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many things you didn’t tell me about in your refrigerator. patient. We describe the time course of disease activity
Tell me about that.” It was an interesting moment during and immunologic response. People can be asymptomatic
which he was a little bit defensive, but it also helped me to for up to three weeks period of time. Some people will
see that his partner wasn’t supportive of what he was develop symptoms within two, three days of exposure.
trying to do nutritionally. I got a lot more insight by being Some people, it may take up to three weeks after exposure
in his home and to be able to see what the challenges that before they develop symptoms. 90% of people who develop
he is working with. I recommended a coach to help him symptoms will do so are going to have symptoms within
with those challenges. I find that there are incredible the first two weeks.
opportunities to support my patients virtually. During that period of time, if there are no symptoms,
One of the opportunities for functional medicine is to whom should we test? Depending upon how long it takes
let practitioners and healthcare systems know and for their immune system to ramp up, so the people who
understand what functional medicine can offer to our are at-risk and have been exposed, we can do viral RNA
people. As we looked at Chris Cuomo on TV saying, testing on them. PCR testing is done from a nasal swab,
“There’s nothing I can do,” while having a ‘compassion oral swab, sputum or saliva. But there’s a significant false
visit’ virtually with Dr. Sanjay Gupta. In fact, there are negative rate, where sampling error occurs, and they just
things that you can do to be able to optimize your diet didn’t capture the virus. Of the people who develop
(minimizing sugar), deal with the stressors pressing on symptoms, only about 50% will show the presence of the
you and to have some movement every day. viral RNA within the first five (5) days.
And there are nutraceutical and botanical agents that The sensitivity rate goes up as symptoms continue. In
have a good level of evidence and a very small risk of harm three to five days after they start having symptoms, that’s
that are worth trying, both for prevention and treatment. when that viral load maximizes, and we can do viral RNA
We want our colleagues and practitioners in other branches testing. There’s a difference between the intact virus (that
of medicine to recognize that there IS something we can causes infection) versus the viral RNA. Those are not the
do to mitigate risk and to decrease the severity of illness same thing. Thus, we test the viral RNA. We want
from COVID-19. In fact, functional medicine is uniquely clinicians to understand the difference between these two
positioned to help patients work with foundational lifestyle things. Additionally, when we do antibody testing, it
factors to improve complex, chronic disease and improve shows exposure and immune response, not immunity. In
their overall health and well-being. order to have people be able to return to work, we need
antibodies demonstrating exposure and immune response,
IMCJ: Do you think that there’s maybe a positive that’s and we also need to see that there is no more viral RNA
going to come out of this, because people are being forced being shed through their respiratory tract. That will give
to as they’re isolated, eat at home and maybe eat a little us confidence, because we do not yet have a true test of
healthier? immunity. The idea that people will walk around with
certificates of immunity is a false perspective. We don’t
Dr Hanaway: That’s true. People now have to eat at home have any testing for immunity.
and to cook on their own. My friend Mark Hyman tells me There is a ‘Wild West’ of testing out there right now.
that (at least up until this point in time) people spend The Emergency Use Authorization (EUA) by the FDA
more time watching cooking shows than they do actually allows tests to be on the market before they’ve actually
cooking. But now, we need to spend time cooking. Again, been approved. There are, unfortunately, labs that are
we can spend time in their kitchens to help them with taking advantage of this and putting less than optimal tests
cooking and determining good foods to eat. That can be a into the marketplace. Thus, we see a significant number of
great opportunity, but we have to capture those false positives and false negatives. We are educating
opportunities. We can’t just assume that they’re going to clinicians to ask the labs to ensure that they deliver high-
happen. We need to educate and walk with our patients in quality, reliable, accurate results?
their learning and understanding so they can apply these
nutritional tools. IMCJ: COVID-19 is something that’s not going to go away
in the next three months, six months, probably going to be
IMCJ: So, shifting gears a little bit, IFM did a webinar on here for a couple of years- how can we participate in group
testing for COVID-19 and maybe just give me some activities and be assured we are not passing the virus but
highlights of what your approach is on the testing side. also not being exposed to it?

Dr Hanaway: Again, the Institute for Functional Medicine Dr Hanaway: There are some fascinating, new innovative
is a non-profit educational organization, so our goal is to tests that are being developed. My colleague, Dr. Helen
educate practitioners to help them to understand what Messier told me last night that there’s now a company in
tools are available, what tests are available, what the results San Jose that’s developing a disposable PCR test; a
mean, and what kinds of testing we should do for each one-time, do-it- yourself test in which the results are

66 Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print Hanaway—Viewpoints