Behavioral, Nutritional and Herbal strategies for maximizing safety and minimizing infection.
Sarah Cohen MD
March 13 2020
Right now, at the advent of a pandemic threat, there is an alarm that is sounding globally. As I consider my elderly and otherwise vulnerable loved ones, I choose to contribute to the chorus of international concern.
While I offer my voice of concern, I also come bearing tools for maximizing safety and minimizing viral transmission. Additionally, I offer speculative natural medicines for reducing disease burden of COVID19..
In the spirit of “First, Do no harm”, I have composed this material with my beloveds in mind, with the intention of keeping people safe. Here I present an Integrative anti-COVID-19 protocol. By virtue of being Integrative, the suggestions include behavioral modifications, medicinal foods/micronutrients, and herbal medicine.
Before I proceed, I will declare my grand appreciation and respect for “cutting edge”, modern medical interventions when they are appropriate and available. But we face a current dire reality wherein no known pharmaceuticals, vaccines, or empirical protocols are available to counteract this public health emergency.
Enter Medicinal Botanicals and Fungi
A scientist by nature, I offer treatments that have emerged from empirical evidence, be it information deemed viable by the scientific method, or wisdom that has survived the test of time. The more quality clinical science, the better! But when the first human case of COVID-19 is identified in Wuhan, China in December 2019, and 3 months later the virus has spread to over 167 countries and left 16,300 human fatalities in its wake, there frankly has not been enough time for clinical trials to answer the questions that this pandemic pleads.
Enter botanicals and medicinal fungi. These are the well-adjusted parents of many of our pharmaceuticals used widely in hospitals today. The Atropine we administer during Advanced Cardiac Life Support, Penicillins, and Aspirin are the first few to come to mind; but that is a topic for another day.
Today’s features are purported anti-viral and immuno-regulatory herbs and fungi, many of which have been tested against the COVID-19 relatives, SARS- and MERS-type Coronavidae. Much of the data we have on these botanical and myco- medicines has emerged from test-tubes and animals, rather than clinical trials in humans. Nonetheless, reduction of coronavirus replication by herbal preparations is demonstrable in the lab. Targeted Coronavirus inhibition is possible with herbs.
Before addressing treatment, let us back up and talk prevention.
Changing Social norms in Pandemic times
Social distancing is the single most effective intervention to stop the spread of infection. This is not about evoking fear. It is about eliciting intelligent action. Changing social norms in pandemic times is a temporary, informed effort to contain this virus.
It is possible to love your neigbors from a 6 foot distance.
COVID-19 is transmitted by way of respiratory droplets. Breathing disperses respiratory droplets. An infected sneeze or cough propels respiratory droplets up to 6 feet, after which point, the viral particles land on surfaces. Unless disinfected, Coronavirus can stay viable on objects for up to 72 hours. Being in the path of respiratory droplets by way of direct contact with saliva, sharing infected air, getting caught in the trajectory of a cough or a sneeze, or touching a surface inhabited by viral particles, then touching one’s face are dangers for contracting the Coronavirus. Epidemiological data demonstrates that every 1 infected person transmits COVID19 to 2 additional people.
Out of reverence (not fear) of each other, may we all declare some personal space? Everyone can hug one another when this is over.
For now, best outbreak prevention practices are as follows:
Hand hygiene is critical. Find the proper 20-second lather technique here: https://www.cdc.gov/handwashing/when-how-handwashing.html
If water and soap are not accessible, Use an alcohol based hand sanitizer with at least 60% alcohol. DIY hand sanitizer recipe by Herbalista Medicine Chest here: https://docs.google.com/document/d/1TDbDUI3AxHv5qH_7W9oPJGc3BBoNlsVItJQkqGRhV1I/mobilebasic
Frequently and at least daily, disinfect high-touch surfaces such as phones, touchscreens, doorknobs, bathroom fixtures, keyboards, and countertops. The virus can be effectively inactivated from surfaces by wipe-down with a solution of ethanol (62-71% alcohol), hydrogen peroxide (0.5% hydrogen peroxide) or sodium hypochlorite (0.1% bleach)
If greeting someone, opt out of handshakes and fistbumps. Consider instead: waving, bowing, or placing hands to your chest in prayer position.
Avoid touching your face.
RSVP with a "No" to gatherings large and small.
If your job allows it, work from home.
Now is a time to rest well by night and circulate blood with exercise by day.
If you are feeling ill, self quarantine. Stay home and restrict contact with others. The most common symptoms of COVID-19 are fever, dry cough, fatigue, body aches and shortness of breath. Note that these can be symptoms of other respiratory illnesses besides COVID-19. Cough or sneeze into a tissue (not into your hands!) and dispose of the tissue, preferably in a lined, covered container. Then wash hands thoroughly. Unless medical attention is needed, opt out of in-person contact with other people until at least 72 hours after symptoms have completely resolved.
If you develop fever and dry cough or shortness of breath, call your Health Care Provider. Before visiting a clinical site, phone in advance (!) to inform that you are experiencing symptoms of COVID-19.
In preparation for possible quarantine, maintain a 2-4 week supply of necessary pharmaceuticals and non-perishable, nutrient dense foods. Do not panic buy. Hoarding causes supply strain, especially for folks who don’t have the financial means for stockpiling necessities.
If you are having a medical emergency, call 911. Notify dispatch if you have symptoms or suspected exposure to COVID-19.
Food Be Thy Medicine
Humans are innately equipped with mechanisms for self repair. Highly coordinated modes of immunity are but one of the body’s many systems for upholding health. We are resilient by design. While life can take it’s toll, and at times there are disruptive circumstances beyond our control, I avow that there are ways to optimize the body’s methods for guarding vitality.
It boils down to food. Nutrition is the reservoir that feeds good health. There are some fundamental principles in using the power of food in our favor. On the contrary, there are definitive ways to sabotage the body with poison that is disguised as food.
Dietary Adjustments to Prime the System:
While studies of vitamins and minerals against Coronavirus have not been completed, it is known that Vitamin C, Zinc and Vitamin D are vital to immune system function.
There is currently a clinical trial underway using high dose Vitamin C to treat COVID-19:
Viral Behavior, Meet Herbal Action.
An enormous amount of data has emerged on COVID19 since its frightening debut merely 3 months ago. As a global community, we have learned tremendously about the behavior of this virus. The international conglomerate of shared knowledge serves us well.
It is not all bad news. Freshly published clinical trials demonstrate success in treating COVID19 using drugs (Chloroquine and Remdesivir) historically prescribed for Malaria and Ebola, respectively. There is ample information at our cleanly washed fingertips. We are in a better state of preparedness with every passing day.
Information on the Clinical course of COVID-19:
Several strains of Coronavirus exist, and predate the identification of COVID-19. The Coronavirus family of infections have historically caused illness ranging from the common cold to fatal disease such as Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome (MERS). COVID-19 is a newly identified strain of Coronavirus as of December 2019.
80% of COVID19 cases are mild.
Kids appear to be protected. No fatalities have been reported in children under 9 years old.
97.9% of cases reported in China were in people over 19 years of age.
Respiratory failure is more likely to develop in men, people over the age of 65, and individuals with underlying disease.
Conditions that render people more vulnerable to COVID-19 complications include, but are not limited to: diabetes (uncontrolled), organ transplant status on immunosuppressive therapy, malignancy, cardiovascular disease, or chronic lung compromise such as COPD.
Dry cough is typically the first symptom. (this is NOT a high phlegm- illness). Fatigue, muscle pain, fever and shortness of breath are common but not always present. Worsening shortness of breath is a sign of advancing disease.
Time from infection with COVID-19 to development of symptoms is estimated to be 4-10 days
An individual who is infected with COVID-19, who has not yet developed symptoms, is contagious.
COVID-19 virus is spread in respiratory droplets. When the virus gains access to the respiratory tract, it hooks itself into receptors called ACE2 in the lungs.
COVID19 attaches to the the ACE2 receptors, and proceeds to hijack the genetic material of human cells. The Virus then uses host DNA to make more virus.
Cascading viral replication causes extreme stimulation of the immune system. The most common mechanism of organ failure and death is essentially “immune system gone haywire”. It is called Cytokine Storm. In the case of COVID-19, the storm begins with inflammatory pooling in the lungs, and if unchecked, ends with multi-system organ failure.
Mortality rate of people with confirmed COVID-19 is reported to be between 2-3 % worldwide. The actual mortality rate of COVID-19 infection is unknown and could be orders of magnitude lower, due to disproportionate testing of sickly individuals.
The clinical course of COVID-19 has been substantially described. The mechanisms of specific herbal preparations are considerably characterized. Indeed, there are unknowns when matching viral behavior with herbal action. But there is a mountain of research which, if approached with open eyes and extrapolating minds, offers possibilities for reduction of COVID-19 disease burden.
Herbal Preparations
The following regimen is derived from laboratory studies using simulated viral models (in vitro), research in animals, case reports in humans and few randomized controlled clinical trials. The featured plants and fungi have been ingested safely as food and medicine for centuries upon centuries. Nonetheless, large scale, high quality clinical research has not been completed for most plants. Natural medicine is not without adverse reactions, risks, and contraindications. This plan is formulated from conjecture, not from “gold standard” clinical research. I am not making any claims about therapeutic efficacy. Rather, I am suggesting that the botanicals and mushrooms listed could theoretically constitute an intervention to minimize transmission and severity of COVID-19.
*Optimal herbal extraction necessitates proper technique and high quality starting materials. Herbal formulas (which include more than one Phyto- or Myco- ingredient) require knowledge of how to dose each component. Herbal apothecaries are typically equipped for this work.
Phase 1. The shield.
The time for Phase 1 is now. Prime the physical and mental defense.
A. Tincture # 1:
3/4 teaspoon (3ml) three times per day
1 part Elder (Sambucus Canadensis) berry and flower
1 part Astragalus (Astragalus Propinquus) root
1 part Holy Basil (Ocimum tenuifolium) leaf (*caution in thyroid disease. can interact with thyroid hormone)
B. Survival Broth Recipe with Shiitake, allium, and Thyme (yields 8 cups)
1 cup, 2-3 times per day or more
Ingredients
80 dried shiitake mushrooms
2 medium yellow onions, peeled and quartered
2 heads garlic, split crosswise
8 sprigs thyme
8 sprigs parsley
2 bay leaf
2-inch strip of lemon, peeled using a vegetable peeler
2 teaspoons black peppercorns
Directions:
In a large bowl, cover the shiitake mushrooms with 16 cups cold water. Place in the refrigerator for at least 4 hours or (preferably) overnight, making sure the mushrooms are completely submerged in the water.
Over a saucepan, strain the shiitake mushrooms, reserving the liquid. Gently squeeze the mushrooms to drain any excess water. Remove the stems and thinly slice the shiitake caps.
Add the onions, garlic, thyme, parsley, bay leaf, lemon and peppercorns to the mushroom liquid and bring to a boil
Reduce the heat to medium and simmer, stirring occasionally, until the broth is reduced by half, about 2 hours. Strain.
If desired, Add shiitake caps back to simmer for 10 minutes. Otherwise Shiitakes can be used for another dish. Enjoy warm or cover and chill until ready to use.
C. Fresh Ginger Root tea (yields 2 cups)
1 cup, 1-3 times per day.
Ingredients
2 inches fresh Ginger rhizome (root), cut into slices (or 1 tsp dried Ginger)
2 tsp honey (raw and local if possible)
1 tsp lemon juice
3 cups water
Directions
In a saucepan combine water and sliced ginger. Gently bring to a boil. Cover and simmer on low heat for 15-20 minutes. Strain and add honey and lemon juice.
Phase 2: Viral Inhibition
To be implemented If COVID19 is reported in local community, or exposure is suspected. Combine with tincture # 1A. Tincture #2:
3/4 teaspoon (3 ml), three times per day
4 parts Thyme (thymus Vulgaris) herb
4 parts Honeysuckle (Lonicera japonica) unopened flower buds
4 parts Cryptolepis (Cryptolepis sanguinolenta) root
3 parts Astragalus (Astragalus Propinquus) root
3 parts Isatis (Isatis Indigotica) root
3 parts Houttuynia (Houttuynia cordata) leaf and root
1 part Licorice (Glycyrrhiza glabra) rhizome (*Caution: can increase blood pressure)
*Additional herbs with reported evidence of anti-viral activity (can sub if above ingredients not available):
Angelica (Angelica Archangelica) root and seeds
Elecampane (Inula helenium) root
B. Steam inhalation with antiseptic herbs.
Repeat 2 - 3 times daily.
Ingredients
1/2 cup fresh thyme (fresh preferred, can substitute 1/4 cup dried Thyme) 1 pint water optional 1-2 drops Tea Tree and/or Eucalyptus essential oil. Large, heat-safe bowl or pot with a fitted lid
Directions
1. Place herbs in a large, heat-safe bowl or pot.
2. In a saucepan, Heat water to boil. Remove from heat for 10 seconds.
3. On a sturdy surface, pour hot water over herbs
4. Cover mixture with lid. Allow to stand for up to 5 minutes.
5. Add optional essential oil
6. CAREFULLY and SLOWLY lower your face over the bowl. Close eyes. Do not burn yourself.
7. Place towel over head to create a steam tent.
8. Breathe deeply over steam for 15-20 minutes.
Phase 3: Immune system regulation. Cytokine balance.
Upon presentation of COVID19 symptoms (Fever, Dry cough, body aches, Shortness of breath), combine Phase 3 with tincture #2. Stop tincture #1.
***This is the time to call your health care provider or State Department of Health to inquire about getting tested for COVID-19A. Tincture #3
3/4 teaspoon (3ml), three times per day
3 parts Baikal skullcap (Scutellaria baicalensis) root
3 parts Rhodiola (Rhodiola rosea) root
3 parts Chaga (Inonotus obliquus) Sclerotium
3 parts Turmeric (Curcuma longa) rhizome
2 parts Japanese Knotweed (Fallopia japonica) root and rhizome
1 part Horse chestnut (Aesculus hippocastanum) seed
1 part Licorice (Glycyrrhiza glabra) rhizome (Caution: can increase blood pressure)
B. Yarrow (Achillea millefolium) and Boneset (Eupatorium perfoliatum) infusion. Sweat it out.
Boneset tea:
Drink 2 oz. 2-3 times per day
Ingredients:
1/2 tsp. dried Boneset (Eupatorium perfoliatum) leaf and flower
8 oz. hot water (just below boiling temperature)
Directions
Place dried leaf and flower in hot water. Steep covered for 40 minutes, preferably in thermos to retain heat. Strain.
Yarrow tea:
Drink 2-4 cups/day
Ingredients
1 tsp. dried yarrow leaf and flower
8 oz. hot water
Directions
Place dried leaf and flower in hot water. Steep covered for 40 minutes, preferably in thermos to retain heat. Strain.
A rash of disclaimers:
***Reliance on herbal medicine for prevention or treatment of COVID19 is NOT a substitute for seeking medical attention in the setting of illness.
*** Nothing I have written here is a substitute for recommendations from public health officials and your health care provider.
**There is no evidence that herbal medicine or supplements improve clinical outcomes of COVID19 infection
**It is possible to mount an allergy (a severe one, even) to any of these herbs. Some of the herbs included above (Yarrow, elecampane) cross-react with ragweed allergy.
**Tincture formulations above are NOT for use during pregnancy or in children unless cleared by your midwife or physician.
**Dangerous Herb-drug interactions can and do occur
References
1. Abidov, M., Grachev, S., et al, Extract of Rhodiola rosea Radix Reduces the Level of C-Reactive Protein and Creatinine Kinase in the Blood, Bull Exp BiolMed., 2004, Jul;138(1):63-4
2. Barak, V, Birkenfield S, Halperin T. et al. The Effect of Herbal Remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002.
3. Bedford, Trevor. Cryptic transmission of novel coronavirus revealed by genomic epidemiology. Bedford Lab. March 2020
4. Buhner, Stephen Harrod. Herbal Treatment for Coronavirus Infections. February 2020
5. Callaway, J.C. Hempseed as a nutritional resource: An overview. Euphytica 140, 65–72 . 2004
6. Chan GC, Chan WK, Sze DM. The effects of beta-glucan on human immune and cancer cells. J Hematol Oncol 2:25 10 Jun, 2009
7. Chen, S.M., Tsai, Y.S., et al, Astragalus membranaceus Modulates Th1/2 Immune Balance and Activates PPARy in a Murine Asthma Model, Biochem Cell Biol, 2014 Oct;92(5):397-405
8. Cheng-Wen, L and Lee Chao PD. Anti-SARS coronavirus 3C-like protease effects of Isatis indigotica root and plant-derived Phenolic compounds. Antiviral Research. Oct 2005:68 (1): 36-42
9. Chiow, K.H., Phoon, M.C., et al, Evaluation of Antiviral Activities of Houttuynia cordata Thunb. Extract, Quercetrin and Cinanserin on Murine Coronavirus and Dengue Virus Infection, Asian Pac J Trop Med, 2016 January
10. Cho, W.C., Leung, K.N., In Vitro and In Vivo Immunomodulating and Immunorestorative Effects of Astragalus membranaceus, J Ethnopharmacol, 2007;113(1):132-41
11. Harokopakis, E., Albzreh, M.H., et al, Inhibition of Proinflammatory Activities of Major Periodontal Pathogens by Aqueous Extracts From Elder Flower (Sambucus nigra), J Periodontal, 2006, Feb;77(2):271-9
12. Hemilä H. Does vitamin C alleviate the symptoms of the common cold?--a review of current evidence. Scand. J. Infect. Dis. 26(1):1-6. 1994.
13. Holshue ML DeBolt C Lindquist S et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020; (published online Jan 31.)
14. Hsuan SL, Chang SC, Wang SY, et al. The cytotoxicity to leukemia cells and antiviral effects of Isatis indigotica extracts on pseudorabies virus. J Ethnopharmacol. May 4 2009;123(1):61-67.
15. Huo, Y., Shi, H.M., et al, Chemical Constituents and Pharmacological Properties of Radix
e, Pharmazie, 2008 Oct;63 (10):699-703
16. Huang C Wang Y Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497-506
17. Jothie-Richard, E., Illuri, R., et al, Anti-Stress Activity of Ocimum sanctum: Possible Effects on Hypothalamic-Pituitary-Adrenal Axis, Phytother Res, 2016;30:805
18. Lau, K-M, Lee, K-M, Immunomodulatory and Anti-SARS Activities of Houttuynia cordata, Jrl. Ethnopharm, 2008:118 (1):79-85
19. Mondal, S., Varma, S., et al, Double-Blinded Randomized Controlled Trial for Immunomodulatory Effects of Tulsi (Ocimum sanctum Linn.) Leaf Extract on Healthy Volunteers, J Ethnopharmacol, 2011 July 15;136(3):452-6
20. Tiralongo, E., Wee, S.S., et al, Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial, Nutrients, 2016 Mar 24;8(4):182
21. Tempesta, MS. The Clinical Efficacy of cryptolepis sanguinolenta in the treatment of malaria. Ghana Med J. 2010;44(1)
22. Malani, PN and Rio CD. COVID-19- New insights on a Rapidly changing Epidemic. JAMA online 2020 February.
23. Murata A. Virucidal activity of vitamin C for prevention and treatment of viral diseases. Proceedings of the First Intersectional Congress of the International Association of Microbiological Societies, Tokyo. September 1-7, 1974.
24. Pao, L.H., Hu, O.Y., et al, Herb-Drug Interaction of 50 Chinese Herbal Medicines on CYP3A4 Activity In Vitro and In Vivo, Am J Chin Med, 2012;40(1):57-73
25. Park, Y.N., Lee, Y.J., et al, Alleviation of OVA-Induced Airway Inflammation by Flowers of Inula japonica in a MurineModel of Asthma, Biosci Biotechnol Biochem, 2011;75(5):871-6
26. Ping, B and Zhang D. et al. In silico screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus. Journal of Integrative Medicine. February 2020.
27. Schnitzler, P et al. Comparative study on the antiviral activity of selected monoterpenes derived from essential oils. Phytotherapy Research. 2010. 24: 673-679
28. Scopel, M. Mentz LA, Henriques AT. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement ALtern Med. 2011: 11:16.
29. Shang, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respiratory Medicine. February 2020
30. Shen HH, Wang K, Li W, et al. Astragalus membranaceus prevents airway hyperreactivity in mice related to Th2 response inhibition.J Ethnopharmacol. Mar 5 2008;116(2):363-369.
31. Steinman E G. Kampfa, et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection. March 2020 Volume 104, Issue 3, Pages 246–251
32. Yang, X. Gao, J. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies Bioscience trends. March 2020
33. Yarnell, Eric. Herbs for Emerging Viral Infectious Diseases. Alternative and Complementary therapies. 22(4). June 2016
34. Yang, Z., Wang, Y., et al, In Vitro Inhibition of Influenza Virus Infection by a Crude Extract From Isatis indigotica Root Resulting in the Prevention of Viral Attachment, Mol Med Report, 2012 Mar;5(3):793-9
35. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, Shi Z, Hu Z, Zhong W, Xiao G. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020.
36. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). (2020-01-30) [2020-02-02]. https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)
37. Yang, Z.C., Qu, Z.H., et al, Astragalus Extract Attenuates Allergic Airway Inflammation and Inhibits Nuclear Factor kB Expression in Asthmatic Mice, Am J Med Sci, 2013 Nov;346(5):390-5
38. Zakay-Rones, Z., Thom, E., et al, Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections, J Int Med Res., 2004 Mar-Apr;32(2):132-40
39. Zou, C., Su, G., et al, Astragalus in the Prevention of Upper Respiratory Tract Infection in Children With Nephrotic Syndrome: Evidence-Based Clinical Practice, Evid Based Complement Alternat Med, 2013;2013:352130. doi:10.1155/2013/35213