Stages of Infection - and what to focus on during these stages.

Dr. Toby

Naturopathic Medical Doctor, Acupuncturist, Chinese Medicine - vis medicatrix naturae

Stage 0 – No Infection – Prevention:

• Follow all public health guidelines, including washing hands and social distancing.
  
• This is the time to focus on prevention, to increase the body’s innate healing ability, strengthen the immune system and antioxidant intake.
  
• Supplements and nutriceuticals which should be considered at this time include vitamin C, quercetin, mushroom extracts, green tea, Nettle root tea, quercetin, N-acetyl-cysteine, and antioxidants found in berries and fruit, such as pomegranate juice, elderberry extract.
• In China, they have found the Chinese herbal formula Jade Screen; Yu Ping Feng San to be preventative.
• Forest bathing, spending time in nature, increases NK cell function and boosts the immune system in other ways.

Stage I Mild (Early Infection):

• This occurs at time of inoculation, incubation, and early establishment of disease
• This is typically non-specific symptoms (i.e. malaise, cough, fever, etc.)
• Depending on where you work, diagnosis is made by respiratory RT-PCR testing, serum testing from SARS-CoV-2 IgG and IgM, chest imaging, CBC (i.e. lymphopenia, leukopenia, etc.), and LFTs
• Treatment during this stage should focus on symptomatic relief and on anti-viral therapy and decrease the progression of the disease.
• Anti-inflammatory therapy that is applied too early may not be necessary as most people will only have mild disease and recover without any difficulty. This may even prolong viral replication which has been described with corticosteroids. Neutraceutical anti-inflammatory support should not have the negative effects of corticosteroids.
• Supplements and neutraceuticals at this time should be similar to Stage 0, but taken more frequently and at higher doses. Anti-viral herbs should be added at this time, these can include herbs high in berberine, like goldenseal, and Chinese skullcap, as well as other anti-viral herbs elderberry, Andrographis and Nigella Sativa (Black Cumin Seed oil).
• Anti-viral Chinese herbal formulas containing Huang qin, Scutellaria baicalensis also called Chinese skullcap, would be very helpful at this stage. Chinese scute, Huang Qin, lactoferrin, stinging nettles root, red algae, quinine and the drug chloroquine have been shown to be endosome fusion inhibitors.  These substances can alkalinizes endosomes which are in the endoplasmic reticulum. The virus needs an acidic environment here to finish making the spike protein. These spike proteins need to get glycosylated in the endoplasmic reticulum. The virus needs the endosome to be acidic. As soon as it gets alkylnated the glycation and “finishing” becomes corrupted and it interferes with the viruses ability to replicate.

 
Stage II – Moderate (Pulmonary Involvement with and without Hypoxia)

• This occurs with establishment of pulmonary disease and inflammation in the lung
• Patients can develop viral pneumonia, with cough, fever, and maybe hypoxia (Defined as a PaO2/FiO2 of <300mmHg)
• Chest x-ray and Chest CT can show bilateral infiltrates or ground glass opacities
• CBC can show decreased white blood cells.
• These patients will most likely need to be hospitalized for observation and management
• Conventional treatment will again focus on symptomatic measures, however antioxidant support should be initiated at the earliest sign of pulmonary involvement to quell the fire of the cytokine storm of Stage III. This can also be initiated during stage one, but increased during this stage to prevent going into full ARDS. Antioxidants like high dose vitamin C, green tea, resveratrol, pomegranate juice, alpha lipoic acid and quercetin should be considered.
• In Stage IIa (Without Hypoxia) patients, corticosteroids should be avoided
• In Stage IIb (With Hypoxia) patients, and patients require mechanical ventilation, anti-inflammatory therapy could be useful but used judiciously
  
  

Stage III – Severe (Systemic Hyperinflammation):

• This will be a minority of COVID-19 patients
• This occurs when extra-pulmonary systemic hyperinflammation occurs (i.e. cytokine storm)
• Can see elevations in IL-2, IL-6, IL-7, granulocyte-colony stimulating factor (GCSF), macrophage inflammatory protein 1-alpha, TNF alpha, CRP, ferritin, and D-dimer
• Can also see elevations in troponin and BNP
• In this stage, tailored therapy will hinge on use of immunomodulatory agents to reduce systemic inflammation
• Corticosteroids may be justified in conjunction with cytokine inhibitors such as tocilizumab (IL-6 inhibitor) or anakinra (IL-1 receptor antagonist)
• IVIG may also play a role
• The patient will be hospitalized at this stage and nutrients and herbs will not be administered. There are current studies in China and Canada using high dose IV vitamin C during this time.