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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   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.  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   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,   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   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   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   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 — 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   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   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   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   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.  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,   if you can imagine, here, we've got the virus, 
and on the virus we have these spike proteins.   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.   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 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   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   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   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   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   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,   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   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   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   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   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,   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 — how do you think the data stacks 
up for those two interventions? 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   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   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.   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   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 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   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   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   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   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   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? 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   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   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 — 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   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   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   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   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   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   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   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   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   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   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   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   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   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   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.   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   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,  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   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.   Patients with more severe disease had less 
type 1 interferon activity in their blood   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   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   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   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,   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   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   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.   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   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.   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."   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   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?   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   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   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,   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.   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   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,   and you don't want to do it for too long — 
about 20 to 30 minutes is probably good enough.   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,   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   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   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   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   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   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   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,   a variety of immune boosting strategies, 
including vitamin D and a few other supplements,   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   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,   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   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,   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..

Motivateyourhealth

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