ArticlePDF Available

Analysis of the Charles De Gaulle Aircraft Carrier Covid19 Epidemic: Infectivity and Fatality in the Young, Healthy, Active Population: Lesson from the Charles de Gaulle Aircraft Carrier Covid19 Experience

Authors:
Alberto Boretti
Alberto Boretti
Alberto Boretti
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

The case of the Charles De Gaulle aircraft carrier Covid19 outbreak indicates those young, healthy and active, apart from very few exceptions, do not get infected even if challenged, or are only very mild or asymptomatic if infected. As per April 20, 2020, of almost 2,000 people challenged, 1,081 got infected. Of the 1,081, only 24 ended up in a hospital. Of the 24, only 1 was reported in need of intensive care. As per April 29, 2020, only 5 were still in the hospital, and 1 in intensive care. As per May 4, 2020, there were only 2 still in the hospital, 1 of them in need of intensive care. On May 11, 2020, only the 1 previously in intensive care was still hospitalized but out of intensive care. Thus, infectivity and fatality are much lower than thought for the young, healthy, active population
Figures - available via license: CC BY
Content may be subject to copyright.
Available via license: CC BY 4.0
Content may be subject to copyright.
1
Mediterranean BioMedical Journals
Integrative Journal of Medical Sciences
2020, Volume 7, ID 174
DOI: 10.15342/ijms.7.174
CASE REPORT
Analysis of the Charles De Gaulle Aircraft Carrier
Covid19 Epidemic: Infectivity and Fatality in the
Young, Healthy, Active Population
Alberto Boretti
Prince Mohammad Bin Fahad University
Dhahran, Saudi Arabia
ABSTRACT
The case of the Charles De Gaulle aircraft carrier Covid19 outbreak indicates those young, healthy and active, apart from
very few exceptions, do not get infected even if challenged, or are only very mild or asymptomatic if infected. As per April
20, 2020, of almost 2,000 people challenged, 1,081 got infected. Of the 1,081, only 24 ended up in a hospital. Of the 24, only
1 was reported in need of intensive care. As per April 29, 2020, only 5 were still in the hospital, and 1 in intensive care. As
per May 4, 2020, there were only 2 still in the hospital, 1 of them in need of intensive care. On May 11, 2020, only the 1
previously in intensive care was still hospitalized but out of intensive care. Thus, infectivity and fatality are much lower than
thought for the young, healthy, active population.
KEYWORDS: Immune System; Covid19; Exercise; Nutrition
Correspondence: Pr Alberto Boretti, Prince Mohammad Bin Fahad University, Dhahran, Saudi Arabia.
Email: a.a.boretti@gmail.com
Copyright © 2020 Alberto Boretti.This is an open-access article distributed under the Creative Commons Attribution 4.0
International, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is
properly cited.
THE CHARLES DE GAULLE AIRCRAFT
CARRIER COVID19 EPIDEMIC
Covid19 (Figure 1 a transmission electron
microscope image shows the virus that causes
Covid19 isolated from a patient in the U.S., emerging
from the surface of cells cultured in the lab) has so
far (June 11, 2020) caused 7,458,993 cases
worldwide for a total of 419,020 fatalities [1]. The
infected fatality rate, which was assumed initially to
be very high, is now demonstrated to be much less.
Asymptomatic and mild cases of Covid19 infection
have finally started to be detected and accounted for.
The fatality rate of Covid19, when these
asymptomatic and mild are included, is likely 0.12 to
0.20 [2]. This is certainly much higher than the
normal flu at 0.095 [3], but almost one order of
magnitude less than what is depicted in the general
press, and unfortunately some scientific literature
such as [4]. Same as the normal flu, Covid19 affects
mostly people with immune systems compromised
[5], [6]. The fatalities are almost entirely within the
risk categories for age or comorbidities [5], [6].
Those young, healthy, and active, apart from very
few exceptions,
do not get infected even if challenged with
the Covid19 virus
are mild or asymptomatic if infected.
The case of the Charles De Gaulle aircraft carrier [7]
is one more proof for the above two statements. With
almost 2,000 healthy people on board, only 1,081 got
infected [7]. All of those on board were challenged.
There is no way to enforce distancing onboard of a
warship where people work with others in small
enclosed areas and the vast majority of the crew lack
of private quarters. As per April 20, 2020 [7], of
the1,081 only 24 ended up in a hospital, the others
being asymptomatic or mild. Of the 24, only 1 was
reported at the date in need of intensive care [7].
Alberto Boretti Charles De Gaulle Aircraft Carrier Covid19 Epidemic
Integr J Med Sci.2020;7:4p 2
While mainstream media (MM) gave worldwide
relevance to the 1,081 infected onboard the Charles
De Gaulle, they did not notice:
the only 24 out of the almost 2,000 exposed
ended up in need of medical attention,
the 1,057 of the 1,081 infected that were
mild or asymptomatic.
The numbers of the Charles De Gaulle aircraft carrier
sometimes also include the supporting vessels. The
interest of MM towards the Charles De Gaulle
epidemic has dropped since the headlines about the
number of infected, completely ignoring the quick
recovery of the infected and the lack of any fatality.
Figure 1 - Novel Covid19 coronavirus. This transmission
electron microscope image shows the virus that causes
Covid19 isolated from a patient in the U.S., emerging
from the surface of cells cultured in the lab. Credit:
NIAID-RML.CC BY 2.0. Image from [21].
The influence of vitamin C (Figure 2 the molecule)
on viral infections is controversial. Pauling [8]
suggested in 1970 that the assumption of Vitamin C
could prevent at least some people from being
infected by the normal flu. There is evidence that
some people remain in very good health, including
freedom from the common cold, year after year,
through the ingestion of only 250 mg of ascorbic acid
per day. The current prevailing opinion [9] is
however that Vitamin C only has modest prevention
power for the common cold. Opposite to cholesterol,
Vitamin C is needed by our bodies but it is not made
in our body. We need Vitamin C for the immune
functions, as well as iron absorption, bone structure,
or healthy skin. According to the review [10], that
accounted for 29 randomized trials with more than
11,000 participants, extremely active people taking at
least 200 mg of vitamin C every day cut the risk of
getting a cold. For the general population, taking
daily vitamin C did not reduce the risk of getting a
cold [10]. Regular supplements trials have also
shown that vitamin C reduces the duration of colds,
but this was not replicated in the few therapeutic
trials carried out [10].
Figure 2 - Vitamin C molecule. Left structural formula
image, right 3D image. Images obtained by using [22].
Taking at least 200 mg of vitamin C per day appears
to reduce the duration of cold symptoms by an
average of 8% in adults and 14% in children [10].
Thus, Vitamin C, if assumed regularly and in the due
amount, helps to make stronger the immune system,
and this is beneficial especially in healthy, active
peoples. The common cold coronaviruses are only
relatives of the Covid19 virus. 15% of common colds
are caused by coronaviruses. Coronaviruses are a
family of viruses that include the common cold
coronavirus, the MERS coronavirus, the SARS
coronavirus, and also the Covid19 coronavirus.
Nutrition is not only Vitamin C, and a strong immune
system is not only nutrition. Young, healthy, active
people do not get infected, or get infected but are
asymptomatic or mild when challenged by the
common cold coronaviruses. It should not be a
surprise that healthy people do not get infected, or get
infected but are asymptomatic or mild, also when
challenged by the Covid19 coronavirus. From the
Charles De Gaulle aircraft carrier experiment, there
is a strong indication that this is the case. In the
younger population suffering from no precondition,
having a healthy, active lifestyle, and a strong
immune system, that is the result of proper nutrition
and regular exercise, in absence of negative
environmental stresses, helps with challenges such as
the Covid19 infection. In the young population, it is
stress, poor diet, lack of nutrients or protein,
inadequate sleep, and lack of physical activity that
can make the difference if challenged by the Covid19
infection.
Of the healthy about 2,000 people challenged by the
Covid19 virus onboard the Charles De Gaulle aircraft
carrier, 1,081 got infected, and of these 1,081, 1,057
did not require special medical attention [7]. This is
a fact that needs an explanation, not be ignored.
As per April 29, 2020 [11], after 9 more days, only 5
members of the crew were still in the hospital. On
May 4, 2020, there were only 2 still in the hospital, 1
of them in need of intensive care [12]. On May 11,
Alberto Boretti Charles De Gaulle Aircraft Carrier Covid19 Epidemic
Integr J Med Sci.2020;7:4p 3
2020, only the 1 previously in intensive care was still
hospitalized but out of the intensive care [13]. This is
another fact in need of an explanation, and not be
ignored.
Thus, a strong immune system, maintained in the
young population through a healthy lifestyle
including exercise, healthy food, and regular intake
of supplements, minerals, and vitamins, is
determinant also for Covid19 infection. The
importance of nutrition and supplements is also
stressed in [14] to [20].
DISCUSSION AND CONCLUSIONS
It is not more general nutrition or Vitamin C alone
that prevents Covid19 infection. It is a strong
immune system in the young population that
dramatically reduces the risk of being infected and
ending up in need of hospitalization if challenged by
the Covid19 virus, and good nutrition and regular
intake of supplements are ingredients of making
stronger the immune system. The numbers of the
Charles de Gaulle aircraft demonstrate much-reduced
infectivity and fatality than thought. Most of the
Covid19 fatalities, for example in the United
Kingdom, are projected at 57% by the end of June in
nurses' homes where protection to the vulnerable was
missing. Opposite, the lockdown of the general
population made no difference as shown by the
fatalities of Belgium and the United Kingdom
compared to those of the Netherlands or Sweden,
Figure 3.
Figure 3 – Number of fatalities, total and daily 7 days
rolling averages per million for Belgium, the United
Kingdom, Sweden and the Netherlands. Images from [23].
The fatalities of Belgium and the United Kingdom are larger
than the fatalities of Sweden and the Netherlands despite
the more severe restrictions. The differences reflect the
protection of the vulnerable more than the exposure of the
young, healthy and active population.
COMPETING INTERESTS
The author received no funding and has no conflict of
interest to declare.
REFERENCES
[1] Worldometer. Coronavirus Update (Live): Cases and
Deaths from COVID-19 Virus Pandemic [Internet].
Worldometers. 2020 [cited 2020 Jul 8]. p. 1. Available
from: https://www.worldometers.info/coronavirus/
[2] Bendavid E, Mulaney B, Sood N, Shah S, Ling E, Bromley-
Dulfano R, et al. COVID-19 Antibody Seroprevalence in Santa
Clara County, California. medRxiv. 2020 Apr
30;2020.04.14.20062463. DOI: 10.1101/2020.04.14.20062463
[3] Services USD of H& H. Estiamted Influenza Illnesses, Medical
visits, Hospitalizations, and Deaths in the United States- 2018-
19 influenza season [Internet]. Centers for Diease Control and
Prevention. 2020 [cited 2020 Jul 8]. Available from:
https://www.cdc.gov/flu/about/burden/2018-2019.html
[4] Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K,
Baguelin M, et al. Impact of non-pharmaceutical interventions
(NPIs) to reduce COVID-19 mortality and healthcare demand.
ImperialAcUk. 2020;(March):3–20. DOI : 10.25561/77482
[5] Istituto Superiore di Sanità. Caratteristiche dei pazienti
deceduti positivi all’infezione da SARS-CoV-2 in Italia.
2020;10000. [Internet]. [cited 2020 Jul 9]. Available from:
https://www.epicentro.iss.it/coronavirus/sars-cov-2-decessi-
italia
[6] Global Covid-19 Case Fatality Rates - CEBM [Internet]. [cited
2020 Jul 9]. Available from: https://www.cebm.net/covid-
19/global-covid-19-case-fatality-rates
[7] French carrier surpasses Theodore Roosevelt with over
1,000 confirmed cases of COVID-19 [Internet]. [cited
2020 Jul 9]. Available from:
https://www.navytimes.com/news/your-
navy/2020/04/20/french-carrier-surpasses-theodore-
roosevelt-with-over-1000-confirmed-cases-of-covid-19/
[8] Preshaw RM. Vitamin C and the common cold. Can Med Assoc
J. 1972;107(6):479–80.
[9] Universitat Harvard. Can vitamin C prevent a cold? - Harvard
Health [Internet]. 2017 [cited 2020 Jul 9]. Available from:
https://www.health.harvard.edu/cold-and-flu/can-vitamin-c-
prevent-a-cold
[10] Hemilä H, Chalker E. Vitamin C for preventing and treating the
common cold. Vol. 2013, Cochrane Database of Systematic
Reviews. John Wiley and Sons Ltd; 2013.
DOI: 10.1002/14651858.CD000980.pub4
[11] Coronavirus sur le « Charles de Gaulle » : Cinq marins toujours
hospitalisés, le porte-avions totalement désinfecté [Internet].
[cited 2020 Jul 9]. Available from:
https://www.20minutes.fr/societe/2770163-20200429-
coronavirus-bord-charles-gaulle-cinq-marins-toujours-
hospitalises-porte-totalement-desinfecte
[12] Coronavirus : presque tous les marins du «Charles de
Gaulle» sont guéris - Le Parisien [Internet]. [cited 2020
Jul 10]. Available from:
Alberto Boretti Charles De Gaulle Aircraft Carrier Covid19 Epidemic
Integr J Med Sci.2020;7:4p 4
https://www.leparisien.fr/societe/coronavirus-presque-
tous-les-marins-du-charles-de-gaulle-sont-gueris-04-05-
2020-8310876.php
[13] «Charles de Gaulle» : le virus aurait contaminé
l’équipage en Méditerranée, puis à Brest - Le Parisien
[Internet]. [cited 2020 Jul 10]. Available from:
https://www.leparisien.fr/societe/porte-avions-charles-
de-gaulle-le-virus-aurait-ete-introduit-en-mediterranee-
puis-a-brest-11-05-2020-8315139.php
[14] Iddir M, Brito A, Dingeo G, Del Campo SSF, Samouda H, La
Frano MR, et al. Strengthening the immune system and reducing
inflammation and oxidative stress through diet and nutrition:
Considerations during the covid-19 crisis. Nutrients. 2020 May
27;12(6):1562. DOI: 10.3390/nu12061562
[15] Meneguzzo F, Ciriminna R, Zabini F, Pagliaro M. Review of
evidence available on hesperidin-rich products as potential tools
against COVID-19 and hydrodynamic cavitation-based
extraction as a method of increasing their production. Processes.
2020 May 8;8(5):549. DOI: 10.3390/pr8050549
[16] Messina G, Polito R, Monda V, Cipolloni L, Di Nunno N, Di
Mizio G, et al. Functional role of dietary intervention to improve
the outcome of COVID-19: A hypothesis of work. Int J Mol Sci.
2020 Apr 28;21(9):3104. DOI: 10.3390/ijms21093104
[17] Caccialanza R, Laviano A, Lobascio F, Montagna E, Bruno R,
Ludovisi S, et al. Early nutritional supplementation in non-
critically ill patients hospitalized for the 2019 novel coronavirus
disease (COVID-19): Rationale and feasibility of a shared
pragmatic protocol. Nutrition. 2020 Jun 1;74.
DOI: 10.1016/j.nut.2020.110835
[18] Maguire G. Better preventing and mitigating the effects of
Covid-19. Futur Sci OA. 2020 May 20;FSO586.
DOI: 10.2144/fsoa-2020-0051
[19] Zabetakis I, Lordan R, Norton C, Tsoupras A. COVID-19: The
Inflammation Link and the Role of Nutrition in Potential
Mitigation. Nutrients. 2020 May 19;12(5):1466. DOI:
10.3390/nu12051466
[20] Calder PC. Nutrition, immunity and COVID-19. BMJ Nutr Prev
Heal. 2020 Jun 20;3(1):bmjnph-2020-000085. DOI:
10.1136/bmjnph-2020-000085
[21] SARS-CoV-2 – Wikipedia [Internet]. [cited 2020 Jul
10]. Available from:
https://sv.wikipedia.org/wiki/SARS-CoV-
2#/media/Fil:SARS-CoV_with_corona.jpg.
[22] PubChem. Ascorbic Acid Ascorbic Acid [Internet]. Vol. 99,
Journal of Korean Forest Society. 2016 [cited 2020 Jul 10]. p.
1–79. Available from: http://molview.org/?cid=54670067
[23] Colombia: Coronavirus Pandemic - Our World in Data
[Internet]. [cited 2020 Jul 10]. Available from:
https://ourworldindata.org/coronavirus/country/colombia?coun
try=~COL
... In the general healthy population, people who do not get infected even if challenged by the Covid19 virus are the majority. There is growing evidence most of the healthy individuals do not get infected, or are asymptomatic, or are mild cases, and hospitalization is mostly needed only for risk categories of elderly people or people with comorbidities, which are almost the totality of the fatalities [1], [6], [9] . Most of the people infected by Covid19, not only navy personnel, are indeed only mild or asymptomatic [1] . ...
... Age, comorbidities, and risk profile of Covid19 deaths corresponds to normal mortality [1] . Generalized lockdown measures have made so far no difference [9], [10] . In many countries, up to two-thirds of all extra deaths occurred in nursing homes, which do not benefit from a general lockdown [1], [9], [10] . ...
... Generalized lockdown measures have made so far no difference [9], [10] . In many countries, up to two-thirds of all extra deaths occurred in nursing homes, which do not benefit from a general lockdown [1], [9], [10] . In many cases, it is not clear whether people for example in nurses' homes died from Covid19 or weeks of extreme stress and isolation [1] . ...
The increasing number of infected in Victoria, Australia since June 15, 2020, is the result of over-testing and over-controlling without safety: the positive rate of Covid19 infection in Victoria is 0.3%
Article
Full-text available
  • Aug 2020
On June 27, 2020, when return to normality was expected, the Victorian government and the mainstream media claimed the existence of “hot spots” of Covid19 infection in Victoria, Australia. This claim was an artifact of the much larger number of tests conducted in the most disadvantaged suburbs of Melbourne to detect an increased number of cases. The rate of positive cases detected over the number of tests performed to achieve this result was stable at about 0.3%, which is the rate experienced in Victoria since the outbreak in March, despite the focus on the areas where positive higher rates were likely. The restrictions have then been made harsher, rather than more relaxed in this state, and return to normality is now suffering nationwide. With a total number of fatalities stable at 104 in a country of more than 25 million people, when the normal flu may take 3,000 people per year, the epidemiological management of the Covid19 infection after more than 4 months of restrictions resembles an Orwellian dystopia more than a correct epidemiological approach.
View
... In April 2020, France's aircraft carrier, the Charles de Gaulle, experienced an extensive outbreak affecting 1081 sailors (approximately half of the crew) following a port call before deployment. 8 Although half of all cases were asymptomatic, 24 sailors were admitted to hospital, and 1 sailor was admitted to intensive care. As data emerged from these outbreaks, it became obvious that the standard sick-in-quarters response, however vigorous, was inadequate for shipboard management of COVID-19. ...
Effectiveness of a COVID-19 Preventive Sequestration Strategy: Deployment of the Aircraft Carrier USS Ronald Reagan (CVN-76)
Article
  • Mar 2022
Objectives: Develop and evaluate a pre-deployment sequestration (PDS) protocol to prevent SARS-CoV-2 cases on board the USS RONALD REAGAN (CVN-76). Methods: The USS RONALD REAGAN includes a crew of approximately 3,000 Sailors and an embarked Air Wing of 2,000 personnel. The PDS was conducted in three waves of 14-day strict quarantines during the months of April and May 2020. Sailors were cleared to board the ship with two negative rtPCR tests at days 14 and 16. The ship was sanitized prior to Wave 1 boarding. Results: From March 1, 2020 through May 31, 2020, a total of 51 SARS-CoV-2 positive cases were detected. During the three waves of PDS, 28 Sailors were found to be positive on exit testing (14, 11, and 3, respectively); no cases were found among the Air Wing. During the first 90 days at sea, no SARS-CoV-2 cases were detected among any of the embarked personnel. Conclusions: Although resource-intensive, the PDS protocol implemented for USS RONALD REAGAN resulted in a COVID-free ship during a global pandemic with unprecedented scope. Elements of this pandemic PDS protocol may be useful in other highly risk-averse environments with no tolerance for COVID-19 infections.
View
... After three weeks, only the 1 previously in intensive care was still hospitalized but out of the intensive care unit [12]. Thus, a strong immune system built through exercise, healthy food and nutrients, helps against COVID-19 infection [9]. The lethality and infectivity of COVID-19 are much less than what has been portrayed [13]. ...
Zinc Augments the Antiviral Potential of HCQ/CQ and Ivermectin to Reduce the Risks of More Serious Outcomes From COVID-19 Infection
Article
  • Feb 2022
  • J TRACE ELEM MED BIO
Treatments do not replace vaccinations or restrictions, but are practical, effective, and safe means to help to reduce the fatality associated with COVID-19 infection. While no treatment is available and effective for all the current and future variants of COVID-19, treatments reduce the risk of COVID-19 becoming endemic and reduce mortality and collateral damages. The use of Zinc (Zn) for COVID-19 infection is here reviewed. Zn supplementation may help in prevention as well as during the administration of therapies. Zn supplementation reduces the risks of serious outcomes from Covid19 infection. Evidence also suggests that Zn helps in treatments of COVID-19 infection if taken in conjunction with antiviral drugs. The literature supports the use of Zn, with improvements towards a lower risk ranging from 37% in late treatment, RR 0.63 CI [0.53-0.74], to 78% in sufficiency, RR 0.22 CI [0.05-0.96].
View
... Thus, the fatality rate of SARS CoV-2 is more than the flu. In addition, the fatality is mostly limited to the vulnerable [7][8][9]. In a healthy population, a strong immune system resulting from exercise, good nutrition, and regular supplements of vitamins and minerals is a guarantee of safety against SARS CoV-2. ...
Favipiravir use for SARS CoV-2 infection
Article
  • Oct 2020
Introduction: The pandemic of SARS CoV-2 has required urgent medical treatments for numerous patients. As no specific antiviral agents were available, different off-the-shelf alternatives have been explored. Objective: Here, we review the rationale behind the use of Favipiravir, and report of the specific studies supporting this treatment being conducted. Methods: Here we analyze the relevant literature to conclude about the present opportunities offered by this therapeutic agent. Results: This antiviral drug approved influenza in Japan since 2014, has a demonstrated in vitro activity against SARS CoV-2 and is being investigated in several trials for SARS CoV-2. Signals of benefit were shown in a small trial for SARS CoV-2. However, in another small study, there was no advantage. Conclusions: Further studies, statistically more significant, are urgently needed to understand the best opportunities offered by this treatment.
View
... Only 24 required hospitalizations, with only 1 requiring intensive care 10 days after the outbreak. In the end, everybody recovered for a total fatality of zero (Boretti 2020d). ...
Covid19 pandemic as a further driver of water scarcity in Africa
Article
Full-text available
  • Apr 2022
  • GeoJournal
Population growth, even if coupled to economic growth, and resources, were already on a collision course, especially in Africa. The 2019 United Nations World Water Development Report provided a dramatic status of world water, however without questioning the main drivers of an imminent water crisis, that were unbounded, unequal, economic, and population growth, within the context of reducing resources in a finite world. Despite the report was a small step forward in awareness, still, it was not proposing satisfactory remedies. With business-as-usual, without acting on the drivers of water scarcity, regional water crises were inevitable in the next 3 decades, starting from Africa. Constrained by political, financial, and energy burdens, the technological improvements that have helped humanity to deal with the increased demand for water, food, and energy over the last 70 years, were likely not enough to avoid the water crisis. On top of forecast is the Covid19 pandemic. Coronavirus cases are (August 4, 2020) 18,446,065 and fatalities are 697,202 worldwide, and still growing. The containment measures enforced for Covid19 infection following the examples in the United Kingdom have already produced significant damage to the world economy. This will limit social expenditures in general, and the expenditures for the water issue in particular. The water crisis will consequently become worse in the next months, with consequences still difficult to predict. This will be true especially for Africa, where the main problem has always been poverty. There is the opportunity of significant health, food, and water crisis, especially in Africa. While the concepts of washing hands and social distancing that are difficult to apply haven’t produce so far major issues with the Covid19 outbreak in Africa, borders closure, restrictions on movement, and more poverty will translate in a lack of food and water potentially much more worrying than the virus spreading.
View
Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand
Preprint
Full-text available
  • Mar 2020
The global impact of COVID-19 has been profound, and the public health threat it represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic. Here we present the results of epidemiological modelling which has informed policymaking in the UK and other countries in recent weeks. In the absence of a COVID-19 vaccine, we assess the potential role of a number of public health measures-so-called non-pharmaceutical interventions (NPIs)-aimed at reducing contact rates in the population and thereby reducing transmission of the virus. In the results presented here, we apply a previously published microsimulation model to two countries: the UK (Great Britain specifically) and the US. We conclude that the effectiveness of any one intervention in isolation is likely to be limited, requiring multiple interventions to be combined to have a substantial impact on transmission. Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread-reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option. We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package-or something equivalently effective at reducing transmission-will need to be maintained until a vaccine becomes available (potentially 18 months or more)-given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing-triggered by trends in disease surveillance-may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound. Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.
View
Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis
Article
Full-text available
  • May 2020
The coronavirus-disease 2019 (COVID-19) was announced as a global pandemic by the World Health Organization. Challenges arise concerning how to optimally support the immune system in the general population, especially under self-confinement. An optimal immune response depends on an adequate diet and nutrition in order to keep infection at bay. For example, sufficient protein intake is crucial for optimal antibody production. Low micronutrient status, such as of vitamin A or zinc, has been associated with increased infection risk. Frequently, poor nutrient status is associated with inflammation and oxidative stress, which in turn can impact the immune system. Dietary constituents with especially high anti-inflammatory and antioxidant capacity include vitamin C, vitamin E, and phytochemicals such as carotenoids and polyphenols. Several of these can interact with transcription factors such as NF-kB and Nrf-2, related to anti-inflammatory and antioxidant effects, respectively. Vitamin D in particular may perturb viral cellular infection via interacting with cell entry receptors (angiotensin converting enzyme 2), ACE2. Dietary fiber, fermented by the gut microbiota into short-chain fatty acids, has also been shown to produce anti-inflammatory effects. In this review, we highlight the importance of an optimal status of relevant nutrients to effectively reduce inflammation and oxidative stress, thereby strengthening the immune system during the COVID-19 crisis.
View
Special Report : Better preventing and mitigating the effects of Covid-19
Article
Full-text available
  • May 2020
Viral infections such as that associated with Covid-19 could potentially be mitigated using lifestyle strategies that include a diet rich in whole plants, complete with soluble and insoluble fiber to enhance the immune system and reduce inflammation. In this manner, the probability of being infected may be reduced, and the severity of the disease mitigated. This article discusses potential strategies.
View
COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation
Article
Full-text available
  • May 2020
The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has engulfed the world, affecting more than 180 countries. As a result, there has been considerable economic distress globally and a significant loss of life. Sadly, the vulnerable and immunocompromised in our societies seem to be more susceptible to severe COVID-19 complications. Global public health bodies and governments have ignited strategies and issued advisories on various handwashing and hygiene guidelines, social distancing strategies, and, in the most extreme cases, some countries have adopted "stay in place" or lockdown protocols to prevent COVID-19 spread. Notably, there are several significant risk factors for severe COVID-19 infection. These include the presence of poor nutritional status and pre-existing noncommunicable diseases (NCDs) such as diabetes mellitus, chronic lung diseases, cardiovascular diseases (CVD), obesity, and various other diseases that render the patient immunocompromised. These diseases are characterized by systemic inflammation, which may be a common feature of these NCDs, affecting patient outcomes against COVID-19. In this review, we discuss some of the anti-inflammatory therapies that are currently under investigation intended to dampen the cytokine storm of severe COVID-19 infections. Furthermore, nutritional status and the role of diet and lifestyle is considered, as it is known to affect patient outcomes in other severe infections and may play a role in COVID-19 infection. This review speculates the importance of nutrition as a mitigation strategy to support immune function amid the COVID-19 pandemic, identifying food groups and key nutrients of importance that may affect the outcomes of respiratory infections.
View
Review of Evidence Available on Hesperidin-Rich Products as Potential Tools against COVID-19 and Hydrodynamic Cavitation-Based Extraction as a Method of Increasing Their Production
Article
Full-text available
  • May 2020
Based on recent computational and experimental studies, hesperidin, a bioactive flavonoid abundant in citrus peel, stands out for its high binding affinity to the main cellular receptors of SARS-CoV-2, outperforming drugs already recommended for clinical trials. Thus, it is very promising for prophylaxis and treatment of COVID-19, along with other coexistent flavonoids such as naringin, which could help restraining the proinflammatory overreaction of the immune system. Controlled hydrodynamic cavitation processes showed the highest speed, effectiveness and efficiency in the integral and green aqueous extraction of flavonoids, essential oils and pectin from citrus peel waste. After freeze-drying, the extracted pectin showed high quality and excellent antioxidant and antibacterial activities, attributed to flavonoids and essential oils adsorbed and concentrated on its surface. This study reviews the recent evidence about hesperidin as a promising molecule, and proposes a feasible and affordable process based on hydrodynamic cavitation for the integral aqueous extraction of citrus peel waste resulting in hesperidin-rich products, either aqueous extracts or pectin tablets. The uptake of this process on a relevant scale is urged, in order to achieve large-scale production and distribution of hesperidin-rich products. Meanwhile, experimental and clinical studies could determine the effective doses either for therapeutic and preventive purposes.
View
Nutrition, immunity and COVID-19
Article
Full-text available
  • Apr 2020
The immune system protects the host from pathogenic organisms (bacteria, viruses, fungi, parasites). To deal with this array of threats, the immune system has evolved to include a myriad of specialised cell types, communicating molecules and functional responses. The immune system is always active, carrying out surveillance, but its activity is enhanced if an individual becomes infected. This heightened activity is accompanied by an increased rate of metabolism, requiring energy sources, substrates for biosynthesis, and regulatory molecules, which are all ultimately derived from the diet. A number of vitamins (A, B6, B12, folate, C, D and E) and trace elements (zinc, copper, selenium, iron) have been demonstrated to have key roles in supporting the human immune system and reducing risk of infections. Other essential nutrients including other vitamins and trace elements, amino acids and fatty acids are also important. Each of the nutrients named above has roles in supporting anti-bacterial and anti-viral defence, but zinc and selenium seem to be particularly important for the latter. It would seem prudent for individuals to consume sufficient amounts of essential nutrients to support their immune system in order to help them deal with pathogens should they become infected. The gut microbiota plays a role in educating and regulating the immune system. Gut dysbiosis is a feature of disease including many infectious diseases and has been described in COVID-19. Dietary approaches to achieve a healthy microbiota can also benefit the immune system. Severe infection of the respiratory epithelium can lead to acute respiratory distress syndrome (ARDS), characterised by excessive and damaging host inflammation, termed a cytokine storm. This is seen in cases of severe COVID-19. There is evidence from ARDS in other settings that the cytokine storm can be controlled by n-3 fatty acids, possibly through their metabolism to specialised pro-resolving mediators.
View
Functional Role of Dietary Intervention to Improve the Outcome of COVID-19: A Hypothesis of Work
Article
Full-text available
  • Apr 2020
  • INT J MOL SCI
Background: On the 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown origin detected in Wuhan City, Hubei Province, China. The infection spread first in China and then in the rest of the world, and on the 11th of March, the WHO declared that COVID-19 was a pandemic. Taking into consideration the mortality rate of COVID-19, about 5-7%, and the percentage of positive patients admitted to intensive care units being 9-11%, it should be mandatory to consider and take all necessary measures to contain the COVID-19 infection. Moreover, given the recent evidence in different hospitals suggesting IL-6 and TNF-α inhibitor drugs as a possible therapy for COVID-19, we aimed to highlight that a dietary intervention could be useful to prevent the infection and/or to ameliorate the outcomes during therapy. Considering that the COVID-19 infection can generate a mild or highly acute respiratory syndrome with a consequent release of pro-inflammatory cytokines, including IL-6 and TNF-α, a dietary regimen modification in order to improve the levels of adiponectin could be very useful both to prevent the infection and to take care of patients, improving their outcomes.
View
COVID-19 Antibody Seroprevalence in Santa Clara County, California
Preprint
Full-text available
  • Apr 2020
Background Addressing COVID-19 is a pressing health and social concern. To date, many epidemic projections and policies addressing COVID-19 have been designed without seroprevalence data to inform epidemic parameters. We measured the seroprevalence of antibodies to SARS-CoV-2 in Santa Clara County. Methods On 4/3-4/4, 2020, we tested county residents for antibodies to SARS-CoV-2 using a lateral flow immunoassay. Participants were recruited using Facebook ads targeting a representative sample of the county by demographic and geographic characteristics. We report the prevalence of antibodies to SARS-CoV-2 in a sample of 3,330 people, adjusting for zip code, sex, and race/ethnicity. We also adjust for test performance characteristics using 3 different estimates: (i) the test manufacturer's data, (ii) a sample of 37 positive and 30 negative controls tested at Stanford, and (iii) a combination of both. Results The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases. Conclusions The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.
View
Vitamin C for preventing and treating the common cold (2013)
Article
Full-text available
  • Jan 2013
  • COCHRANE DB SYST REV
Authors' conclusions The failure of vitamin C supplementation to reduce the incidence of colds in the general population indicates that routine vitamin C supplementation is not justified, yet vitamin C may be useful for people exposed to brief periods of severe physical exercise. Regular supplementation trials have shown that vitamin C reduces the duration of colds, but this was not replicated in the few therapeutic trials that have been carried out. Nevertheless, given the consistent effect of vitamin C on the duration and severity of colds in the regular supplementation studies, and the low cost and safety, it may be worthwhile for common cold patients to test on an individual basis whether therapeutic vitamin C is beneficial for them. Further therapeutic RCTs are warranted. AVAILABLE AT: http://www.mv.helsinki.fi/home/hemila/CC/CC.htm
View
Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol
Article
  • Apr 2020
  • NUTRITION
Objectives Beginning in December 2019, the 2019 novel coronavirus disease (COVID-19) has caused a pneumonia epidemic that began in Wuhan, China, and is rapidly spreading throughout the whole world. Italy is the hardest hit country after China. Considering the deleterious consequences of malnutrition, which certainly can affect patients with COVID-19, the aim of this study is to present a pragmatic protocol for early nutritional supplementation of non-critically ill patients hospitalized for COVID-19 disease. It is based on the observation that most patients present at admission with severe inflammation and anorexia leading to a drastic reduction of food intake, and that a substantial percentage develops respiratory failure requiring non-invasive ventilation or even continuous positive airway pressure. Methods High-calorie dense diets in a variety of different consistencies with highly digestible foods and snacks are available for all patients. Oral supplementation of whey proteins as well as intravenous infusion of multivitamin, multimineral trace elements solutions are implemented at admission. In the presence of 25-hydroxyvitamin D deficit, cholecalciferol is promptly supplied. If nutritional risk is detected, two to three bottles of protein-calorie oral nutritional supplements (ONS) are provided. If <2 bottles/d of ONS are consumed for 2 consecutive days and/or respiratory conditions are worsening, supplemental/total parenteral nutrition is prescribed. Conclusion We are aware that our straight approach may be debatable. However, to cope with the current emergency crisis, its aim is to promptly and pragmatically implement nutritional care in patients with COVID-19, which might be overlooked despite being potentially beneficial to clinical outcomes and effective in preventing the consequences of malnutrition in this patient population.
View