Osher Center experts answer commonly asked patient questions around preventing the spread COVID-19.
Question: Can I hug my Grandmother?
Answer: Social restrictions are being cautiously lessened. Medical / Public Health experts generally agree that social isolation has been effective in slowing the spread of Covid-19 and decreasing the loss of life. Medical / Public Health experts also generally agree that social connection is very important for our mental and physical health.
So, does it make sense to hug your elderly grandparent or mother or father or loved one on a special day—or just because you really miss each other? Public health experts generally agree that such considerations are not amenable to a formula or a test result to provide an absolutely correct answer for each and every individual situation.
As various restrictions are lifted, we will have to be thoughtful and willing to assess relative risks and take responsibility for our own actions—as we do in many situations in our lives. Here is a common sense, simple checklist to consider before visiting an elderly loved one who has been isolated. It assumes that you, the visitor, have been responsibly limiting contacts in general prior to the visit and that on the day of the visit, you and your loved one are free of Covid-19 symptoms
- Carry hand sanitizer to use just before and after touching any item in the shared space.
- Wear a standard facemask and ask your loved one to wear one too while you are close or inside.
- Arrange for the visit to be outdoors instead of in an enclosed space (if possible).
- Limit the time of being closer than six feet.
- Avoid touching hands or face.
- Wash your hands often.
Remember, following these guidelines does not guarantee no chance of transmission But it greatly reduces the chances–leaving a small relative risk that many thoughtful and considerate people find reasonable.
Hopefully you can stay around and chat from a few feet away—nothing beats human presence. And follow-up with virtual hugs as well— by phone, facetime or video chat.
Social distance does not have to mean social isolation from people we care about.
– Donald B. Levy, MD
- Cohen S, Janicki-Deverts D, Turner RB, Doyle WJ. Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychol Sci. 2015 Feb; 26(2): 135–147.
Question: Should patients be using a saline nasal rinse (also known as sinus irrigation with saline) on a regular basis to help prevent and/or treat symptoms of COVID-19?
Answer: According to the World Health Organization, there is no present evidence that regularly rinsing your nose with saline prevents or treats COVID-19. Using a saline rinse may reduce nasal symptoms associated with the common cold and allergic rhinitis; however, the evidence is limited. Importantly, given that COVID-19 is transmitted by droplets, (involving the face, hand, and nose), it is important that anybody using a nasal rinse device (e.g. spray, squeeze bottle) maintains appropriate hygienic and sterile practices as directed on the user instructions, and does not share the device with anybody else. – Darshan Mehta, MD, MPH
- https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters (accessed April 1, 2020)
- King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015 Apr 20;(4):CD006821.
Question: Can taking dietary supplements prevent contracting COVID-19?
Many dietary supplements—botanical, vitamin and mineral preparations—have reasonable evidence to support claims that they enhance the immune response in such a way as to inhibit the growth of viral pathogens and thus help treat or prevent the common cold, influenza and influenza-like illnesses. None can claim to effect a total cure on a specific virus and there is no evidence that any natural remedy can effectively treat or prevent COVID-19. Claims of benefit would have to be based on a hoped-for stimulation of the general immune response that fights viruses in general
Answer: Zinc lozenges or other orally dissolving zinc formulations have been shown to reduce the severity and duration of viral upper respiratory infections consistent with the “common cold” and possibly influenza and flu-like viruses The mechanism of action is believed to be interference with viral replication by the zinc in the oropharynx –hence the need for oromucosal application.
The best effect is at the onset of symptoms—slowly dissolving in the mouth zinc acetate or zinc gluconate lozenges containing 12-23 mg of elemental zinc every 2-3 hours delivering about 100 mg of zinc daily for about 7 days. Side effects for some include a bad taste in the mouth and nausea. Two brands rated by ConsumerLab are Nature’s Way™ and Cold-Eeze™ – Donald Levy, MD
• ConSumerLab.com. Zinc Supplements and Lozenges review. Updated 3-10-2020
• Hemilä H. Zinc acetate lozenges for the treatment of the common cold: a randomised controlled trial. BMJ Open , 10 (1), 2020
• Hemila H. Zinc lozenges and the common cold: a meta-analysis comparing zince acetate and zinc gluconate, and the role of zinc dosage. JRSM Open,8(5) 2017.
• Eby G. Zinc lozenges as cure for the common cold—a review and hypothesis. Med Hypotheses 2010; 74(3): 282-92. Review.
• Te Velthuis AJW et al. Zn+ inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. Plos Pathog 2010. ;6(11):
Answer: Black Elderberry or Sambucus nigra has been studied by mass spectrometry and molecular docking in cell culture and in clinical trials. Anthocyanidins from the fruit are readily detected in bloodstream following ingestion and these are thought to be responsible for anti-viral and immune priming effects. The extract reduces symptoms when given to patients with influenza A or B. Flavanoids in the berry may inhibit neuraminidase in H1N1 to roughly same degree as prescription medications.
Of Note: A recent media report of a small test-tube (in vitro) study suggests the possibility that elderberry could produce an overabundance of modulators of the immune response or “cytokine storm” and actually cause harm. There is no strong evidence to support this and with longstanding and widespread use of elderberry, there is no evidence that this medicinal herb induces cytokine storm syndrome in humans. – Donald Levy, MD
• Hawkins J, et al. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-365.
• Porter RS, Bode RF. A Review of the Antiviral Properties of Black Elder (Sambucus nigra L.) Products. Phytother Res. 2017;31(4):533-554
• Shahsavandi S, Interfering with lipid raft association: a mechanism to control influenza virus infection by Sambucus Nigra. Iran J Pharm Res. 2017;16(3):1147-1154.
• Krawitz C. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and Influenza A and B viruses. 2011;25(11):16
• Swaminathan K. Binding of a natural anthocyanin inhibitor to influenza neuraminidase by mass spectrometry. Anal Bioanl Chem. 2013;405(20) 6563-72
• Natural Medicines. April 2020 [www.naturalmedicines.com]
Question: Are homemade hand sanitizers as effective against the virus as store bought?
Answer: The CDC recommends alcohol-based hand sanitizers (ABHS) which contain at least 70% isopropyl (rubbing) or 60% ethanol (drinking) alcohol. Most store-bought formulations add aloe or glycerol to help hydrate the skin and enhance absorption. Anything higher than the above percentages of alcohol are not necessary as some amount of a water-based ingredient helps the solution penetrate the outside envelope of the virus and inactivates it quickly. To be as effective as ABHS products, homemade mixtures need to contain the minimum alcohol content.
Some well-known companies offer non-alcohol-based hand sanitizers with an alternative disinfectant, usually a quaternary ammonium compound such as benzalkonium chloride, which is effective against many types of microorganisms but has less reliable activity against corona viruses than the ABHS products. This ingredient may also be an irritant to some patients with sensitive skin. We recommend reading the fine print regarding the active ingredient in any non-alcohol-based product.
In any case, visibly soiled hands need to be washed with soap and water before any sanitizer can be effective. – Donald Levy, MD
- The Centers for Disease Control and Prevention (2020)
- Tamimi AH et. al. Food Environ Virology (2014 and 2015)
- Kurgat EK. Int J Hyg Environ Health. (April 2019)