The Coronavirus (COVID-19) and Chinese Medicine: A Guide for my Patients

Microscopic view of coronavirus

Last updated 4/4/2020 at 12:42 PM, Eastern.

This is a write up for the patients of my clinic, so that they can be informed about the coronavirus (COVID-19), about the best recommendations for prevention within the US, as well as understanding Chinese Medicine in relation to it. I am updating it on a nearly daily basis, as new useful information becomes available. – Scott Schauland

As of 3-16-2020, Ginkgo Leaf Acupuncture is temporarily closing on a week by week basis. This is due to the fact that some research has shown how the virus can spread by simply breathing normally, and can linger in the air for up to 3 hours (sources for that information are further down in this blog post). It’s impossible to screen for who is infected and who isn’t at this time, since people can be asymptomatic while shedding the virus. In order to protect the health of my patients, I am not having any appointments. I’m encouraging everyone to stay home as much as possible, and if going into the great outdoors, keep 10 feet distance from other people to be safe. Disinfect any surface you touch, and wash your hands for at least 20 seconds.

Regarding the different names used for the coronavirus – officials have named the virus that causes the disease, “SARS-CoV-2” and have named the disease that results from catching the virus, “COVID-19”. So technically speaking, you catch the SARS-CoV-2 virus and then you develop COVID-19 symptoms. For ease of use, it’s fine to use the layman’s term of “coronavirus”, since everyone knows what we’re referring to. But technically, there are many different types of coronaviruses, and this is a new breed of one. (source: World Health Organization).

Symptoms might only first appear up to 14 days after being exposed to the virus. That means people can be going about their life, unaware that they’re spreading it to others for potentially 2 weeks. Also, a study has found that the virus can still exist in the respiratory tract 37 days after the illness began, potentially meaning that a person can potentially still be infectious long after symptoms have passed. While authorities are giving a 14 day safety period, I would suggest to really think about a 37 day safety period. Officials are trying to slow the spread, but I personally encourage stopping the spread. Some sources say that while a virus can be detected for longer periods, such as 37 days, it might be possible that the virus is no longer contagious to other people; they suggest that the 14 day period is effective. (sources: Centers for Disease Control and Prevention; The Lancet; Stat News)

The virus is now well established in Michigan, in the Grand Rapids area, and in Kent County. Michigan Department of Health and Human Services has created an official coronavirus page that’s continually updated, which is good to check. (source: Michigan.gov)

If you’re in the Grand Rapids area and are wondering if you’ve caught the virus, here are resources for you:

  • People in Michigan can call a statewide coronavirus hotline operated by the Michigan Department of Health and Human Services, open seven days a week from 8 a.m. to 5 p.m. at 1-888-535-6136.
    • Operators can help guide you to the appropriate resources, but they can’t diagnose or make clinical decisions.
    • You can also email [email protected] at any time. They will respond between 8 a.m. to 5 p.m. 7 days a week.
  • Another option is to call Spectrum Health’s COVID-19 hotline at 616-391-2380 and schedule a virtual screening with a Spectrum Health provider, who can then determine if the caller needs further evaluation.
    • You can be pre-screened by phone if you call this number, and they can then direct you to a drive through testing site in Grand Rapids. (source: MLive)
    • It reportedly takes 3+ days to know your results if you get tested. If they determine you’re ineligible in the prescreening phone call (which would most likely be due to a lack of available testing kits) but you still have cold or flu symptoms of any type, quarantine yourself at home and contact your hospital about how long to remain there. Just because you don’t qualify for testing, doesn’t mean you’re not infectious. You should assume that you have it, and are contagious. (source: MLive)
  • People experiencing immediate life-threatening symptoms should call 911. Some of those symptoms include the following (but this is not a comprehensive list):
    • Difficulty breathing or shortness of breath
    • Persistent pain or pressure in the chest
    • New confusion or inability to arouse
    • Bluish lips or face (source: CDC)
      • “The big thing is, if you have a fever and have difficulty breathing, you need to be discussing symptoms with someone – preferably over the phone,” said Dr. Dan McGee, hospitalist at Helen DeVos Children’s Hospital in Grand Rapids. (source: MLive)

It would not be a good idea to just show up suddenly at the ER, hospital, or testing site. That would potentially cause you to catch the virus from others if you didn’t actually have it, or spread it to others if you did. Call first for an appointment.

The CDC has encouraged people over 60, or who have or are close to those with underlying health conditions (such as heart, lung, or kidney disease, or diabetes, among others), to isolate at home for the next several weeks and avoid going out as much as possible. If you live with someone who is at risk, stay isolated at home with them instead of going out. (source: MLive)

I personally encourage every single person who reads this to isolate themselves as much as possible, and take every single preventive measure (disinfecting surfaces, handwashing, etc) seriously, in order to slow or halt the spread of this virus. Based on all available info, I think the spreading of this virus isn’t going to merely be a couple of weeks, but will last for many months. When numbers of confirmed cases are reported in your area, the actual number of those infected is much higher. Also, a confirmed person has been spreading the virus for some time. Since people are symptom free while being contagious, it’s best to assume that every person you see might be contagious, that every surface you touch might be contaminated, and take all possible preventive measures. The best preventive measure is staying at home, and not being around other people.

The virus is thought to spread through these means:

  • Being within approximately 6 feet (minimum) of someone who is infected.
  • The virus is spread through the air (such as someone coughing, and the particles lingering in the air, which is then breathed in by someone else. One study has demonstrated that coronavirus particles can be airborne, and linger in the air for 3 hours. Other research and experts, within an article on Stat, say that it’s rare yet possible for the virus to linger in the air).
  • Also, the virus can last on surfaces, which when touched can then spread via touching the mouth, eyes, face, etc. (source: Centers for Disease Control and Prevention; The New England Journal of Medicine; Stat News)
Here’s a video showing clearly that microdroplets can linger in the air for some amount of time.
At 2:49 in the video, Dr. Fauci makes clear that one possible way the virus spreads is by become aerosolized after sneezing or coughing, and can linger in the air.

Due to the potential for the virus to linger in the air, I recommend wearing homemade masks if you have to do a necessary supply run to the grocery store. There are studies which show that a homemade mask made from cotton t-shirts or “tea towels” (AKA dish rags) can be more effective than no mask, although they’re not quite as good as an N95 mask. Healthcare providers in hospitals should be the ones getting all available N95 masks at this time, in order to protect them from getting sick, so they can continue treating others. After wearing it, you should first wash your hands thoroughly, then treat the mask as if it’s potentially infected when you take it off of your face. (sources: Smart Air Filters; Emerging Infectious Diseases; PLoS One)

It’s most likely that the virus can last on surfaces for up to 9 days. Some other studies specifically for this SARS-CoV-2 virus give a shorter amount of time, but I think it’s better to play it safe by using this older study from the Journal of Hospital Infection regarding all coronaviruses. Common household cleaners (which must contain 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite/bleach) can deactivate the virus within one minute of exposure. That means: spray it on, wait over 60 seconds, then wipe it off. There is also a list of disinfectants that can be used against the virus which the EPA has released (see EPA link). If you’re worried about a shipment containing the virus on it, you can disinfect it, or let it sit for at least 10 days. (source: Journal of Hospital Infection; EPA)

Some people have compared the coronavirus to influenza, and have downplayed the significance of COVID-19, because people are much more likely to get the flu than get the coronavirus. While it’s true that more people have had the flu, the case fatality rate for COVID-19 is significantly greater, which is why all educated healthcare professionals are taking it more seriously. It’s important not to listen to fraudulent and ignorant sources when it comes to health information. (sources: Centers for Disease Control and Prevention; Johns Hopkins CSSE Global Map)

Based on the statistics within China, COVID-19 seemed to affect people higher in age more so than others. In terms of children below the age of 9, a few hundred were infected, but there have been zero deaths. In contrast, those 80 and older had a fatality rate of 14.8%. Also, it might be the case that men have a higher fatality rate (2.8% vs 1.7%), but that could also be attributed to the fact that men in China smoke cigarettes much more than women. In critical cases of COVID-19 (5% of all cases), certain preexisting conditions could worsen the patients’ condition. In other cases that weren’t critical (95% of cases), such as mild (81%) and severe (14%), there were no deaths. Remember, those are just some early statistics out of China. Reports from Italy show younger people also being strongly affected. (source: Journal of the American Medical Association; ITV News)

There is currently no vaccine for COVID-19, but some groups have been working on one. Trials in the US would take over a year. There could be a treatment that involves using a recovered person’s antibodies from their plasma, but it’s not being used yet and might not be available to enough people to be significant. It might also be possible that hydroxychloroquine and azithromycin combined will turn out to be an effective treatment, although I was personally told by a physician that each drug on their own can potentially cause heart rhythm disturbances. (sources: Time; The Jerusalem Post; Johns Hopkins Hub; Mediterranee Infection)

In order to prevent catching the virus, the CDC recommends these very important strategies. I include my own analysis after each one in italics:

  • Avoid close contact with people who are sick.
    • This won’t help in asymptomatic cases which can last up to 14 days; so, I personally think it’s also important to avoid highly crowded areas if possible. Also, best to avoid restaurants, and prepare your own food at home.
  • Avoid touching your eyes, nose, and mouth.
    • Only N95 masks used properly can filter out the virus, and should be used by healthcare providers that are more likely to be exposed to the virus. So, wearing a typical facemask won’t help prevent catching it or spreading it. The CDC doesn’t recommend the public to wear facemasks, and purchasing N95 style masks can cause a shortage that would affect healthcare providers. It’s also the case that most people don’t know how to use facemasks, so even if they had the right type, due to not being trained they would be ineffective at preventing the spread of the virus. It can suffice to simply make a habit of not touching your face, and following all preventive measures as much as possible.
  • Stay home when you are sick.
    • Even if you think it might not be COVID-19, you should assume that it might be. The only way to tell is through being tested; so if you’re sick at all, stay at home, and contact your local hospital.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
    • If you don’t have a tissue, cough or sneeze into the fold of your elbow at all times. This will prevent the particles from spreading through the air. You should also tell others to do this if they are coughing or sneezing into the air.
  • Clean and disinfect frequently touched objects and surfaces using a disinfectant spray or wipe.
    • Examples of more frequently touched items: doorknobs and handles, car keys, cell phone, charge cards, pens. Pay attention to anything that you touch throughout the day, and make a list for disinfecting all of those things.
    • These are the required ingredients of a cleaning spray or wipe for disinfection: at least 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite (bleach).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
    • Purell is a good brand of hand sanitizer, and it’d be smart to keep a small bottle on you at all times. At least personally, I can’t find a bottle of it anywhere, due to the increased demand for it. Hand washing is more effective than using hand sanitizer (sanitizer is only for when you’re in public and can’t get to a sink), and you should make sure you’re scrubbing your hands longer than 20 seconds. Get a good lather, and rub it all over every part of the hands, fingers, and wrists. Wash your hands any time you’ve touched something in public, right away.
      (source: Centers for Disease Control and Prevention)

Here’s a good video from Johns Hopkins Medicine that demonstrates the proper handwashing technique. If you’re not already washing your hands this way, you should watch and change how you do it:

I personally think it’s a good idea to stock up on at least a few weeks’ worth of food that has a longer shelf life. This site has some good ideas on the types of food to get. In multiple countries now, they quarantined entire cities, which I’m sure in many cases have made it much more difficult to find food in the ways that people were used to doing. Be prepared! Even in our own country, there have now been times where all of the grocery store shelves were empty, and people couldn’t buy the food or supplies they needed. So, accessing food could potentially become difficult here, not only due to a potential quarantine, but also due to panic buying wiping the shelves clean. Additionally, if you fall ill, life will be much easier if you already have food in your house and don’t have to worry about getting it delivered. Instead of stockpiling as much as possible, I recommend getting a few extra items a couple times per week. Also, be sure to have any medical supplies that you will need on hand.

When you go to the grocery store, make sure to sanitize every area of the cart that you’ll touch prior to using it. Do a very thorough job, sanitizing all areas for over 1 minute. Right after you leave the store, sanitize or (better yet) wash your hands. Think about disinfecting your car door as you open it, and disinfecting the surfaces of the items you purchase. Fruits can be washed with plain soap. It’d be a good idea to avoid raw vegetables – better to cook them in order to hopefully deactivate the virus. If you touched your cell phone or keys at all, disinfect them.

This doctor made a good video demonstrating an effective strategy of bringing groceries and supplies in the house.

If you’re getting food and supplies delivered, consider using a service that doesn’t require face to face contact with the delivery person. Some delivery services will leave the items outside your door after knocking, and all transactions can be done electronically. Use those companies. I highly encourage you to disinfect the surfaces of anything delivered to you, prior to bringing it into your house (at least 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite/bleach; spray on the surface, wait at least 60 seconds, then wipe off). If you get a meal delivered from something like Uber Eats, it would be a good idea to put the food on a plate, throw all packaging away, wash your hands thoroughly, then reheat the food (at least 135 degrees for over 15 minutes; source: Advances in Virology) so that it’s piping hot again in order to minimize the risk of the virus entering your mouth from being on the food.

Health officials out of France have indicated that it’s possible for certain anti-inflammatory medications to worsen the disease in a person who has caught the virus. They advise people to take Tylenol (generic name acetaminophen, also known as paracetamol) for pain and fever, and not to take anti-inflammatories such as Ibuprofen, cortisone, etc. Others have indicated that this is just preliminary info and that we don’t know enough yet about the disease, but the World Health Organization has now repeated the recommendation according to Science Alert. Another update: officially, the WHO has now gone back on that and are saying there aren’t enough studies to demonstrate this. (source: The Guardian; Science Alert; WHO Twitter)

In regard to Chinese Medicine:

We have received some good information from China on how COVID-19 patients have been treated there. This PDF gives the best rundown of the stages of the symptoms through a Chinese Medicine lens, and how it’s treated differently at each step. There are a few different schools of thought for how to treat patients with the disease beyond this PDF, and the primary strategy is herbal medicine. According to news coming out of China, 80% of the hospitalized patients there have received TCM treatment alongside pharmaceutical antiviral drugs (none of which are approved for COVID-19, according to the CDC’s claim that there is no treatment for it). It’s hard to discern if herbal medicine has helped the patients recover, since most of these cases would recover on their own anyway, although there is some data which shows it has definitely helped. (source: South China Morning Post; Pharmacological Research)

A common misconception is that Chinese Medicine would have to “cure the virus” or basically be antiviral in order to be legitimate. That is not the case! We can use Chinese herbal medicine to manage symptoms. COVID-19 isn’t a disease in Chinese Medicine theories (although treating “epidemic diseases” has been a large component of Chinese Medicine over the past 2,000 years), but coughing, fever, shortness of breath, body aches – these are all things that we commonly deal with. To be clear, instead of “treating COVID-19” a practitioner of Chinese Medicine only “manages symptoms” of their patients; this is very important to make clear in light of the FDA cracking down on fraudulent COVID-19 treatments. (source: FDA)

If you’re sick, it’s important that you don’t come in for acupuncture treatments. Coming into the clinic would potentially spread the virus to others. Anyone with a fever, cough, shortness of breath, or other cold or flu symptoms should not come for acupuncture. Unfortunately, I’m making the decision to turn patients away if they have any symptoms, or if they’ve been near someone who was infected, until COVID-19 is a thing of the past. If someone schedules and shows up with cold or flu symptoms, or if they’ve been near an infected person, I will have to ask them to leave and they won’t be charged for their appointment. Then I will disinfect anything that was potentially touched.

If you’re sick, instead of seeing an acupuncturist, you should contact your local hospital and ask them for advice about what to do. If your condition worsens at all, you should remain in contact with them, because severe cases can require hospitalization. It would be best to avoid going into the ER without talking to them first, because you could potentially spread or catch the virus.

I’m available for HIPAA compliant telemedicine for those who can’t come in. I’m able to form a diagnosis based on the signs and symptoms we explore in discussion, and based on images of the tongue. Treatment can include: self-acupressure, qigong, meditation, lifestyle changes, dietary guidance, herbal medicine if it’s available, etc. I’m a practitioner of the full spectrum of East Asian Medicine, and acupuncture is just one tool that I use. The real key to getting people better is correct diagnosis.

In terms of herbal medicine or acupuncture needles in my clinic, they are received from US companies who have stored them for much longer periods of time, or even produced them here in the US. I’ve also had them in my clinic for over 10 days already. If herbal medicine has to be special ordered from an herbal company, I will personally disinfect the outer packaging, just in case.

If you’ve read the PDF above that describes treatments in China, you will see preventive treatments being mentioned. I can do those. While these acupuncture and herbal medicine interventions might help to some degree in terms of increasing health and wellness, they won’t prevent someone from catching a virus.

The true preventive measures are the handwashing, staying away from other people, etc, outlined above.

I’ve implemented a thorough disinfection and prevention plan as of 3-11-2020 to ensure that my clinic remains a safe place that doesn’t increase someone’s risk of catching this virus.

Update on 3-16-2020: due to the concern about the virus being airborne, the clinic is temporarily closing on a week by week basis. When the doors are reopened, these disinfection procedures will be in place.

  • I am personally disinfecting all of the following before and after each patient comes to the clinic: my treatment table and stool, door handles on the main door, treatment room door handles, bathroom door handles, light switches, sink faucets, soap dispensers, toilet handles and seats. Furthermore, any items that I commonly use are disinfected: pens, phone, ipad, and clipboard. It’s an incredibly exhaustive disinfection protocol for a one room clinic.
  • As a patient enters, I am personally instructing and guiding them in proper handwashing technique at the sink right away. Besides ensuring that their hands are clean when entering the clinic, it’s also good because it’s a way of learning what we should be doing at this time when entering any building.
  • Anyone who has any signs and symptoms of the cold/flu will unfortunately be turned away from the clinic. For those patients, I am able to do telemedicine and diagnose based on talking about symptoms and seeing tongue diagnosis through a video chat. I can advise on self-acupressure, diet, qigong, and lifestyle changes, and can order herbal medicine. If you have symptoms, you should self-isolate right away, avoid spreading it to other people, and contact your local hospital about it.
  • Previously I would ask patients to exhale or cough during needle insertions to try and make acupuncture as comfortable as possible. But in the case of an asymptomatic person with the virus, doing this could potentially spread it through the air, or onto me. So now there won’t be any special breathing during needling. If anyone is coughing or sneezing, they will be asked to leave the clinic right away, and no other patients will enter that treatment room for at least 3 hours.
  • I will be using a humidifier/diffuser with bay laurel essential oil in my treatment room, a variety of which has been shown to be one of the most effective essential oils against SARS-CoV viruses (source: Chemistry & Biodiversity). It’s not something that would definitively prevent the spread of the virus, but it’s something that can potentially decrease the likelihood of the virus lingering in the air.

Remember to use the CDC’s recommended preventive measures! They are the most important means of stopping the spread of the virus.

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