Coronavirus Part 2: What are the symptoms, and what can you do?
4/2020
We are in the thick of the COVID-19 pandemic which is yet to peak. There is a lot of uncertainty and fear, as the media and people’s minds are occupied by numbers (how many diagnosed, how many dead, how many ventilators needed but not available). Not enough information is out there on what we can do.
Wuhan China is my hometown. I have watched closely since the coronavirus broke out there. I have collected and sorted through lots of information, both truths and myths. I hope to find reliable information and practical tips on what we can do to minimize the risk of infection and to treat it when you suspect you have the symptoms.
I shared what I know with my patients and friends in two emails. One friend suggested that I post the emails on my blog. Here's the second email discussing the symptoms and pathology of COVID-19 and ways you can treat it.
Dear Patients,
First，thank you all for the warm feedback and kind words since my last email. It tells me that I am you doing something useful. I apologize if I have not replied to each of your emails. But if you have questions, I will get back to you as soon as I can.
Several patients asked me how many pills of Yu Ping Feng they should take for prevention. The answer is half of the suggested dose on the bottle. Many brands contain small teapills and recommend 8 pills, 3 times a day. In such case, I recommend taking 6 teapills, 2 times a day, for prevention.
As it’s important to stay calm and have a plan, in this email I will break down the prevention and treatment plans in steps and discuss what to do in each stage.
Step 1: Minimize exposure to the virus.
This can be achieved by social distancing, shelter in place, minimizing trips, wearing facemask and using gloves or disinfecting wipes when outside home, etc. This can reduce your risk substantially. On both societal and personal levels, this is most important.
Step 2: Minimize the number of virus particles entering the lungs.
What if you are still exposed to virus after following the first instruction? No worries!
Here is a fact many people don’t know: one viral particle does not make you sick. You have to have sufficient numbers of virus entering the respiratory tract to cause diseases. Therefore, wash your hands, gargle the mouth, rinse the nose and wash the face/eyes when you return from trips. This will reduce the number of virus entering your lungs.
Step 3: Strengthen your immunity.
As I mentioned in my last email, you can improve your immunity with supplements and herbal medicine. Let me share two anecdotal accounts about Yu Ping Feng San (Jade Screen formula). In a recent interview, Dr. Wu Xia, a specialist in respiratory medicine and Chinese medicine who treated COVID-19 patients in Wuhan stated that she and her colleagues took Yu Ping Feng San to improve immunity and prevent infection. I also have a patient whose mother lives in upper state New York. She’s had respiratory infections leading to pneumonia or bronchitis every winter for years. Two years ago I told my patient about Yu Ping Feng as a preventative measure. I suggested her mom starting this in the fall and continuing for several months until early spring. Since she adopted this approach, she hasn’t had respiratory infections.
Many other things are important for immunity too. I can’t stress enough the importance of eating healthy, a relaxed mind and good sleep in strengthening immunity.
If you do these, you will most likely be among the 80-86% lucky people (depending on the source of information) who have no symptoms or mild symptoms when infected with the novel coronavirus.
Before we go onto step 4, let’s discuss the role of immunity and the characteristics of COVID-19 in layman’s terms.
Why is immunity important for fighting virus?
This is a no brainer. Differing levels of mmunity determines why some patients have only mild to moderate symptoms and recover within 5 to 7 days, while others go into a “cytokine storm” and sometimes organ failure.
I like to make this analogy. Strong immunity is like a German shepherd or golden retriever. It is strong, confident and gentle. When there is a threat, it can defeat the enemy and finish the battle quickly. Weak immunity is like a little Chihuahua. It’s weak, insecure and hyperactive. It doesn’t fight well, so it tends to overreact and bark unnecessarily.
If you have a German shepherd immunity, you can defeat the virus quickly. If you have a Chihuahua immunity, your immunity can be exhausted easily and go into a hyperactive mode. Sometimes it is forced to launch the last battle against enemies at the cost of self-destruction. That can lead to cytokine storm and organ failures.
What are the common COVID-19 symptoms?
I am quoting word by word the clinical summary of an ER doctor in New Orleans who has seen several hundred COVID-19 patients.
“2-11 days after exposure (day 5 on average) - flu-like symptoms start. Common are fever, headache, dry cough, myalgia (back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
Day 5 - increased shortness of breath, and bilateral interstitial pneumonia from direct viral damage to lung parenchyma.
Day 10 - Cytokine storm leading to ARDS (acute respiratory distress syndrome) and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea.”
What do we know about COVID-19 pathology?
There are many aspects that make this coronavirus different from others. I will mention a few that I consider important, especially in informing the treatments.
This virus appears to affect the lower respiratory tract rather than upper respiratory tract first. This can explain partly why throat swabs initially gave false negative results. CT scan often shows bilateral interstitial pneumonia, anecdotally starting most often from the right lower lobe of lungs.
The cough is a dry nonproductive cough. Thick mucus clogs small airways, making it difficult to breathe and exchange oxygen. So many patients have hypoxia (low blood oxygen). Thick phlegm is also difficult to expel. It’s like thick gravy sticking to the pot. Autopsy results in China confirmed that a large amount of viscous exudate in the pulmonary alveoli of the patients caused severe hypoxia in patients and led to respiratory failure.
Patients with poor outcome often have low white blood cells, low lymphocytes, sometimes low neutrophils and platelets as well. This suggests that their immune function is low or being exhausted.
Step 4: What can I do if I start to feel sick?
First, stay calm, because you have a plan and you will recover.
See your doctor as soon as possible. Get tested. Several medications such as Remdesivir and hydroxychloroquine/Azithromycin combination have shown positive results in treating COVID-19.
If you have a low-grade fever (100-101 F), do not lower it too fast. Higher body temperature helps kill virus. Fever is part of the body’s immune response. Let it do its job first.
If your temperature is higher than 102 F for an adult, you need to bring it down somewhat. Try acetaminophen (Tylenol) first, not ibuprofen (Advil, Motrin). Although there is a debate on this WHO suggestion, I still think it is prudent to follow it. Here is why. I am quoting from the Coronavirus Resource Center of Harvard Medical School, updated on March 27.
“Some French doctors advise against using ibuprofen (Motrin, Advil, many generic versions) for COVID-19 symptoms based on reports of otherwise healthy people with confirmed COVID-19 who were taking an NSAID for symptom relief and developed a severe illness, especially pneumonia. These are only observations and not based on scientific studies.
The WHO initially recommended using acetaminophen instead of ibuprofen to help reduce fever and aches and pains related to this coronavirus infection, but now states that either acetaminophen or ibuprofen can be used. Rapid changes in recommendations create uncertainty. Since some doctors remain concerned about NSAIDs, it still seems prudent to choose acetaminophen first, with a total dose not exceeding 3,000 milligrams per day.
However, if you suspect or know you have COVID-19 and cannot take acetaminophen, or have taken the maximum dose and still need symptom relief, taking over-the-counter ibuprofen does not need to be specifically avoided.”
Be well hydrated whether you have a fever or not, and especially when you run a fever. You need water, electrolytes and sugar. Water and electrolytes help maintain fluid balance, while sugar provides energy. The easiest way to get all these is by drinking Pedialyte, Gatorade or Powerade. For those patients who have used my electrolyte recipe, you can continue to use it. Make sure you drink at least 60 oz of fluids per day.
Keep your lungs moist and help loosen the phlegm. Remember the mucus tends to be thick like gravy and hard to cough out? In order to cough it out, you need to thin it and loosen it up first. You can do this in two ways. One is by taking long steamy showers on a regular basis. Take deep breath through the mouth while taking the shower. The other way is by pouring hot steamy water in a large bowl, placing your face above it with a large towel covering your head and the bowl (so the steam does not escape) and breathing deeply.
Practice deep breathing on a regular basis, even when it hurts. Randy Reynolds, a retired respiratory specialist recommended pursed lip breathing exercise. Breathe in deeply and slowly, then exhale through tight lips as if you are blowing out a candle. Blow until you have completely emptied your lungs, and you will be able to breathe in an even deeper breath. This helps keep lungs expanded as well as increase your oxygen level. Do it for 2 minutes, twice a day.
Eat healthy regularly. Easier said than done, especially when you are sick. Many COVID-19 patients experience poor appetite, nausea, loss of smell, abdominal discomfort, diarrhea, etc. But this is when you need good nutrition most, because you need the strength to fight. So eat a small amount regularly, even when you don’t want to. It’s also helpful to take a moment now and think about what are your comfort foods, something that is easy to make, not too rich or heavy and easy for digestion. For example, my comfort foods are chicken noodle soup and rice congee with Chinese pickles and scrambled eggs. So I made sure these ingredients are in the house.
What supplements and herbs can I take when I feel sick?
Continue to take Vitamin C and zinc. You probably need a higher dosage now. Vitamin C 1000-2000 mg, zinc 50mg. New York hospitals are treating some COVID-19 patients with large doses of intravenous administration of vitamin C. Vitamin C may not prevent or treat the infection directly, but it may protect the body from excessive damage by free radicals released by cytokine storm. Many studies also showed it can lessen the severity and shorten the duration of symptoms in common colds and flu. As for zinc, Dr. Zev Zelenko, a family physician in New York, shared his out-patient treatment regimen which has given positive results. It includes:
1. Hydroxychloroquine 200mg twice a day for 5 days
2. Azithromycin 500mg once a day for 5 days
3. Zinc sulfate 220mg once a day for 5 days
- Continue to take licorice root. In Chinese medicine, licorice is used to transform phlegm, reduce cough, soothe stomach, increase energy, clear heat and detox the body. It is a simple herb, but does wonderful things. Here again is the link to buy licorice root extract on Amazon.
Stop taking Yu Ping Feng. It is great for prevention, not so good for treatment, especially when there is fever or dry cough.
Continue to take Yin Qiao (Yin Chiao), if you have it. It can shorten the course of viral infection. Many modern herbal formulas effective for SARS, H1N1 flu and most recently COVID-19 are based on this 200 year old formula. However, it may not be strong enough by itself. You can combine it with the herbs I will discuss below.
As I said before, there are several herbal formulas that showed significantly positive results in treating COVID-19 in China. But most are not available in US. However, I was very excited to see two of them on Amazon and Ebay today. Get them when they are still available. Make sure you check the arrival date. Some are in stock in US or Canada. Some are shipped from China and will take a long time to arrive. If you don’t find them online today, keep searching. Use the names of these two formulas as the key words for searching, i.e. Lianhua Qingwen capsule, Ganmao Qingre granules.
You can take either one or combine these two herbs. They have different ingredients and slightly different functions.
Lianhua Qingwen Capsules. This is my favorite and to-go-to herbal medicine for respiratory infection. It was developed for SARS in 2003. A paper published in Pharmacological Research on March 20 demonstrated its anti-viral and anti-inflammatory activity against the new coronavirus. Unpublished data (presented at a conference on March 26) showed that it reduced the percentage of COVID-19 patients progressing to severe conditions by 50%. Buy 3 packs of 24 pills per pack, which is 6-day supply. Take 4 pills, 3 times a day.
Lianhua Qingwen Capsules can be purchased from Amazon or Ebay.
Ganmao Qingre Granules. This is a great formula for cold and flu, especially good for symptoms such as fever with chills, headache, body ache, GI discomfort, etc. Pharmacological screening of herbal ingredients and in vitro studies suggest it may reduce the impact of cytokine storm. Buy 2 box of 10 sachets, a 10-day supply. Take 1 sachet, twice a day.
Huo Xiang Zheng Qi Pian. This is a classical formula for GI symptoms related to stomach flu, traveler's diarrhea or overeating. For COVID-19 patients, it is especially good for symptoms such as nausea, bloating, poor appetite, diarrhea, etc.
Purchase in tablet form or as an alcohol based tincture
To relieve congestion and cough, you can combine the above herbs with mucolytic or expectorant medicine. For example, Mucinex, N-Acetyl cysteine (NAC) and Myrtol.
Recent reports from Japan showed protective effects of some asthma drugs, such as Rx Advair and OTC Flonase. If you have asthma and use these medicines anyway, continue to use them. From what read, it appears that small doses of steroids may be protective, though large doses may be detrimental.
If you have seen a doctor and followed the above suggestions but the symptoms persist or get worse after 3-5 days, please feel free to email me to schedule a phone or video consultation. I might be able to customize a herbal formula for you based on the herbal formulas reported to be effective for COVID-19 in China. I want to make sure they are applied properly to each individual case.
Stay healthy!
Y. Clare Zhang, PhD, MAcOM, LAc
Y. Clare Zhang Practice of Oriental Medicine
6650 N. Oracle Road Suite 100, Tucson, AZ 85704
2930 N. Country Club Road, Tucson, AZ 85716
Tel: (520)320-1953
Website: www.clarehealth.com
Blog: www.tucsonacupuncturist.org
Dispensary: https://wellevate.me/dr-clare-zhang
