COVID-19 Letter
The COVID-19 pandemic is unlike anything the modern world has seen. You are all aware of the many public health recommendations/rules which have been appropriately implemented over the last week. (social distancing, frequent hand washing, covering mouths for cough and sneeze, masks and self-quarantine if symptomatic). Regarding sanitation, surface wiping with 62-71% ethanol, .5% hydrogen peroxide, or .1% Sodium hypochlorite (bleach) kills 99% of the virus within 1 minute.
As a service to you, I have been researching scientific theories of why this virus has such a high fatality rate. There are denominator reasons (ie the United States was ill prepared for an outbreak of this type, testing has only been done on a small number of potentially infected persons, etc.), but there are also numerator reasons. That is the science I will discuss in this letter. I must emphasize that this is a theory and is sent to you as a postulate rather than scientific fact...yet, pandemics require out of the box thinking and action.
The severity of the illness is determined from the response of the lungs to the inhalation of this virus. Research (footnote 1,2) suggests that, similar to SARS and MARS, two other corona viruses, the effect of the virus at a cellular level is mediated through angiotensin II, an enzyme which is prevalent in the lung, gut, kidney ad blood vessels. Therefore, a logical medical recommendation is to reduce the level of angiotensin II in the body. In order to do this, we need to reduce exposure to medications which raise the level of Angiotensin II. The list of medications which cause this are extensive and very popular. In fact, I was on one of them myself and stopped it today.
Angiotensin II is increased when we block conversion of angiotensinogen to angiotensin. This is the mechanism of action of angiotensin converting enzyme inhibitors (ACEI-see list below) and angiotensin receptor blockers (ARB-see list below). In addition, ibuprofen and thiazolidinediones (TZD's) raise angiotensin II levels. Therefore, I am recommending the following:
Email me a list of your current medications so I can compare it with the medication list I have, review your chart, and make personalized recommendations within 24 hours by email or phone.
I suspect this will generate concerns and questions. Please email those to me (clinic@oregondirectprimarycare.com). I will respond by email or phone depending on the nature of the question.
Depending on the progress of this epidemic, I may be switching the location of visits for ill patients. If you are ill, please call us at 503-894-9464 so that we can determine the best course of action for you.
Dr. Bert Berney
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