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available in seven minutes. I know that there are certain Dr Hanaway: Well, we don’t know about the antigenic
airlines that are doing testing before they have people get drift of the SARS coronavirus in terms of how it may shift
on the plane. I know that there are projects being developed and change. We don’t know if this will become endemic,
by the American Academy of Family Physicians and like influenza. But like influenza, as with SARS-CoV-2,
others that recommend the viral RNA test be done on our focus is to be able to optimize the overall health of the
patients before pre-op. This constitutes an admission individual, to decrease the severity of symptoms, and to
ticket to the hospital, not that they are immune but rather decrease the long-term sequelae, the downstream effects
a test to determine that they actually do not have the virus. of having been infected. All crises provide opportunities.
There is a difference between the sensitivity of a test What do we have to learn from this and how can we do
and the positive predictive value. For example, if you live this differently?
somewhere with a 1% prevalence of the SARS-CoV-2 In a public health perspective, we’re learning what we
virus, e.g. middle America, even a test with 95% good need to do to prepare. From a clinical perspective, we
sensitivity and specificity will have significant false recognize that people who have complex chronic disease
positives when we measure a population. If we were to are the ones who are at greatest risk for the morbidity and
measure people in line for a football game, we get five mortality of COVID-19. Knowing this, and using risk as a
times as many false positives as true positives. factor to help motivate individuals, we have an opportunity.
But, if the prevalence in a population is 25%, such as Our colleagues in other branches of medicine may not feel
the recent data from New York CIty, and we do the same test that they have a lot of ‘tools in their toolkit’. With
in a similar group of people waiting in line for a football functional medicine we say, “Here are a number of tools to
game, there will be five times as many people who have true help these patients. Our patients are out there, concerned
positives than false positives. Here I’m talking about the about getting infected. We have a significant opportunity
public health perspective, not the clinical perspective. We to decrease their risk of illness, decrease their severity of
have to understand the prevalence of the SARS-CoV-2 in illness, and to improve them in recovery. This is a great
the population because it will make a difference in how we opportunity. We are currently reaching out to various
apply testing to make clinical decisions. healthcare systems and letting them know about the tools
In consideration of testing we break it down differently that we have available.
between the determination of risk for each person: the We encourage them to apply these tools first to the
time course of exposure of symptoms, of resolving healthcare workers on the front lines. Help them to be able
symptoms or in recovery. We see people in all three to mitigate the risk, and assess how it works? We don’t
phases, and will make different recommendations to have real-world data yet. We don’t have randomized
people whether they’re exposed, whether they have control trials. We need to look at real world medicine and
symptoms, or whether they’re showing symptoms after ask, “What works and what doesn’t work?” Thus, we need
having the virus infection. to gather the evidence to be able to understand which of
We find that recovery from COVID-19 can be these components work the best. The Institute for
complicated. There are issues that persist in a number of Functional Medicine is excited to be a part of the journey
people that relate to the pulmonary system and difficulty toward health and healing,
breathing or the mitochondria and energy production or
the vasculature and micro clotting, or even the brain with
‘brain fog’ and PTSD. There are many different factors that
we’ll be dealing with on the recovery side as well. Again,
functional medicine looks at the whole person and is
working to understand the mechanism of action of the
virus infection. We’re targeting treatments, low-risk
treatments using food, using other lifestyle factors, using
well-researched botanicals and nutraceuticals to be able to
guide our treatment recommendations, in prevention,
treatment and recovery.

IMCJ: To wrap up, do you think this is an opportunity to
educate your conventional healthcare practitioners who
really didn’t understand functional medicine? Because it
seems that a functional medicine approach can be a much
better long-term solution as opposed to just being able to
create a pill or vaccine that’s going to cure the particular
case of COVID, but next year, maybe it mutates and the
pharmaceutical solution does not work?

Hanaway—Viewpoints Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print 67