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Kyle Allred: Dr. Seheult, as a critical care physician you've been on the front lines for the recent wave of COVID-19 hospitalizations in the United States, and specifically in California where you work, but a primary focus of your previous videos on COVID-19 has been strategies to avoid needing hospitalization. So as more and more people test positive for COVID-19 or know someone that tests
0:22
positive or lives with someone that tests positive, you put together a list of strategies to consider if a positive test result comes back or if symptoms develop. So tell us about your list, and then we'll go through each item one by one. Dr. Seheult: Yeah, thanks, Kyle. So the purpose of this video is good, practical information for if you turn positive or someone you know turns positive for COVID-19.
0:45
You know, I've been asked so many times recently because of the increasing numbers, "what do I do, what to do if you're staying home? When to go to the hospital? What do you do if somebody is in your home that turns positive? What can you do to prevent the spread of infection within a household?" That's exactly what we're going to talk about right now. Kyle: So if I got tested today and a positive
1:08
test came back, and I just have mild symptoms, what's one of the first things that I can do while I'm at home? Dr. Seheult: Well, if you're not having really shortness of breath, you're probably okay. But if there's any kind of lung discomfort or shortness of breath, it may be worthwhile investing in a device called a pulse oximeter. This is a device that just slips onto your finger and it basically tells you two different things. Number one, it tells you what your pulse is,
1:32
your heart rate, and it also gives you something called the SPO2. That's your oxygen saturation. Now generally speaking, if your oxygen saturation is 95 and above, then you're probably okay. If it starts to drop down, however, at rest between 90 and 94, then you're kind of getting into sort of a yellow zone, if you will, a "caution zone." But if it drops less than 90, so if it's in the 80s
2:00
in other words, then that's more of a "red zone." That's where you are clearly hypoxemic and you'd probably need to go into the emergency room to be evaluated for supplemental oxygen. If you don't have a pulse oximeter, some of the surrogates for this would be persistent shortness of breath or if you have cyanosis, or blue lips or tongue. Now it's possible to have shortness of breath and not
2:25
need oxygen, but if you don't have the ability to measure your oxygen, your peripheral oxygen saturation, with a pulse oximeter, then that's the next best thing is looking for shortness of breath and seeing if you need to go to the emergency room. Now if you're already on oxygen as a as a baseline, because you've got lung disease, then you should be on your regular amount of oxygen, and your oxygen saturation should be kind of where you're used to it being. If it starts to
2:51
drop down, that would be the same sort of situation where it's time to go to the hospital and be evaluated, because that could be a sign of low oxygen saturation, could be a sign that you're getting pneumonia from COVID-19. Kyle: You know there's a lot of different pulse oximeters out there that one could purchase. There's the medical grade ones for maybe a couple hundred bucks; there's the type that you show that just go on a finger -- a really small and portable --
3:16
some of those sell online for as cheap as twenty dollars. How can someone tell what's a good pulse oximeter to consider buying? Dr. Seheult: Well, they've actually done some tests to see how accurate they were and we'll post that in our description below. You can see here the ones that seem to do well on at least independent evaluation. Kyle: Any other tips for using it? Anything that people should know when they're
3:39
using a portable pulse oximeter? Dr. Seheult: Yeah, it's just like taking a blood pressure. So you need to be sitting down for a couple of minutes, not doing anything exertive, and be at rest. Slip it on your finger. Don't take the first number that pops up. It's got to sort of learn your pulse a little bit, and so give it about 30 seconds to adjust, and then read the number off. Kyle: What about nail
3:58
polish? If I'm wearing nail polish. Dr. Seheult: Yeah, so you want to make sure that it's reading the color of your blood, so you don't want to have any nail polish on the finger that you're using it on. So that's a good point, you want to remove the nail polish on the finger. Kyle: What if I live at high altitude, say in Santa Fe, New Mexico at 7,000 feet? Dr. Seheult: Yeah, so as you go up, that's a natural reason for your
4:21
oxygen saturation to drop, so high altitude would be one of those things, and you may want to have somebody who's not at risk or having COVID symptoms to put it on just to kind of see what it would be normally at that level. If you're up at you know 15,000 feet, 10,000 feet, a normal person's saturation is going to be probably in the low 90s, high 80s. Kyle: What is unique about COVID-19 and this virus, the SARS-CoV-2 virus, that makes the pulse
4:50
oximeter so relevant? Dr. Seheult: Yeah, it's the thing that we learned about very early on during the pandemic in new york was these "happy hypoxics." So in other words, they look fine in every other way except for the fact that this pneumonia is really preventing oxygen from being diffused into the pulmonary circulation, and it's really one of the first signs that people are starting to progress.
5:13
So, I think it's a very sensitive tool to use is hypoxemia and it can be very valuable. Kyle: How is hypoxemia different than hypoxia? Dr. Seheult: Okay, so hypoxemia is specifically the lack of oxygen in the blood. Hypoxia is the lack of oxygen in the tissue, so it's a very specific thing, but for our purposes here, both are happening at the same time. So the second thing that we're going to talk about is antibodies, and these are known as "monoclonal antibodies." So,
5:42
if you can imagine, here, we've got the virus, and on the virus we have these spike proteins.
5:49
Well what the monoclonal antibodies do early on in the infection is they will bind to those spike proteins and prevent that virus from entering your cells.
6:03
And this of course is important because it can reduce the viral load, and if it does so, there's a theoretical chance at least that it could reduce the severity of disease. So there are currently two companies that have come up with some monoclonal antibodies that have gotten emergency- use authorization from the FDA. The first one is Eli Lilly, and the name of their antibody is called bamlanivimab, and the other company is Regeneron, and Regeneron actually has two antibodies
6:32
in one medication. The first one is casirivimab and the second component is imdevimab. Now both of these underwent randomized controlled trials and were shown to be effective at reducing the viral load and also reducing hospitalizations, and so the niche that these medications occupy are those patients that are not sick enough to be admitted to the hospital, but yet have a positive COVID test
7:00
and are at risk for progression to hospitalization. So it's not for everybody who's COVID positive, and so for interest of time, let's go over the data for bamlanivimab. So the results of a phase two trial involving bamlanivimab was published in the New England Journal of Medicine on October 28th. This was a randomized placebo-controlled trial that looked at 467 people who were positive for COVID-19
7:27
and had mild to moderate symptoms and were not sick enough to need hospitalization. So why is timing so important with monoclonal antibodies? Well, monoclonal antibodies are man-made proteins that function just like human antibodies in the immune system, and so they're very good at stopping the virus outside the cells. This is kind of how vaccines work; they teach your immune system to
7:51
develop antibodies that block or limit the ability for the virus to infect or enter your cells, but once SARS-CoV-2 has infected the cells, they've actually come in and got into enough of the cells that antibodies aren't able to neutralize the virus, and you need T cells, cytotoxic T cells, which are specialized for dealing with infected cells. So if monoclonal antibodies are given late in the course
8:15
after a lot of that virus has already entered a lot of the cells, they're going to have limited, if any, benefit. And what they found was that on day 29, the percentage of patients who were hospitalized was 1.6 in the intervention group and 6.3 in the placebo group, and when they dug down deeper and looked at a post-hoc analysis looking at high-risk groups -- for instance people equal to or older than
8:39
the age of 65 or BMI equal to or greater than 35 -- the percentage of hospitalization was 4.2 in the intervention group and 14.6 in the placebo group. Now as you can see here, while bamlanivimab or the other monoclonal antibodies from Regeneron are not approved for everybody with COVID-19, there's still a large amount of people that fall into this category. Take a look: anybody with a BMI of greater than or equal to 35, anybody greater than or equal to 65 years of age,
9:12
anybody with diabetes, chronic kidney disease, immunosuppressive disease, anybody receiving immunosuppressive treatment, and it doesn't end there. Anybody greater than or equal to the age of 55 with hypertension, that's a lot of people, or other chronic respiratory diseases or COPD, and so you can see here that there's a large group of people that fall into this category and so it would be important to make sure that if you or someone you knew fell into this category
9:41
and they were COVID positive, they would be eligible for receiving this medication if it was available in your area. Kyle: For the bamlanivimab, bamlanivimab, do you actually need to pronounce it correctly to receive the medication? [Laughter] Dr. Seheult: If they did there would be very, very few people receiving that medication, so it's taking me the better part of a few days to be able to say bam-lanivimab Kyle: But along those lines, I have heard that a lot of these monoclonals
10:12
are sitting on the shelves or sitting in storage rooms and not actually getting used. You work at two different hospitals in southern California; are you actually treating patients with these? Dr. Seheult: Yeah, absolutely. There's a lot of people that don't know about these medications, don't know the niche, and it's because their providers aren't aware of these things. Things are happening so
10:32
rapidly that medications are becoming available and we just don't know how to prescribe them. And that's one of the reasons why we're doing this video, Kyle, is so that people can be aware of it. You're absolutely right, there's been a lot of this medication that's been distributed, but it's not being used. Now, this medication is IV only, and so it has to be infused in a facility that can monitor the patient for the hour that it takes to infuse it, and so at
10:58
one of the hospitals that I work at they infuse this regularly in the emergency room, monitor the patient, and then obviously they're -- because of the fact that they're not going to be admitted to the hospital after the infusion is done -- they're sent home. Kyle: One of the things I know that you wanted to do in this video, Dr. Seheult, was highlight the things that we have really solid data for,
11:18
preferably randomized placebo-controlled trial data for, and then things that we have maybe less strong data for -- observational data or data from other illnesses that may be similar to COVID-19. So for the first two things you've talked about -- these monoclonal antibodies and the pulse oximeter --
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how do you think the data stacks up for those two interventions?
11:43
Dr. Seheult: Yeah, well, pulse oximetry is almost a part of us. It's almost part of our "DNA." We've had multiple studies that go back decades -- even, you know, even 100 years -- looking at oxygen and measuring oxygen and knowing when we need to put people on oxygen, so that data's been around for a long time. In terms of the monoclonal antibodies, that was submitted to the FDA through an
12:07
emergency use authorization, and the basis of that application was a randomized, controlled trial, and the end points were met -- that hospitalizations were reduced -- so the evidence is pretty clear, and it's good evidence, and it's a randomized, controlled trial, which is the gold standard for evidence. Now if we talk about some of the other things -- for instance, supplements -- that has varying levels of evidence. Probably the supplement that has the best level of evidence is
12:33
vitamin D. We've got randomized, controlled trial data in a couple of instances -- one out of India with the shade study and also out of Spain with calcifediol study, which showed in a randomized, controlled trial (albeit small) that there was definitely benefit in that group with COVID-19 that receive vitamin D supplementation. Kyle: So speaking of vitamin D, let's let's talk about that now.
12:58
Dr. Seheult: Yeah, so if you look back at our update 59, which I would encourage everybody to look at, I would stick with everything that i've said there in terms of preventing COVID-19 to be exactly the same as if you were treating COVID-19. And real briefly, in update 59, we talked about vitamin C, how there's really not an optimal dose that we're aware of. Vitamin D, on the other hand, is
13:19
a different story. Initially, when I made the video, I was taking 2500 international units and I wanted my levels to be higher after I got them checked. I'm actually taking 5000 international units a day. The Endocrinological Society is saying that the upper limits that you can take without a physician supervision is 4000 international units a day. So if you've been supplementing with vitamin D
13:44
all along and you come down with COVID, continue to supplement with vitamin D, but if you're watching this video and you have not been supplementing with vitamin D, you you probably should start. And there is some evidence -- but you probably would want to check with your primary care health care provider first -- there is some evidence out of India in the SHADE study where they gave 50,000 units
14:04
orally daily for seven days, and then ramped it back down to a regular dose of approximately 4000-5000 units (international units). So there is some data there in that study. At the end point, there was an increased clearance of the virus; there was decreased inflammatory markers. There's ongoing trials, so we'll find out more, exactly what the optimal dosing is, but remember not everybody can take 50,000 units or even supplemental vitamin D as we've talked about
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before. There are some conditions, like sarcoid, which that would not be the optimum thing to do so. Kyle: 50,000 units sounds like a lot to me. That sounds like a whopping dose over seven days, but the patients in the study didn't get toxicity on that dose? Dr. Seheult: No. No, in fact we've talked about this in our vitamin D video that we released a couple of weeks ago, Kyle, that showed that
15:00
in an analysis where they looked at over 20,000 patients in the Mayo Clinic and looked at people who supplemented anywhere from 0 up to 55,000 units daily, there was only one person that had hypercalcemia from vitamin D toxicity in 20,000 patients, and as they said, it's probably the most safe fat-soluble vitamin there is. Kyle: Are there any other vitamins that you would take with vitamin
15:22
D to potentially allow it to work better? Dr. Seheult: Yeah, there's some evidence that's emerging that vitamin K2 is beneficial in helping with vitamin D. I would just make a caution there that there is emerging evidence that this is the case, but for those of you who are on blood thinners, specifically Coumadin or Warfarin, obviously taking vitamin K is going to be counterproductive to your therapy
15:46
that you're getting with that medication, so I would not recommend that in that situation. The other element that's very helpful and beneficial if you're taking vitamin D is magnesium as well, and there are some studies that look into that, as well as dosing. Kyle: And I think it bears repeating again that none of these are recommendations for people to go out and do on their own, but always to discuss with their medical professionals first, correct?
16:13
Dr. Seheult: Absolutely, and the other thing I would add to is none of this is a hundred percent protective or curative, so you still have to do all of the other things that the CDC is saying, like mask-wearing, distancing, all of that this is, again, is a way of of tipping the scales in favor of you. In terms of your immune system, one of the other things that I mentioned back in MedCram 59
16:35
a number of months ago was that I took Quercetin, and while there is some data in ebola and other viruses that Quercetin may be beneficial, we were waiting for studies to come out on Quercetin in SARS-CoV-2. There's a good review of Quercetin in Natural Product Communications put out by SAGE Publications that was published this month in December, and it basically goes over the prior data in other viral infections and also in vitro studies that seem to indicate that Quercetin might
17:07
be beneficial. But, again, we have no randomized, placebo-controlled trial data. It seems as though the risks of Quercetin supplementation is pretty low, which makes the benefit-to-risk ratio fairly high if one wants to consider supplementation with Quercetin. If we look at NAC, or n-acetyl cysteine, in MedCram update 59 we talked about how it was used in a randomized, placebo-controlled trial to ameliorate the symptoms of the flu virus -- not COVID-19 but the flu virus --
17:40
and because of this and also the antioxidant properties of n-acetyl cysteine and the oxidative stress theory that we see in ACE2 inhibition that we see in COVID-19, it was felt again that the benefits of taking supplemental NAC outweighed the risks, especially over a winter season, but consider scaling back or stopping them once this pandemic has subsided. You know, the n-acetyl cysteine was tested with influenza during a winter season, so I don't think we should be on
18:14
n-acetyl cysteine for the rest of our lives. I do think that supplementation with vitamin D is going to be beneficial during a winter season, especially if you live above the 35th parallel. Kyle: Okay, well, you Dr. Seheult have four different board certifications that you maintain in internal medicine, critical care, um let's see what else, pulmonary medicine, and sleep medicine as well. So I
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think the next thing that you wanted to talk about was was sleep. Dr. Seheult: Yeah, so sleep is very important , especially now that we're talking about people getting vaccinations. So it's not only important if you have COVID-19, but it's also important if you're planning on getting vaccinated because we've got good data that goes back many years in terms of the flu vaccine that if you are getting
19:02
at least seven hours of sleep prior to vaccination, the antibody response and the immune response is much more robust and better after vaccination if you've had a good night's sleep, and that also goes along with trying, again, to prevent yourself from getting the infection. They did a study where they purposely put rhinovirus into the nasopharynx into their nose, basically, of students, and those that had a good night's sleep
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from previously when they interviewed them, had much less chances of getting a cold and getting the virus than those that had not been. So sleep is very, very important. The other thing I would mention about sleep is it's particularly the hours of sleep early in the night. It is those hours that is associated with slow wave sleep, so the hours of sleep before midnight are probably worth more
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by hour than those after midnight. So turning off electronic devices, turning off the television, not reading your facebook page or comments are things that get you emotionally charged. These are all things that are going to prevent you from going to sleep. It's better to shut down at that point, go to bed, and get that slow-wave sleep. By the way, that slow-wave sleep trial is associated with growth
20:17
hormone secretion, which is really, really important in terms of longevity. Kyle: But if I've just tested positive for COVID-19, I might be a little nervous, gonna be hard to get a good night's sleep. Is there anything else, like any supplements I could take? Anything else you'd recommend if I'm having trouble sleeping? Dr. Seheult: So we've talked before about the oxidative nature of COVID-19 and the fact that the
20:42
ACE2 receptors taken out, and the bottom line here is that we are seeing more and more evidence that oxidative stress is playing a significant role in the deleterious effects of SARS-CoV-2.One of the things that would help in terms of sleep, and also in terms of an antioxidant, is melatonin. Now some people might notice that melatonin works really well for them, other people not so much so, but
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taking a supplement -- maybe three to five milligrams about an hour before bedtime of melatonin -- would be beneficial in some people in terms of antioxidants, but also in in terms of helping you get to sleep and falling asleep, so that you can get the seven hours of sleep that you need. And then finally zinc, which has been talked about quite a bit. Still recommending it, but not greater
21:30
than 40 milligrams of elemental zinc per day, and because zinc can be complex with many different ionic compounds, such as picolinate, such as sulfate, you've got to look up the actual elemental zinc in each compound and make sure that you shouldn't be taking more than 40 milligrams a day. So with the exception of vitamin D everything else should be about the same whether you're trying to prevent COVID-19 infection or whether or not you have it. But is there anything else
21:59
that you should be doing on top of this if you come down with symptoms of COVID-19? To answer this question, let's again review the course of SARS-CoV-2 infection and how it progresses. So we learned early on in the course of this disease in a paper published in the Lancet in mid-February that from infection to symptoms is an incubation period of about five days, and then after symptoms develop, there's about seven days where these symptoms become more and more
22:32
progressive, and if it leads to hospitalization, that's when it's going to occur at about the seventh day approximately. And so the course of the disease in those people who are symptomatic is they get the infection and, of those people who are symptomatic, about 20 percent of those patients will go on to need hospitalization, ventilators in the intensive care unit, and potentially even
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death. But 80 percent of those patients who develop symptoms will actually get better on their own, and the reason why they get better on their own in the early phase is because of the immune system, and as we've talked about this before, there is the innate immune system, which you see here on the left, and there's the adaptive immune system which you see here on the right. And each of those
23:19
have their own cell types. We've talked about immunization and that has a lot to do with what we see there on the right with the T cells and the B cells and plasma cells, which make antibodies, but it's becoming increasingly clear in the early part of the infection -- that part of the infection where the patient is at home and he's having mild symptoms -- that the part of the immune system that's really responsible for taking care of this is the innate immune system, and
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unfortunately this portion of the immune system, the innate immune system, gets weaker with age. And the particular cell types that are involved with the innate immune system are the monocytes and the natural killer cells, and one of the primary out products, if you will, of the innate immune system is the interferon response. It's very important that this molecule interferon does exactly what it's named to do and that is to interfere with viral infections.
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What we're finding out is that the SARS-CoV-2 virus is interfering with the body's interferon, and that's why it's allowed to progress through that seven-day period of time and progress even to the point of needing hospitalization. Here's a paper that was published in March in the Asian Pacific Journal of Allergy and Immunology, where they looked at the first SARS virus and also MERS and other coronaviruses, and they said here very interestingly that it was the active viral
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replication later results in a hyper production type one interferon response. That's after it is suppressed early and what they say here, basically based on all of this data, is that these facts strongly indicate that the innate immune system response is a critical factor for disease outcome,
25:07
and those predictions bore out here was a paper that was published by Dr. Gough, where she reviews the data and says that studies of SARS and MERS suggest that the interferon response is delayed compared with coronaviruses that cause mild disease, and with milder cases of these two coronaviruses that can cause severe disease, the patients with severe SARS or MERS had higher viral loads and delayed interferon responses; thus it could be that the patients most susceptible to
25:37
severe disease are those that cannot mount an effective early antiviral immune response. She goes on to state that a study of 50 patients with cases ranging from mild to severe found that gene expression profiles indicating type 1 and type 2 interferon responses were highest in patients with mild to moderate disease and were low in patients with severe or critical disease. A similar difference in type 1 interferon activity was detected in the serum from the patients.
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Patients with more severe disease had less type 1 interferon activity in their blood
26:13
and this is data from August of 2020, which was published in the prestigious journal, Science, and it shows exactly what the doctor was talking about. Here we see the amount of interferon, which is being secreted and, compared to no disease, we see a large amount in mild disease and increasingly lower levels as we get more critical, indicating that the interferon response is very, very important. Again, looking at interferon activity, we see it being elevated in mild disease
26:44
and much lower in critical disease. Also published in Science were two papers that basically explained nearly 14 percent of all of the severe COVID-19 cases that were studied and essentially what they found was that in patients with mutations in their ability to mount an interferon response there was essentially no interferon, and they only found these type of patients in severe cases. In addition
27:13
to that, they also found patients with antibodies to interferon and, again, those interferon levels were very low in these patients and only these patients were found in the severe category. In other words, there were never patients with antibodies against interferon in the mild cases, whereas if we look at those patients that did not have any mutations and did not have antibodies against interferon, here we see a very large smattering of interferon responses, and these
27:44
patients were more mild. So because of all of this, it seems as though to me that any way possible that we can enhance particularly the innate immune response early on in the course of this disease, there is a potential for limiting progression, because of what we are seeing in terms of the signature of COVID-19, which is suppression of interferon. Well if you look at the data in terms of the innate immune system, in terms of the interferon response, and in terms of fever,
28:18
it's well been studied that fever can in fact enhance the interferon response, as indicated here by a Representative publication here in 2002, and what they did here was they stimulated human monocytes by whole body hyperthermia. This was 12 healthy volunteers, which were immersed in a 39.5 degrees Celsius hot water bath to increase their body temperature, and what they found was that three hours after in-vivo hyperthermia, the response of monocytes to endotoxin was enhanced
28:53
by an ex-vivo lipopolysaccharide stimulation assay. Essentially what they're doing there is they're giving the body a stimulus to tell them that there's an infection and they see what happens, and what they found was that there was a greater expression of tumor necrosis factor alpha release and that they concluded the thermal effect of fever directly activates monocytes, which increases
29:16
their ability to respond to a bacterial challenge. And this is part of the reason why I was hesitant to treat a fever that wasn't above 103 Fahrenheit early on in the course of the disease, because it seems to me as though the fever is enhancing that very portion of the immune system -- the innate immune system -- that's required to put an end to the progression of COVID-19, but there were more studies.
29:43
In this one, researchers at the University of Toronto took seven healthy volunteers and looked at the effect of cold water at the end of heating and exercise. In other words, heating them up and giving them exercise, and then putting them in a cold bath to see what happens to natural killer cells, lytic units, etc., and this is exactly what they found: they said that this study suggests that, despite popular beliefs that cold exposure can precipitate a viral infection, the innate
30:09
component of the immune system is not adversely affected by a brief period of cold exposure. Indeed, the opposite seems to be the case. The fall in core body temperature resulting from cold exposure led to a consistent and statistically significant mobilization of circulating cells, an increase in natural killer selectivity, and elevations in circulating IL-6 concentrations.
30:31
But the real tour de force in terms of publications was this one titled "Hyperthermia in Humans Enhances Interferon-beta Synthesis and Alters the Peripheral Lymphocyte Population."
30:43
So basically mitogen stimulation is something that stimulates the cells of the immune system as if there was a foreign invader, and what it showed was that when they took interferon and measured the amount of interferon that was released from lymphocytes after mitogen stimulation at different body temperatures, there was a ten-fold increase in interferon response at 39 degrees celsius, and
31:08
again this is the very molecule that is lacking as we found out earlier in the early course of COVID-19, which led me to think, is it possible that early on in the course of COVID-19, if we were to do hyperthermia in some way, could it alter the course and the progression of this disease?
31:29
And at first this sounded kind of far-fetched. Is it something so simple that might have such a big benefit? Well, first of all, we don't know if it has a big benefit, but if we looked earlier in history, things like this have been done before and I looked to the example of Dr. Julius Wagner-Jauregg, who was an Austrian psychiatrist and noted that his patients with neurosyphilis got better when they had a fever, so he went ahead and infected them with malaria on purpose
31:56
and essentially cured them of their neurosyphilis simply from the fever of the malaria, and then he cured them of their malaria using the known techniques at the time for this. Dr. Wagner-Jauregg was awarded the Nobel Prize in Medicine in 1927, and as you can see here according to this article that was published in 2013, simple immersion of the individual in a hot bath or placing him in a heat cabinet was one of the means by which this was done, and I suspect a lot of
32:27
these techniques were forgotten because the very next year after Dr. Wagner-Jauregg won his Nobel Prize, in 1928, we discovered penicillin and opened up a completely new door of therapeutics, and so once againI do not have randomized placebo-controlled trial data showing that hydrotherapy is effective in treating COVID-19, but there seems to be biological plausibility that it could work,
32:56
and that's why I am interested to see randomized controlled trial data being done and studies being performed to see whether or not this in fact works. What are the risks of hydrotherapy? Well you have to use hot water and so there is the potential of burning. There's also the potential of heating up someone's body to the point that they could have arrhythmias, although that seems to be pretty rare.
33:19
Other than that, the risks seem to be pretty minimal. You don't need to leave your house; there's no prescription that needs to be written; and you're not using up resources that need to be used by somebody else. And so because of this, I believe that the benefits outweigh the risks currently for hydrotherapy, and if anyone is interested in looking more into this, I will have links in the description below. Kyle: Could people also use hot and cold showers or
33:45
a hot tub or a sauna if they have access to that to get the same effect? Dr. Seheult: Yeah, absolutely. It's just a matter of getting the temperature up. So, for instance, the problem with some spas at least in the United States is that their maximum temperature is set to 104 degrees Fahrenheit. That may not be enough to get the core body temperature up. You really want to be sweating; that's how you know that you're getting your core body temperature above where it should be,
34:11
and you don't want to do it for too long -- about 20 to 30 minutes is probably good enough.
34:16
In terms of showers, as you'll notice when we talked about this back in update 59, taking a hot shower followed by a cold shower is a good what we call a "tonic" or something that keeps your immune system on sentinel mode, looking for things, if you actually come down with the disease. I don't know if just doing contrast showers is going to be enough to really get the immune system going, so sauna would be great, spa would be great. If you could get the temperature up hot,
34:42
water baths, hydrotherapy where they they use hot towels to to heat up and then cover the patient. Generally speaking, what you want to do is you want to heat up the body comfortably, so by making sure you've got a cold towel on your head or neck, so that your head is not warming up in temperature, just the body. Do that for about 20 minutes and then a very quick cool down at the end, and allow
35:06
that to stimulate the part of the immune system that is suppressed in COVID-19. Kyle: If someone tests positive and they are not sick enough to need to go to the hospital and they're going back home, what are some strategies that they can employ to prevent other people that they live with from getting sick? Dr. Seheult: Yeah and this is the real problem because spread happens at home. A great analogy to use if you're in a home is to think about somebody who smokes in your
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home. If they're on the other side of the house smoking, you might not be able to smell the smoke, but after a long period of time that smoke is gonna is, basically, gonna infiltrate the house, and eventually you're going to smell that smoke, and that's really the way it is with the spread of this virus. So you've got to think about both modes of spread if you want to prevent both modes of spread, and the first mode of spread is with large droplets, and that's where
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masks come in. So these large droplets will have the virus in it, and if someone's talking to you, these droplets are going to fly across a few feet, but on the other hand, you'll see as we talked about with smoking that you can be on different sides of the house wearing a mask, but eventually the other way of that virus spreading which is tiny little particles which become airborne and just suspend in the air. The way you prevent that is by turning the air over, and so having
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a house that's closed up with the windows closed, the doors closed, you're not going to get the kind of air exchanges that you need, and so to reduce the amount of COVID transmission through airborne, cracking the window open, ventilating the house, putting in some hepa filters in your air filtration, or even portable air filters as well. Having all of these things going at the same time is a multi-pronged approach to preventing spread to you. Now the other thing you do is
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isolate that person who is positive to one area of the house. They can crack the windows open in that area of the house, have air filtration going, maybe they're going to have to wear some warmer clothing to compensate for the window that's cracked open, but again these are all things that can work together. I think actually cracking the window open and getting air exchanges and ventilation is even more important than the time that we put in wiping down surfaces. That's
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actually probably not a large way that this virus is spread. Kyle: Okay, Dr. Seheult, to summarize: if I were to get a positive COVID-19 test, and I have either no symptoms or mild symptoms, you would recommend potentially getting a pulse oximeter, checking to see if i'm in the category of patients that might benefit from prophylactic monoclonal antibodies, you know, antibodies in advance of getting sick,
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a variety of immune boosting strategies, including vitamin D and a few other supplements,
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hyperthermia if i have an opportunity to do that -- whether it's with warm towels or a hot tub or a bath or hot-cold showers or a sauna if you have access to that -- sleep, trying to optimize my sleep, getting at least seven hours a night, and then certainly trying to prevent the spread to other people, so isolating myself in the home to the best of my ability, opening a window a few inches for
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ventilation, considering replacing my heating and cooling system air filters with a high efficiency filter, and I believe it's a MERV 13 or higher that you really want to capture those virus particles, and then finally, if one can afford it, a portable HEPA filter unit. Anything else that i'm missing? Dr. Seheult: No, I think that that really there is the low hanging fruit part of the purpose of me making this video,
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Kyle, is because I get so many people asking me, "Dr. Seheult, what do I do I've got COVID-19 and i'm feeling sick? It's been three or four days , what do I do?" And now what I'm going to do is I'm going to simply refer them to this video, because I think everything that you've just said there there, Kyle, is everything that I've been telling people in the last couple of months that have
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been calling me about "what do I do?" This is exactly what I think we ought to be doing and hopefully it will start to flatten the curve in addition to everything else that we know is helpful, including wearing masks, outside social distancing, and all of those other things that we need to be doing. You can help support us by visiting our website MedCram.com, subscribing to this YouTube channel,
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and turning on alerts by clicking on that bell icon, hitting the like button, leaving comments, and most importantly, sharing these videos with friends and family. Thanks for joining us.
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