Newly updated (in fact, wholly rewritten) August 30, 2020. The original version of this article can be found here.
I recently released Version 5.0 of The Food and Supplement Guide for the Coronavirus, with the largest overhaul being the use of three different protocols depending on whether one is in a low-risk, moderate-risk, or high-risk environment.
This was motivated by two concerns. First, the COVID-19 crisis has persisted far longer than many of us suspected when it first became clear it was hitting us. The original protocol up through the fourth version had high doses of some herbs and nutrients that, when used in perpetuity, could extend beyond the durations shown to be safe and risk potential nutritional imbalances. Second, as the constant stream of ambulance sirens passing my NYC apartment faded into an occasional occurrence, and as the case and mortality data shrank in unison, it became more and more clear that the priority I gave to COVID-19 prevention in my own life should adjust to the changing risk of my environment.
What I was doing on March 17 when I wrote the first version of this article reflected the earliest version of what I would now consider the high-risk protocol. Today, I place myself firmly in the low-risk camp. For me, this means that I now use nutritional and antimicrobial reinforcements specifically meant to reduce COVID-19 risk intermittently rather than daily, that I have relaxed some of my hygiene practices to a cost-benefit ratio that matches my current environment, and that I'm gradually shifting the ways I support my mental health from indoor fun and comforts to outdoor activities in other low-risk environments.
Why I Consider Myself and My Environment Low-Risk
There are three reasons I consider myself and my environment to be low-risk:
- NYC seems to have hit herd immunity. This is the single most important reason in the list. Within NYC, compared to the average daily total death rate of 147, COVID-19 has gone from causing 598 deaths per day at its peak to 2-8 deaths per day. That's going from a quadrupling of the usual total mortality rate to only 3% of the usual total mortality rate. Cases and deaths have unrelentingly decreased since April 8, and have bottomed out with no signs of reversal in the last 4.5 months. Neither a theoretical waning of immunity after 3 months nor a slow but steady opening up (characterized by mediocre compliance with the restrictions in many neighborhoods) have caused even the slightest hints of an uptick during that time.Why? As I covered yesterday, two recent papers, one apparently destined for the Proceedings of the National Academy of the Sciences, suggest that the herd immunity threshold for COVID-19 when spread naturally (as opposed to immunity produced by randomly distributed vaccinations) is 10-20% and that NYC has not only reached it, but overshot it.It seems that has to be the case from the data. The lockdown was much more severe in early April when we had more than 500 deaths per day. If months of opening up causes the deaths to only go down, then it cannot be the restrictions pushing those deaths down. It can only be that the collective susceptibility of the population has been fundamentally altered.
- Work from home. I've been privileged to work from home throughout the entire pandemic, so I've been on the lower end of the risk spectrum even when the pandemic was raging in NYC. Early in the pandemic, however, my girlfriend had indoor classes and work, giving me indirect routes of exposure. Her work and school is also remote, now, however, so I'm more firmly planted in the lowest-risk end of the spectrum.
- I may have already gotten COVID-19. As I described in COVID-19 Specifically Targets Sweet Tastes, I suffered what is possibly one of the worst illnesses of my life and what is definitely the worst illness of my last 20 years in early February. I got it immediately after returning from air travel, and several days after one of my girlfriend's friends was very sick. Either of these could have been exposures.I probably had a terrible fever, but didn't take my temperature. I suffered from terrible chills and my skin often felt very hot. There were several days where I could barely bring myself to get up off the couch, and my sense of taste was dramatically altered. My taste for sweet was specifically blunted, and bitter tastes were extremely exaggerated. I couldn't bare the taste of coffee or Gerolsteiner mineral water, which I usually love, and I could only stand to drink sweet smoothies, which barely tasted sweet. LMNT salty electrolyte mix was the one thing that saved me from severe dehydration. I needed the salt to get water down, and to hold on to it, and the sweet taste of LMNT made it the only source I could tolerate.I dismissed this as likely the flu for many reasons at the time, but the more I've read about COVID-19 over the ensuing months, the more I've changed my mind to believe that was what I'd been sick with. Months later, I got an antibody test, and it was negative. However, the chances of a false negative at that late date were very high, so I don't think the test has much value.
Why I'm Still Being Cautious
Despite all of this, I still believe I should be cautious. Here's why:
- Herd immunity does not mean any particular individual cannot get sick. Herd immunity means life can go on as normal and the incidence will steadily decline rather than growing exponentially. Herd immunity describes a population, not an individual. If someone with COVID-19 coughs on me, has an extended face-to-face conversation with me, or spends time with me in an enclosed space, I run the same risk of becoming ill as I would if there were no herd immunity. Herd immunity basically just means that any given person I encounter is very unlikely to actually have COVID-19. Still, “very unlikely” is not “zero.”
- Herd immunity doesn't apply outside my herd. Since herd immunity doesn't in and of itself provide me any specific individual immunity, traveling to areas of higher-risk is as high-risk as the area I'm traveling to.
- I still don't know for sure I had COVID-19, and it might not guarantee immunity. While I think I probably had COVID-19, I don't know for sure, and we still don't know whether immunity may wane after several months. I suspect it doesn't in the majority of people. Otherwise NYC should be seeing upticks as we open up after 4.5 months. But it could well wane in a minority of people.
Nutritional and Antimicrobial Strategies
On the average day, I now focus my diet around satisfying my daily nutritional needs in a way that I enjoy, rather than packing in any nutrients specific to COVID-19 protection.
However, if I travel, spend time in an area where I expect to have mixed with travelers, spend more than a few minutes indoors in a public place, or do something out of the ordinary that makes me start sneezing, I have a little cocktail prepared.
The most important part of this cocktail is 10% povidone-iodine solution that I have diluted to 0.5% by mixing one part in 19 parts water, loaded into a neti pot sinus rinse bottle. Before and after anything described above that I consider risky, or any time I start sneezing, I use this according to the instructions, using only the slightest press of the valve to allow a tiny bit of the solution into one nostril to flow out the other, repeated on each side. In the unlikely event I feel like my throat is inflamed, I will also gargle with it. (See my comments on safety before using here.)
I found this to be remarkably potent in the 24 hours after I helped a friend move. This involved moving dusty things, so it's possible it was a case of allergies, but it also involved spending considerable time in the back of a U-Haul truck. I find it very plausible that the people who used it before me were sick with a cold, the flu, or COVID-19, and released aerosols into the back in the hours before my friend and I used it. I also think a virus might survive much better in aerosols in the back of a U-Haul truck than anywhere else, since it would be shielded from the antimicrobial effects of light.
I kept getting intense bouts of sneezing in the 24 hours following the move, but the povidone-iodine nasal irrigation put an immediate stop to each bout that lasted 4-5 hours. After a day of rinsing each time they returned, they disappeared for good.
The other parts of the cocktail are as follows:
- 700-1000 milligrams of elderberry extract (the equivalent of 25 grams of fresh fruit) per day of use, which I get from Abby's low-carb glycerine-based formula when at home and Gaia Black Elderberry capsules when traveling.
- 180 mg Allimax, with stabilized allicin from garlic, taken once before and after a concerning potential exposure if I'm only moderately concerned, or doubled up and taken several times a day if I'm more concerned.
- Life Extension Enhanced Zinc Acetate lozenges, once before and after a concerning potential exposure, and used intensively if I start sneezing or otherwise feel sick (continuously until the sneezing stops and otherwise every two hours). Notably, the povidone-iodine has proven so powerful in putting an end to any sneezing that I will now wait for evidence the sneezing persists after a nasal rinse to start using the zinc lozenges.
Hygiene and Social Distancing
The frequent and aggressive handwashing of the early pandemic really did a number on my hands. My skin is still damaged from it, with eczema in between my fingers. The most important antidote for this is topical shea butter and daily sunlight. It tends to heal very well and go away when I get 20 minutes of daily sun with my fingers spread apart, but if I fall behind on sun exposure it comes back.
I still make sure to wash my hands after handling incoming packages and touching public surfaces. However, early in the pandemic I would wash them for about a minute, getting each set of surfaces a good ten seconds of scrubbing time. I also erred on the side of washing my hands if I thought I may have touched something that touched something that touched something that might have been touched with someone with COVID. Now I try to limit my handwashing to after I use the bathroom, before I eat, and when I directly touched public surfaces. I tend to push elevator buttons with my elbow and open doors with my arm, so if I go outside and come back in all hands-free I'm not going to wash my hands.
My apartment building requires me to wear a mask in the common areas. Masks are also required in any indoor places in the city, and in outdoor areas where keeping six feet apart isn't reasonable. I don't mind wearing a mask in these situations, and I comply with all the rules. I will take my mask off if I'm inside my apartment, inside my car, or outdoors in an area that isn't crowded.
Fortunately, I don't need to commute for work and I happen to own a car. Free or cheap parking is more often available in the city now than it would be normally. So, for the occasional commute into the city I use my car instead of public transportation.
I still avoid unnecessary contact with crowds, and comply with any social distancing regulations. For example, if I'm walking down the street, I opt for the less crowded side; if I'm resting in the park, I pick the less crowded area. If I'm in an elevator with someone else, I take the opposite side.
All that said, I consider the outdoor air extremely safe for the reasons I described in “How Dangerous Is the Outdoor Air for COVID-19?” I don't worry about passing people on the street, and I'm not going to avoid a park or a beach just because there are a lot of people there. Virtually all COVID-19 transmission occurs indoors.
Shifting My Fun Outdoors
In the early pandemic, it was cold outside. Even as it warmed, state parks and beaches remained closed at first. Virtually every enjoyable part of living in the city had been brought to a standstill.
Although I always tried to get 20 minutes of outdoor sunshine for the sake of my circadian rhythm, vitamin D, and skin health, I mostly turned toward the comforts of my apartment. I played Mario Kart more often. I bought an eliptical, which I couldn't really afford, but which I consider an absolute necessity for mitigating my head and neck tension. My girlfriend and I would play Just Dance on Nintendo Switch for fun and to get some extra exercise.
I shifted my dietary habits from a focus mainly on whole food nutrition to include an emphasis on comfort food. This included Magic Spoon high-protein, low-carb, zero-sugar breakfast cereal, putting cream in my coffee and using milk and cheese liberally (even though casein gives me a slight inflammatory reaction), and eating more snacks. I increased my alcohol consumption to one glass of wine with dinner on 5-6 nights a week, rather than 1-2 nights per week. Finally, I purposefully allowed myself to gain quite a bit of weight.
All of this was based in a recognition that being cooped up in my apartment for months and enduring the financial stress of trying to keep my business afloat in the midst of a COVID-induced economic slump would take an extreme toll on my mental health. I chose to reallocate my efforts toward enjoying the inner life of my apartment keeping my stress level at bay, and I still consider this the right decision.
Now that things are partially opening up, I'm gradually reallocating my efforts toward outside fun. An occasional outdoor restaurant, hiking once every week or two, an occasional beach day, and a weekly aimless car ride have proven to be favorites. I also went on a brief “workation” earlier in the month to Maine. I chose it on the basis that I could drive there and avoid air travel (which I consider rather risky and wouldn't do unless necessary), the case loads were very low, as a New Yorker I was exempt from their quarantine period, and Acadia National Park provides stunning beauty and plenty of opportunities for outdoor fun.
Now that my opportunities for fun are beginning to return, I'm easing up on the comfort food. I'm gradually returning my focus to a more strict whole-foods approach, and reducing my consumption of wine and dairy. As a result I'm losing some of the weight I gained, but my plan is to wait until I feel more truly “back to normal” to engage in an intensive leaning out. Ripped abs are still not my top priority.
Different Places Require Different Approaches
I would not follow an approach like mine if I lived in an area where case loads were still high or still increasing, where sudden opening up changes were imminent and their consequences unknown, or if I used air travel out of necessity, worked or went to school in an indoor environment, or worked in close contact with known or suspected COVID-19 cases. The previous version of this article outlines how I approached the high-risk environment I faced in March, and Version 5 of The Food and Supplement Guide for the Coronavirus has my detailed protocols for low-, moderate-, and high-risk environments. It's important to follow local public health guidance and to tailor your approach to own perception of risk. Let me know how you approaching this, on social media, or in one of the “discuss” options below.
Stay safe and healthy,
I am not a medical doctor and this is not medical advice. I have a PhD in Nutritional Sciences and my expertise is in conducting and interpreting research related to my field. Please consult your physician before doing anything for prevention or treatment of COVID-19, and please seek the help of a physician immediately if you believe you may have COVID-19.
* The term “preprint” is often used in these updates. Preprints are studies destined for peer-reviewed journals that have yet to be peer-reviewed. Because COVID-19 is such a rapidly evolving disease and peer-review takes so long, most of the information circulating about the disease comes from preprints.
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