Natural Therapies and Coronavirus (covid-19) What you should know…
Natural Therapies and Coronavirus – What You Should Know Now
by: Peter Bongiorno ND, LAc www.InnerSourceHealth.com march 9, 2020 note: This article is meant to enhance conventional medical recommendations, not replace them. Please speak to your licensed physician for your health care.
I – Introductory Thought – 2
II – Where Did This Virus Come From? – 2
III – Statistics: Some Good News and Not Good News – 3
IV – Statistics: The Possibly Better News – 3
V – What About Children? – 3
VI – Don’t Panic – The Virus Will Probably Reach You – 4
VII – If I Don’t Need to Panic, Why All the Hoopla? – 4
VIII – What Should I Be Doing Right Now to Best Prepare and Protect Myself? – 5
IX – What Should I Do and Take Supplemental-Wise to Prepare For Covid -19 Reaching My Community? – 9
X – What Do I Do and Take If I Believe I Have Contracted the Coronavirus? – 10
XI – Summary Chart of Covid-19 Support Recommendations – 15
XII – Resources and References – 16
“But what does it mean, the plague? It’s life, that’s all.” – Albert Camus
“What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.” – Albert Camus
Albert Camus wrote a book called “The Plague” in the 1940’s and was able to capture the dynamics of a pandemic situation. These above quotes, I think sum up what we already know from a spiritual standpoint – that these things can and will happen, and we will rise up, help each other and get through this.
Inner Source Health and I are sending you our best prayers, healing energies and love during this time. In the not too far future, we will be able to say “that was scary, but we made it through and learned something valuable.”
– blessings, dr. peter
Where Did This Virus Come From?
As I am sure you are well aware, there is a new virus that has originated in China. Dubbed the Covid -19 or “coronavirus” (because it looks like the sun’s corona when viewed by electromicrograph), this bug seems to have originated from bats in China and transferred to an animal called the pangolin that brought the new virus to us humans. Because the bat immune system is a strong one, it is able to harbor viruses well, and is considered a training ground for developing viruses. Conflicting theories suggest snakes1 may be the original source, while an uncorroborated NY Post article2 actually suggests this is a bioterrorism lab experiment in China gone awry. Understanding past virus history over the last century, it is most likely that it was indeed a virus that came from the wild, not from a lab.
Statistics: Some Good News and Not Good News
The good news is it seems the vast majority of people who get infected with this new virus have mild or no symptoms. Studies in China suggest over 80% of infected people have a mild illness: but the not so good news is that about 12 percent do have a severe illness, with 2 or 3% of infected patients having a fatal condition. Theoretically – if this becomes a global pandemic infecting millions of people, a fatality rate of 2 to 3% would be catastrophic and could approach the 50 million people lost during the Spanish Flu of 1918.
Statistics: The Possibly Better News
What we just discussed is the doomsday scenario that many experts believe is not likely. Studies from other areas and China, and also, from other parts of the world, suggest the fatality rate is much lower at 0.2 to 0.7 percent. It is possible that all these dire predictions are inflated because the focus of these studies have looked at already very sick people, and likely have not counted the possibly thousands of cases with mild or no symptoms that were never counted. For perspective, the seasonal flu, by comparison, has a mortality rate of about 0.01 percent. So, once we have all the data, it is our best hope that this coronavirus may end up not having much more of an impact than the flu (which does kill about 300,000 worldwide every year – not something to sneeze at).
One good sign is that the World Health Organization believes the COVID-19 does not spread as easily as the typical seasonal flu3 – so with a higher possible death rate, less spread is very, very important. A number of doctor friends of mine that I have talked to personally believe that the Covid-19 will be another moderate to severe flu- type of disease in terms of impact. I hope they are correct.
Also, according to a well-researched article from the New Yorker,4 if this virus follows others like it from the past, this strain may infect a lot of people, but will most likely not prove to be more virulent than others we have seen in the recent past and will likely subside in a few months. Probably the most positive statistics just came out of South Korea, who has the most aggressive testing, and the most accurate statistics. Out of 158,000 people tested, 6284 people tested positive, and 42 deaths.5 This translates to a 0.0067 death rate, which is far below influenza.
Because it is a new virus, we can’t be sure how mild or severe it will be which is why there is all is hype – but we can look at the current data and reasonably hope for the best.
What About Children?
For you concerned parents out there, it is important to note that children are least likely to contract the coronavirus and there is little sickness, and are virtually no deaths in children.6 Although we are not sure why this is, it seems children have a stronger innate immunity. The innate immune system is a first line part of the immune system that dismantles viruses and bacteria the first time we come in contact with a new one.
Don’t Panic – The Virus Will Probably Reach You
Right now, the covid-19 virus is spreading quickly in many parts of the country. Monitoring going on in Nassau and Suffolk counties for many people7 with a number of confirmed cases in the New York area,8 California, Maryland, Florida and Washington State, and relatively low numbers of confirmed virus throughout other areas of the United States. The few deaths seem to have occurred in elderly patients with underlying illness. While still few in numbers, it is probable that the virus will be at all our doorsteps in the coming weeks to two months.
It is very likely there are actually many, many more cases in our midst that we do not know about because the lab tests have been unavailable due to poor decisions by the government and Centers for Disease Control (CDC) in the manufacturing of lab testing.9 As a result, even though everyone saw this coming, the CDC has squandered weeks and months of testing ability, which is inexcusable. I bring this up only because we need to learn how to best prepare for the next virus by learning from our mistakes – a mistake is only a mistake when we do not learn from it.
But one consolation in all this is that this may mean the virus effect has been mild enough here that we have not noticed anything more than the moderately to severe flu season that has been recorded. As testing begins in the U.S., we will undoubtedly see greater numbers in diagnosis of Covid-19. This does not mean you are in any greater danger than you are right now. But as more confirmed cases surface, we will have to deal with the fact that the economy will suffer and the medical system could get overwhelmed as we have seen in other countries already. This is why having natural medicines at your ready is important. That is what this article is about.
If I Don’t Need to Panic, Why All the Hoopla?
Again, please take a deep belly breath and do not panic – this will not be doomsday.
The reason, though we need to take this seriously and disrupt our life and society is to protect those of us who are seniors, and those who have predisposing health issues, especially those with lung diseases. People in this category are 3.4 times more likely than otherwise-healthy flu patients to require ventilators and other intensive care (around 6 of 10 people in the U.S. have at least one underlying health condition.10 Average age of death for people from Covid-19 is 80 years of age.11 So for populations at risk, this is more than just a flu.
Public health measures like quarantines, washing hands, etc… do work. In fact, right now in Wuhan, China, infection rates have dropped12 and they are more worried about outsiders bringing the disease back into the country. We need to help insure the spread is as minimal as possible, to protect the aged and the sick who are most at risk.
What Should I Be Doing Right Now to Best Prepare and Protect Myself?
It seems likely that this virus will indeed make its way through the whole country like most viral flus this year, and possibly for years to come. In my opinion, we should ‘expect the best, but prepare for the worst’. Here are some steps I think you can take now:
1 – Wash Your Hands SUPER Well: I know you are hearing this all the time, but this is probably the top thing you can do to protect yourself. When you wash your hands, use soapy warm water. A hand wash should take as long as singing “Happy Birthday” twice. Studies show that most people don’t wash their hands long enough, and also show that we tend to miss our fingertips, our wrist areas and in between the fingers.13 Washing with soap is the top way to remove coronavirus from your body. Alcohol wipes (70% or greater) are good, but the lipids in the soap interact with the virus in a way that removes it the best by far, for the structure of this virus falls apart when soap hits it.
If you cannot get soap and water and need a transportable alcohol-based virus-fighter, here’s a homemade recipe for homemade hand sanitizer:
– 2/3 cup of 91% alcohol – 1/4 cup aloe vera gel – optional: a few drops of your favorite calming essential oil (like lavender) mix and place in container
2 – Don’t Touch Your Face: touching your face might be the main mode of transmission of virus from a surface to your reparatory tract.14 so start practicing now not to do this. If you feel an itch on your nose or forehead, breath through it without touching your face.
3 – Sneeze or cough into a tissue, then throw it out: this is probably the best way to stop the spread of virus to others, if you have it. Don’t sneeze into your hands, for then you can spread the virus even better with your hands onto surfaces. If you don’t have a tissue, sneeze into your elbow, and then wash that clothing when possible, for virus can hang on there for days if not washed.
4 – Keep up the naturopathic basics: people who maintain healthy lifestyles are known to fair the best to not get sick, and have better outcomes if they contract the virus. Here a few tips to remember:
- get plenty of sleep: at least 8 hours a night for optimal immune function. Studies on the rhinovirus shows lack of sleep makes us more susceptible to catching virus.15 Don’t get to bed late either – your most restorative sleep is in the early evening. Try to be in bed by 10 to 11PM
- exercise moderately: moderate exercise has been shown to improve immune function and potentially reduced the risk and severity of respiratory viral infection. However, extensive exercise is shown to be immunosuppressive16 – so right now, do what is comfortable for your body, but not too much more. Also, exercise can help burn off some of the stress hormones too…
- stress / meditation / relaxation work: stress lowers the ability of the immune system to deal with viruses.17 Keeping a meditation practice, and lowering stress load will help.
- stay positive and laugh: don’t keep watching the news – the media is very negative-driven. Conversely, daily laughter boosts immune ability18, and lower prevalence of diseases like heart disease19.
Do or watch something every day that makes you laugh –
(btw, I found the above posted on Dr. Peter D’Adamo’s facebook Journal Club page, which is an amazing resource for information – https://bit.ly/39BUTyE )
- eat an anti-inflammatory diet: today’s Western style diet is proven to lead to increased inflammation, reduced control of infection, and increases in auto- inflammatory disease.20 Eating nutritiously is good for both prevention and treatment of viruses. Fasting may actually help the virus take over, so I do not recommend fasting if you feel ill. In my practice I find to help patients avoid and treat viral disease it is key to:
o avoid: all dairy products, sugary foods, fried foods, trans-fats, and red
o follow a Mediterranean Diet: high in fish, vegetables, nuts, beans, and
olive oil is best.
- don’t smoke: smoking is a major risk factor for advanced respiratory distress syndrome, the main reason people can die from coronavirus.21 The virus attacks the respiratory cilia cells, which are already damaged from smoke. Smoking allows much better virus transmission. Quitting smoking may help prevent the transmission and sickness of Covid-19.22
4 – Take Some Supplements for Respiratory Protection:
Please note that there is no clear direct evidence on supplements to prove that supplements will prevent or treat Covid-19. However, there is evidence from other corona and similar viruses that these may help. As much as possible, I footnoted the research for you to see for yourself what is available.
Also, please note this is not a sales pitch to purchase vitamins from us at this time of crisis. I included links to Amazon so you can easily see the names and contents of of quality products we would recommend – there are many places to purchase these, so choose what is convenient for you. – vitamin D 1000iu to 2000iu a day: Vitamin D deficiency is known to be much more prevalent in Advanced Respiratory Distress (ARDS), which is the major concern in patients who get very sick from Covid-19. Low vitamin D is shown to directly contribute to worsening of ARDS,23 likely because you need vitamin D to keep a balanced immune and inflammation reaction. Some people with low levels of D may need even more.
– selenium 200 micrograms (mcg) a day: Selenium deficiency may make it easier to
catch viruses.24 Supplementation can protect antioxidant capacity in the lungs in those with acute respiratory distress (ARDS is the major medical concern in patients with coronavirus)25 as well as help patients already being treated for advanced lung inflammation.26 Proper selenium levels may be protective to smokers.27 ARDS is the main danger for patients who are coronavirus positive. A single Brazil nut contains 68 to 91 micrograms (mcg) of selenium.
– Vitamin C 1000mg a day: higher levels of vitamin C as used in intravenous therapy may help patients who have respiratory distress syndrome as well.28 Possibly keeping levels in the body higher might help prevent it, although we do not know that for sure. One doctor’s case report from China suggests high dose had helped him and his family. See footnote29 although I cannot confirm the veracity of this report. In our office, we use a Vitamin C with Flavonoids:
– vitamin A 10,000 iu a day: Vitamin A deficiency can stop innate immunity by impeding
normal regeneration of mucosal barriers damaged by infection.30 Innate immunity is the first line of defense against a new virus like the Covid-19. While there is no data showing
vitamin A prevents or treats coronavirus, my experience in clinic suggests with other viral illnesses suggest benefit and may be worth taking in low doses.
* Please note pregnant women should NOT take extra vitamin A.
What Should I Do and Take Supplemental-Wise To Prepare For Covid-19 Reaching My Community?
1 – purchase BPA free humidifiers for your home environment: it is harder for viruses to thrive in a humid environment.31 Moist air keeps your lung and respiratory airways moist, which makes life tougher for a virus
– 2.4 Liter Humidifier: https://amzn.to/32MqqeD
– Large Capacity Humidifier: https://amzn.to/2wgoleW
2 – pick up a couple N95 masks (if still available): while it is not proven that face masks will prevent you from getting a virus,32,33 if you are sick, you can help stop others from getting sick which is especially important around elderly and immune-compromised persons. Also, information from the Spanish Flu suggests wearing masks may have helped lower infection rate. The mask is likely helpful for people who tend to touch their face a lot, to help block the hands from getting to the nose and mouth.
Please, do not hoard masks – doctors and medical personnel need these as well to help others.
You can make your own mask too: https://bit.ly/38ywcSr
As the supply chain may replenish by increased production, you can look for masks like these:
– https://amzn.to/38jL9YB – https://amzn.to/2whNWE8
3 – Prepare your home for quarantine: Hopefully you will not have to, but it may become necessary to stay home for a few weeks to help stop the spread of virus depending on where you live. This will mean you will need to prepare your home and purchase items like foods, toilet paper, and prescriptions medicines to have available. Here’s an article that may be useful to help prepare:
If you are sick and under self-quarantine, these are some important precautions to follow:
- call for phone medical help if you need it
- stay at home, and don’t have visitors. Shop online to receive packages and food
- if you live with others, keep yourself in a ventilated bedroom (open windows), and don’t share towels and toiletries
- all waste should be double bagged
What Do I Do If I Believe I Have Contracted the Coronavirus?
Don’t panic, and check in with a call to your medical doctor. Proper testing will hopefully be available soon and your doctor can decide best when you may need testing. It is best not to run to the doctor or hospital, for we need to keep these options available for the more vulnerable patients who get severe illness.
The coronavirus can have a few stages. The first is cough and fever, like any cold or flu. Most people (probably around 80%) will only experience this particular stage (one man from Nebraska described having caught the corona virus here: https://bit.ly/3aEu8JU ). The second stage occurs when the virus starts to move into the lungs. In this phase, patients will experience lung symptoms, like more coughing, phlegm, and possibly like being short of breath. In the third phase, the lungs become very inflammed, and it can be very hard to breath. Here is a CDC guideline for symptoms: https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID19- symptoms.pdf
Using natural medicine supplements can help with the first, second stages and is worth a shot in the third stage, especially if medical intervention is not available.
FOR STAGE I:
– Chicken soup, soups with garlic, ginger tea and warming chai spices: in this early phase of infection, there is the opportunity for your body to get rid of it. These foods can help your system do that. Chicken soup is known by grandmothers and researchers alike to modulate the immune system and kick out colds and viruses.34, 35 Garlic has shown to have inhibitory effects on other coronaviruses like the Infectious bronchitis virus in cell studies.36 Garlic can be diced and added to anything: manuka honey and nut butter. Just get it in. Fresh ginger made into foods and tea may have the best effect over dried versions.37
– Nasal Rinses: Saline nasal irrigation is a therapy with roots in Ayurvedic medicine
where you can bathes the nasal mucosa with in spray or liquid saline to help get rid of the mucus that is harboring the virus. Getting rid if it earlier may help prevent the virus from getting into the lungs. Medical literature supports the use to help upper respiratory conditions.38 One 2019 pilot study of 68 people suggests the lowering of illness by 1.9 days and lowering the use of medication by 36% and most importantly, transmission to other people by 35%. With the Covid-19, this could be a huge benefit to getting this thing cleared out as soon as possible.39
o https://amzn.to/2TweTx4 o https://amzn.to/2v46DuK
– Wet Sock Treatment: Inner Source Health’s Dr. Dawn Siglain was recently featured on News12 showing the world this relied-on naturopathic old-age remedy for colds and flus. While there is no known research on this treatment, we do see in clinic how it helps reduce high fevers and can usher patients out of flu symptoms. As such, it may be a good addition to your immune support strategy. Please see Dr. Dawn’s video here: https://youtu.be/xmy__Tbmw54 and directions for Wet Sock care can be found here: http://www.innersourcehealth.com/news_blog.aspx?EntryID=1059
– Elderberry – in cell studies, this herb has been shown to be protective by inhibiting avian infectious bronchitis (a type of coronavirus) early in the infection phas
– e.40 A clinical trial of the flu showed that 15 ml (about 1 tablespoon) of
elderberry four times a day for 5 days found significant relief and less time with the flu than a placebo41 and other trials showed clear reductions of cold duration and severity in air travelers.42 And, it’s delicious
o https://amzn.to/3aECOjJ o https://amzn.to/2xl0iMn o https://amzn.to/39wwXNf
– Zinc lozenges: there is research suggesting lozenges in
the early onset of a cold may help get rid of the cold. Using them throughout the day, might be helpful according to medicine.net,43 where it is speculated that it can help deter the virus early on, before it gets into the lungs. I am not sure this is completely validated by research, but I don’t think it can hurt, and anything that might gets rid of the Covid-19 before getting to the lungs is worth trying. It is recommended take the lozenge then carefully lie down and let the lozenge dissolve slowly on your throat, to coat the whole area and help get rid of virus.
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other important precautions to take:
– stay at home, don’t have visits. Shop online to receive packages and food
– call for phone medical help if you need it
– if you live with others, keep yourself in a ventilated bedroom (open windows), and don’t share towels and toiletries
– all waste should be double bagged
FOR STAGE II and III, If the Virus is Moving into Your Lungs, besides contacting your physician, consider these options:
If you are feeling short of breath, check your oxygen saturation with a pulse oximeter. Sometimes anxiety can feel like shortness of breath, and your oxygen levels are actually fine. Normal pulse oximeter readings usually range from 95 to 100 percent. Values under 90 percent are considered low.44 If yours is getting low, call your doctor right away. Here are some examples of pulse oximeters you can obtain:
o https://amzn.to/2VSrMTH o https://amzn.to/2vBxpLr
– curcumin: curcumin has been shown to limit lung injury in pneumonia from
influenza in lung cells and mouse models45 by shutting down an inflammatory component of the immune system called Nf Kappa B, 46 and curcumin supplement can help lower inflammation. In the patients who have severe and life- threatening
illness, it is inflammation in lungs that caused the damage. There are a few curcumins available that are good quality:
o https://amzn.to/2xkyszN o https://amzn.to/2TGDvlC
– Stinging Nettles (Urtica Doica) Tea and Supplements: nettles is a well known anti-
allergy herb. It may have properties that help disrupt the ability of the coronavirus to attach to our cells in the lungs.47 Nettles root may be better than leaf for therapeutic effect.
o nettles supplement:
o nettles tea:
– Astragalus: is an ancient Chinese herb used for overall health and embattled immune function. Studies in cell lines48 and chickens49 both suggest this herb can have an inhibitory effect against infectious avian bronchitis, a type of coronavirus. Again, this doesn’t prove it will work in humans, but suggests it might be helpful.
o https://amzn.to/2vO9d8B o https://amzn.to/2xj7j01
– Andrographis paniculata (穿心蓮 Chuān Xīn Lián): this is another ancient Chinese herb well known for sinus and respiratory support. We often recommend it in our office for those with chronic sinus and lung congestion. Research shows it can work as a broad-spectrum antiviral to help restrain virus replication and virus-induced pathogenesis.50 Andrographis has already been shown, in cell tests, to be effective against avian influenza A (H9N2 and H5N1) and human influenza A H1N1 viruses, likely by stopping the ability of viruses to bind to our cells.51 Most specifically for coronavirus, it looks like it has the ability to help decrease expression of a protein (called the ACE2 receptor) that the Covid-19 latches on to in the lungs.52 This may be a key to prevent the big problems Covid-19 can cause.
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– Vitamin C 1000mg to 5000mg a day: as mentioned earlier, higher levels of vitamin C as used in intravenous therapy may help patients who have respiratory distress syndrome as well.53 If you are having lung issues, talk to your doctor about using
intravenous vitamin C adjunctively to your conventional care. If you are in the hospital and breathing is severely compromised, ask your doctor about intravenous vitamin C therapy, which is being currently tested in South Korea, and has been shown in one case of ARDS to reverse a very severe syndrome.54
o most vitamin C’s are pretty good. But, this is a type of powdered C that allows
extra high doses orally, which might help best:
– Huang Lian Jie Du Tang (HLJDT): lastly, I wanted to mention an ancient Chinese herbal formula translated as “Coptis Decoction To Relieve Toxicity.” This herbal mix is used for “clearing heat and cooling the blood.” In patients who have lung sickness from virus, it may help lower lung inflammation by lowering key factors involved in overrevving up the immune system which can cause damage in the lungs. Studies on this herb have only been done on rats.55 While I recommend getting to a hospital for care if you can, it may be worth considering these herbs if a person has significant lung issues and cannot get proper hospital medical treatment for any reason. These herbs are meant to only be used in the short term (1 to 2 weeks).
note: For those Chinese medicine practitioners out there, there is also more complete analysis of how to use Chinese medicine to treat coronavirus. I am exploring these and plan to send out further information about using Chinese herbal formulas in a more specific manner, but here is the reference, if you are interested : https://bit.ly/3cDZdPH
see next page for summary chart of recommendations for each phase of illness. Please note these are not meant to replace conventional medical advice, but may help your body’s immune system deal, especially earlier on, so that the virus does not move deep into the lungs. Each supplement has been further explained above.
XI – Summary Chart of Coronavirus Support Recommendations*:
Viral Stage Supplement Recommendations No symptoms – prevention Selenium – 200mcg a day
Vitamin D – 1000iu a day, with food Vitamin C – 500mg twice a day Vitamin A – 10000iu a day with food
Stage I – fever and flu like symptoms Continue above and add:
Chicken Soup Zinc lozenges – thoughout the day Elderberry Nasal Rinses Stage II – fever and beginnings of cough Continue above, and add:
Nasal Rinses Curcumin Stage III – fever, cough and lung symptoms, especially shortness of breath and /or if saturation of oxygen is low
Above, and add: Astragalus Andrographis Nettles Huang Lian Jie Du Tang Vitamin C – high doses (5000mg a day in divided doses)
* this chart does not replace medical advice from your physician. Remember to always call your physician if you are experiencing mild symptoms and go to the hospital for conventional care if you are experiencing moderate to severe symptoms.
in appreciation: To Jerome and Marylou Bongiorno for content review and additions, Dr. Dawn Siglain for reviews and additions, Drs. Victoria Liotta and Dr. Pina LoGiudice for reviews, and to Dr. Robert Kachko and Ben De la Cruz for their thoughtful consultation
RESOURCES / REFERENCES:
Dr. Peter D’Adamo’s excellent data resource for possible anti-virals: https://www.datapunk.net/covid19/antivirals.pl
Dr. Peter D’Adamo’s journal club: https://bit.ly/39BUTyE
CDC’s dedicated 2019-nCoV website https://www.cdc.gov/nCoV
NYSDOH’s dedicated 2019-nCoV website: https://www.health.ny.gov/diseases/communicable/coronavirus/
NYSDOH directory of local health departments: https://www.health.ny.gov/contact/contact_information/
1 https://www.scientificamerican.com/article/snakes-could-be-the-original-source-of-the-new- coronavirus-outbreak-in-china/ 2 https://nypost.com/2020/02/22/dont-buy-chinas-story-the-coronavirus-may-have-leaked- from-a-lab/ 3 https://www.thedenverchannel.com/news/national/coronavirus/who-says-coronavirus-is- deadlier-than-seasonal-flu-doesnt-spread-as-easily 4 https://www.newyorker.com/news/daily-comment/the-new-coronavirus-and-preparing-for- the-next-viral-pandemic 5 https://www.statista.com/statistics/1095848/south-korea-confirmed-and-suspected- coronavirus-cases/ 6 https://www.nbcnews.com/health/health-news/we-simply-do-not-understand-why- coronavirus-sparing-children-puzzling-n1147951 7 https://www.newsday.com/news/health/coronavirus-long-island-nassau-suffolk-cases- 1.42265909 8 https://www.wsj.com/articles/first-case-of-coronavirus-confirmed-in-new-york-state- 11583111692 9 https://www.propublica.org/article/cdc-coronavirus-covid-19-test 10 https://www.statnews.com/2020/03/03/who-is-getting-sick-and-how-sick-a-breakdown-of- coronavirus-risk-by-demographic- factors/?fbclid=IwAR26VTIKKlL1mMnMyNxtUQAKNlpo_iutaM8SkXUciyRfvzi4xbyt8dqylbc 11 https://www.cnn.com/2020/03/08/politics/surgeon-general-coronavirus/index.html 12 https://www.sciencemag.org/news/2020/03/china-s-aggressive-measures-have-slowed- coronavirus-they-may-not-work-other-countries
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