020-
COVID-19 is a new strain of coronavirus to which humans have not got immunity. It originated in China and has quickly spread around the world. Earlier this year, the UK Government predicted that up to 80% of people will get it and that 1% of those who get it may die. It can develop into a very acute respiratory tract infection and then anyone who is vulnerable can catch pneumonia and other illnesses and succumb to those.
At Breakspear Medical, we are very keen to support our patients and we have been following the Public Health England guidelines for healthcare professionals.
About the virus
Corona viruses are a family of viruses made from RNA (Ribo Nucleic Acid), a single strand of four different amino acids carrying the genetic information of the viruses. There are many species which cause respiratory and gastrointestinal illness in humans and animals.
The pandemic coronavirus, COVID-19, spreads readily between people in droplets from coughing, sneezing or talking. The droplets may remain airborne for three or four hours but lose their infectivity rapidly. Within about an hour, half of their potency has gone. Based on various reports, they may remain viable on surfaces like plastic and stainless steel for two to four days and on cardboard for about 24 hours.. After six to seven hours on steel or plastic, half of the particles have lost viability i.e. no longer likely to cause infection. As a result, it is strongly advised that one use caution with objects or surfaces that are possibly contaminated. You should avoid touching door knobs or elevator buttons with your hands. The viral particles picked up from cloth are only 1% of the number of particles picked up from hard surfaces. Natural fibres break up the droplets in which the virus is suspended, allowing the virus to dry out quickly and die.
The incubation period from exposure to illness is two to 14 days, with an average of five days.
- Phase one – gradual illness with fever, new dry cough, fatigue, aches, pains, sore throat and/or change in smell or taste. 80% of people recover, 20% enter phase two.
- Phase two – worsening cough, shortness of breath, with or without chest pain, fever, and possibly low blood pressure.
Both groups continue to shed the virus in secretions and may still be contagious even after symptoms end. Coronavirus pneumonia is viral, and may not necessarily be due to a secondary bacterial infection.
To cause disease, the virus must enter the cell, replicate and damage the cell, then escape to infect adjacent cells.
Symptoms related to COVID-19 infection occur as a result of the immune system trying to deal with the infection. When the symptoms worsen, this is likely to be due to an overactive immune response, hence why at late stages of the disease, antiviral agents may not work. It is important to support the immune system through this phase, which is where the use of anti-oxidants and anti-inflammatories will help. These immune boosting therapies should not be used at the point when severe sepsis has set in, but rather as prevention or early infection only.
Are you at risk?
Currently, the Public Health England website recommends:
Stay at home if you have coronavirus symptoms.
From the coronavirus NHS UK website, stay at home for seven days if you have one or all of these symptoms:
- a high temperature / fever – you feel hot to touch on your chest or back
- a new, continuous cough – this means you’ve started coughing repeatedly
- a change in smell or taste
Do not go to a GP surgery, pharmacy or hospital. You do not need to contact 111 to tell them you’re staying at home.
Everyone, including health and social care workers, should self-isolate if they develop a new continuous cough or fever or loss of/change in smell or taste. The individual’s household should also self-isolate for 14 days as per the current guidelines and the individual should stay at home for 7 days, or longer if they still have symptoms other than cough or loss of sense of smell or taste.
Testing for coronavirus is not needed if you’re staying at home.
However, if a person has not recently returned from travels abroad and has not been in contact with a confirmed case, it may well be another upper respiratory tract infection, such as a rhinovirus or a common cold. In fact, some of our patients often have flu-like symptoms as a consequence of chronic illness; these patients often benefit from the upper respiratory tract infection (URTI) support regime that we can provide upon request. We have also been prescribing a product called KiB 500, which is a naturally-derived product for boosting the immune system in relation to infections, and regard this as a useful first line defence. (If you would like more information on the URTI support regime or KiB 500, please email email@example.com and request more information. It is best to be prepared and to actively intervene at the earlier stages of infection.)
Furthermore, we can use other herbal anti-viral treatments or prescription anti-virals, if required. There are a number of investigations that we can use to identify the specific type of infection in the upper respiratory tract and these investigation reports can be helpful to decide the most effective treatment protocol on an individual basis.
We are very keen to continue to support our patients and should our patients wish any additional help, our Pharmacy can issue the upper respiratory tract infection support (see Advice section below) and also the KiB 500 kits, which can be kept for use should occasion arise.
The best thing is to avoid exposure. If sick, stay at home. Wear a surgical mask if exposed to others to protect them. When coughing or sneezing, cover the nose and mouth with the forearm or with a tissue. Dispose of tissues in a closed container after each use. Avoid shaking hands. Social distancing of two metres helps to avoid viral spread.
Even after contracting the virus, there have been anecdotal reports of people becoming re-infected. One should still practise personal protective measures anyway to protect oneself from other infections that would result in a reduced immune system function.
New measures at our clinic
We have implemented some stringent measures to maximise your protection at the clinic. These include but are not limited to:
- taking the temperature of every person who enters the clinic. Anybody with a fever will be taken immediately to our quarantine room, to be further examined by a doctor
- handwashing notices have been displayed around the building to remind staff and patients alike to wash their hands for at least 20 seconds more frequently
- any equipment used by multiple persons, such as the chip/pin device in Accounts and the pen on Reception must be sprayed and wiped after each use
- patients on the ward will be spaced out as far as possible
- staff numbers at the clinic have been reduced to reduce footfall, and therefore reduce the risk
The following are recommended cleaning agents, which may be used on hard surfaces that have demonstrated efficacy within 30 seconds of contact:
- 70% alcohol
- 0.5% hydrogen peroxide
- 0.1% bleach
If you suspect or know that you have ever had Covid-19, inform Reception before booking your appointment.
Dr Jean Monro, our Medical Director, recommends a nutritional supplement programme to help with upper respiratory tract infections, commonly referred to as the common cold (see Advice section below).
How to protect yourself & others
Go to the Government guidelines to learn how to avoid catching or spreading the coronavirus.
Be sure to:
- wash your hands with soap and water often – do this for at least 20 seconds
- always wash your hands when you get home or into work
- use hand sanitiser gel if soap and water are not available
- cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
- put used tissues in the bin straight away and wash your hands afterwards
- try to avoid close contact with people who are unwell
Our suggested supportive and preventative measures (references below):
- Melatonin accumulates in mitochondria, and has both antioxidant and anti-inflammatory activity. The anti-inflammatory effect of melatonin can be enhanced by high doses of vitamin C.
- Vitamin C in high doses to gut tolerance may be taken throughout the day, particularly prior to becoming infected.
- Flavonoids e.g.: Elderberry fruit, Houttuynia cordata have demonstrated inhibition of the coronavirus activity in cells by inhibiting a viral enzyme, 3CL protease.
- Adequate sleep
- Moderate exercise, if able
- Maintaining a healthy diet consisting of lots of green vegetables and fruits
- Vitamin D
- Vitamin A
- Zinc in individualised doses is helpful
- Medicinal and dietary mushrooms can stimulate innate anti-viral immunity e.g.: Coriolus, Maitake and Reishi
- Pre-biotics can be used
- Two mushrooms, Shiitake and Coriolus, have anti-inflammatory effects that may counteract immune hyperactivity of advanced coronavirus infection and may not need to be stopped.
Providing mental support
The current COVID-19 pandemic is profoundly unsettling for many reasons, including the uncertainty and isolation. Our mental health expert, Daniel Segal, BA Psychology, MSc Mental Health Counseling, can help those suffering from anxiety, stress, depression and relationship issues and help anyone develop positive processes, techniques and schedules to find peace of mind to gain a sense of control in their life. Current patients of Breakspear Medical or anyone else may book a session. (Clinical information is not required.) Please contact Reception to arrange your Skype appointment: +44 (0)1442 261 333. More info…
Dr Monro’s upper respiratory tract infection support
Dr Monro advises that this vitamin regime can be taken for a period of seven days to help acute upper respiratory tract viral infections and includes the following supplements:
Vitamin A may help to prevent most bacterial and viral disease, exerting anti-viral effects against the viruses that cause the common cold and influenza. It may increase the effectiveness of the cells that produce antibodies and increase the proliferation of lymphocytes in response to challenges by antigens. Deficiency of this vitamin increases susceptibility to bacterial and viral diseases via numerous mechanisms that involve the immune system. Beta-carotene is the precursor of vitamin A.
Dose recommendations: Check the dosage with your supplier, pharmacist or physician. During pregnancy, women should be particularly cautious.
Vitamin C may help to counteract many types of bacterial and viral diseases, including the influenza virus. It may help to prevent respiratory tract infections, may reduce the severity of respiratory infections and may accelerate the recovery from respiratory tract infections.
Vitamin C may help to prevent the common cold and may reduce the severity of symptoms and duration of the common cold.
Dosage recommendation: Usually 10g per day can be tolerated by an adult if taken throughout the day. The dose used will vary according to individual tolerance. Bowels can become loose with too much vitamin C.
Vitamin E is a potent antioxidant and has the ability to modulate host immune functions. It also plays an important role in the differentiation of white blood cells.
Dose recommendation: There are different forms of vitamin E. Read product labels for daily recommendations or check the dosage with a pharmacist or physician.
Vitamin B12 has important immunomodulatory (modifies the function of the immune system) effects on cellular immunity. It may facilitate the production of antibodies, and may accelerate recovery from bacterial and viral diseases.
Dose recommendation: There are different forms of vitamin B12 available, it is regarded as non-toxic. 1mg per day is often recommended.
Results of a randomised controlled trial support the theory that vitamin D taken each day for production of antibodies may accelerate the recovery from bacterial and viral diseases.
Considerable evidence has been presented that in influenza epidemics or with the common cold infections are brought on by seasonal deficiencies within the innate immune response
Maintenance of a good levels of vitamin D should significantly reduce the incidence of acute viral respiratory tract infections and the burden of illness.
Dose recommendation: 2,000 – 5,000IU of vitamin D per day is often suitable but if pregnant or breast feeding consult a physician.
Flavonoids can stimulate the activities of numerous immunity related cell types. Research has highlighted that flavonoids including quercetin, hesperetin and catechin can be particularly effective in anti-infective activity.
A considerable body of evidence suggests that plant flavonoids may be health-promoting, disease preventing and anti-inflammatory dietary compounds. Good sources of these flavonoids are:
Quercetin – Apples, peppers, dark cherries, all berries, tomatoes, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, cabbage, kale), green tea.
Hesperetin – Citrus fruits (in membrane and peel), apricots, plums, bilberry, green and yellow peppers, broccoli, buckwheat.
Catechin – Chocolate (dark 70% +), apple peel, apricots, cherries, peaches, blackberries, black grapes, strawberries, blueberries, raspberries, green tea, pecans, pistachio, almonds, hazelnuts.
While coronaviruses have been around for a long time, COVID-19 is a virus that was unknown to science just a few months ago and it has spread globally at an unprecedented pace. Scientists around the world are working to find ways to best treat it and on creating a vaccine while whole populations are held on lockdown. While our doctors read as much information as they can about recent findings, they are also reading older papers which may contain clues to finding treatments and further developing an understanding of this virus.
To help anyone wishing to learn more, we offer some of the interesting papers available below for further reading.
Would you be able to participate in Covid-19 university online survey?
Dr James Faulkner, a Reader in Exercise Physiology at the University of Winchester, in collaboration with the University’s of Southampton, Portsmouth, Swansea, Oxford Brookes and Gloucestershire, is running a survey which will capture physical activity and wellbeing data during different phases of the UK government’s response to Covid-19.
Please find below a links to their survey. The survey only takes 10 minutes to complete. Thus far, they have collected 2500+ responses but would like many more if possible.
Emergence of more transmissible SARS-CoV-2
A new, real-time mutation tracking in SARS-CoV-2 was set up, which helps identify mutations of the virus, which will help in predicting mutations which may alter transmission or resistance to interventions. These finding will have important implications for SARS-CoV-2 transmission, pathogenesis and immune interventions.
Covid-19 immunology review: What we know and priorities for research
The British Society for Immunology and The Academy of Medical Sciences have joined forces to publish a new expert summary, which rapidly reviews current COVID-19 immunology research and identifies urgent research priorities. The paper reviews what we know about Covid-19 from immunology research and highlights knowledge gaps that could hamper efforts to get the pandemic under control.
The Academy of Medical Sciences and the British Society for Immunology established an expert advisory group in early April 2020, chaired by BSI President Professor Arne Akbar. Together the experts reviewed the limited research that is currently available and identified key research priorities.
Supplements for protecting against & treating colds, flus & COVID-19
Australasian College of Nutritional and Environmental Medicine (ACNEM) 2020: The ACNEM have put out a video in which Professor Kylie O’Brien and Professor Ian Brighthope discuss COVID-19. Their summary is that for the prevention of colds and flu, vitamin C (1g – 2g daily), vitamin D (1,000 – 4,000 IU daily) and zinc (30mg per day) are recommended. The older the individual, the higher the amount of vitamin C is required. The diet of an individual should also be considered; no sugar, no alcohol and with a good broad diet. There are one billion people worldwide who are vitamin D deficient because of poor diet, because of lack of exposure to sun and from clothing restricting skin exposure. They recommend the following supplementation for treatment of cold and flu (not pneumonia); increased dosage of vitamin C, D and zinc, supplementation with vitamin C up to 10,000mg daily (spread out over course of the day, bowel tolerance will vary), supplementation with vitamin D,4,000-10,000 IU daily and supplementation with zinc, 60mg daily (for a maximum of two weeks). For the treatment of severe cases, pneumonia, ALI and ARDS they recommend intravenous highdose vitamin C, dosage can range from 50g to 200g (more if the patient is critical). Chinese hospitals have been using a dosage of 50g+. You would need to test for G6PD deficiency.
The importance of vitamin C
Orthomolecular Vitamin C Antiviral Mechanisms Vitamin C (Ascorbic Acid, AA) Antiviral Mechanisms (10). M J Gonzalez: Vitamin C (Ascorbic Acid, AA) Antiviral Mechanisms. Direct antiviral mechanisms: 1) Disruption of viral capsid by structurally interfering its glycoprotein envelope. 2) Damage of the viral capsid 3) Inhibition of viral replication. Indirect physiological mechanisms: 4) Increases cellular Immunity (Natural Killer Cells) 5) Increases humoral immunity 6) Increases antiviral proteins 7) Increases energy 8) Limits the main source of fuel of pathogenic organisms, sugar 9) Potent, quick antioxidant action when provided in proper doses to prevent the cytokine storm 10) Maintains structural integrity of cells by favouring collagen formation.
Intravenous vitamin C for reduction of cytokines storm in acute respiratory distress syndrome
This paper reviews the effects of IV vitamin C on the immune system response, the antiviral properties of IV vitamin C, and finally the antioxidant properties of IV vitamin C to specifically address the cytokines’ storm characteristic of the acute respiratory distress syndrome (ARDS) that occur in the later cycle of Covid-19 disease.
The importance of vitamin D
The BMJ Editorials, 28 February 2020: In a letter to the BMJ, John Watkins, Consultant Epidemiologist, discusses why he feels vitamin D is important to help health care workers and first responders.https://www.bmj.com/content/368/bmj.m810/rr-42
- P H Cobbold, Emeritus Professor, Cell Biology, University of Liverpool UK. 02 March 2020: Vitamin D3 is a hormone that acts as a superpromoter for about 2000 genes, 10% of our genome with a broad defensive function. D3 is known to up regulate expression of the anti-microbial peptides that act against bacteria, fungi and enveloped viruses. The VDRE (vitamin D receptor) is present in human lung epithelial cells.
- P H Cobbold, Emeritus Professor, Cell Biology, University of Liverpool UK. 08 March 2020: D3 is a hormone with a 400 million year evolutionary history which exerts a broadly defensive role in almost every cell in our body by controlling the expression of 2000 genes, one in ten of our genome. Taking up to D3 4000 IU pd. It takes two to three months for the blood level to fully stabilise after boosting uptake. So blood D3 rises too slowly. Bolus administration is feasible under medical advice.
- A R Garami, Senior Biomarker Consultant, CEO, BL, Switzerland. 12 March 2020: ARS-CoV-2 virus enters into human cells via the same receptor, angiotensin-converting enzyme 2 (ACE2). During the course of the infection virus particles bind to ACE2 and get internalized into human cells. The virus particles bind to numerous ACE2 molecules and sequester them from the cell surface. Its loss of function can lead to serious consequences. Lower ACE2 results in the atherosclerosis, hypertension, heart failure, chronic kidney disease, serious lung injury. It decreased by age. In addition, significantly lower levels seen in aged males. This could be explained by the fact that ACE2 gene is X chromosome located and so males have loss of a reserve capacity. People lacking vitamin D have a weaker innate immune defense against SARS-CoV-2.
- G K Schwalfenberg, Family Physician, University of Alberta. 05 April 2020: Vitamin D has a significant impact on our immune system being important in barrier function. Recent evidence shows that vitamin D down regulates the binding site of the COVID-19 spike glycoprotein thus reducing the virulence of the virus. Vitamin D also reduces the cytokine storm. In order to correct the vitamin D winter low, rapid supplementation with 10,000IU of vitamin D3 can be safely employed. Also, a one time 50,000IU dose of vitamin D3 when one becomes ill. This one time dose should be followed by a reasonable daily dose of at least 5000IU. Smoking reduces vitamin D levels. Those that are older have increased likelihood of being vitamin D deficient, the skin with increasing age becomes less efficient at producing vitamin D. Modifiable risk factors for COVID-10 infections would include discontinuing smoking normalizint vitamin D levels quickly, and using universal mask protection.
- M Silberstein. Associate Professor, School of Molecular & Life Sciences, Curtin University, Perth, WA Australia. 09 April 2020: Potential direct therapeutic role for vitamin D. Administration of vitamin D (eg by intramuscular injection) as a treatment in acutely ill patients with COVID-19.
Dr Nyjon K Eccles BSc MBBS MRCP PhD, Strengthening Resilience to Viral Threats: With Particular Reference to COVID-19. April 2020: Vitamin D deficiency has been shown to increase risk of ARDS (acute respiratory distress syndrome) which is the main complication of COVID-19 infection. Vitamin C and iodine also used for possible treatment and prevention. Vitamin C is known to reduce ferrous Fe2+ conversion to ferric Fe3+ https://thenaturaldoctor.org/media/articles/
Additional (nutritional) supportive information
EVMS Medical Group, Paul Marik MD, Chief of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. April 6th 2020 https://www.evms.edu/covid-19/medical_information_resources/
Suggested approach to prophylaxis and treatment of COVID-19 includes:
- Vitamin C 500 mg BID and Quercetin 250-500 mg BID
- Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1-2months, reduce the dose to 30-50 mg/day.
- Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 1-2 mg at night
- Vitamin D3 1000-4000 u/day (optimal dose unknown). Likely that those with baseline low 25 OH vitamin D levels and those living at high altitude will benefit most
From the point of view of prevention it is the prophylaxis in particular that is important.
He has also outlined treatment for mildly symptomatic patients who are admitted and those with respiratory symptoms.
Amongst the items for optional treatment components (the Full Monty) are included:
- Thiamine 200mg q 12 (PO or IV).
- Azithromycin 500 mg day 1 then 250 mg for 4 days (has immunomodulating properties including down regulating IL-6; in addition Rx of concomitant bacterial pneumonia).
- Melatonin 6-12 mg at night (the optimal dose is unknown).
- Zinc 75-100 mg daily.
- Magnesium: 2 g stat IV. Keep Mg between 2.0 and 2.4 mmol/l. Prevent hypomagnesemia (which increases the cytokine storm)
- Broad-spectrum antibiotics if superadded bacterial pneumonia is suspected
Other points for people in hospital are itemised.
He continues with many thoughts including these:
- We are facing a Global Health Crisis of unimaginable magnitude. We are all in this together.
- COVID-19 results in a dysregulated and exuberant immune response. Downregulating the cytokine storm is an essential component of the treatment of severe COVID-19 disease.
- COVID-19 patients developed a severe hypercoagulable state
- The World Health Organization has now launched the SOLIDARITY trial to investigate four potential treatments: remdesivir, chloroquine/hydroxychloroquine; lopinavir and ritonavir; and lopinavir and ritonavir plus interferon-β. It will likely take many months before this study is completed.
- Preliminary data suggests that chloroquine and hydroxychloroquine decrease the duration of viral shedding. Chloroquine has favourable immunomodulating properties
- Zinc (Zn++) inhibits viral RNA dependent RNA polymerase (replicase). Chloroquine and hydroxychloroquine are potent Zn ionophores that increase intracellular Zn concentrations.
- Ascorbic acid has numerous proven biological properties (anti-inflammatory, anti-oxidant, immune enhancing, antiviral)
- Very recent data suggests that in addition to being a potent anti-oxidant, melatonin may have direct antiviral effects against COVID-19. In healthy people, melatonin levels plummet after the age of 40 years. This may partly explain the increased risk of death in patients with COVID-19 who are over the age of 40. Melatonin may therefore have a role in both the prevention and treatment of COVID-19.
- Vitamin D has important immune-enhancing effects. Prophylactic vitamin D should be considered especially in the elderly.
- Quercetin is a plant phytochemical Experimental and early clinical data suggests that this compound has broad antiviral properties (including against coronavirus)
Consider also COVID-19 previously provided which mentions melatonin, elderberry, Houttuynia tincture and upregulation of Sirtuin, supplements include: chocolate, broccoli, resveratrol, cucurmin, green tea extract, quercetin and berry products especially elderberry
Coronavirus pneumonia might be closely related to abnormal haemoglobin metabolism in humans
Wenzhong L; Hualan L (2020): COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv. Preprint.: Inside red cells is the haem molecule which has four arms, each with an iron atom on it which can capture oxygen and also release oxygen. The haem molecule in the middle is known as a porphyrin. Coronavirus attacks the porphyrin and inhibits human haem metabolism. A report of 99 patients with coronavirus pneumonia found that the haemoglobin and neutrophil counts of most patients decreased. The amounts of serum ferritin, erythrocyte sedimentation rate, C-reactive protein, albumin and lactate ehydrogenase of many patients increased significantly. All of this means that the patients’ haemoglobin is decreasing and the iron ions are increasing and this causes inflammation in the body. C-reactive protein and albumin are increased as a result of inflammation. Cells react to stress due to inflammation producing large amounts of serum ferritin which binds to the free iron ions to reduce damage. Coronavirus pneumonia might be closely related to abnormal haemoglobin metabolism in humans because combining viral proteins and the haemoglobin can cause pathological reactions. Chloroquine might be able to prevent this to a certain extent to relieve the symptoms of respiratory distress. An anti-viral, Favipiravir could inhibit the viral proteins binding to porphyrin preventing the virus from entering the cells. https://doi.org/10.26434/chemrxiv.11938173.v7
Fast-track drug trials
Article in Financial Times. 10 April 2020. Clive Cookson: The trial started by examining three treatments recommended by an expert panel advising the chief medical officer. Iopinavir-ritonavir combination used to treat HIV; dexamethasone, a steroid that reduces inflammation and hydroxychloroquine, the malaria medicine. They have added azithromycin, an antibiotic with anti-inflammatory properties. They have aligned the Recovery trial protocol with the World Health Organization’s Solidarity trial, using the same doses. The trial started by examining three treatments recommended by an expert panel advising the chief medical officer. Iopinavir-ritonavir combination used to treat HIV; dexamethasone, a steroid that reduces inflammation and hydroxychloroquine, the malaria medicine. They have added azithromycin, an antibiotic with anti-inflammatory properties. They have aligned the Recovery trial protocol with the World Health Organization’s Solidarity trial, using the same doses. https://www.ft.com/clive-cookson
- Coronavirus Protection. Article by Leo Galland M.D. 24 March 2020 Available from: https://www.bsem.org.uk/posts/45-coronavirus-protection
- O’Brien, K. & Brighthope, I. (2020) ‘Nutritional Medicine: Not a soft approach to combatting COVID-19’, ACNEM [Online], Media release 24 March 2020.
- Hemila, H., Chalker, E. (2013) ‘Vitamin C for preventing and treating the common cold’, Cochrane Database Syst Rev., 1: CD000980.
- Carr, A.C., Maggini, S. (2017) ‘Vitamin C and Immune Function’, Nutrients, 9(11), pp.1211. https://doi.org/10.3390/nu9111211
- Peng, Z.Y. (2020) ‘Vitamin C infusion for the treatment of severe 2019-nCoV Infected pneumonia’, gov, US National Institutes of Health. Available at: https://clinicaltrials.gov/ct2/show/NCT04264533
- Chen, N., Zhou, M., Dong, X. et al. (2020) ‘Novel coronavirus pneumonia in Wuhan, China: a descriptive study’, Lancet Adv., Available at: https://doi.org/10.1016/S0140-6736(20)30211-7
- Wang, T., Du, Z., Zhu, F. et al. (2020) ‘Comorbidities and multi-organ injuries in the treatment of COVID-19’, The Lancet., 11 March 2020. https://doi.org/10.1016/S0140-6736(20)30558-4
- Cheng, R.Z., Shi, H., Yanagisawa, A. et al. (2020) ‘Early large dose intravenous Vitamin C is the treatment of choice for 2019-nCov pneumonia’, Orthomolecular Medicine News Service, 16 Feb 2020. Available at: http://orthomolecular.org/resources/omns/v16n11.shtml#Ref13 [accessed 18 March 2020]
- Nabzdyk, C.S., Bittner, E.A. (2018) ‘Vitamin C in the critically ill- indications and controversies’, World J Crit Care Med, 7(5), pp. 52-61.
- Furuya, A., Uozaki, M., Yamasaki, H. et al. (2008) ‘Antiviral effects of ascorbic and dehydroascorbic acids in vitro’, Int J Mol Med, 22, pp. 541–545.
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