In conjunction with the British Society for Ecological Medicine, the main medical doctors' association practising nutritional and environmental (i.e. ecological) medicine, we've produced immune support guidance specifically for children, teachers and families as kids prepare to return to school.
Multiple sources of evidence suggest that there is no justification for ongoing school closures during the tail of the present Covid-19 pandemic wave. This includes a detailed summary of evidence on the transmission potential and susceptibility of children and other groups to severe disease undertaken by the Royal College of Paediatrics and Child Health, and a major review of the effects of school closures on Covid-19 disease risk and mortality which concluded the evidence of benefit was at best marginal and only when school closures coincided with the peak of infection. Additionally there are genuine concerns that long-term social distancing if applied to reopened schools could lead to significant psychological and emotional harm and damage to children.
UK government guidance for protective measures in education and childcare settings currently proposes a 5 level hierarchy in which efforts are made to minimise contact and mixing “as much as possible….by altering….the environment (such as classroom layout) and timetables (such as staggered break times).”
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Based on the lack of evidence of benefit of such social distancing and the risk of harms, the Alliance for Natural Health (ANH) International and the British Society for Ecological Medicine support the reopening of schools with resumption of normal mixing.
However, we advocate a number of additional precautions be taken to minimise risks to staff and children, as well as to guard against any risk of uncontrolled community infection. These include:
Staff training to help identify Covid-19 symptoms and initiate test, track and trace programme
Shielding of vulnerable adults and children to minimise SARS-CoV-2 infection risk
Provision of guidance for immune support for children, the families of children returning to school and staff.
The present briefing document provides guidance for immune support for both children and adults.
The ANH proposed on 21 May an 11-step strategy for school reopening which is summarised in a 2-page sharable infographic. The ANH is fully in support of the proportionate approach to school reopening as proposed by the Us For Them campaign which attempts to balance the risks and benefits of different options while supporting social justice and equity among children.
The present guidance should be considered in the context of the latest UK government guidance for parents and carers in relation to the reopening of schools.
Nutritional immune support guidance
The key elements of any immune support approach should involve three main considerations:
Maintaining a healthy internal environment of the body – including appropriate nutrition and adequate hydration
Maintaining a healthy external environment – including minimising unnecessary negative stress, healthy social environments and minimising exposure to environmental chemicals
Engaging in healthy behaviours –including adequate and regular outdoor physical activity and adequate sleep quality and quantity.
The present guidance concerns itself primarily with nutritional support. The ANH provides guidance on healthy eating both for children and adults, in its Food4Kids and Food4Health guides, respectively. There is a an adapted version of the adult guide for vegans. This guidance seeks to maintain healthy weight, metabolic and immune function by ensuring reduced intakes of common food allergens, the consumption of diverse, nutrient-dense diets with a minimum of added sugars and highly processed foods, enhancing metabolic flexibility and minimising addiction to processed foods.
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Given the importance of specific micronutrients in maintaining innate immunity and widespread sub-optimal levels of key micronutrients as demonstrated through the rolling UK National Diet and Nutrition Survey, daily supplemental intakes of three micronutrients is strongly recommended to enhance prevention for children and adults in schools and other educational settings where social distancing is not practiced or may be difficult to enforce.
The following daily dosages for food supplements are recommended for each of the respective age groups. These doses have been increased over those previously recommended by the BSEM given additional experience and research results relating to Covid-19. We suggest that many people find the most practical way of consuming these doses is by addition of ascorbic acid to water and then drinking the 'vitamin C water' in divided doses (on its own or in more water) throughout the day and evening (see notes below table).
2,500 milligrams (half a rounded teaspoon of pure ascorbic acid) daily in divided doses
5,000 milligrams (1 rounded teaspoon of pure ascorbic acid) daily in divided doses
7,500 milligrams (1.5 rounded teaspoons of pure ascorbic acid) daily in divided doses
10,000 milligrams (2 rounded teaspoons of pure ascorbic acid) daily in divided doses
*Vitamin C (ascorbic acid) should be taken throughout the day and evening to maintain blood levels. The daily dose of powder can easily be dissolved in warm water which can then be chilled, diluted to taste and taken throughout the day, in divided doses. It can also be taken in tablet or capsule form, for instance in 500 mg and/or 1000mg capsules several times a day. Note: Too much vitamin C may give you loose bowels. This is not an adverse effect but rather a sign that you have taken enough and can reduce the dose slightly.
† Zinc supplements (e.g. citrate, monomethionine forms) should preferably be consumed with main meals that do not contain cereals or grains given these can reduce zinc absorption. Alternatively, zinc gluconate may be consumed between meals in lozenges.
Value for money
Given most countries won't sanction handing out vitamins and minerals to children at the expense of the public purse, we did some UK-specific research on how much it might cost parents to give their kids and themselves what we regard as the three most important micronutrient supplements for immune system support and covid prevention. We looked at products containing vitamins C and D and zinc, selling in three outlet types: major multiples, health stores and online.
The results showed that vitamin C could be purchased per 500 mg dose unit for as little as 2.5 pence, vitamin D for 1.7 pence per 25 mcg (1000 IU) dose unit and zinc for just 0.8 pence per 10 mg dose unit. However the quality between the various products varies hugely. Our advice is to try to take the most natural forms of the supplements, avoid the less well absorbed forms of minerals (e.g. zinc oxide), and consume the least or no non-nutritive additives.
You can download our Excel spreadsheet that includes our analysis. It has three tabs that allow you to access selected vitamin C, vitamin D and zinc containing products, including a list of all the ingredients. We have also provided in the spreadsheet our subjective analysis of the quality of the products based on nutrients forms and composition, using a 3-step grading system from good, to intermediate, to not recommended, especially for children.
You'll note that based on our own subjective assessment of quality based on label claimed composition, the lowest quality products were by and large found in the major multiples, with the highest quality products being found in health stores - and, in among the Wild West of the internet, also online.
However, you look at it, these three micronutrients can provide very low cost prevention in the face of concerns over SARS-CoV-2 infection.