Dear Mark: Coronavirus Questions

Mark Sisson sitting in a blue shirtOkay, so this situation is upon us. There’s no denying that all anyone can focus on is the coronavirus. There are several different names used for it, but I’ll use coronavirus and COVID-19 for today’s post. I asked across different venues for your questions and concerns about the topic. I tried to get to as many as I could.

Let’s just get into it:

Why do you think kids have not been so affected?

Good question. Many of the more serious issues with this happen in the lungs as a result of prior “co-morbidities” such as smoking, diabetes, COPD, or just having lived in an area of high air pollution for many years. Then there’s the notion that much of the damage that happens to infected people happens as a result of “cytokine storms,” an example of an immune system over-reacting to the insult. Because adults have been exposed to other strains of flu over their lives and have other antibodies for those flus, there might be a dangerous “mismatch” between what’s needed for COVID-19 and what their arsenal currently holds. Kids haven’t had the time to develop all the mismatched antibodies. All speculation.

And also, kids definitely have the potential to carry and transmit the virus even if they themselves don’t exhibit strong symptoms. One recent Chinese study found that 90% of kids with the virus were asymptomatic or showed just mild or moderate symptoms.

How safe do you think U.S. kids are?

I think kids are quite safe as long as this is reasonably curtailed.

When they say risk increases with age, they mean cellular age, not chronological right?

I hope so! That’s certainly part of it. If you are healthier and more robust in general, regardless of chronological age, you are likely to be more “robust” when under immune assault.

Tips for pregnant women and COVID-19?

Do whatever you can to avoid exposure. Full stop.

The CDC maintains a page for information regarding pregnancy and breastfeeding with COVID-19, but frankly it’s a lot of “we don’t know.” So far according to the CDC there is no known transmission from mother to baby via amniotic fluid or breastmilk. Of course, please consult your doctor immediately if you are pregnant and develop any symptoms.

Do you think that it’s overhyped or a real danger?

Both. It’s a real danger for some (mostly older infirm individuals with co-morbidities) and they should do whatever they can to avoid contracting. OTOH, the damage to the world economy is even now almost incalculable. How much of this was due to over-hype versus just poor prior planning will be the subject of debate for decades to come.

I do think once more testing rolls out, we’ll see that far more people are infected than we think, but that the fatality/severity rate drops.

Why the fear and hysteria from the media… what am I missing?

Humans are story-tellers by our nature. We have always used storytelling as the primary means of communication. Fireside tales, books, radio, TV, movies, Internet, gaming, school history classes, jokes—they are all stories. Every good story needs a villain. In this case, the media has found the consummate villain: an actual threat that hits all the right notes. In order to compete with other media outlets (and hence to sell ads) the tendency is to take a set of facts and weave them into a narrative that is both compelling and horrifying. COVID-19 allows for an infinite number of tales of woe and heroics—not to mention the ability for all sides to play politics with the other side.

Is it really as bad as the media is putting on?

IMO, no, but it’s early days and the situation is changing every hour. We will see.

According to UK researchers who created a mathematical model of transmissibility, each coronavirus case infected on average 2.6 other people in Wuhan. They also estimated that blocking over 60% of transmission would be necessary for infection-control measures to effectively control the outbreak. The outbreak is worsening in Europe, particularly in Italy as of today, but South Korea appears to have slowed its epidemic for now. This article in Science Mag credits the slowing number of new cases in South Korea to diagnostic capacity at scale, tracing contact with infected persons, and case isolation.

There’s another angle that I haven’t seen discussed much: air pollution. Wuhan is notoriously polluted, with terrible air quality and high levels of particulates in the air. The population also smokes quite heavily, particularly the men (who happen to be at greater risk). Smoking (and, I imagine, constant exposure to air particulate pollution) has been shown to increase ACE2 expression. That could very well be why it hit that area so hard.

If you catch & recover, is there a chance of future health issues as a result of having had it?

Apparently, reports are that a smallish percentage of people who contract this and recover are left with some damage to lung and or cardiac tissue. Maybe that recovers over time. Too early to opine. The same thing happened with SARS, if I recall correctly.

Can you get it more than once?

Remains to be seen. Some researchers are saying yes, that people are getting re-infected. Others are saying a person can “recover” but the virus lies dormant and reemerges. We just don’t know and won’t until long-term data is available.

Do you think fasting would have any positive effect on resisting it?

I would not undergo any dramatic fasting protocols at this time. I personally would adhere to my compressed eating window and limit intake to healthy fats, quality proteins, and organic vegetables. Fresh is great, but frozen and some (BPA-free) canned, jarred, vacuum-packed, and pantry items can provide quality Primal nutrition as well.

How does keto affect the body’s immune system?

In most cases a keto diet seems to support a healthy immune system, provided the foods you are eating are real, natural, etc. Whether that offers any specific protection against COVID-19 is impossible to say.

Do you think we should transition to workouts that aren’t at a public gym?

I would certainly limit my exposure to other peoples’ sweat and exhaled gases. I don’t plan to do any public gym workouts, and now most gyms have closed temporarily or will likely close across the country as the virus continues to spread. There are tons of things you can do in your home or your yard or even in a vacant field.

This is the perfect opportunity to get outside, get some sun (or cold), and move your body through fresh air. The fresh air will reduce the risk of transmission, as will the lack of people around you. The sun will increase nitric oxide, which showed some effectiveness at reducing the ability of a related virus—SARS—to replicate. And exercise is a great way to improve your overall health and resilience, as well as get out of the house and out of your own mind.

Best practices for fevers?

Stay hydrated (water and electrolytes; salty lime/lemon water). Stay in bed. Rest.

Avoid sugar and refined carbs. Sugar is one of the worst immune suppressors.

Do all the things your body is telling you to do.

In adults, I see no reason to reduce it until you’re getting to very serious temperatures—over 105, 106ºF. There’s actually very little evidence that fever in and of itself is dangerous. Rather, this study suggests that it’s whatever’s causing the fever that’s dangerous. The fever is the response. Animal studies indicate that treating fever with anti-pyretics might actually increase the risk of mortality, at least in influenza.

In fact, news stories are circulating, questioning whether it’s advised for patients to take ACE inhibitors and anti-inflammatory drugs such as ibuprofen if they’re experiencing COVID-19 symptoms. An article published on Science Alert suggests that the World Health Organization is digging into research presented in The Lancet that hypothesizes that COVID-19 patients with diabetes, cardiac diseases, or hypertension who are treated with ACE2-increasing drugs are at a higher risk for severe (and possibly fatal) infection. There’s concern among cardiology societies about these suggestions; the WHO has yet to release an official recommendation.

But, of course, if you’re running an extended fever and you suspect you might have coronavirus, get medical attention immediately and let them take it from there.

Are endurance athletes more at risk?

Probably. I say that because most endurance athletes overtrain to the point of occasional immune compromise. Now is not the time for that. Cut training back to 40% during this time.

Meat and corona?

Possibly my favorite meal.

My son is 22 and has asthma. Should I be worried?

Given the recent data, he is probably less likely to suffer severe consequences if he is infected based on his age, even though most of the severest cases involve lung and/or cardiac damage. Still, if I had asthma, I would do everything possible not to contract this. Not worth the risk.

Do you think when the sun comes out to play again this will die down?

I think it will absolutely help. Check out this thread on the UV index of the most affected areas. It really does seem like UV and weather and humidity can affect the viability of the virus and its ability to take hold, but this is all speculation.

A real problem will be the damage done to global economies. That might take a while to recover.

Good items to stock up on?

See Primal Provisioning for Staying at Home.

Would you travel during this outbreak?

Absolutely not.

Will taking vitamin D help people avoid getting sick?

This is a tricky one. Normally, I’d say yes, it can’t hurt and very well might help. But with coronavirus, that gets more complicated. One thing vitamin D may have the potential to do is increase ACE2 expression, and ACE2 is the same receptor to which coronavirus binds. It’s the “entry point,” how it gets in and starts destroying cells. Organs with high rates of ACE2 receptors, like the lungs, appear to be the most affected organs.

If vitamin D increases ACE2 in the lungs, for example, that could leave you more open to infection. I certainly would avoid “megadoses” of vitamin D. If you take it, do something like 1000 IUs max, or get it through food (salmon, sardines, pastured eggs, mushrooms) or cod liver oil.

Similar to the Spanish flu in 1918?

Maybe. It seems to show some similar patterns, but diverges in others. Basic concept of virulence seems similar and the same danger of overloading the medical system applies.

Tips on remaining calm and perspective amongst the panic?

The majority of the damage will be done and over in a few months. Accept what is, and know that you are doing the best you can with the tools you have.

Avoid stress. Stress increases ACE2 expression, dampens general immunity, and makes your time hanging out and relaxing impossible and miserable.

I read somewhere that a low-carb diet and high doses of vitamin C could reduce one’s chance of getting (seriously) sick from the virus. Is there any proof on that or reason to believe those claims are true?

Probably very little proof, but it’s not out of the realm of possibility. The single best thing you can do to shore up immunity is avoid sugars and industrial seed oils, get sleep, limit stress. One of the co-morbidities I’m seeing bandied about in serious patients are blood sugar disregulation, type 2 diabetes, and other conditions linked to poor glucose tolerance. In that case, using a low-carb diet to normalize glucose levels certainly won’t hurt. Of course, you don’t have to go low-carb to normalize glucose levels; it’s just that many people find that works for them.  

Vitamin C has promise. There were reports of Chinese doctors using IV vitamin C in patients and having success. IV vitamin C is a little difficult to arrange at home, but oral vitamin C is perfectly safe even at high doses and liposomal vitamin C seems to be even more effective than plain oral vitamin C.

Is it possible that frequent hand washing and sanitizer could actually hurt us by removing beneficial protective bacteria? I’m washing but also bathing my hands in dirt.

You have to look at this from two angles: acute and chronic.

Chronic sanitization of our environments and bodies promotes a worse immune system that’s more susceptible to illness and more likely to overreact to otherwise innocuous inputs.

Acute sanitization of our environments and bodies can protect us against dangerous microbes.

If you’re picking lettuce out of your garden, you can probably eat it without washing your hands.

If you’re in LAX (Los Angeles International Airport) opening the bathroom stall, touching the faucet, and flushing toilets, you should wash your hands.

And if there’s “something going around,” it’s a good idea to wash your hands and be a little more vigilant. Native Americans had robust immune systems and got plenty of microbial exposure and likely had incredibly impressive gut biomes and very little incidence of autoimmune diseases. But when they encountered smallpox, they died. They were vulnerable to an entirely novel infectious agent because they’d never encountered it before and it was sufficiently virulent.

Preparation we DO need to make… What are you doing???

I’m staying in my condo with Carrie. I have enough food stored for several weeks. I’m only going outside to go to the beach right outside the building, go for rides on the beach, runs, sprints, etc.

Staying calm, staying serene, and being prepared.

Also, read this thread and take it to heart.

That’s it for today, folks. If you have any follow-ups, I can try to get to them for next time. Ask away down below. Thanks for reading, and make sure to take care of yourself and your family.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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55 thoughts on “Dear Mark: Coronavirus Questions”

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  1. As always thank you Mark for bringing reason to what could be an otherwise emotional driven situation. Stay safe on your end. Everyone keep pitching in your efforts. It will work. Hopefully many good things come from this event at its conclusion.

  2. It is always so refreshing to read you. Common sense to the maximum potential. Thanks Mark!

  3. So what’s a 62 yo with asthma as general anxiety to do? Gotten lots of sleepless nights. BTW, my wife is a GP and will be continuing to work, oh…and I’m going to be taking care of my autistic teenage daughter.

  4. I’m on a cellphone so will keep it short. The huge threat from COVID may not be death rates but the strong—some would say almost inevitable—collapse of our healthcare system. That’s why healthy people (who incidentally might be carriers of the virus) should not downplay its effects. This is one time I don’t see the media overhyping this.

  5. Mark, You are adding to this pharma panic by not emphazing taking extra vitamin C. Check out for MANY studies that back up the claims about vitaminC, big pharma and govt. do not want you to do this because they can’t make money from vitamins. Panic is a useful tool to enact more controls.

  6. I really think you should be addressing the real reason people are being asked to stay home and away from others. I work in an inner city hospital in a (at this time) little affected state. We are already experiencing shortages of protective equipment and almost run at near capacity on a daily basis. Most people will likely get COVID-19 over time. We don’t want everyone sick at once. You’ve heard this from our government and from the media, but I’m telling you from the bedside perspective that an overwhelming number of cases in the US will strain hospitals. Days before a person shows symptoms they are likely able to infect others; if you aren’t careful we could be deciding whether to intubate you’re grandmother or intubate your neighbor. I don’t want to see those decisions having to be made. If we do get COVID-19 I hope we are apart of the 80% who fair well, but someone has to be the other 20%. And someone has to be apart of the 3-5% in an ICU. So I plead with you to do your part and put aside your social life, your gym time, your weekly shopping trips etc. to help slow the curve.

    1. This IS the most important message. I think most people find it hard to change their lives so deeply without a personal danger, so they turn the personal danger into the reason… Good luck at your hospital! I hope that your local communities are taking the message to heart and following the guidelines.

  7. Thank you, Mark. Good calm advice, as always. I’m in France, where we’re in lock down, so there are some choices I don’t hav to make. but I loved your post. I’ve been Primal for nearly 5 years now, loving every minute, and now 71 – which makes me cross when I find I’m classified as an at risk group!
    I feel 25, and – well, every 70+ Primal person understands.

    Keep up the good work.

    Love and good health to all!

  8. Mark, thank for the usual thoughtful post. Is there any usefulness in taking supplementing with colostrum at this time? Also, aside from exercise are there other ways to increase nitric oxide?
    thanks again

  9. I’m curious to know what “asymptomatic” and “mild” symptoms and cases are like. I’m hearing a lot of people having similar symptoms – sore throat, mildly elevated fever, mild decrease in energy. But none can get tested due to the lack of testing available. Any thoughts of resources?

  10. I’m a member of a support group for people with anosmia (no sense of smell). I became a post-viral anosmic a couple of years ago from a very mild case of influenza–cold and flu viruses can attack the olfactory bulb and damage the nerve. Getting my sense of smell back took three or four months; some people take much longer, or never regain it.

    All that to say, anosmia is being mentioned in the media as a side effect of COVID-19 infection. People don’t have stuffy noses or blocked sinuses; their sense of smell simply disappears. Anosmia may sound trivial, until you realize that food loses all its flavor (you’re left with only the “true tastes” of salt, bitter, sweet, sour, and umami), and you can’t smell natural gas, or burning food, or your baby’s dirty diaper, or your own BO.

  11. As always, Mark, a dose of calm reality. Thank you so much and take care

  12. Mark, I enjoy and appreciate your site and your advice. But I believe it’s irresponsible to say that the media has overhyped this. It’s always tempting to blame the messenger, but i this case, I believe it’s the media that have pushed our authorities to gradually, if incompletely, face hard truths, facts and urgent needs. Too much of the country thinks underestimate the coronovirus and this doesn’t help. Thanks.

  13. While spring and summer are on their way in the Northern Hemisphere, it’s heading into winter in the South. Given the global nature of this, until we have a vaccine (or so many people get it and then recover and are likely immune) we will keep passing it around the globe from one winter to another, in waves.

  14. Children have up to 10x more melatonin than adults. Melatonin inhibits the NLRP3 inflammasome protein from inciting cytokine storms. Coincidence?

    Nitric oxide also inhibits NLRP3. Coronavirus dies off every year in the spring when people start getting outside in the sunny, warm weather. Coincidence?

    Also, coronavirus is one of 14 RNA and DNA viruses whose envelopes are lipid coated. It’s been shown that monolaurin (extracted from lauric acid from coconut oil) dissolves these envelopes and the virus loses its protective envelope and dies.

  15. Excellent insight and summary. Thanks for posting. Hope you are well, Mark.

  16. I’m not so sure about that UV index thread, correlation does not equal causation. The countries listed as doing well all had to survive SARS and swine flu, so are more practiced at responding to pandemics and have reacted much quicker to try and control Covid. Australia has reasonably high levels of UV but seems to be following the same trend as everywhere else, almost in lock step with Canada.

  17. The coronavirus is listed in the AMA Encyclopedia of Medicine 1989 edition and on page 1051 as a COMMON COLD. It’s not new and the so called pandemic is nothing but a psyop/hoax. A
    Martial law beta test and breakdown of the economy NWO long laid plan. No one is sick or dying from this. DO NOT consent to testing or dangerous vaccines.

    1. Nope.
      the Covid-19 is a TYPE of coronavirus. That is why is has it’s own designation. The common cold is another TYPE of coronavirus. The difference is like a yappy Pomeranian versus an angry Rottweiler – both make you cautious but one could take your arm off.
      Humans love patterns and conspiracies, but sometimes Mother Nature really does toss us hot potatoes, and there doesn’t need to be an evil mastermind behind it.

  18. Thx Mark,
    I’m a little confused on the vitamin D as I was under the impression that it was beneficial in preventing and dealing with respiratory infections especially in people who have lower levels of D due to living in Northern climates. I live in a northern climate where winter is six months and I don’t get much sun during those months.
    Should I be taking a D supplement such as 1000 it’s?

  19. “Possibly my favorite meal.”

    LOL … an instant classic!

  20. Your assessment of the risk and your comments on the damage that hype and hysteria have caused match my own exactly!

  21. I know it’s been said but thank you again for a level headed article not politicizing the event or spreading hysteria. Your “Meat and Corona is my favorite meal.” Was well played though I prefer Pacifico. Thank you again always look forward to your articles

  22. Do aymptomatic people and especially children continue to shed indefinitely or does their body take care of the virus?

  23. I’m a bit confused Mark regarding the Vitamin D post. I was always led to believe that it assisted body in fighting flus and respiratory viruses so confused how with COVID 19 it could be detrimental.

    1. Same here, I’m a bit alarmed by the post since my family takes 10,000 IU of vitamin D3 w/K2 daily. I searched for any studies or even anecdotes online that I could find, and I found nothing to back up Mark’s comments, so I would love more factual info on this topic. In fact, everything I was able to find stated that Vitamin D may in fact reduce ACE2. Any solid evidence to confirm or refute the statements made in this post would be appreciated!

  24. I understand about not being in a gym and around a lot of people, but I’m a long distance swimmer and spend most of my time in a chlorinated pool. Chlorine dismantles the virus. I am so frustrated because we are not allowed to swim because they mandated the close of the gyms in the state I live in. I would imagine that a chlorinated pool would be one of the best and safest place to be in.

    1. From what I have heard, you are correct about the pool itself. However, in most cases, people will bathe before or after, put clothes in a locker, touch the railing as they get in/out of the pool, use door handles along the way. Not to mention the MANY people that seem to spit out mucus into the pool, or onto the tile immediately adjacent to the pool.

  25. I would encourage any women who are anaemic to remedy that immediately.
    Increasing iron increases haemoglobin and the oxygen-carrying ability in your blood.
    COVID patients get interstitial pneumonia and require oxygen!

  26. Great info; Not that we’re anywhere near disaster prepping but when I saw your “food for several weeks” comment I wondered what a primal pantry would look like when stocked for a month. Along the same lines, even preserved foods have expiry. How does one stock a primal pantry for a months worth of food while cycling through it so things don’t expire? Food for thought!

  27. Sorry to be pedantic, but there are actually not “several names for it.” The official WHO naming convention, followed by the CDC, is thus:
    The virus is SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).
    The disease caused by SARS-CoV-2 is called COVID-19 (coronavirus disease 2019).
    Naturally, the general public is just calling it COVID-19. But health writers like yourself should follow the official nomenclature.

  28. What about N-acetyl-cysteine?

    Many thanks for the word on Vitamin D, ditched today.

  29. Best corona virus post I have read. Thank you! I am looking for the silver lining in all of this…getting very creative with home workouts, more time to read, optimize my sleep and have meaningful conversations with friends and loved ones (even if it is over the phone.)

  30. Mark I have been a fan going back a long time but your dismissal of “the media” really bothered me.

    While people in power have been telling us it’s NBD for weeks (and some still are), reporters risking their health around the world have been the only source of real information. “The media” has been the only source of real information.

    1. True. Some states are doing nothing to little (guess which ones) so the media and internet are lifelines for information.

  31. Hey Mark,
    They’re now trying to get Hydroxychloroquine out as a treatment (it’s a zinc ionophore). Quercetin may possibly work also in treatment and prophylactically. It’s over the counter and is currently being tested in China.

  32. Great job Mark, thanks for all you do to provide level-headed, rational information in a time where that doesn’t always seem to be a priority. Like some of the other responses to your post, I’m also a little confused on the Vitamin D information you discussed. I’ve always been under the impression that sufficient/high levels of D are integral to immune function. Also, there seems to be a disconnect between your thoughts on D in this context and the UV index correlation. Wouldn’t it stand to reason that those who live in areas with a higher UV index would – generally – have higher levels of Vitamin D? Or, is it the separate benefits conferred by UV exposure that are instrumental here? I’m very curious to hear your thoughts on this. Thanks again…for all you do!

  33. Thanks Mark! Your calm and scientific analysis of everything always makes for an enjoyable and helpful read. Take care!

  34. Is it safe to swim in a public pool with the virus going around?

  35. Mark, do you think it worth using a sauna every day, ie would that keep the virus from taking hold if one was exposed?
    20 minutes above 135f, for example.

  36. Mark,
    Since 1. COVID-19 outbroke and spread mostly in places during winter (low sunlight expoxure), 2. people with worst outcomes were those with comorbidities/conditions associated with low vitamin D levels (old age, hypertension, cancer, metabolic disease and copd) and 3. Vitamin D has a crucial role in immune response, don’t you think the true pandemic is actually LOW SUN EXPOSURE?

  37. Question: does taking an ACE inhibitor result in an increase of vitamin D3 levels in the body?

  38. Re:
    Because adults have been exposed to other strains of flu over their lives and have other antibodies for those flus, there might be a dangerous “mismatch” between what’s needed for COVID-19 and what their arsenal currently holds.

    Mark, please confirm that you know that this virus isn’t a ‘flu’ virus otherwise it makes me a bit concerned!

  39. Mark, I’m surprised that you didn’t come right out and suggest the Primal Blueprint as an effective way to fight co-morbidities that are responsible for 99% of covid-19 deaths. In the end, isn’t it all about our metabolic health?

  40. Forgive me if this was already mentioned but there is talk in my office (naturopathic oncology) that there is a possible correlation of low infection rates in children to the fact that they produce higher levels of melatonin.

  41. Here’s something I’m really curious about,…I wonder how many people (if any) who are living the primal lifestyle, or who are at least eating primaly, have been infected with the covid-19.

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