COVID-19 Issues and Traditional Chinese Medicine (TCM)
- What are COVID-19 Variants of Concern (VOCs)?
- What are the unusual symptoms of COVID-19?
- How long will COVID-19 virus survive on surfaces?
- How long can an COVID-19 infected person be contagious?
- What are the types of COVID-19 tests and how to choose?
- When to take rapid tests for COVID-19?
- What to do when I am isolated at home?
- What is long COVID and how long it will last?
- How does Chinese Medicine view on infectious diseases like COVID-19?
- How does Chinese Medicine manage COVID-19?
- How Chinese Medicine manages to treat COVID-19 as new variants are likely to emerge?
- How can Chinese Medicine help asymptomatic COVID?
- How can Chinese Medicine help elderly COVID infections?
- How can Chinese Medicine help COVID recovery?
Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-Cov-2 virus, which is a new strain of virus to human. After two years of global pandemic, it is still unclear when and how it will end. Since the Omicron emerged to be the dominant variant, many people false treat it as a “bad flu.” COVID-19 is a highly contagious infection, if we ignore our health protections, it will let the pandemic threat to be endless.
Health professionals are still working hard to better understand this novel coronavirus as well as its impacts on health. For the public, it is important to check with your local health authority for the most relevant guidance and take appropriate precautions, so that we can continue to protect ourselves, people around and our community.
1. What are COVID-19 Variants of Concern (VOCs)?
The SARS-Cov-2 virus is an unstable virus; it changes constantly, and so new variants are expected. However, it is difficult to predict when or what will come for the next COVID-19 wave. Scientists keep monitoring their impacts on human health, a variant becomes a VOC when it acts below:
- spreading more easily
- causing more severe conditions
- escaping the immune protection provided by the vaccines or natural immunity after infections
- making viral tests less accurate
- making treatment less effective
For the COVID-19 infections, the original strain had totally replaced by the variants in 2021. Until April 2022, VOCs identified globally are:
| Variants | Breakout Times | Impacts |
| Alpha | Dec-2020 |
|
| Beta | Feb-2021 |
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| Gamma | Jan-2021 |
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| Delta | Mar-2021 |
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| Omicron | Nov-2021 |
|
www.twreporter.org/a/sars-cov-2-variants
en.wikipedia.org/wiki/Variants_of_SARS-CoV-2
www.yalemedicine.org/news/covid-19-variants-of-concern-omicron
Please keep in mind that the more the virus circulates, the greater chances a VOC will emerge, and then another surge of COVID-19 cases come again. The best way to slow the emergence of a new VOC is to follow public health advice.
2. What are the unusual symptoms of COVID-19?
COVID-19 affects different people in different ways. People can have many presentations and may change over time too. Fever, cough and fatigue are typical symptoms of this primarily respiratory infection, others include breath shortness or difficulty breathing, muscle or joint pain, sore throat, runny nose, chills and headache.
A growing list of atypical symptoms in COVID patients are recorded:
- Digestive problems such as poor appetite, nausea, diarrhea and abdominal pain, which can be alone or accompany with other COVID symptoms.
- Loss of smell or taste (without a stuffy nose).
- Skin changes such as small bumps, hives, discolored or blisters. COVID toes are chilblain-like lesions that often develop in children and young adults with no or only mild symptoms.
- Hoarseness, speaking or swallowing problems, that due to the nerves of vocal cords are irritated.
- Pink eye, light sensitivity, sore and itchy eyes.
- Strokes and blood clots among people hospitalized with COVID-19
- Confusion is common in older people, especially for those with severe cases.
Experts said many above atypical symptoms may not be caused by the virus directly but are the body’s immune response to the novel coronavirus.
3. How long does COVID-19 virus survive on surfaces?
Person-to-person spread is the main mode of COVID-19, the risk of infection through contact with contaminated surfaces or objects is generally low. Facts reported by the US Centers of Disease Control and Prevention are below:
- The SARS-Cov-2 virus can remain viable within minutes to hours on porous surfaces, while remain viable days to weeks on non-porous surfaces; common non-porous surfaces are like stainless steel, plastic and glass.
- It is expected 99% infectious virus on non-porous surfaces to be reduced within 3 days in indoor environments.
- The risk of infection from entering a space where a person confirmed with COVID-19 is low after 24 hours.
- The indoor risk can be reduced by wearing masks (both infected and healthy), routine cleaning, and frequent hand washing.
(www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html)
Generally, coronaviruses can degrade quickly when exposed to UV light and high temperature, they survive longest in low temperatures or low humidity. Household detergents are well enough to clean most of the germs on surfaces; disinfectants are unnecessary unless someone at home is sick or is positive for COVID-19 within the last 24 hours.
4. How long can an COVID-19 infected person be contagious?
Experts said that the most contagious time is likely to occur 2 days before symptom onset to 3 days after COVID symptom onset. The risk of transmission is largely reduced after 6 days of symptom onset.
The length of COVID-19 infectivity is affected by the severity of infection, the intensity of exposure, and individual immune state. It is possible to be contagious for longer period of times, people with moderately or severely immunocompromised might have a longer infectious period. Whether and how symptoms are correlated to the infectivity is still under studying.
Asymptomatic COVID can still pass the virus to other people, studies suggested that many transmissions come from this route in the Omicron wave. Rapid test is a reliable way to check whether you are contagious or not, especially for those without symptoms.
(www.healthline.com/health-news/how-long-before-someone-with-covid-19-isnt-contagious#Do-certain-symptoms-suggest-were-contagious?)
5. What are the types of COVID-19 tests and how to choose?
Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, which can be identified as below:
| Nucleic acid test | Antigen test | Antibody test | |
| Other Name | NAATs or PCR test | Rapid test | Serological test |
| Target | Genetic materials of virus | Specific markers on virus | Antibodies of body |
| Sample collected | Mucus or saliva | Mucus | Blood |
| Accuracy | High | Less accurate than PCR test | High (3 weeks after infection) |
| Purpose | Gold standard for COVID-19 diagnosis | Self-check the infection risk or check for infectivity | Check immune status due to past infection, vaccines, or both |
| Limitation | Too sensitive for active infection | No sensitive enough for diagnosing COVID-19 | May be undetectable if too early or too late from the onset of symptoms |
www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-antibody-tests/faq-20484429
* False-negative result: it is possible to be infected but get a negative result.
* False-positive result: the test shows positive for an infection but not actually.
6. When to take rapid tests for COVID-19?
Self-testing along with vaccination, wearing mask and keeping physical distancing can largely reduce the transmission of COVID-19. Many test kits for COVID-19 are available, they provide rapid results (few minutes) and are simple to use. The result not just lets you know if you are currently infected with COVID-19, but also tells whether you are infectious to other people, so that you can avoid the virus from spreading to those around you in time. Experts recommend taking self-test as below:
| Situations | Timing |
| Have any of the COVID-19 symptom | Immediately |
| Exposed to someone with COVID-19 |
|
| Going to an indoor event or gathering | Immediately before the event or gathering |
7. What to do when I am isolated at home?
Most people with COVID-19 have mild symptoms, they can get better at home without medical care. The infected persons are highly infectious before and after symptom onset, isolation for them is therefore required. Specific guidelines by the local health department are changing with time, you should visit your local official site for the latest updates. However, some basic steps to care for yourself and to protect others are below:
- Stay home for whole designated period
- Inform close contacts, separate yourself from others including pets
- Keep your own place well ventilated
- Well rest and keep yourself hydrated
- Wear a well-fitting mask if you are sick, and for those who around you too
- Get self-tests on the recommended days
- Cover your mouth when coughing and sneezing
- Wash your hands often with soap
- Clean and disinfect regularly for all surfaces you touched
- Handle household garbage properly
- Avoid sharing personal or household items
- Monitor your condition carefully, call for emergency if you appear symptoms like trouble breathing, pain or pressure in the chest, pale or blue-colored lips, and confusion
- If you need to go out for medical visit, call in advance and avoid public transportation
8. What is long COVID and how long it will last?
Long COVID refers to a wide range of new, returning, or ongoing health problems after the initial COVID infection. People may present as different types and combinations of health problems, that can last for weeks, months or years.
People with COVID usually take a few days to a few weeks to restore their usual state of health, however some may take much longer for a full recovery. Common complaints are like fatigue, shortness of breath, cough, joint pain and chest pain. WHO said that more than 200 symptoms have been reported, and the symptoms can come and go or relapse over time, that seriously affect the daily performances of people.
Long COVID is more often in those with severe illness, however anyone who has been infected can experience the symptoms, even the mild cases or asymptomatic people still have the changes. Some estimated data for long COVID as below:
- 13.3% at 1 month or longer after infection
- 2.5% at 3 months or longer (based on self-reporting)
- More than 30% at 6 months among hospitalized patients
(https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects)
People with long COVID may face a variety of problems and continue to have new ones. Since there is no specific test to diagnose long COVID, it makes doctors hard to explain and manage it. Individualized management plan that involves major lifestyle changes is necessary for recovery.
Healthcare professionals are still working hard to better understand about long COVID, such as its risk factors, health impacts of different variants, treatment options and protection for the vulnerable groups.
9. How does Chinese Medicine view on infectious diseases like COVID-19?
Plague was a major problem is ancient China, TCM had accumulated extensive experiences of epidemic diseases in very early times. In 1642, Treatise On Pestilence, the first book for epidemic diseases proposed the concept of pestilent influences (li qi):
- Epidemic diseases were caused by pestilent influences which are highly contagious.
- The pathogens were something that can be treated by herbs.
- The pathogens entered through mouth and nose, and how body responding was determined by the quantity and virulence of pathogens and the body’s own resistance.
- Each epidemic disease was associated with specific pathogens and clinical features.
- The types of pathogens affected men were not the same as those in beasts
- Inflammatory skin diseases such as rashes or boils may be due to these pestilent influences.
TCM believes epidemic outbreaks are due to a combined result of climatic, social and environmental factors, such as droughts, floods, extreme climatic changes, wars as well as pollution. Since epidemics are highly contagious and could be fatal, appropriate insolation and sterilization to prevent community transmission are always on top priority. For those who are close contacts and susceptible groups, it is recommended to consume preventive herbs and make lifestyle changes, in order to protect themselves against the infection.
Herbal therapy is the first line of treatment for epidemics. Physicians will diagnose the major pathological (disease) changes by observing the clinical presentations of patients; then they take references other factors such as age, climatic condition, geographic location, diet and lifestyle to design appropriate remedy for patients. This holistic approach cares the overall body reactions and the interactions with immediate surroundings, which are effective in arresting disease progression and bringing favorable outcomes in earliest possible.
It is uncommon for TCM physicians to use one single herb or a fixed formula to treat all COVID patients. They will manage each patient according to their currently clinical evaluations, so that the patients’ innate power can be mobilized effectively, and then eliminate the virus timely and restore the usual state of health. In China, the experience of COVID treatment has been well reflected that TCM is very helpful in arresting the progression to severe disease, shortening the time of virus clearance, improving the prognosis, and reducing the death rate. It also has a good preventive effect too.
10. How does Chinese Medicine manage COVID-19?
TCM knows little about the novel coronavirus, but COVID-19 is just similar to any plague described in the ancient classics. Pestilent influences emerged suddenly around the environment; they are able infected anyone easily, cause similar features and pathological changes inside the body. The pathogens enter through the nose and mouth, the lung system is not the only one attacked, others can also be affected such as the digestive and nervous systems. The overall functioning (qi movements in TCM term) is disturbed internally, even the fundamental distribution and circulation of the body. A comprehensive analysis of the disease condition is essential before treatment.
Physicians have reached a consensus that “toxic dampness scourging the lung system” is the core pathology for COVID-19; other influences such as climatic condition, geographic location, body constitution, diet and lifestyle as well as developmental stages lead to different presentations among people, such as heat, cold and other signs; when going into a critical condition, people often show blood stasis and deficient signs (exhaustion of resistance). It should be noted that deficient (a declined resistance) may be occurred at very beginning.
Health authority in China has clinical guidance for COVID-19, and the protocols for TCM management have been updated to the 9th version, in which divides people into several managing groups:
| Managing Groups | Advice |
| Medical surveillance (unconfirmed) |
Select proprietary Chinese medicines according to individual symptoms |
| Mild cases | Select herbal prescriptions as suggested, 3 to 6 days; two proprietary Chinese medicines (may take longer than above) and acupuncture therapy are recommended |
| Moderate cases | Select and modify herbal prescriptions as suggested, 3 to 6 days; two proprietary Chinese medicines (5 to 10 days) and acupuncture therapy are recommended |
| Several cases | Select and modify herbal prescriptions as suggested, feed in several small portions; several herbal injections and acupuncture therapy are recommended |
| Critical cases | An integrated East and West approach, TCM often used for symptoms relief and supportive, e.g. promoting bowels, anti-cramps, smoothing blood circulation, lowering temperatures, and immune moderations |
| People in recovery | Select herbal prescriptions as suggested; moxibution and acupuncture therapies are recommended |
The suggested herbal prescriptions and their clinical efficacy can be viewed here.
11. How Chinese Medicine manages to treat COVID-19 as new variants are likely to emerge?
Chinese medicine and Western medicine are very different in their understanding and treatment of diseases. For COVID-19 management, the main difference between conventional and Chinese medicines is that TCM physicians pay more attention to the body reactions rather than the new virus itself. From TCM viewpoints, exogenous pathogens have gone through tremendous changes over thousands of years, but our body has limited evolvement relatively. No matter what pathogen attacks the body, physicians can still identify useful pathological traces through constant presentations such as fever, pain, swelling, palpitation, or shortness of breath. A disease can be interpreted as a responsive state of body while struggling with pathogenic factors, external pathogen is only a triggering factor, internal weakness or disharmony is the root for disease development. Syndrome differentiation (identifying disharmony pattern of body) is the premise and foundation of TCM treatment. Physicians group the collected symptoms and signs into a particular diagnostic category, which then uses it to design a treatment. The diagnostic process enables physicians to evaluate at which stage the disease has developed, what body parts have involved, and the degree of conflict between the body resistance and the pathogenic factors.
Taking the Omicron infection for a sample, TCM experts said that it is less virulent in comparison to the Delta variant or the original strain. Omicron is less likely to cause inflammation of the lungs but more prone to develop upper respiratory symptoms such as sore or dry throat and cough. It is often diagnosed as a disharmony of toxic dampness complicated with wind; wind pathogens cause typical symptoms like headache, fever, sore throat, runny or stuffy nose, cough with white phlegm or dry cough. When the infection further proceeded, the wind pathogens will transform into heat and irritate deeper to the body, the respiratory signs may then alike other variants, however digestive symptoms are still unlikely. During the recovering, patients may experience general weakness, fatigue and palpitations, which indicate the body has not cleared the heat, and also qi and yin are damaged; many patients in previous variants have similar situation too.
From above observations, TCM claims that the core pathology of COVID-19 remains unchanged, but the clinical presentations have sone changes, that are mostly upper respiratory symptoms like sore and dry throat, and digestive symptoms are not common as before. As a result, with just a little adjustment, the previous protocols released by TCM health authority are still effective.
Regardless the viral changes, TCM management is always based on the presenting patterns of patients and is flexible to adjust along the course of infection. TCM treatment can fulfill the real health needs of each patient and be applied in a timely manner. TCM treatment for COVID-19 provides comprehensive therapeutic effects, that can mobilize different parts or levels of the body’s defensive system, meaning our own innate abilities are activated and coordinated to fight off the SARS-Cov-2 virus directly.
For fairly new infectious diseases, TCM is a handy yet effective option, even though they have unknown pathogenesis and no effective drugs or vaccinations. The epidemics like SARS in 2003 and bird flu in 2013 had gave TCM opportunities to learn lessons, accumulated valuable experiences and now becomes a unique advantage.
12. How can Chinese Medicine help asymptomatic COVID?
According to the Shanghai scenario, asymptomatic COVID accounts for 90% of total cases. Since PCR test becomes the gold standard for COVID-19 diagnosis, the high ratio may be associated with tight and large-scale screening that helps find infections in the earliest possible. Also, many people may still be in incubation period, not yet develop COVID symptoms, and the high vaccination shots play a role too.
For those asymptomatic COVID, conventional medicine says they don’t have the COVID signs, but TCM still identify their disharmony patterns. Physicians can find some subtle or seemingly irrelevant signs on the patients, such as fatigue, limb heaviness, greasy tongue coating, uncompleted feeling after bowels, gastric or abdominal distention. TCM intervention in this early stage is very helpful, which can regulate the immune functioning, halt the disease developing and ensure the body shifting towards positive outcomes. People can restore to their usual state of health and turn to a negative test result speedy, helping them get back to a normal life.
13. How can Chinese Medicine help elderly COVID infections?
Elderly people are likely to get very sick from COVID-19 because many of them have underlying health problems, such as hypertension, diabetic, heart disease, strokes, dementia or cancers. These factors make them susceptible to COVID-19 and make them easily turning into heavy or critical conditions. According to TCM experiences, it is no difficult to handle elderly people with COVID infection alone, but when they also accompany with an unstable underlying health problem, then it is likely be a clinical difficulty.
Conventional medicine treats elderly COVID by addressing symptoms or supportive care, so does Chinese medicine. A detail clinical consultation is important to clarify the primary and secondary symptoms and prioritize the treatment. Multidisciplinary union, east and west integration, early intervention and supportive care will all be required. Clinically, TCM specializes in resolving some stubborn problems, such as persistent fever, confusion, constipation, sticky phlegm that difficult to cough up, and fluid accumulation in the lungs. When these thorny problems are resolved in time, it can largely reduce the deterioration progress and mortality.
14. How can Chinese Medicine help COVID recovery?
Many COVID patients continues to experience different symptoms, such as fatigue, trouble breathing, brain fog, and poor sleep after acute COVID infection. Long COVID indicates that people are still undergoing recovery, some health problems may also be due to health complications lingering after recovery. The process of COVID recovery varies from person to person.
As mentioned, COVID-19 affects different people in different ways. There are many different presentations, and even change over time. In TCM experiences, after recovered from the acute COVID infection, people tend to remain in a deficient state, which often presents as lung and spleen under-functioning, or qi and yin deficiency. Treatment based on syndrome differentiation provides an individual management to solve these miscellaneous and complicated health problems. The remedies are designed according to specific needs of each person, they ensure a notable and rapid improvement after treatment. Treatment results not only benefit the physical body, but also provide psychological comfort to the patients, enhancing their compliance to rebuild health.
Take those with insomnia and anxiety as an example, physicians will ask about details about their sleep problem and degree of daytime disturbance, others like emotional and physical states, diet and lifestyle are also taken for references. Since the diagnosed disharmony usually involves liver qi stagnation and blood failing to nourish heart, a remedy that aims at soothing the liver, regulating qi movement, nourishing the heart and soothing the mind will be chosen. Beside regular herbal remedies, physicians often encourage their patients to modify their diet and lifestyle and engage in traditional exercises.
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What are the unusual symptoms of COVID-19?
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