The coronavirus outbreak originating in China, and now spreading around the world, has become an increasing concern. As of today, we have 68 confirmed cases in the United States, including our first death in Washington state in a 50-year old male with underlying health issues. On January 31st, the World Health Organization declared the virus a global health emergency. On February 25th, Dr Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases told reporters, “It’s not so much a question of if this will happen anymore, but rather more of a question of exactly when this will happen.” We are likely poised at any moment for a rapid expansion of this novel coronavirus, currently named COVID-19, in a similar manner to Italy whose numbers recently shot up over a week-long period from 7 infected to over 1100.
I have been keeping an eye on the spread of the virus over the past few weeks, and gathered here some information that I hope might answer the following three questions: How worried should we be? What preparations can we make in the next days and weeks, as we watch the virus creep its way ever closer to where our families and communities reside? Are there ways that we can support our immune system and remedies we can have on hand that would be helpful to treat symptoms?
Addressing the last question, I wanted to particularly highlight in this article how effective Chinese herbal formulas can be in treating all phases of viral illness, and share with you some of the strategies being used currently in China. In fact, as of February 10th, The Chinese government announced that all patients with confirmed COVID-19 infection in Wuhan are to use Chinese herbal medicine in combination with Western medicine. Currently doctors of both Western and Chinese medicine are collaborating to treat symptoms, and results reported from Wuhan have been promising (see Resources). We heard similar reports after the SARS epidemic in 2003.
As a long time Chinese herbal practitioner, I have used herbs over and over again to treat viral symptoms, and in my family we have avoided the use of antibiotics for many years. Chinese herbs can be particularly effective for managing respiratory symptoms such as those predominant in the previous SARS and current COVID-19 infections. However, they must be used correctly; formulas must be modified with a change in symptoms, and ideally should be delivered under the care of a qualified Chinese herbalist. But before we talk herbs, let’s address the first two questions.
How worried should we be?
As of today, February 29, 2019, according to official reports there are over 79,000 cases in China, with over 2800 deaths and almost 40,000 recoveries (see Resources). The virus has spread to 46 countries, with China, South Korea, Italy, Japan, and Iran being the hardest hit, but with overall fatalities low at this point. The virus appears to be highly contagious, but with a fatality rate not much higher than the flu. In fact, a recent study posted on February 9th that looked at 1099 patients from 552 hospitals in 31 Chinese provinces showed only a 5% ICU admission rate, and a 1.36% death rate--the equivalent of 1.36 deaths per 100 people with the infection (see Resources). We can compare this to the average fatality rate from influenza at 0.1%, or 1 death per 1000 people.
Rate of contagion is another story. The infection rate of COVID-19 is thought to be on average 2-3 times that of the flu; so if one person gets the virus, they can spread it to between 2-4 people. The majority show symptoms on day 3 after contracting the virus; however, there are also reports of “super spreaders” that can be contagious for days before symptoms emerge, and end up spreading the illness to dozens of other people. In fact, recent studies show that the incubation period can be as long as 24 days. While the first symptom for most (over 85 percent) is a high fever, about twelve percent of those infected do not get fevers and appear to be asymptomatic for 2-14 (and potentially up to 24) days while nevertheless carrying and shedding the virus. For this reason, at this point it is considered largely inevitable that the virus will spread worldwide.
Also for this reason, the true number of cases is almost definitely far larger than the number that have been officially confirmed by lab tests, and the numbers we are seeing reported through standard media outlets. In fact, biomedical experts using epidemiological models suggest that the infection and fatality numbers are likely up to ten times what is being reported (see Resources). Many additional factors affect accurate case reporting from China, including: data being withheld by the Chinese government; shortage of test kits for the virus; agencies not receiving and reporting infections and fatalities quickly enough; hospitals turning away patients due to overwhelm, including lack of quality hospital care and lack of ICU beds; and people infected and dying in their homes.
Overall, like the flu, deaths appear to be highest in those of advanced age (especially over the age of 60), those with preexisting respiratory compromise or illness, and those who are immune-compromised. China has an astonishing 68 percent of men who smoke, and some of the worst air pollution in the world; in some places, pollution is so bad it is the equivalent of smoking a pack of cigarettes a day. Because fatality in COVID-19 is due to respiratory failure, it is thought that these factors might significantly elevate the number of fatalities in China beyond what they would be in other countries where these factors might be much lower. Fortunately for concerned parents, children appear to contract only mild symptoms of the infection if any at all--although of course, there is the question of whether they may be contagious while asymptomatic.
What preparations can we make in the next days and weeks, as we wait for the potentially inevitable virus to creep into our own communities?
While the virus appears to be mild for the majority, the fact that the virus is so contagious means that strong efforts need to be in place to protect those in a weakened immune or health condition. In my family, we have already started to adopt more stringent hand washing, including instructing our teenage daughter to wash her hands in between classes at school. Getting into a habit of carrying around extra disinfectant wipes to wipe down surfaces at the supermarket, gas station, recreation center, and other common public areas of potential infection is helpful. This would include regular wiping down surfaces at home, especially door handles.
We are also starting to refrain from public hand shaking, hugging, and other physical expressions that bring one in close contact with non-family members. Antiviral masks can be worn in highly public and crowded areas, such as airports and especially hospitals. Note that many of these masks have already sold out both in local stores and online; nevertheless it is possible to make your own and there are youtube videos posted online.
I would also advise those over 60, and especially those with a weakened respiratory or immune system, to avoid public places altogether if the virus starts to spread and until rates have significantly died down. Have friends or family leave groceries on your front porch, order online, and stock up now on basics. There appears to be about a three month lapse from initial reports of infection to peak number of infections. This means in China the numbers should be peaking the month of March, so watch for a decline after that. In the United States the first reports started coming out in January, so we might expect our peak to be around the end of April. However, this is obviously only a guess.
On a positive note, many experts believe that COVID-19--like other coronaviruses--will weaken significantly as the weather warms up. Coronaviruses, such as those causing the common cold, tend to be seasonal. Viruses spread through respiratory droplets that are released when an infected person coughs or sneezes--and the droplets are better at staying afloat when the air is dry and cold. When the air is humid and warm, the droplets fall to the ground more quickly, making transmission harder. However, this is only an assumption based on the behavior of other coronaviruses, so public health officials warn to plan for the unexpected and the possibility that it could drag on into the summer.
Are there ways that we can support our immune system and remedies we can have on hand that would be helpful to treat symptoms?
The answer is YES! First and foremost, when it comes to supporting your immune health:
1) Don’t neglect your sleep! Clinical studies show that sleep and the circadian rhythm (normal sleep - wake cycles) exert a strong regulatory effect on the immune function, include a specific role of sleep in the formation of immunological memory. This role appears to be associated in particular with the stage of slow wave sleep. Many people these days do not achieve the stage of sustained slow wave sleep for the periods of time necessary to boost immune health. This is due to stress levels that cause unnatural rises in cortisol. So get your stress levels down too, any way you can.
2) Include immune-modulating supplements into your daily routine, including targeted vitamins and minerals. Refer to the following article “Coronavirus Preparedness Checklist” which was recently put out by Wendy Myers of Myers Detox for recommendations. You can also check out my article "Building Immunity: Seven Powerful Ways".
3) Cut back on carbohydrates (ALL, not just refined) and sugars. Ever since I went on a very low carbohydrate diet of meat and animal-sourced fat, seafood, and vegetables I noticed a dramatic improvement in my immune function. In fact, I haven’t caught a cold or flu virus at all this year despite constant exposures through my family and patients. Remember that fruit is very high in sugar (albeit sugar attached to fiber which is much better than refined sugars) and should generally be eaten sparingly. You can also pay attention to consuming more of the low glycemic fruit, such as blueberries, grapefruit, lemons/limes and avocado and either cut out altogether or eat very little of the high glycemic fruit such as bananas, pineapple, and mangoes.
4) Consider treating with Chinese herbal formulas If you do end up catching COVID-19 (or any other nasty virus for that matter). Here at Denver Community Acupuncture we are stocking herbal formulas based on what our colleagues are using in China. Because herbal formulas may also be in short supply (due to their heavy use in China currently), we will save them for people who are symptomatic and need support. We will need email or phone correspondence with symptoms, and then request friends or family come and pick them up. Please do not show up in clinic if you are symptomatic!
Please be careful not to use antiviral herbs unless you are actually starting to show symptoms! Antiviral herbs according to Chinese medicine are cold and bitter, and if used incorrectly can easily hurt and actually weaken the host, particularly if they have preexisting digestive issues. This includes popular antiviral herbs sold in health food stores, such as Isatis, Coptis, Echinacea and Goldenseal. Also, if used too much or too early (such as for preventive purposes, before the actual onset of symptoms), they can contribute to Damp conditions in the body (see explanation below). This is an example of how mass marketing of herbal medicine without proper training and instruction can actually damage the health of those seeking to self-medicate.
COVID-19 is a respiratory illness, and people in critical care are suffering from pneumonia and fluid buildup in the lungs leading to acute respiratory distress syndrome (ARDS). In China, they are seeing a preponderance of what we call Damp Accumulation and poor water regulation and metabolism over the course of this virus. Therefore most of the herbal formulas currently being used “clear Damp” and support the free flow of water metabolism in the body. Thus the best way to prevent COVID-19 from becoming serious or even lethal, is to clear any preexisting Damp before any viral infection occurs. There are Chinese herbal formulas that can be used--but once again, these should only be taken if actual Damp signs are present. This should be determined with the help of a Chinese herbal practitioner.
Please note, diet is critical here: avoiding “Damp” and “Phlegm” engendering foods can make the difference between progression into pneumonia and no progression. These include: all dairy, all sugar including high glycemic fruit such as mangoes, bananas and pineapple, high carbohydrate diets especially those high in wheat and wheat products, nuts and nut butters, and most especially alcohol. Emphasize cooked vegetable and meat dishes, fish and seafood. Also, do not overeat!
The best way to utilize Chinese herbal formulas for viral illnesses, is to start right away at the first sign of infection, and then CHANGE or modify the formulas as symptoms change. This could mean changing the formula every few days, and sometimes even with a 24 hour period! Please refer to an earlier article I wrote on the use of Chinese herbs in treating viral illness here.
Chinese herbs can be used effectively together with Western medicine, and that is exactly the way they are being utilized in China. Most will have no need to visit a hospital, and Chinese herbs by themselves can be a great support throughout all phases of viral illness, to both decrease the amount of time spent ill, and to prevent more serious complications. Again, please note: do not try and self-diagnose or self-treat with herbs! It is possible to cause damage and complicate viral illness if the wrong herbs are given at the wrong time, particularly in the case of more serious viral illnesses like COVID-19.
Here's a timeline of how symptoms progress among typical patients:
Day 1: Patients run a fever. They may also experience fatigue, muscle pain, and a dry cough. A small minority may have had diarrhea or nausea one to two days before.
Day 5: Patients may have difficulty breathing — especially if they are older or have a preexisting health condition.
Day 7: This is how long it takes, on average, before patients are admitted to a hospital, according to the Wuhan University study.
Day 8: At this point, patients with severe cases (15%, according to the Chinese CDC) develop acute respiratory distress syndrome or ARDS, an illness that occurs when fluid builds up the lungs. ARDS is often fatal.
Day 10: If patients have worsening symptoms, this is the time in the disease's progression when they're most likely to be admitted to the ICU. These patients probably have more abdominal pain and appetite loss than patients with milder cases. Only a small fraction die: the current fatality rate hovers at about 1.36%.
Day 17: On average, people who recover from the virus are discharged from the hospital after 2 1/2 weeks.
The symptom picture in progressive phases of COVID-19 infection typically looks like:
Onset of Illness: fever (mostly low grade), aversion to cold and fear of cold, chills, headache, ticklish throat, soreness of muscles of limbs, no sweat or night sweats, lung CT negative
Onset of illness: fever (could be high or low), aversion to cold, sore and dry throat, dry cough, little mucus, sore and painful muscles in the limbs, weakness, headache, CT scan reveals both lungs to have scattered ground-glass opacity (GGO).
Progressing to Early Stage Pneumonia: fever (more pronounced in the afternoon), alternating chills and fever, cough, bitter taste in the mouth, chest stuffiness, stifling sensation, chest and hypochondriac fullness and distention, irritability, nausea or vomiting, no appetite, weakness, CT scan reveals both lungs to have multiple scattered or large pieces of ground-glass capacity (GGO).
Progressing to Early Stage Pneumonia: low grade fever or absence of fever, dry cough, little mucus, dry and sore throat, fatigue, weakness, poor appetite, chest stuffiness, epigastric distention, nausea or vomiting, loose stool.
Progressing to Pneumonia: Cough, stifling sensation, stuffiness and distention of the chest, asthma and wheezing that worsens with exertion, accelerated breathing, thirst, irritability, reddish yellow urine, CT scan reveals both lungs to have multiple scattered or large pieces of ground-glass opacity (GGO). Fibrotic changes of the lung are visible.
Recovery Phase: Absence of fever, dry cough, chest stuffiness, shortness of breath, shortness of breath upon exertion, dry mouth, weakness.
I personally am not worried as much about the virulence of COVID-19 as the impact that the virus could have on the economy and daily lives of millions of people across our state and country. I think it is important to realize that the lethal impact of the virus is likely far less in the United States than in China for reasons stated above, and that we are well resourced to address any impact that it may have on our society. I wish all of you well in the days, weeks and months ahead, and want you to know that myself and my colleagues are here to support you in whichever way we can.
For daily tracking of COVID-19 world-wide: Worldometer
Webinar on the Coronavirus with Wendy Myers
COVID-19 Preparedness Checklist (including immune boosting supplements)
Research published February 9th analyzing 1099 patients from 552 hospitals in 31 Chinese provinces
"How COVID-19 is Currently Treated in China (2019-nCoV) with TCM" Compiled, Translated by John Chen, Pharm.D., Ph.D., OMD., L.Ac., and Lori Hsu, MTOM, MS
"Building Immunity: Seven Powerful Ways", by Darcy Greenwald, L.Ac
"Resolve Cold and Flu Invasions Quickly with Chinese Herbal Medicine", by Darcy Greenwald, L.Ac