By John Staversky, Certified Clinical Herbalist
By now everyone has heard about COVID-19. But what is it, and what does it look like if you catch it? What stages does an individual with COVID-19 pass through? This blogpost is designed to address these questions and also to shed light on how Traditional Chinese Medicine describes this condition and the stages of this disease (Part 2 of this article). One quick note before we start: the following discussion is intended to provide a base of knowledge to think about COVID-19 in terms of Traditional Chinese Medicine; however, there are no herbal or formula recommendations in this post because consulting a trained TCM practitioner (in consult with a doctor) is the only sane way to go. DO NOT try to self-treat this condition. If you find yourself getting sick (or testing positive for the Corona virus (SARS COV-2)) then contact a doctor right away. Sorry to be so blunt, but this is no joke—consult with a doctor first; consult with an herbalist or acupuncturist if have one, but don’t go it alone. There’s too much at stake, and you are too important to take that kind of risk!
What is COVID-19?: COVID-19 (short for Corona Virus Disease – 2019) is the disease caused by the coronavirus SARS CoV-2. Very similar to SARS CoV-1, which was responsible for the SARS (Severe Acute Respiratory Syndrome) outbreak in 2002-3), this disease starts in the upper respiratory tract with flu-like symptoms and moves down into the lung to cause pneumonia. In severe cases, the airways become so inflamed/plugged up and the lungs become so damaged that the internal organs of the body eventually become starved of oxygen and can eventually fail.
How do you catch it?: COVID-19 is contracted when someone touches a surface contaminated by a viable strand of the SARS CoV-2 virus and then touches a facial orifice (mouth, nose, or eyes). All of the research I have reviewed agrees that COVID-19 is not transmissible through the skin-to-skin contact—the virus must be introduced into the body by other means. As of this writing, there is no consensus on whether or not the Corona virus can also be transmitted by airborne particles; much has been written about how far the virus travels through the air before falling to the ground (as well as how long the virus stays viable outside the body), and although I have not seen any reliable consensus on these two issues, I believe it is the wise course of action to assume that the virus is in fact (1) transmissible via airborne particles and (2) potentially viable on any surface you may come in contact with (e.g. gas pump handles, doorknobs, tomatoes at the market, your Amazon packages) and to take appropriate precautionary measures to avoid becoming infected. In this regard I think of the virus like glitter—it gets everywhere, sticks to everything, and is a royal pain to get rid of.
Hand Washing and Sanitizer. The corona virus is a virus and thus not affected by anti-bacterial soap. What happens with hand washing is that the surfactant in the soap breaks down the lipid sheath encasing the virus so that it is no longer viable. This takes 15-20 seconds to happen (hence the calls to hand wash for 20 seconds—it’s not just an arbitrary number!). Hand sanitizer made with a solution of at least 65% alcohol is necessary to dissolve these lipid sheaths and render the virus inert. Other anti-viral agents (such as vinegar and witch hazel) have not been shown to affect the virus—only alcohol present in the solution in sufficient concentration dissolves these lipid sheaths.
What does it look like if you get COVID-19,?
Category 1: Asymptomatic people: Although it has been estimated by the WHO that up to 70% of the population will eventually be diagnosed/catch COVID-19, many of them will be asymptomatic; that is, they will show no outward signs of the disease and perhaps they will never even know that they had it. But it is important to note here that these asymptomatic people are still carriers of the Corona virus and that they can get other people sick-- this is one of the reasons it is so difficult to contain.
Category 2: “Mild” Illness (i.e. illness that does not require hospitalization): Greater than 80% of the people who contract COVID-19 will come down with an illness much like the flu and will not require medical attention to get better. That being said, this does not mean that the flu won’t be bad—there are numerous anecdotal accounts of people with cases of COVID-19 that, while not requiring hospitalization get absolutely levelled by the other symptoms (e.g. fever, wracking body aches, and shortness of breath so severe that they are winded by walking from the bedroom to the bathroom)… so don’t be fooled by the term “mild illness”—some folks who get this are lucky and won’t “suffer” too much, but COVID-19 can be absolutely awful even while not (strictly speaking) necessitating hospitalization.
Category 3: Illness requiring hospitalization: Less than 20% of those who contract COVID-19 will require hospitalization. Among this population, it is estimated than between 10-20% will be admitted to the ICU because they are having significant (i.e. life threatening) trouble breathing; 3-10% will require intubation, and for 2-5% of those hospitalized, COVID-19 proves fatal.
What are the stages of COVID-19?
COVID-19 starts in the upper respiratory tract. The virus is introduced to the inside of the body through the eyes, nose, or mouth and it travels down the throat and into the lungs. Once in the lungs, the spikes on the virus attach to certain lung receptors, replicate, and release the virus into the body. Once the virus incubates (a period lasting anywhere from 2-14 days), the patient may start to develop symptoms of COVID-19.
The first stage of COVID-19 symptoms look like those of a rather generic acute-onset cold or flu: fever, dry cough, sneezing, runny nose, muscle aches, headaches, and sputum production—so it is hard to tell if the patient has COVID-19 of some other flu-like virus at this time
In stage two of COVID-19, the lung symptoms worsen—so now we start to see dyspnea, wheezing, and shortness of breath along with the symptomology characteristic of stage 1. These new symptoms, from a Western perspective, are the early signs of pneumonia. At this point, a CT scan or X-ray would start to show visible problems in the lung.
In stage three, we get what is known as the cytokine storm. As the virus replicates in the lung (and the pneumonia progresses), the immune system detects its presence and reacts. In some patients, the immune cells hyper-respond and he/she has an auto-immune-like response in which cytokines (inflammatory immunological proteins which are normally present to fight off infections) are produced uncontrollably. These cytokines exacerbate existing inflammation of the airways in the lungs and can lead to Acute Respiratory Distress Syndrome (ARDS)—one way to think about ARDS is that it is the existing pneumonia plus the inflammation caused by the cytokine storm. With ARDS, the lungs become plugged up with a thick, viscous sputum which, combined with severely inflamed airways (bronchi and alveoli) deep within the lungs causes anoxia. That means that sufficient oxygen does not enter the blood to nourish the internal organs. At this point patients require ICU care and possible intubation to keep them alive.
Discussion of TCM diagnoses and treatment principles for COVID-19
In the second part of this post, we will look at COVID-19 through the lens of TCM—that is, how the symptoms and Western diagnoses translate into TCM diagnoses and treatment strategies. As was stated in the introduction, no specific herbal recommendations for self-treatment will be made below as this blog is for informational purposes only.
General aspects of disease prevention:
Good nutrition: Speaking generally, healthy foods will tend to promote healthy outcomes—inputs to avoid are what you would expect: excessive sugar, fat, and processed food; excessive alcohol is also detrimental to the immune system. Also, it is important to drink plenty of fluids. For one, the Corona virus starts in the throat, and sipping warm liquids (especially a warm, mild infusion with garlic (for it’s anti-viral properties)) as often as you can may help to move the virus down from the throat to the stomach where it can be dispatched with by the acid in the stomach. But it is also important just to drink water now, because if and when a fever hits you can ride it out longer if you’re properly hydrated. Fever is the body’s response to invasion by the virus-- your immune system is literally raising the temperature of the internal environment both to (1) optimize the functioning of the immune system and (2) create a less hospitable environment for the virus to replicate. If you’ve been drinking enough water before you get sick (especially if you’re someone who runs hot/presents with heat signs under normal circumstances) then the fever will be more effective at aiding your immune system’s function/killing the invading pathogen.
That being said, I have a couple of comments to make on this subject: first—this is an extraordinarily stressful time on too many levels to count, so just do the best you can to eat well and don’t beat yourself up for an ice cream sundae on Movie Night with your kids—a week of Movie Nights with ice cream sundaes, however, might be pushing it, though! The second note to pass along on this subject is that there is a well-developed literature regarding food as medicine (as in the example of the garlic tea mentioned above). You can research these things on your own, but this is a great thing you can bring up with a trained TCM practitioner and really target your food choices for almost any TCM diagnosis out there (to include those associated with each stage of COVID-19.
Supplements: Vitamin C, Vitamin D, and Zinc are three basic nutrients that are linked with positive outcomes for the immune system:
Vitamin C 1000mg/3x day. Some comments: Vitamin C is water soluble, which for our purposes here means that the body cannot store it up for future use (i.e. you have to take it everyday); also, the body cannot process more than about 2000mg every three hours (unless you get it through an IV). Lastly, taking too much vitamin C will give you diarrhea, so start slow and be aware of your body’s reactions.
Vitamin D: While one cannot really know if there is a vitamin deficiency without bloodwork, in our clinic, we tend to assume most people are Vitamin D deficient (especially when we are spending time cooped up and out of direct sunlight) and start at a dosage level 5000 IU’s/day. The daily dosage can go higher for a set period in people with Vitamin D deficiencies.
Zinc: Zinc has strong anti-viral properties and is known as an immune-system booster. The dosage window for zinc is 15-100mg/day (together with copper in a 15:1 Zn:Cu ratio).
Probiotics: The Chinese data (cited in the WHO report in the bibliography) noted that 5-10% of the patients who came down with COVID-19 also had GI symptoms—nausea/vomiting and diarrhea. Anecdotal evidence from the US is suggesting a higher rate of COVID-19 patients showing these GI symptoms; this points to a correlation between healthy food choices, good digestion, a healthy gut biome, and the reduction in the severity of symptoms associated with COVID-19. Pro-biotics can help with this.
Lymphatic Circulation: The Lymphatic system is a circulatory system which does not have its own pump (like the heart or lungs for their respective circulatory systems). Instead, muscle contractions account for approximately 1/3 of lymph circulation through the body and diaphragmatic breathing accounts for the other 2/3. So it is especially important (especially in the semi-lockdown phase that we’re in as of this writing) to exercise daily. In addition to helping you feel better emotionally and physically, regular exercise also circulates lymph.
Breathing from the diaphragm is also a great booster for the lymphatic system health. This can be achieved through a number of techniques (there are more free videos out there that you can count!). In the clinic we often prescribe a technique called belly breathing. When we teach this technique, we have the client lie down (although sitting or standing works too) and draw in a slow deep breath to a slow count of 5 (or more) by expanding the belly. If you can feel the belly expanding with the breath (as opposed to the chest expanding), then you are using the diaphragm to draw the air into your body successfully. Then exhale slowly, letting the belly deflate.
Qi Gong: Qi Gong is a form of gentle exercises practiced in China for millennia. It is a wonderful way to relax the mind and emotions… and there are also forms of it which specifically tonify Lung Qi and Wei (Defensive) Qi, so it is definitely something worth checking out both for its general overall wellness benefits as well as its potential role in preventing/mitigating the effects of COVID-19 specifically.
TCM and Disease Prevention
In TCM disease theory, a disease either develops over time from imbalances of the internal organs in the body or you contract it because an outside agent invades the exterior layers of the body and then travels down into the interior. COVID-19 is a disease that fits the latter model. There is an outside agent (or external pathogenic factor—in this case the SRS CoV-2 virus) which invades the body’s exterior layers and then moves into the interior layers as it progresses.
Another relevant aspect of TCM theory is that the exterior layer of the body is protected from invasion/sickness by what is called Wei (or Defensive) Qi. At the level of analogy, this is fairly straightforward—the pathogenic factor invades, and the Wei Qi circulates in the exterior layer of the body between the skin and muscles and expels it. So it follows from this that the first line preventative measure in dealing with COVID-19 is to strengthen the Wei Qi using various Qi tonics (herbs/formulas that tonify Qi). It is important to note here because Qi tonics stimulate the immune system that one must be very careful if they have a history of auto-immune disease and to tread with caution, preferably in consult with a trained TCM practitioner (For example, Jade Screen (Yu Ping Feng San) is 65-70% qi tonics and should be used with supervision if there is auto-immune history).
A second strategy for incorporating TCM into one’s preventative routine is to identify pre-existing conditions/weaknesses and address these before one gets sick with COVID-19. On one level, this means drinking enough water, eating well, exercising, and doing what you need to do to grapple with both the anxiety that is natural to feel during a pandemic as well as the emotional disjoint of a “stay-at-home”/semi-quarantine situation we are experiencing now. This is a profound change to our lifestyles that is forcing us to examine patterns of behavior and relationship dynamics that have hitherto gone unnoticed… in other words the auto-pilot has been turned off and that is an enormous upheaval, so honor that—not only for what it is intrinsically but for the connection that emotional well-being has to immunity and disease prevention.
On another level, working with a trained TCM practitioner you can identify pre-existing conditions, address them in terms of TCM diagnoses, and apply treatment strategies accordingly. Here are some examples in the chart below:
Lymphopenia (decrease in lymphocyte count)
Wei Qi Deficiency
Thrombocytopenia (low platelet count)
Various pre-existing conditions (e.g. smoking, asthma, diabetes, obesity, old age, Hx of getting sick etc…)
Various forms of Deficiency (primarily Lung Qi and Kidney Yin in this list, but dependent on differential diagnosis; also overall Qi and Jing deficiency).
Stage 1: Wind-Heat Invasion (Catching the Virus, initial stages of the body trying to fight it off)
In TCM theory, diseases are caused by the invasion of external pathenogenic factors into the exterior layer of the body (the Cou Li space—the space between the skin and muscles). If the body’s Qi (primarily Wei, or Defensive Qi) is stronger than the invading pathogen, then disease does not occur. If, however, the relative strength of the external pathenogenic factor is greater (either due to weakened Wei Qi or an especially virulent pathogen), then the disease will get gain a foothold in the exterior and the patient will show symptoms of a Wind invasion; COVID-19 is what is known in TCM as a warm disease, and even if it starts out as Wind-Cold Invasion, clinically it turns quickly into Wind-Heat invasion.
Clinically, a Wind-Heat invasion is characterized by most of the symptoms seen in the early phase of COVID-19: Fever, (dry) cough, sneezing, and body aches (especially behind the neck, the armpits, and behind the knees). In addition, a hallmark of a Wind-Heat invasion is that it is always “acute onset”, which simply refers to a disease/condition that you catch from the outside (cold or flu) as opposed to something that develops over time in the interior of the body (pathologies of the internal organs such as diabetes, heart disease etc…). The tongue will be red and the pulse should be close to the surface (floating) and rapid.
In TCM, the treatment strategy for dealing with Wind-Heat invasion is to Release the Exterior/Expel the pathogen form the exterior layers of the body.
Stage 2: Damp-Heat in the Lungs (Infection moving from the exterior to the interior)
What happens next with the progression of COVID-19 is that the disease starts to sink into the lungs—the virus moves down into the lungs, attaches to the airways, and begins to replicate. At this point, the body’s immune system continues fighting the disease and we begin to see the symptoms worsen into those associated with the Western diagnosis of pneumonia: the inflammation of the airways worsens and we begin to see dyspnea (wheezing/shortness of breath), severe fatigue, continued fever coupled with severe muscles aches, etc...).
In terms of a TCM diagnosis, this is the beginning of Damp-Heat in the Lungs. As the external pathenogenic factor penetrates into the lungs, it transforms into heat and the result is fever and infection. In the clinic, we look to the tongue and pulse to confirm these observations and analysis of the patient’s presentation: the tongue is red in color (indicating heat) and possibly swollen with a dry, sticky coating. The pulse will be slippery and rapid.
The treatment strategy for this stage of COVID-19 is twofold: first is to transform phlegm and drain it from the body (both by expectoration and through the stool) and to drain heat. Secondly, the disease can be thought of as being trapped between the interior and exterior layers of body; therefore, it may also be useful to use herbs/formulas appropriate for harmonizing the interior and exterior layers of Qi (in order to keep the disease from becoming more firmly/deeply rooted in the interior of the body).
Stage 3: Damp-Cold in the Lungs (worsening pneumonia 🡪 cytokine storm 🡪 ARDS)
If the infection continues to worsen and burrow deeper into the interior layers of the body, we see more inflammation and severe blockage of the airways. We also start to see pulmonary edema—fluid starts to accumulate in the lungs that is sticky, viscous and therefore difficult to expectorate (this is the point at which the cytokine storm may occur, greatly exacerbating the existing inflammation). In terms of TCM, what is happening is that the Damp-Heat is transforming into Damp-Cold in the Lungs. At this point, we see the tongue become paler and swollen and darker in color as the lungs lose their ability to provide sufficient oxygen to the blood. The pulse also becomes weaker and deeper. The phlegm is congealing into nodules that further plug the airways and make breathing severely problematic without medical assistance.
At this point, the TCM treatment strategy is to resolve phlegm, expel cold, and tonify Lung Qi to restore breathing.
Hopefully this article has helped to promote some understanding of COVID-19 and the current situation—what it is and things that you can do to help protect you and your family from this novel turn of events in our lives. Through common sense, good nutrition, supplementation, and the help of one of the many dedicated TCM herbal practitioners out there, you too can mitigate the effects of COVID-19 and get on with healthy living.