Delighted to welcome Tommy who will be at Healthy Heights on Thursday - Tommy has been involved in Health and Nutrition Retail Management since 1985, and as a Qualified Nutritionist since 2000; starting his career in New York, United States and continuing his deep passion in the last decade in Sydney, Australia.  So he understands first hand the importance of nutritious food, high quality supplements, and how they can make a monumental change to your life and completely overhaul your health and well-being.  

Tommy has designed his own range of high quality sports and nutritional powders, with more than 30 years in the field of Nutrition, he is a well known and respected practitioner with peers and customers.   His knowledge and love of health promotion with kindness and intention to improve the individuals journey, has earned him the respect of all who encounter him....... a great gain for our little apothecary...

www.healthaddicts.com.au

Here are a few suggestions that may be particularly helpful:

1. Echinacea is a popular herb that is traditionally used to boost the immune system and prevent viral infections. Some studies have suggested that echinacea may be effective against certain viruses, such as the common cold and flu viruses.
2. Elderberry is a berry that is rich in antioxidants and is traditionally used to boost the immune system and prevent viral infections. Some studies have suggested that elderberry may be effective against certain viruses, including the influenza virus.
3. Ginger is a warming herb that is commonly used to improve digestion and boost the immune system. It may also help alleviate symptoms of colds and flu, such as cough and sore throat.
4. Garlic is a well-known herb that is used for its antibacterial and antifungal properties. It may also have immune-boosting effects and help alleviate symptoms of colds and flu.
5. Licorice root is a traditional herb that is used for its anti-inflammatory and immune-boosting properties. It may also help alleviate symptoms of colds and flu, such as cough and sore throat.
6. Thyme is an herb that is commonly used in cooking, but it also has medicinal properties. It may help alleviate symptoms of respiratory infections, such as cough and congestion.
7. Oregano is an herb that is rich in antioxidants and has anti-inflammatory and antibacterial properties. It may also help alleviate symptoms of respiratory infections, such as cough and congestion
8. Lemon & Ginger: Both lemon and ginger are rich in antioxidants and have anti-inflammatory properties that may help support the immune system and alleviate symptoms of respiratory infections.
9. Turmeric contains a compound called curcumin, which has potent anti-inflammatory and antioxidant properties that may help support the immune system and reduce inflammation in the body.
10. Elecampane is traditionally used to treat respiratory infections and may have antimicrobial and anti-inflammatory properties that may help alleviate symptoms of respiratory infections.
11. Motherwort is traditionally used to support the cardiovascular system and may also have antiviral properties that may help fight viral infections.
12. Marshmallow root contains compounds that may help soothe irritated mucous membranes in the respiratory tract and alleviate symptoms of coughs and sore throats.
13. Myrrh is a resin that is traditionally used to treat infections and has been shown to have antimicrobial properties that may help fight viral infections.
14. Berberine is a compound found in several plants, including goldenseal and Oregon grape, that has been shown to have antimicrobial and antiviral properties.
15. Phellodendron bark contains compounds that have been shown to have antiviral and antimicrobial properties.
16. N-acetylcysteine (NAC): NAC is a nutrient that may help reduce inflammation in the body and support the immune system.  Traditionally used to treat pneumonia.
17. Vitamin C is an essential nutrient that has been shown to have immune-boosting properties and may help reduce the severity and duration of colds and flu.
18. Horseradish contains compounds that may help support the immune system and alleviate symptoms of respiratory infections, such as congestion.
19. B vitamins are essential nutrients that play a role in many physiological processes, including immune function.
20. Zinc is an essential mineral that has been shown to have antiviral properties and may help reduce the severity and duration of colds and flu.
21. Elderflower is traditionally used to treat respiratory infections and has antiviral and anti-inflammatory properties. A bitter cooling herb.
22. Yarrow is traditionally used to treat respiratory infections and may has antimicrobial and anti-inflammatory properties.  A bitter cooling herb.
23. Peppermint is traditionally used to alleviate symptoms of respiratory infections, such as cough and congestion, and its a cooling bitter herb and helps to reduce symptoms of flu and fever as well as having antimicrobial properties.
24. Catnip: Catnip is traditionally used to treat respiratory infections and has antiviral and anti-inflammatory properties.

It is also important to talk to your healthcare provider before using any herbs or supplements, particularly if you are pregnant, nursing, or taking any medications

Lion's Mane mushrooms contain bioactive compounds such as beta-glucans, polysaccharides, and hericenones, which have been found to have a wide range of potential health benefits. These include boosting cognitive function and memory, reducing inflammation, improving digestive health, and supporting the immune system.
Studies have shown that Lion's Mane mushrooms may stimulate the growth of nerve cells and enhance the production of nerve growth factors, which can help protect and regenerate brain cells. This makes it a potentially promising natural remedy for neurological conditions such as Alzheimer's disease and Parkinson's disease.

Lion's Mane mushrooms are also rich in antioxidants, which can help reduce oxidative stress and inflammation in the body. This can lead to improved cardiovascular health, reduced risk of cancer, and enhanced overall immunity.

Overall, Lion's Mane mushrooms are a nutrient-dense superfood that may offer numerous potential health benefits. However, more research is needed to fully understand the mechanisms behind these benefits and to determine the optimal dosages and methods of consumption.
 
There has been growing interest in the potential health benefits of Lion's Mane mushrooms, and several studies have been conducted to investigate these claims. Here are some examples of the research on Lion's Mane:

1. Cognitive function: Rossi, Paola, et al. "Dietary supplementation of lion’s mane medicinal mushroom, Hericium erinaceus (Agaricomycetes), and spatial memory in wild-type mice." International Journal of Medicinal Mushrooms 20.5 (2018).
2. Dementia: Datsen, Sophia. "Lion’s mane mushroom: A fungus to remember, a novel venture into dementia therapy." (2022).
3. Degenerative disease: Kochoni, Emeric, and Vincent Ezin. "Lion’s Mane (Hericium erinaceus)." Mushrooms: Nutraceuticals and Functional Foods(2023).
4. Neurodegenerative diseases: Parkinsons: Kumar, Satish. "Evaluation of Hericium erinaceus (Lion’s Mane) mushroom strains on different substrates." (2022).
5. Immune system: Panda, Sujogya Kumar, and Walter Luyten. "Medicinal mushrooms: Clinical perspective and challenges." Drug Discovery Today 27.2 (2022): 636-651.
6. Digestive health: Tada, Hiroyuki, et al. "Hericium erinaceus ethanol extract and ergosterol exert anti-inflammatory activities by neutralizing lipopolysaccharide-induced pro-inflammatory cytokine production in human monocytes." Biochemical and biophysical research communications 636 (2022): 1-9.
7. Cancer: Wong, Jack Ho, et al. "Mushroom extracts and compounds with suppressive action on breast cancer: Evidence from studies using cultured cancer cells, tumor-bearing animals, and clinical trials." Applied Microbiology and Biotechnology 104 (2020): 4675-4703.
   
   

Overall, these studies suggest that Lion's Mane mushrooms may have a range of potential health benefits, including improving cognitive function, protecting against neurodegenerative diseases, boosting the immune system, promoting digestive health, and potentially reducing the risk of cancer. However, more research is needed to fully understand the mechanisms behind these benefits and to determine the optimal dosages and methods of consumption.
 
How to use Lions Mane:
 
Lion's Mane mushroom can be used in a variety of ways and can be consumed on its own or combined with other supplements or foods. Here are some examples of how Lion's Mane can be used:

1. Dietary supplement: Lion's Mane mushroom is available as a dietary supplement in the form of capsules, powders, and tinctures. It can be taken alone or combined with other supplements to enhance its potential health benefits.
2. Coffee and tea: Lion's Mane mushroom powder can be added to coffee or tea to create a "mushroom coffee" or "mushroom tea." This can provide an energy boost and improve cognitive function.
3. Smoothies: Lion's Mane mushroom powder can be added to smoothies to boost their nutrient content and provide potential health benefits.
4. Recipes: Lion's Mane mushroom can be added to a variety of recipes, such as soups, stews, and stir-fries. It has a mild, nutty flavor and a firm, meaty texture that can make it a good substitute for meat in vegetarian or vegan dishes.
   
   

Other mushrooms: Lion's Mane mushroom can be combined with other mushrooms, such as Reishi, Chaga, and Cordyceps, to create a blend of mushrooms with potential health benefits. This blend is sometimes referred to as a "mushroom complex" or "adaptogenic mushroom blend."

We recommend adding one scoop of powdered Lion's Mane Powder Mix into your favorite mug and mixing with hot water or a non-dairy milk, before adding in your morning tea or coffee to start your day with purpose and focus.

Overall, Lion's Mane mushroom can be used in many different ways to provide potential health benefits. It is important to follow the recommended dosage and consult with a healthcare professional before taking any supplements.

MAKE A SHAKE : Blueberries, beets and a brain boost, great for students.
INGREDIENTS

•  1 banana
•  ½ cup beetroot powder
• 1 cup frozen blueberries
• Scoop of Cacao
• 1-2 tsp Lions Mane Powder
• Acai (frozen or powder)
• Tbsp of MCT
• 1 cup non-dairy milk

PREPARATION
Mix all ingredients in a blender, blend until smooth!
 
 
Compiled by Maxine White April 2023 for educational purposes only
 
​

Pathophysiology

In general we develop immunity to disease in two ways:

Primary Infection:  Pathogenic infectious agents stimulating a host immune system response (humoral and cell mediated immunity) that mitigates pathogenic infection including antibody production that promotes recovery and subsequent acquired immunity.

Vaccination: Exposes the body to antigens that mimic disease causing pathogens, stimulating adaptive immunity and memory of the antigen without causing the disease.  The process of acquiring vaccine immunity is referred to as immunisation.

Treatment RecommendationsCore RecommendationsHigh Bioavailability Zinc with Vitamin C
Zinc and vitamin C to support the development, function and mediation of immune cells required to strengthen the immune response and enhance vaccine efficacy.
Mechanism of Action/Clinical Research:

• Zinc is involved in several aspects of immunological function, including the development, function and mediation of immune cells such as neutrophils, monocytes and natural killer (NK) cells, as well as the development of acquired immunity and T lymphocyte function[62]; which are important processes for infection prevention and maintaining vaccine immunity.[63]
  • A prospective longitudinal study involving 208 children aged between 7 months to 15 months found a positive association between serum zinc levels and tetanus vaccine titres, indicating that zinc status may enhance immunological memory.[64]
• Vitamin C supplementation has been shown to reduce the duration and severity of infections[65] and is increasingly efficacious when combined with zinc, with deficiencies of vitamin C and zinc both severely compromising immune responses.[66]
• Vitamin C stimulates white blood cell production and function, enhances NK cell activity and chemotaxis, supports clearance of spent neutrophils from sites of infection, increases serum levels of antibodies, and augments lymphocyte differentiation and proliferation;[67] facilitating innate and adaptive immune responses necessary for acquiring immunity.
  • Studies have shown that experimentally induced vitamin C deficiency leads to impaired cellular and humoral immune response.[68]
  • Vitamin C supplementation of 200 mg/d administered for one to three months was shown to increase IgG and IgM serum levels and improve humoral immune response in the ageing population.[69]

Vitamin D3
Vitamin D to modulate innate and adaptive immunity, necessary to illicit a strong immune response to acquire vaccine immunity and increase host resistance to infection.
Mechanism of Action/Clinical Research:

• It is well known that vitamin D plays an important role in regulating immune function, with deficiency impacting the activity of T regulatory (Treg) cells[70],[71] and Th cells[72], as well as the production of antibodies and regulation of dendritic cell function.[73]
• Vitamin D enhances the adaptive immune response by increasing the differentiation of monocytes to macrophages and stimulating white blood cell proliferation, essential to the neutralisation of viral infections.[74]
• With receptors expressed on a wide variety of cell types, vitamin D is involved in the modulation of activated T and B lymphocytes, necessary for acquired immunity.[75]
  • A retrospective study involving 200 patients with chronic kidney disease who had undergone hepatitis B vaccination found that patients with vitamin D deficiency <10 ng/mL (equivalent to 25 nmol/L) demonstrated lower seroconversion rates and antibody formation compared to patients with higher vitamin D status.[76]

Select a probiotic formula that corresponds to the patient’s age.
For adults and children over 12 years:
​Mechanism of Action/Clinical Research:

• Probiotics induce cellular immunity in phagocytic and NK cells, and promote IgA secretion into saliva to enhance vaccine effects. Additionally, probiotic metabolites, such as short-chain fatty acids (SCFAs), and the peptidoglycan components of probiotics, exert benefits on the host gut epithelium and microbiota by modulating the immune function.[77]
• Lactobacillus paracasei administration has been found to increase the length of time a vaccine is effective.[78]
  • A meta-analysis of randomised control trials found that probiotic interventions, including Lactobacillus paracasei, administered for 2 to 28 weeks improved seroconversion and seroprotection rates to influenza vaccines (including H1N1, H3N2 and B strains).[79]
• Studies have demonstrated Lactobacillus plantarum (HEAL9), Lactobacillus paracasei (8700:2) and Lactobacillus rhamnosus (LGG®) all have the capacity to induce IL-10, a key anti-inflammatory and immunoregulatory cytokine, which is expressed by Tregs and Th2 cells.[80]
• LGG® has been shown to protect against viral infection, including the common cold and influenza, by stimulating respiratory NK cell activity, and up-regulating antiviral interferon gamma (IFN-γ).[81],[82]
  • A clinical trial involving 898 participants who were administered 500 million colony forming units (CFU)/d each of HEAL 9 and 8700:2 for 12 weeks revealed a 30% reduction in the incidence of recurring colds and an 18% decline in analgesic use compared to placebo.[83]
  • A randomised, parallel, double-blind, placebo-controlled study involving 272 subjects supplemented with either 500 million CFU each of HEAL9 and 8700:2 or placebo for 12 weeks demonstrated a 28% reduction in the duration of the common cold and a reduction in total symptom scores by 24%.[84]
• L. plantarum (HEAL9) and L. paracasei (8700:2) have been shown to stimulate the innate immune response.[85]

​References
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[94] Jungersen M, Wind A, Johansen E, Christensen JE, Stuer-Lauridsen B, Eskesen D. The science behind the probiotic strain Bifidobacterium animalis subsp. lactis BB-12®. Microorganisms. 2014 Mar;2(2):92-110.
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This document discusses the mechanisms of action of a number of different botanical and nutraceutical agents. These agents can be considered as immunoadjuvants, defined as substances that act to accelerate, prolong, or enhance antigen-specific immune responses by potentiating or modulating the immune response.[1]

A coronavirus such as SARS-CoV-2 can be deadly because of its ability to stimulate a part of the innate immune response called the inflammasome, which can cause uncontrolled release of pro-inflammatory cytokines, leading to cytokine storm and severe, sometimes irreversible, damage to respiratory epithelium.[2] The SARS-CoV-2 virus has been shown to activate the NLRP3 inflammasome.[3,4] 

A 2016 review article[5] entitled “Natural compounds as regulators of NLRP3 inflammasome-mediated IL-beta production” notes that “resveratrol, curcumin, EGCG [epigallocatechin gallate], and quercetin are potent inhibitors of NLRP3 inflammasome-mediated IL-1beta production, typically acting at more than one element of the involved pathways. However, it should be noted that these polyphenols have an even much broader biological effect, as they influence a variety of pathways.” For example, these polyphenols modulate NF-kB upregulation, which is useful to counteract the COVID-19 ’hyper-inflammation.[6]

A preprint released on March 23, 2020, identified the ability of plant bioactive compounds to inhibit the COVID-19 main protease (Mpro),[7] which is necessary for viral replication. There is much excitement surrounding the recent identification of Mpro, and it is a current potential pharmaceutical drug target. Kaempferol, quercetin, luteolin-7-glucoside, demethoxycurcumin, naringenin, apigenin-7glucoside, oleuropein, curcumin, catechin, and epicatechin-gallate were the natural compounds that appeared to have the best potential to act as COVID-19 Mpro inhibitors. Though further research is necessary to prove their efficacy, this study provides the biologic plausibility and mechanistic support (SARS-CoV-2 protease inhibition) to justify their use.

For these reasons, we recommend the following compounds, at standard dosages, to prevent activation of the NLRP3 inflammasome, to decrease NF-kB activation, and to potentially inhibit SARS-CoV-2 replication. There is no literature to support a regimen of a single vs. multiple agents. Our recommendation is to use higher dosing and/or multiple agents when patient contextual factors (e.g., patient desire, pre-existing inflammation, multiple co-morbidities, higher risk, etc.) and/or therapeutic decision-making warrant such use.

Recommended Interventions

QUERCETIN

Quercetin has been shown to have antiviral effects against both RNA (e.g., influenza and coronavirus) and DNA viruses (e.g., herpesvirus). Quercetin has a pleiotropic role as an antioxidant and anti-inflammatory, modulating signaling pathways that are associated with post-transcriptional modulators affecting post-viral healing.[8]

Mechanism(s) of action against non-COVID-19 viruses
Promote viral eradication or inactivation:[9],[10],[11],[12],[13]
•Inhibition of viral replication
Favorably modulate viral-induced pathological cellular processes:
Modulation of NLRP3 inflammasome activation[5],[14],[15]
Mechanistically promote resolution of collateral damage and restoration of function:
Modulation of mast cell stabilization (anti-fibrotic)

CURCUMIN

Curcumin has been shown to modulate the NLRP3 inflammasome,5 and a preprint suggests that curcumin can target the SARS-CoV-2 main protease to reduce viral replication.18

Mechanism(s) of action against non-COVID-19 viruses
Favorably modulate viral-induced pathological cellular processes:
Modulation of NLRP3 inflammasome activation[5],[19],[20],[21]

EPIGALLOCATECHIN GALLATE (EGCG)

Green tea, in addition to modulating the NLRP3 inflammasome and, based on a preprint, potentially targeting the SARS-CoV-2 main protease (Mpro)7 to reduce viral replication, has also been shown to prevent influenza in healthcare workers.28

Mechanism(s) of action against non-COVID-19 viruses
Favorably modulate viral-induced pathological cellular processes:
Modulation of NLRP3 inflammasome activation[5],[28],[29]

N-ACETYLCYSTEINE (NAC)

N-acetylcysteine promotes glutathione production, which has been shown to be protective in rodents infected with influenza. In a little-noticed six-month controlled clinical study enrolling 262 primarily elderly subjects, those receiving 600 mg NAC twice daily, as opposed to those receiving placebo, experienced significantly fewer influenza-like episodes and days of bed confinement.[36]
Mechanism(s) of action against non-COVID-19 viruses:[36]Favorably modulate cellular defense and repair mechanisms:
Hypothetical: repletion of glutathione and cysteine
Outcomes data supporting their mitigating effects on illness from other viral strains
Reduce progression from colonization to illness
Reduce the severity and duration of acute symptoms

RESVERATROL

Resveratrol, a naturally occurring polyphenol, shows many beneficial health effects. It has been shown to modulate the NLRP3 inflammasome.[5] In addition, resveratrol was shown to have in vitro activity against MERS-CoV.[43]

Mechanism(s) of action against non-COVID-19 viruses
Favorably modulate viral-induced pathological cellular processes
Modulation of NLRP3 inflammasome activation[5]
Outcomes data supporting their mitigating effects on illness from other viral strainsMERS-CoV[43]
Influenza[44],[45]

VITAMIN D

Activated vitamin D,1,25(OH) D, a steroid hormone, is an immune system modulator that reduces the expression of inflammatory cytokines and increases macrophage function. Vitamin D also stimulates the expression of potent antimicrobial peptides (AMPs), which exist in neutrophils, monocytes, natural killer cells, and epithelial cells of the respiratory tract.[54] Vitamin D increases anti-pathogen peptides through defensins and has a dual effect due to suppressing superinfection. Evidence suggests vitamin D supplementation may prevent upper respiratory infections.[55] However, there is some controversy as to whether it should be used and the laboratory value that should be achieved. Research suggests that concerns about vitamin D (increased IL-1beta in cell culture) are not seen clinically. The guidance we suggest is that a laboratory range of >50 and < 80ng/mL serum 25-hydroxy vitamin D may help to mitigate morbidity from COVID-19 infection.

Mechanism(s) of action against non-COVID-19 viruses[55],[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76],[77],[78]

Favorably modulate cellular defense and repair mechanisms:
Activation of macrophages
Stimulation of anti-microbial peptides
Modulation of defensins
Modulation of TH17 cells
Favorably modulate viral-induced pathological cellular processes:
Reduction in cytokine expression
Modulation of TGF beta
Outcomes data supporting their mitigating effects on illness from other viral strains
Reduce progression from colonization to illness Reduce the severity and duration of acute symptoms and complications

VITAMIN A
Vitamin A is a micronutrient that is crucial for maintaining vision, promoting growth and development, and protecting epithelium and mucus integrity in the body. Vitamin A is known as an anti-inflammation vitamin because of its critical role in enhancing immune function. Vitamin A is involved in the development of the immune system and plays regulatory roles in cellular immune responses and humoral immune processes through the modulation of T helper cells, sIgA, and cytokine production. Vitamin A has demonstrated a therapeutic effect in the treatment of various infectious diseases.[95]

Mechanism(s) of action against non-COVID-19 viruses [95],[96]Favorably modulate cellular defense and repair mechanisms:
Modulation of T helper cells
Modulation of sIgA
Favorably modulate viral-induced pathological cellular processes:
Modulation of cytokine production
Outcomes data supporting their mitigating effects on illness from other viral strainsNo data available

ELDERBERRY

Elderberry (Sambucus nigra) is seen in many medicinal preparations and has widespread historical use as an anti-viral herb.[103] Based on animal research, elderberry is likely most effective in the prevention of and early infection with respiratory viruses.[104] One in-vitro study reported an increase in TNF-alpha levels related to a specific commercial preparation of elderberry[105] leading some to caution that its use could initiate a “cytokine storm.” However, these data were not confirmed when the same group performed similar studies, which were published in 2002.[106] Therefore, these data suggest it is highly implausible that consumption of properly prepared elderberry products (from berries or flowers) would contribute to an adverse outcome related to overproduction of cytokines or lead to an adverse response in someone infected with COVID-19.

Mechanism(s) of action against non-COVID-19 viruses[103],[107],[108],[109],[110],[111],[112]
Favorably modulate cellular defense and repair mechanisms
Favorably modulate viral-induced pathological cellular processes
Outcomes data supporting their mitigating effects on illness from other viral strainsNo data available

PALMITOYLETHANOLAMIDE (PEA)

PEA is a naturally occurring anti-inflammatory palmitic acid derivative that interfaces with the endocannabinoid system. There was a significantly favorable outcome in five of six double blind placebo-controlled trials looking at acute respiratory disease due to influenza.[115] Dosing was generally 600 mg three times daily for up to three weeks. There are multiple mechanisms of action associated with PEA, from inhibition of TNF-alpha and NF-kB to mast cell stabilization. In influenza, it is thought that PEA works by attenuating the potentially fatal cytokine storm.

Mechanism(s) of action against non-COVID-19 viruses[115]
Favorably modulate cellular defense and repair mechanisms
Favorably modulate viral-induced pathological cellular processes

VITAMIN C

Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C accumulates in phagocytic cells, such as neutrophils, and can enhance chemotaxis, phagocytosis, generation of reactive oxygen species, and ultimately microbial killing. Supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections.[120] Vitamin C has been used in hospital ICUs to treat COVID-19 infection.

Mechanism(s) of action against non-COVID-19 viruses [120]
Favorably modulate cellular defense and repair mechanisms
Favorably modulate viral-induced pathological cellular processes

ZINC
Zinc contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. There is also evidence that it suppresses viral attachment and replication. Zinc deficiency is common, especially in those populations most at risk for severe COVID-19 infections, and it is challenging to accurately diagnosis with laboratory measures. Supplementation with zinc is supported by evidence that it both prevents viral infections and reduces their severity and duration. Moreover, it has been shown to reduce the risk of lower respiratory infection, which may be of particular significance in the context of COVID-19.

Mechanism(s) of action against non-COVID-19 viruses120,121,122,123,124,125,126,127
​Favorably modulate innate and adaptive immune system
Favorably modulate viral-induced pathological cellular processes, attachment, and replication

www.ifm.org/news-insights/the-functional-medicine-approach-to-covid-19-virus-specific-nutraceutical-and-botanical-agents/

This resource is only intended to identify nutraceutical and botanical agents that may boost your immune system. It is not meant to recommend any treatments, nor have any of these been proven effective against COVID-19. None of these practices are intended to be used in lieu of other recommended treatments. Always consult your physician or healthcare provider prior to initiation. For up-to-date information on COVID-19, please consult the Centers for Disease Control and Prevention at www.cdc.gov.