Treating Viral Infections: What’s To Be Done?

[ed note: Michael Jorrin, who I dubbed “Doc Gumshoe,” is a longtime medical writer (not a doctor) who shares his thoughts with Gumshoe readers a couple times a month. He usually does not specifically cover investment ideas, and his words and opinions are his own — his past columns can be found here]

Lots of things will kill viruses. Out in the open, they’re not especially tough. If you get something on your hands that is contaminated with virus, washing your hands will do the trick. A mild disinfectant will take care of viruses on most surfaces. Even if you eat or drink something that contains viruses, chances are your stomach acids will dispose of the evil critters. And if they get past that obstacle, in many cases your immune system will recognize the “foe” signal and mount an attack.

The question is how to combat the virus once it has gained entry into your cells? That question is, unfortunately, considerably more complicated than it looks. It is true that there are some effective antiviral drugs – that is, quite effective as treatment for some specific viruses. However, at this time there are no broad-spectrum antivirals, although researchers are currently working to develop broad-spectrum antivirals (more about that further on in this piece). Clinicians need to be reasonably certain of the identity of the virus before they attack any viral infection with a drug. And even then, there are no drugs for many viral infections. Therefore, the first step in treating viral infections is arriving at an accurate diagnosis.

That’s not necessarily the case with bacterial infections. Lots – perhaps the majority – of bacterial infections are treated based on the clinician’s best guess as to the causative pathogen. This is known as “empiric” treatment – empiric because the clinician’s decision is grounded in experience rather than in specific data. The form of treatment based on a clear and positive identification of the specific pathogen responsible for the infection is called “definitive” treatment, and it’s obviously the ideal. The clinician takes dead aim at the culprit and eliminates that population of pathogens quickly and effectively, and – we hope! – without killing too many of the beneficial bacteria that colonize the gut, and also without creating resistance in the pathogenic bacteria. In order to accomplish that feat, however, the pathogen has to be identified, and this can take more time than is practical, especially since some pathogens are not quick to grow out in a culture; meantime the patient is not getting any better.

With empiric therapy, the clinician evaluates the symptoms and consults his/her own experience, as well as current knowledge of “what’s going around.” So, although the clinician may not be able to identify the specific pathogen with the greatest confidence, he/she chooses an agent that will hit the likeliest pathogen, but also a fairly wide variety of other pathogens that might also be involved – in other words, a broad-spectrum antibiotic. Many of the most widely used antibiotics, such as those in the beta-lactam class, which includes all the penicillin-related drugs, are broad-spectrum antibiotics. Empiric therapy with broad-spectrum antibiotics has obvious potential benefits for patients, to wit: patients receive treatment more quickly and probably recover more quickly. But there are downsides. This practice has certainly led to overuse of antibiotics and has contributed to the increase in antibiotic-resistant pathogens. A typical scenario, which I described in considerable detail in “How Worried Should We Be about Antibiotic Resistance” back in October of 2013, which you can see here, is when Clarence, a child with a cold, is prescribed an antibiotic because his mother is reluctant to take the doctor’s word for it that Clarence has a virus and will get over the cold in a couple of days.

That little imaginary case history emphasized that the antibiotic would not do one single solitary thing to help Clarence get over his cold. But it did not make the point which is relevant to our current discussion, namely, that there is no current antiviral drug that is effective against cold viruses. That does rather leave the doctor in a situation that is less than ideal. “Yes, Madam, little Clarence has an upper respiratory infection, also known as a cold. Yes, you quite correctly kept him out of school today, so that at the very least he would not infect the whole class with his cold – not that he hasn’t in all likelihood already passed on his cold to several of his little friends. But no, Madam, we have no medication that will cure his infection or make him recover any sooner. Take him home, make sure he gets plenty of rest and is well fed. Chicken soup might help him clear out the snot.”

The doctor, while confessing to the lack of an effective antiviral drug for the common cold, might suggest steps that would perhaps help Clarence get over his cold more quickly and might also alleviate the symptoms – antitussives (cough medicine), expectorants, decongestants, and the like, although some of these are not recommended for young children. Depending on the doctor’s inclination, he/she might recommend certain vitamins and/or micronutrients, not specifically as treatment for Clarence’s cold, but to bolster his overall immunity.

I am specifically not going to list the vitamins and micronutrients that may have an effect on immunity, because if I did that in each case I would have to go into considerable detail regarding such matters as what dose not to exceed, the putative effect of each vitamin or micronutrient, and the strength of the evidence about the effectiveness of those substances. The same thing goes for herbs and other supplements. And the list of micronutrients, vitamins, supplements, and herbs that have been suggested as immune-boosters is lengthy. Harvard Medical School publishes a sensible guide on boosting the immune system, which you can access here. In general, this is what they say helps the immune system:

  • Don’t smoke.
  • Eat a diet high in fruits, vegetables, and whole grains, and low in saturated fat.
  • Exercise regularly.
  • Maintain a healthy weight.
  • Control your blood pressure.
  • If you drink alcohol, drink only in moderation.
  • Get adequate sleep.
  • Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.
  • Get regular medical screening tests for people in your age group and risk category.

“Many products on store shelves claim to boost or support immunity. But the concept of boosting immunity actually makes little sense scientifically. In fact, boosting the number of cells in your body — immune cells