Searching for Immunity Boosters & Possible Lessons from Spanish Flu (Lecture 47)
Welcome to another MedCram COVID-19 update. As the infection continues to grow around the world, the United States continues to lead the world in total cases and the epicenter at this point is clearly in New York.
Yesterday we looked at data that seemed to imply that hot and cold temperature regulation affected the part of the immune system, namely the innate immune system that helps with targeting viral infections and foreign invaders. And this part of the immune system is particularly affected, especially in the SARS-CoV2 viral infection, specifically natural killer cells and monocytes.
And we showed some data that hyperthermia and then cooling off actually improved surrogates for the immune system in terms of the number of monocytes and their stimulation and response to foreign invaders.
We also took the example of a sauna in terms of some of the data that’s been done in terms of preventing viral infections. But the point was not to advocate specifically for sauna bathing or for anything in particular, but just ways that people’s temperature can be elevated and then reduced. I think the ideal answer to this would be something that could be easily accessible for the majority of the world’s population and certainly, unlike Finland, we can’t all have our own sauna.
And so the purpose of today’s video is really to get some practical solutions that answer the data that we’ve been given. So I encourage you to watch the whole video. Okay. I wanted to review again exactly what it is that’s going on with this coronavirus infection.
First of all, at day 0, when somebody becomes infected, there’s about a five-day period where there is no symptoms. We call that the incubation period and let’s say that of all the people that become infected, they won’t show signs during those 5 days. And so this is at a hundred percent and then over the next seven to eight days, so by the time we get to day 12, there’s going to be a pretty dramatic drop-off in the number of patients that are going to have issues so that we are down to approximately at this point twenty percent.
And the reason for this drop is really for one reason and that’s the host’s immunity, your immune system. With a start-off at a hundred percent drop down to about 20%, this 20% will need to be hospitalized because of pneumonia shortness of breath, etc. And so they will go into the hospital at this point.
The specific part of your immune system that is really hammering this virus and is the reason why 80% exit the cycle and they don’t need any more care. It seems as though based on the studies that we looked at last time was because of innate immunity and this is the portion of the immune system that is very strong in terms of taking care of these viral pathogens. It is the monocytes. It’s the natural killer cells. Remember in our last video we showed you that these monocytes which should be up here in terms of frequency are actually down here. They are impaired.
We also showed you in this article “The longer incubation period is probably due to their immune evasion properties, efficiently escaping host immune detection at the early stage of the infection.” And that has to do with again these monocytes and part of the innate immunity. Look back at our last update for more information on that.
We also showed how temperature, both hot and cold, could actually enhance this immunity and the question is whether or not we could figure out how to improve immunity. We could shift this curve down and actually have less needing to have hospitalization. Well, as it turns out COVID-19 is not the only disease that requires monocytes as the key player in the fighting of its infection.
Here’s a paper that was published less than a year ago in Frontiers in Immunology. They go through and they actually note “these results demonstrate for the first time that intermediate monocytes control the differentiation of Treg subsets in Treponema pallidum/HIV-1 co-infections. New insights into an immunological mechanism involving monocytes and Tregs in HIV-infected individuals with syphilis.”
So the key here I want you to see is that there is an association with monocytes with syphilis and that’s very interesting because as we showed last time “Human monocyte stimulation by experimental whole body hypothermia” was augmented and we could see here that “three hours after in vivo hyperthermia, the response of monocytes was enhanced.” But this shouldn’t come as a surprise to anyone who knows the history of the treatment of neurosyphilis as we know now, but they didn’t know then monocytes are involved with the treatment of neurosyphilis and also syphilis.
And if we look here there was a physician by the name of Julia’s Wagner-Jauregg. And what he found interestingly is that by stimulating the body to make a fever actually sped up the treatment of neurosyphilis. Well, how did he cause the patient to actually have a fever? By infecting him with malaria. Now, of course, we’re not advocating to infect people with malaria. Remember this was before penicillin and as it’s noted here in the article. They say “actually malaria infection was an acceptable risk for the patients, as quinine would be administered as soon as the syphilis was cured.”
They also mentioned interestingly that “for centuries heat has been used in various ways for the cure of mental diseases and even Hippocrates noted that malarial fever could have a calming effect in epileptics. It should also be noted that Dr. Wagner-Jauregg received for his work in terms of treating neurosyphilis the Nobel Prize in medicine.
Now interestingly the article goes on to show that the therapeutic regimen that was completed with the administration of quinine sulphate to terminate the malarial infection was done in the hospital under strict monitoring of patients‘ vital signs. And there’s a number of ways of actually causing the patient to have a fever. They talked about the injection of foreign protein, parasitic diseases, chemical substances. But it’s interesting what they end up on here, which is immersion of the individual in a hot bath or placing them in a heat cabinet. And this was used well into the 1950s.
However, with the introduction of penicillin in syphilis treatment, fever therapy effectively ended because now we had an antibiotic. And so one has to realize here that there was a major change in the way we did medicine in the United States and in the world instead of doing home remedies or these other things that were done as mentioned in this article.
We went down a road of randomized placebo-controlled trials that were funded by companies that were able to make medications, not to say there was anything wrong with that because we’ve certainly derived the benefit in the last 50 to 60 years in this department. But the question is what’s happened to some of these other potential treatments and are any of these other treatments worthy of looking at once again?
Remember our timeline. When a patient has symptoms at five days and goes to the emergency room, what is told to him is for him to go back home because he doesn’t meet the admission criteria to go in the hospital. Meanwhile, the virus is making inroads on the patient and is suppressing the immune system until finally the house is fully inflamed and the patient is admitted to the hospital with pneumonia.
And what we’ve been doing up to this point for Covid-19 in this country is we’ve been trying to improve and increase the resources at the hospital in terms of ventilators, in terms of rooms, in terms of medications and in terms of staffing to meet that demand of 20% who will eventually need to be hospitalized.
And the question that remains is there‘s some simple remedy that could be investigated that would be available in someone’s home, that they wouldn’t have to go to the store to buy, that a production company wouldn’t have to deliver. Is there something simple enough that can reduce this curve enough to bring down the demand at the hospital and prevent this overwhelming tsunami of patients that require health care delivery.
So this statement here where it was used well into the 1950s intrigued me. So I decided based on the internet and all of the archives that we have available to us to dig down deeper and figure this out.
So there’s probably no more illustrious character in the history of hydrotherapy than John Harvey Kellogg. This physician wasn’t the inventor of hydrotherapy, but he was certainly its most ardent advocate.
因此，在水疗史上，没有比约翰·哈维·凯洛格（John Harvey Kellogg）更杰出的人物了。这位医生不是水疗法的发明者，但他无疑是水疗法的最热情的拥护者。
He also is the one that invented Kellogg’s Corn Flakes. His brother was the entrepreneur who started the business. He wanted to change breakfast in the morning because of what people were eating at the time. It was all eggs and ham and he was a health advocate.
As an interesting side note, one of the people that visited him at the Battle Creek Sanitarium, where he was presiding, was a man by the name of Post, who took the idea and erected his history.
He actually was the doctor to many famous patients, including President William Howard Taft. And you can see the rest of the list there, including Henry Ford and Thomas Edison.
他实际上是许多著名患者的医生，包括总统威廉·霍华德·塔夫脱（William Howard Taft）。大家可以在此处看到列表的其余部分，包括亨利·福特和托马斯·爱迪生。
He wrote a 1500 page compendium on rational hydrotherapy and the technique of their application in the treatment of disease. And I show this to illustrate a couple of things. Number one: just how quickly treatment can completely be obsolete and not practiced in most hospitals in the United States today, hydrotherapy is not used at all in terms of an infectious disease standpoint.
One must realize that this book was published decades before the discovery of penicillin and antibiotics. And so from an infectious disease standpoint, the randomized placebo-controlled trial in terms of medications that can treat and prophylaxis against infections has been the way that we have gone in the last hundred years. And of course specifically the issue with Covid-19 is we have no randomized placebo-controlled trials at this point.
The other point that this brings up is to clarify and to show what the state of affairs were in the other denominational sanitariums that were sister sanitariums of the Battle Creek Sanitarium at this time. So when we come back to our initial issue here of trying to bring down this curve, we are left with this situation after 1950. We have a world where we live in randomized placebo-controlled trials, and we’re able to compare. Prior to 1950, we do not have that very often.
Typically, there is physicians that are practicing based on observation, based on anecdotal evidence. Because of the drop of hydrothermal therapy from the scene prior to 1950, it is going to be very difficult to find a randomized controlled trial looking at hydrotherapy in a population base where we have people who are infected and are being treated. We have already shown in this update and in the last update some interesting findings that are surrogates in most cases and in some cases mild viral infections of little consequence like colds.
The question of course is: can hydrotherapy or hydrothermal therapy or temperature regulation affect Covid-19 in any way, shape or form? And unfortunately, I don’t think we’ll ever have that answer. What we can do is we can look at next best scenarios, and that’s what we attempt to do next.
So this is by no means a medical journal. In fact, it is a religious periodical published by the review and herald publishing company. But in its 1919 edition, there is an article written by Doctor Ruble, who is the medical director of the New England Sanitarium in Massachusetts.
So this is what Dr. Ruble had to say in the height of the Spanish Flu pandemic in the northeast of the United States. He says here that the infecting agent of influenza, whether germ or virus, has not yet been identified, and there is no laboratory method by which it can be differentiated from a common cold, or bronchitis, or other inflammation of the respiratory tract. Remember that Doctor Ruble is writing this prior to the discovery of DNA, prior to the electron microscope.
And I find that his insights are quite valuable. “The following are the principal methods of prevention: First, isolation of those who have symptoms of the disease from those who are well. Second, inoculation seems to have good effect in some cases, but its value is questionable. Third, each person should keep as well as possible, by proper habits of eating, drinking, sleeping, exercising, and breathing.“
It’s interesting that even at that time they knew that sleeping was important. “An important matter in treating the disease is to protect the patient from exposure, especially immediately following the cessation of abnormal temperature. Every subject of the disease should remain in bed as many days after the temperature becomes normal as he had a temperature, in order to be sure to avoid a recurrence of a possible pneumonia.” And then he goes on to talk about in the Boston Medical Journal millions of people that this influenza virus has taken around the world.
And I want you to be understanding of a certain point. In these days, there was no intensive care units. There were no ventilators. There were no ICU nurses. There were no intensivists. And so if you’d got pneumonia, you had about a 50/50 chance of making it. The entire treatment at this point was to prevent you from getting the pneumonia.
I find that an interesting dichotomy because today if you go to the emergency room, they will tell you not to come back until you do have a pneumonia, and then they can treat you with antibiotics, with an intensive care nurse, with a respiratory therapist and, if needed, a ventilator.
The next part of Dr. Ruble’s treaties is talking about the sanitarium treatment of influenza, which I find very interesting. So what Dr. Ruble describes is two situations: the situation in the Army Camps and the situation in the sanitariums in New England. And so the Army Camps, remember that these were soldiers coming back from the first world war and bringing with them unfortunately the Spanish flu epidemic, which became the pandemic.
Now Doctor Ruble doesn’t report the actual number of cases, but he does have percentages, so we don’t know the number of cases, but we do know that about 20% of the soldiers coming back in the Army Camps came down with the influenza virus.
Those translated into cases of pneumonia (about 16%). They said about one in six. And then from there, there was about a 40 percent conversion rate into deaths, which gives us a total of about six point four percent case fatality rate for the Army Camps.
But over in the sanitariums, they were able to treat the inpatients with the hydrotherapy, but they’re also able to treat outpatients. There was nothing special about being inpatient. And they try to match the treatment with the outpatients.
Remember, this is the time where they didn’t have ICU beds. There was no ventilators. There was no ICU nurses. So a lot of the treatment could be done both in and outpatients at the same time. However, the outpatients may have differed a little bit from the inpatients in that they may have waited a little bit longer to be treated, whereas those in the inpatient side were treated immediately.
So on the outpatient side, they recorded 677 patients, of which 55 cases got pneumonia and that was about eight percent and then those 55, 26 of them died, which worked out to about 3.8 percent mortality. Now the inpatient side: these patients were being treated in the sanitariums and these might have been more likely to be the doctors, the nurses who came down with symptoms in the sanitarium and they knew what to do and they started therapy right away.
So those had about 446, which led to 11 cases of pneumonia, which is about two percent and that led to six that died, which was giving us a total mortality of about 1.3 percent. So of the 55 that went to 26 here in the outpatient, that was about 47 percent, and of the 11 here, six went to deaths. That’s about 55 percent.
So how would I interpret these results? Well, the first thing that I notice is in the army camp versus the sanitarium. The army camp would be where I would expect the best physicians, the best technique and the best ancillary services, and for those patients that developed pneumonia, you can see here that the Army had the best outcomes.
However, how many actually developed pneumonia in this case? 16% develop pneumonia in the army camp, 8% as an outpatient and 2% as an inpatient. You can see that the hydrotherapy or hydrothermal therapy, because they used hot and cold, was the best at reducing the incidence of pneumonia.
And you’ve got to remember that in this day and age pneumonia was a death sentence pretty much and so everything was done to prevent the patient from getting pneumonia. You remember what Dr. Ruble said about making sure that the patient laid in bed and still so that they wouldn’t get the secondary infections that cause pneumonia.
Remember this was before antibiotics and you can see when this approach was taken that the best mortality rate was patients that were treated for early in the sanitarium, when they knew they would be treating them exactly according to the protocol. Second best was when they trained the facilities at home to take care of the patient and then worst is when they weren’t doing the hydrotherapy and presumably these cases led extensively to a lot of pneumonia, which led to an excess case fatality rates.
So that kind of brings us back to our graph and here we have the population. And what we’re trying to do is isolate, which is trying to prevent the number of people from getting infected, which is represented here by this first bar.
Then we have symptoms and there’s about twenty percent of these people who are infected, which will end up at the hospital and what we’re trying to do there is increase the capacity at the hospital by getting ventilators, by making sure that our health care workers have personal protective equipment, by getting more beds, by getting nurses and respiratory therapist and ancillary services ramped up.
But also we are doing randomized control trial, so we can have medications to treat people with. So we’re working a lot here at this end and that happens only when the patient comes to the hospital after they have shortness of breath and pneumonia. And we’re doing a lot here at this end to make sure that only a small portion of the population actually gets the infection and I think those are all important things that we should do.
But when the patient comes to the emergency room here and is told to go home and not come back unless they have symptoms of shortness of breath. We are doing a lot of nothing in this period of time here when the immune system I believe needs help. And remember here if we have a situation where 80% of the people who get the infection are going to do well and it’s this 20 percent that needs to come to the hospital.
If we can just improve that immune function by a few percentage points, five percentage points, then what we’re doing is we’re only having 15% going to the hospital. If you can drop this 20 down to 15%, then that there represents a 25 percent reduction in the number of people needing ventilators, needing beds.
What’s also important here is that whatever it is that you need to do here it has to be something that doesn’t have to be produced. You don’t have to go to the store to buy it. And the nice and interesting thing about hydrothermal therapy, if in fact this works and we don’t have randomized placebo-controlled trials that show us that it works, but if it does work, it’s something that anybody can do.
And with that, I just want to thank the viewers out there who’ve been watching these videos because there’s been a lot of feedback and there’s been a lot of ideas and some of you have forwarded me articles that I would not have known about if it wasn’t for your work and time. And I think that’s one of the things about this forum and this channel that allows us to move forward.