COVID-19 UPDATE: Lessons Lived, Lessons Learned

This morning, preparing to be on a panel on lingering symptoms of COVID-19 with a group of other amazing herbalists hosted by the Matthew Wood Institute of Herbalism, for the first time in a long time I looked back at what I wrote in March, just before I got sick myself. I was pleasantly surprised to find that there is little I would change, but there are several things I would like to add, drawing from the lessons lived through my own illness (probable COVID-19, but not confirmed as testing was not available to me during the acute phase, and would be hard to get in this county even now) and lessons learned through working with others with both confirmed and suspected COVID-19 infections.

(The two major corrections I would offer to my earlier work: we now know that very few people present with a significant fever during acute COVID-19 infection – but the diaphoretic herbs I recommended are still relevant as vasodilators in a disease marked by vasoconstriction. Also, what kind of mucus people do or don’t produce during acute infection is far more varied than early reports suggested.)

PREVENTION

In addition to being one of the most important aspects of any form of medicine, prevention is always perhaps the most speculative -- we can’t know what would or would not have happened if we had made a different set of choices. Still, there are lessons I’ve learned from the experience of the first few waves of this pandemic:

-- We need to dispense with the idea that this is a disease that only impacts people whose health is already compromised. This is simply not true.

A person’s health status does seem to impact how the disease presents: people with diabetes/insulin resistance, cardiovascular disease, and compromised immune function are the most likely to experience the Acute Respiratory Distress Syndrome that most people associate with COVID-19 infections, young people seem to be the most likely to have heart attacks and strokes, robust people who seldom get sick seem to avoid the worst acute symptoms but are likely more prone to chronic symptoms. And, these are just some of the most easily recognized patterns and probabilities.

Some of the people I am working with who have tested positive for COVID-19 after getting sick are athletic people with excellent diets and no known pre-existing conditions.

Also, the idea that this disease “only” impacts people who are already “unhealthy” is fraught with judgements rooted in the most puritanical parts of our culture, the parts of our culture that believe that people who are struggling with their health are morally inferior and reaping the consequences of bad choices. And it ignores the fact that although the US is a wealthy nation, there are many, many people who have no access to nourishing food, safe housing, and clean water. The most rigidly righteous elements of hippie, New Age, “alternative health,” and “spiritual” communities, which have always displayed significant if concealed and sometimes unconscious racist, classist, ableist, and authoritarian tendencies, are blending with the fascist and proto-fascist right because of these shared value judgements.

-- You can do the right things and still get sick. Precautionary principles in a pandemic demand that we assume that everyone will be infected eventually and that preventative measures are harm reduction measures that may delay infection and will hopefully diminish the severity of the symptoms when you do get sick.

I did everything “right” -- I took preventative herbs, masked every time I was outside the house, limited my interactions with people, maintained social distancing every time it was physically possible, ate healthy foods, maintained excellent hygiene -- and I still got sick. All it takes is one exposure. In my case, I am almost certain that it was being confronted in the small, enclosed foyer of a grocery store by an unmasked stranger coming in close in a way that blocked me and loudly asserting that there were no new cases of the disease being reported that day. I can’t be certain, of course, but that was 48 hours before I got sick and was my only risky interaction in the weeks leading up to my illness.

I am convinced, however that some of the “right” things I did prevented my illness from becoming truly catastrophic. Most of those were measures around cardiovascular health. In the months before I got sick, I began including significantly longer sessions on the elliptical trainer alongside my daily weightlifting (something I was intuitively guided to in the autumn, when we now know the virus was first reaching the East Coast from Europe.) When I first read about the virus primarily targeting the ACE-2 receptors throughout the body, as someone who deals with recalcitrant hypertension I also began increasing my dosage of herbs that reduce ACE-1 – Hawthorn and Reishi. My logic was that if I could reduce my baseline levels of angiotensin, I could reduce the levels to which angiotensin would spike in the event of ACE-2 dysregulation, thus reducing vasoconstriction and thus reducing the resultant tissue and organ damage.

It is impossible to prove a negative, but for several reasons I am a person who should have been at high risk for heart attack or stroke during my illness, and I mercifully avoided them. I also have several factors that would put me at risk for more severe acute respiratory symptoms than those I actually experienced once I was ill.

-- Get a pulse oximeter now if you don’t already have one, and begin taking readings several times a day to establish a baseline. Pulse oximeters are important tools for assessing the severity of your respiratory symptoms once you get sick, but the information they provide is only useful in the proper context. Everyone’s baseline will be a little bit different. Pulse oximeters work by measuring light absorption in the fingertip – but they are calibrated for people with light skin. I think they can still be useful for people with darker skin, but only if a person has established a baseline of what a “normal” reading would be for someone with skin like theirs. Also, for someone with a history of chronic respiratory disease, your baseline blood oxygen levels may be lower than the 98-100 percent that is considered “normal.” Doing everything you can to elevate that baseline is an excellent idea, but knowing the baseline will let you know how rapidly your condition is deteriorating if you do get sick. That said, anyone with a pulse oximeter reading lower than the low 90’s should seek immediate medical attention.

ACUTE RESPIRATORY SYMPTOMS

One of the reasons I am near certain that I did indeed have COVID-19 is that the symptoms I experienced were qualitatively different from any I have experienced before – and as someone who had severe asthma and frequent bronchitis and pneumonia over the first three decades of my life, I have experienced a broad range of respiratory symptoms. I felt like my lungs were made of dried out leather that was being heated and stretched.

As a result, respiratory demulcents played an even more important role in my personal protocol than I expected. Every 2-3 hours, I would take a combination of Pleurisy Root, Mullein, and Solomon’s Seal. (Solomon’s Seal is increasingly rare in the wild -- please only buy from producers who cultivate the plant, or substitute Shatavari which is a botanical relative whose roots share demulcent qualities with those of Solomon’s Seal and their shared cousins, False Solomon’s Seal and Asparagus.) These demulcents also help lubricate the fascia, helping to loosen constriction in the chest, especially combined with a respiratory tract relaxant like Lobelia.

Lobelia is the herb that I am convinced kept me from needing hospitalization. It loosened the constriction in my chest and in my airway, allowing me to breathe, and allowing me to cough. Later, I managed to acquire some New England Aster which helped loosen muscular constriction in my chest further. (It is blooming right now in Maine and I suggest that fellow New Englanders gather thy Asters while ye may.)

The one surprise for me was that I never developed the thick, sticky mucus that I had expected based on early reports from China. I did, however, after I was out of the most severe acute stage, develop profuse, thick, but non-sticky mucus. Elecampane was a tremendous help in clearing it and brought a consistent measurable increase in my blood oxygenation. The same was true of two rarer respiratory herbs that I love and have relationships with – Eastern Skunk Cabbage and Osha – I was lucky enough to have tinctures of these herbs on hand sent by friends with impeccable harvesting ethics, but I cannot support their commercial harvest, and, especially in the case of Osha, I would urge you to acquire them only from someone you know and trust who has a long term relationship with a particular wild population. Better yet, stick with Elecampane and Angelica.

I found herbal steams tremendously helpful when I was able to do them – but when I was at my sickest it was hard to get the energy and focus to accomplish the task. When I was still struggling but had a bit more energy, I went into my backyard and gathered needles from freshly fallen Pine boughs, the most resinous Pine cones I could find, and Alder twigs and cones, heated them in a big, covered iron pot on the stove long enough to build up a good steam, and then took the pot from the stove and hunched over it using a towel to make a tent to hold in the steam. It brought tremendous relief.

VASOCONSTICTION AND VASODILATION

A virus that dysregulates ACE-2 will have the effect of upregulating angiotensin. As its name suggests, angiotensin constricts blood vessels. In addition to continuing the high doses of Hawthorn and Reishi I was already taking before I was sick, when I was sick, every few hours I would take a combination of Lobelia, Yarrow, Black Cohosh, and a warming aromatic herb to dilate my blood vessels and promote circulation. Careful with these if your blood pressure tends to run low!

Angiotensin also stimulates adrenal release of aldosterone which raises blood pressure by increasing sodium retention in the kidneys. For this reason, though I know many people love it as a respiratory demulcent, I would personally recommend that anyone with even the slightest tendency toward hypertension avoid Licorice during the acute phases of COVID-19 infection because it upregulates aldosterone. Many herbalists I respect greatly disagree and contend that the effect of Licorice on blood pressure is overstated, but I find that even small amounts spike my blood pressure.

Potassium is the balance to sodium when it comes to blood pressure regulation, but Potassium supplementation can be a tricky business if you don’t know your levels. Bananas are a good and easy source of potassium for those who tolerate fruit sugars well. I personally am healthiest on a ketogenic diet, so I favor electrolyte powders as a way of keeping my potassium up.

While I was sick, I frequently experienced strange tingling sensations in my lips and my fingertips, a symptom I have also heard many other people report, and which I feel is likely related to diminished circulation. I find that small doses of Prickly Ash combined with slightly higher doses of Yarrow and Hawthorn can help address this.

COGNITION, CONSCIOUSNESS, AND DREAMING

Many people report strange and vivid dreams during COVID-19 infection, and many find that engaging and working with the content of these dreams has profound, positive effects on their lives moving forward.

I am something of an outlier in this regard. I tend toward waking visionary states, and find these tend to be more frequent sources of insight for me than my dreams are. I did find that while I was sick, these visionary states would at times be even more intense than usual, and that in the months that have followed, I have spent longer and longer periods in these kinds of visionary states. It all has a very strange effect on my experience of time.

I also found that unresolved emotions around loneliness, loss, and the fear of loss grew in intensity when I was sick, often reaching unmanageable levels. I eventually found that 15 drops of a Psilocybe cubensis oxymel and 3-5 drops of a Devil’s Club tincture would help me shift that experience fairly rapidly. Once I was well enough, combining these medicines with a short burst of strength training – usually a quick set of push-ups – would help even more. With all of this, your mileage is likely to vary.

Mental clarity was very hard to find when I was sick, and I have had more frequent bouts of intense brain fog and diminished access to language in the months that have followed – it is hard to differentiate between what is COVID-19 specific here and what is the burnout Autistic people experience after we have been through periods of prolonged stress. Consistent with Autistic burnout, my weakest cognitive capacities have been the slowest to recover, in my case those are in the area of executive function, the ability to plan and execute tasks. This is especially difficult to navigate because the rest of my cognitive capacities are more or less back online, and since my thinking and perception feel “normal” for me, I feel like I should have a “normal” (for me) level of executive function. It can lead to committing to things that I feel like I should be capable of but cannot actually complete. (Already a major problem for someone with executive function issues.) One manifestation of this is repeatedly setting out to write back to people and finding myself unable to finish and then feeling increased pressure for longer and better notes the next time I try to catch up on correspondence. (So if you are wondering why I take forever to reply to personal messages, this is why. I always think I am just about to have more capacity.)

My greatest ally in this regard continues to be Calamus.

In Chinese medicine, the heart is the primary organ of consciousness and perception. The watery heart Yin represents the heart’s capacity to take in information from the world – it is nourished by beauty. The senses are spoken of as the “orifices of the heart.” The fiery heart Yang represents our capacity to express ourselves.

When we’re overwhelmed with sensory and emotional information, the heart Yin can overwhelm the heart Yang, clouding the senses with a thick fog and first obscuring and then drowning out the fire of expression. Think of the heavy, dull feeling that lingers in your head after being in a noisy, crowded store with bright fluorescent lights in December.

Intense memories – sensation and emotion re-experienced outside their original time, place, and situation – bring their own fog, cutting us off from the experience of being present here and now. They can distort our perception of current events and prevent us from responding coherently.

Growing in the marshy muck in the shallows of lakes and ponds, Calamus with its green rush-like leaves and its bright yellow flower has a spicy root that clears the waters of the heart by reigniting the heart Yang. Its sweet scent engages the senses, its bitterness grounds us and activates the enteric nervous system which processes the sensory information coming in from the fascia of the entire body, and its pungent heat focuses the mind and senses and stimulates circulation to the brain.

This makes it an especially important medicine for Autistic people like me. Sensory gating is the process by which people filter sensory information – including the felt sense of others’ emotions and our own – so we only have to consciously interpret the information that is most important and most relevant, parameters set both by our belief structures and our bodies’ past experiences. Autistic people tend to have wider open sensory gating channels than most people, which allows us to perceive things others miss but also can overwhelm us with information which we can have a hard time prioritizing and sorting. In response, we can go into sensory shutdown, and those of us who usually have access to speech can lose that access altogether.

When this happens to me, a few minutes in a dark room and a few drops of Calamus can often help me become reoriented and recover my ability to speak. Hawthorn is often a nice addition to the Calamus, helping to soothe the hyperreactivity of my senses by cooling the heart (and possibly by reducing histamine and other pro-inflammatory compounds in my blood vessels.) Schizandra can be a nice addition as well, helping to gather my attention inward toward my heart.

Cannabis is another important ally for me in regaining my ability to communicate, though for many people it has the opposite effect. I like combining it with Calamus and Holy Basil.

FATIGUE AND STAMINA

I was exhausted the entire time I was sick, and while I have recovered some of my previous energy levels, I find that I still get bouts of fatigue. This seems to be fairly universal among people who get COVID-19.

When I was sick, it was easy to tell when I was overdoing it and needed to rest. In this more chronic phase of the illness, I have found it far harder to predict both my physical stamina and my mental stamina.

Some days, I can exercise for hours without getting winded or tired. Other days, climbing one flight of stairs will leave me winded. There does not seem to be any rhyme or reason to it, and my stamina levels can sometimes even be all over the map in a single day.

In my early recovery, Cordyceps and Coca leaf were tremendously helpful in rebuilding my lung capacity.

I was lucky during my convalescence to have access to an ethical source of American Ginseng, a nourishing, warming, restorative root that helps rebuild physical stamina, and it made a huge difference. However, American Ginseng is endangered in the wild, so I recommend Eleuthero (“Siberian Ginseng”) instead. Their medicines are very, very similar.

Currently I am focusing on rebuilding my stamina with Eleuthero and Astragalus decocted in bone broth – 1-3 cups a day – a practice I wish I had begun earlier. Currently I am using Immune Broth from Avena Botanicals for this purpose – it also contains Burdock, Reishi, and Shitake. I decoct it in organic beef bone broth for 8 hours and add a little vinegar to offset the bitterness. It has made a huge difference in my energy levels, but I still have days when fatigue catches me by surprise and all I can do is finish what is most essential and then wait it all out.

DIGESTIVE SYMPTOMS

Many people I work with experienced severe diarrhea early in their illness, and for some that has been a persistent problem. Blackberry root remains my herb of choice in this regard.

A lot of people experience new food intolerances during and after their illness -- intolerances that were likely latent but not presenting acutely before. In my case, the dairy intolerance I told myself I had resolved returned.

I also am no longer able to handle sugar alcohols like erythritol in more than the tiniest amounts now. They give me horrible gas and intense brain fog now. I suspect this is a result of changes in my gut microbiome.

JOINT INFLAMMATION

I am much more prone to joint inflammation than I was before I was sick. I now precede and follow every workout with Solomon’s Seal (Shatavari is a perfectly good substitute too.)  A bright side is that this has forced me to pay more attention to proper form when lifting weights or kayaking. High doses of fish oil also help me on days of intense exercise – 3-5 g of EPA/DHA. Flax oil will not do the job --- it has a net pro-inflammatory effect because of it Omega-6 content and the fact that our bodies cannot efficiently convert ALA into EPA/DHA and due to the fact that ALL commercial Flax oil is rancid. Bone broth is helping in this regard too.

People I work with who have chronic inflammatory conditions like Lyme disease are seeing that their flare-ups are far worse post-COVID.

DO YOU NEED TO TALK WITH AN HERBALIST? I have always had an unspoken policy of never turning away someone for an herbal consultation because they could not pay the rate I was asking. In these times, I want to make that explicit. As long as we are dealing with this pandemic, I am willing to have people pay whatever they can afford to pay for a phone consultation with me. In the part of Western Maine where I live, the internet bandwidth is too small to support Zoom or Skype calls and my phone plan only allows me to call people in the US, but I am willing to work with people anywhere if they can call me. I am not able to supply herbs to people, but the herbal dispensary I send my clients to for custom formulae remains open and able to ship herbs right now. As much as possible, I will try to help you work with herbs that you have on hand or can easily access. E-mail me at tobarnaofa@gmail.com (If you can afford my usual rates, please book here.)

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