May 05, 2020

POLICY STATEMENT FOR COVID-19 PANDEMIC IN CANADA

The Canadian Integrative Medicine Association

 

GENERAL

We support federal, provincial and local public health authority recommendations that promote the health of Canadians.

We encourage early intervention with integrative medicine therapies and consultation with integrative medicine physicians and other healthcare professionals. This is particularly relevant when there are limited conventional therapies that can be recommended to patients.

 

INFORMED CONSENT

We hold that informed consent, without coercion, is essential for all medical treatments and procedures including integrative medicine options.

 

PREVENTION

We encourage all lifestyle measures that reduce the risk of infection and, if infected, increase the likelihood of rapid and full recovery. These include access to shelter, good food, adequate sleep, sufficient fluid intake, fresh air, exercise, interaction with friends, relatives and community, exposure to nature, smoking cessation, and moderation of alcohol intake.

We emphasize the importance of psychological wellbeing, particularly with quarantine and social distancing protocols. Activities such as yoga, mindfulness training, dance, music, social interaction at a distance, and prayer are known to reduce stress emotions such as fear, anxiety, anger, despair, and depression.

We identify psychological counseling and support as essential for ameliorating the mental and emotional trauma that some people are experiencing during this pandemic and the resultant social isolation protocols.

We recommend nutritious food. We also encourage the use of supplements to both improve health generally and to increase resistance to viral infections, as per the current recommendations of the International Society for Orthomolecular Medicine (ISOM)(1-25) and in accord with the Institute for Functional Medicine (26).

We emphasize the importance of vitamin D3 and vitamin C supplements in the elderly population and residents of Care Homes in Canada because of the absence of sun exposure and poor nutritional status in this population.

We recommend that healthcare providers and hospital staff, who have increased risk of exposure to SARS-CoV-2, be provided with nutritional supplements to enhance their resistance to infection and inflammation.

We recommend baseline serum 25-hydroxyvitamin D3 testing for all patients in long-term care and for anyone admitted to hospital in order to determine if vitamin D3 deficiency is a contributing factor to severe COVID-19 infection and to gauge the need for supplementation.

We support the current recommendations of ISOM for optimizing immune function for all Canadians, with modifications for children. For adults, these recommendations are:

  • A minimum of Vitamin C 500-1000 mg 1-3 times daily. This dose can be increased to bowel tolerance* to optimize prevention and support treatment of active infection.
  • Vitamin D3 4000 IU daily from October to May, with serum 25-hydroxyvitamin D testing to ensure a level of 100–150 nmol/L.
    • Canadians should continue vitamin D3 supplementation year-round if they have inadequate sunshine exposure in the summer months. This is likely to occur in office workers, the elderly, and skin cancer patients (who are avoiding sun exposure).
  • Zinc 20 mg daily. This is often contained in a good-quality multivitamin.
  • Magnesium: Start with 50-100 mg daily and increase to bowel tolerance* (preferably magnesium bisglycinate). Caution: If you have any kidney disease, consult your healthcare provider before starting Mg.
  • Selenium 100 mcg daily.

[*bowel tolerance: increase dose until loose stools, then reduce dose slightly to maximize intestinal absorption.]

 

TREATMENT

We support the early use of “low risk - high benefit” therapies for treating suspected or confirmed COVID-19 patients. At this time, these therapies include:

Hydroxychloroquine (27) and zinc, with or without azithromycin should be considered, based on best-available evidence and ongoing clinical trials. Zinc becomes a powerful anti-viral agent after it is carried into cells by transporters, like hydroxychloroquine, where it disrupts viral replication.

 

CONVENTIONAL MEDICATION

We recommend frequent review of the use of conventional medications known to increase susceptibility to pneumonia and respiratory failure through various mechanisms, such as suppression of respiration and immunosuppression (27).  This is particularly important for elderly patients.

We advise minimizing the use of anti-fever drugs, such as acetaminophen (Tylenol), ibuprofen (Advil), and aspirin, for mild-moderate fever (29).  Most viruses are temperature sensitive and fever is considered to be a component of the body’s defence response. We recommend caution using anti-inflammatories, such as ibuprofen, in COVID-19 disease (30,31).  

 

REFERENCE

1. International Society for Orthomolecular Medicine recommendations at www.ISOM.ca

2. Comprehensive article on Vit C at http://orthomolecular.org/resources/omns/v16n25.shtml

3. Graham Player, PhD, Andrew W. Saul, Damien Downing, MBBS, MRSB and Gert Schuitemaker, PhD. Published Research and Articles on Vitamin C as a Consideration for Pneumonia, Lung Infections, and the Novel Coronavirus (SARS-CoV-2/COVID-19). Orthomolecular Medicine News Service. Mar 22, 2020.

4. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst. Jan 2013.

5. Fowler, A A, et al. Effect of Vit C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients with Sepsis and Severe Acute Respiratory Failure. JAMA, 2019:322(13):1261-1270.

6. Wald E et al. Hydrocortisone/Ascorbic Acid/Thiamine Use Associated with Lower Mortality in Pediatric Septic Shock. Critical Care Medicine. 2020:Vol 48:1.

7. Marik, P.E., Khangoora, V., Rivera, R. et al. Hydrocortisone, vitamin C and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest. 2017; 151: 1229–1238.

8. May, J.M. and Harrison, F.E. Role of vitamin C in the function of the vascular endothelium. Antioxid Redox Signal. 2013; 19: 2068–2083.

9. Padayatty, S.J. Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone. Am J Clin Nutr. 2007; 86: 145–149.

10. Nathens, A.B., Neff, M.J., Jurkovich, G.J. et al. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002; 236: 814–822.

11. Collier, B.R., Giladi, A., Dossett, L.A. et al. Impact of high-dose antioxidants on outcomes in acutely injured patients. JPEN. 2008; 32: 384–388.

12. Giladi, A.M., Dossett, L.A., Fleming, S.B. et al. High-dose antioxidant administration is associated with a reduction in post-injury complications in critically ill trauma patients. Injury. 2010; 41: 857–861.

13. Fowler, A.A., Syed, A.A., Knowlson, S. et al. Phase 1 safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014; 12: 32.

14. Zabet, M.H., Mohammadi, M., Ramezani, M. et al. Effect of high-dose ascorbic acid on vasopressor requirement in septic shock. J Res Pharm Pract. 2016; 5: 94–100.

15. Du, W.D., Yan, Z.R., Sun, J. et al. Therapeutic efficacy of high-dose vitamin C on acute pancreatitis and its potential mechanisms. World J Gastroenterol. 2017; 9: 2565–2569.

16. Tanaka, H., Matsuda, T., Miyagantani, Y. et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch Surg. 2000; 135: 326–331.

17. Matsuda, T., Tanaka, H., Reyes, H.M. et al. Antioxidant therapy using high dose vitamin C: reduction of postburn resuscitation fluid volume requirements. World J Surg. 1995; 19: 287–291.

18. Sven-Olaf K, et al. Vitamin C in Sepsis. Curr Opin Anaesthesiol. 2018 Feb;31(1):5-60.

19. Martineau, AR et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017; 356.

20. Dancer RCA, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax 2015;70:617–624.

21. Charan J et al. Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012 Oct-Dec;3(4):300-303.

22. Bjelakovic G, et al. Vitamin D supplementation for prevention of mortality in adults. Cochran Database Syst Rev. 2014 Jan 10(1):CD007470.

23. Sabetta JR et al. Serum 25-hydroxyvitamin D and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One. 2010 Jun 14;5(6).

24. Urashima M et al. Randomized Trial of Vitamin D Supplementation to Prevent Seasonal Influenza A in Schoolchildren. Am J Clin Nutr , May 2010,91 (5), 1255-60.

25. Mendes MM et al. Impact of high latitude, urban living and ethnicity on 25-hydroxyvitamin D status: A need for multidisciplinary action? J Steroid Biochem Mol Biol. 2019. 188:95-102.

26. Institute for Functional Medicine recommendations at www.ifm.org/news-insights/the-functional-medicine-approach-to-covid-19-virus-specific-nutraceutical-and-botanical-agents/

27. Vincent M et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J, Aug 2005;2:69.

28. Joan-Ramon Laporte, M.D. In the Midst of the Sars-CoV-2 Pandemic, Caution is Needed with Commonly Used Drugs that Increase the Risk of Pneumonia. Risk, April 2, 2020. https://rxisk.org/medications-compromising-covid-infections/

29. Evans S et al. Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol, Jun 2015; 15(6): 335-349.

30. Medical opinions on the avoidance of ibuprofen during Covid-19. Summary article. https://www.snopes.com/fact-check/covid-19-nsaids-ibuprofen/ [Accessed March 16/20]

31. Bancos S et al. Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells. Cell Immunol. 2009;258(1):18-28.

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