COVID Treatment—Balancing the Benefit and the Evidence

Key Points

Misinformation about COVID abounds, making knowing what to do difficult.
BCCT seeks to sort the facts from the myths, looking for the most credible and current scientific evidence.

Authors

Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher

Nancy Hepp, MS, BCCT Project Manager

Last updated April 7, 2021.

Highlighted Videos

Advice on how to spot disinformation about COVID-19 from the Union of Concerned Scientists.

BCCT advisor, hospice and palliative care physician and author BJ Miller, MD, explores the future of palliative care in the face of the COVID-19 pandemic.

Physician and clinical instructor Roger Seheult, MD, provides practical information about his own regimen and what he tells his patients.

Integrative Health Resources on Treating COVID-19 Symptoms and Aiding Recovery

Donald Abrams, MD, has famously said about integrative medicine: “The lower the risk, the lower the burden of proof.” If something is unlikely to hurt you and may well benefit you, it may be worth your consideration. While the therapies offered on this page have not been tested on the COVID-19 virus, most are unlikely to hurt you and show indications of possible benefit. Those for which the risk is clearly greater than the benefit are listed in the Supplements to Avoid section below.

Based on research in MERS, another coronavirus, early detection and treatment are key to increase your chances of recovery.¹ Report symptoms as soon as possible, get tested and follow monitoring and treatment protocols.

Some of the better integrative health websites and resources that we respect:

ConsumerLab.com report on the known effects of several supplements and natural products on viruses: Natural Remedies and Supplements for Coronavirus (COVID-19)
The Institute for Functional Medicine:

The Andrew Weil Center for Integrative Medicine:

Integrative Approaches to COVID-19
Integrative Considerations during the COVID-19 Pandemic, authored by Lise Alschuler, Andrew Weil, Randy Horwitz, Paul Stamets, Ann Marie Chiasson, Robert Crocker and Victoria Maizes

Note that recommendations from these sites differ, yet there is considerable overlap.

Health professionals may also want to review further information at the end of this page in the For Healthcare Professionals section.

Judicious Use of Complementary Medical System Approaches

Naturopathic medicine, functional medicine, traditional Chinese medicine, Ayurveda and other systems each have approaches to wellness, to immune support, and to fighting viral infections. Following a specific approach may help you avoid overloading your body by using a shotgun approach—taking everything that anyone recommends, irrespective of possible interactions or side effects, or of its potential benefit for your situation.

Supplements Recommended by Knowledgeable Integrative Health Practitioners

Some herbal and nutritional supplements and other integrative practices may be of benefit.

In general, supplements and products that regulate a healthy immune response are beneficial before infection. But no human trials have been completed with natural products and COVID-19. Balance the potential benefits with costs and potential harm from supplements. See our list above of some trusted websites for recommendations from credible practitioners. Note that these recommendations vary.

Recognize that supplements that boost immune function may be beneficial before infection but afterward might contribute to an inflammatory cascade. At that point, recommendations often shift.

These supplements are recommended to reduce risk of COVID-19 infection and/or to lessen symptoms or severity of infection. Please refer to the respected websites and resources listed above to get guidance on when, how much and how to take supplements:

Astragalus (Astragalus membranaceus)
Elderberry (Sambucus nigra) (controversial during an active infection)
Garlic (Allium sativum)
Licorice root (Glycyrrhiza glabra)
Medicinal mushrooms (full mycelium mushroom extracts, but not polysaccharide extracts)
Melatonin
Quercetin
Turmeric / curcumin
Vitamin C (also see How to Strengthen Your Inner Shield by Cynthia Li, MD
Zinc pills or lozenges for about a week or so when symptoms of COVID-19 begin (even if you don't have a zinc deficiency). Some caution against nose sprays or swabs that contain zinc, as these have been linked to loss of smell.

The French Agency for Food, Environmental and Occupational Health & Safety published an advisory paper urging caution with taking food supplements (botanicals) that could lower the body's immune response.² A commentary on the paper proposed that readers make sure "that actual risks are adequately assessed and not inflated nor overestimated, since botanicals may still offer a range of valuable therapeutic options to study in depth." The commentary seeks "to identify all appropriate clinical uses and potential risks of botanicals, to avoid dangerous interactions with drugs and, at the same time, to outline a list of evidence-based indications (and contraindications) of medicinal herbs in any stage of the disease."³ The commentary reviews benefits and cautions of these products:

Echinacea spp.
Astragalus membranaceus
Curcuma longa (turmeric, whose main active agent is curcumin)
Uncaria tomentosa (cat's claw)
Andrographis paniculata (green chiretta)
Pelargonium sidoides (South African geranium)
Sambucus nigra (elderberry)

The commentary authors provide a summary of which plants or derivatives may be beneficial throughout each stage of COVID-19 evolution: Cautions and opportunities for botanicals in COVID-19 patients: a comment on the position of the French Agency for Food, Environmental and Occupational Health & Safety.

Preliminary Evidence with COVID-19

Melatonin

In a large observational study of individuals from a COVID-19 registry, use of melatonin was associated with a 30 percent reduced likelihood of testing positive for COVID-19 compared to use of angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors.⁴ In another study, melatonin exposure after intubation was associated with a positive outcome in COVID-19.⁵

Vitamin D

Deficiency is associated with higher mortality and more severe symptoms,⁶ while supplementation is associated with lower mortality, quicker clearing of the virus, less severe symptoms and decreased levels of fibrinogen (thought to contribute to the higher risk of blood clots in COVID-19).⁷

The Debate over Vitamin C (and Other Supplements)

The question of whether vitamin C, either oral or high dose intravenous (IV), is actually beneficial is debated. In fact the debate over vitamin C mirrors the debate over many other supplements and natural products mentioned here.

Supplements to Avoid

Some remedies are not backed by evidence and/or may be unsafe. ConsumerLab details particular danger with these that should not be used:

Miracle Mineral Solution (sodium chlorite)
Chlorine dioxide kits
Colloidal silver (although some sources recommend gargling with colloidal silver mouthwash, making sure not to swallow)

Oleander is a more recent suggestion that also should not be taken, as it it highly toxic.⁹

If you have an active infection or you think you might have the infection, don’t take or immediately stop taking these immunostimulatory agents which increase inflammatory cytokines:¹⁰

Polysaccharide extracts from medicinal mushrooms
Echinacea angustifolia and E. purpurea
Larch arabinogalactan

Elderberry (Sambucus nigra) is somewhat controversial. It is widely considered helpful for reducing risk of viral infections, and some experts think it may help reduce risk of COVID-19, but there is no scientific evidence of this. With an active viral infection some practitioners recommend discontinuing it, while others do not believe it will be harmful. See the Commentary below.

Note that we have removed vitamin D from this list as new evidence has emerged, as noted above.

Other Therapies and Approaches

During a 2003 SARS outbreak, inhaled nitric oxide improved lung function, reduced time spent on a ventilator and showed antiviral activity. Several device companies have recently received FDA's blessing for emergency expanded access to offer inhaled nitric oxide gas for treating COVID-19.¹¹

Preliminary results show low-dose radiotherapy may offer benefit for severe COVID-19–induced pneumonia and is being investigated in clinical trials.¹²

Some COVID-19 treatment protocols, such as the MATH+ treatment protocol, use the H2 blockers famotidine or cimetidine, based on weak but encouraging evidence that these drugs might protect against severe illness and death.¹³ This is considered an off-label use of these drugs.

On the other hand, worse results are seen in patients using proton-pump inhibitors (PPIs). Use is associated with "a significantly increased likelihood for a severe or fatal course of COVID-19" and increased odds for secondary infections.¹⁴ PPIs reduce stomach acid production and are used to treat GERD, peptic ulcers, and H. pylori infections. The study authors provide this advice:¹⁵

Clinicians involved in the management of patients with COVID-19 receiving PPIs should routinely assess if PPI is appropriately indicated; if no appropriate indication, PPI should be discontinued. In patients with appropriate indications, the risk of continuing PPI should be balanced against the risk of discontinuation; otherwise, patients may also be switched to famotidine, a histamine-2 blocker, which has been associated with reduced risk of adverse outcomes in patients with COVID-19.

Commentary

Naturopathic oncologist and BCCT advisor Heather Wright, April 6, 2020: There was an active debate about elderberry within our organization. I believe elderberry is okay and will be supportive, as do others in our community. I will say I have had two patients over the years with confirmed elderberry allergy, though, so this is not unheard of. I do not think elderberry will contribute to the inflammatory cascade in COVID. I also don’t think people can or will take enough of it to do harm. Elderberry syrup on all bottles recommends very low doses. I don’t see my patients going beyond conservative dosing on labels and at those doses I believe they will be safe and that it will be supportive.

View All References

More Information

Treatments for COVID-19

Highlighted Video: Diaphragmatic Breathing

Digestive and Liver Health services at Michigan Medicine demonstrate diaphragmatic breathing. Evidence suggests that diaphragmatic breathing, pursed-lip breathing, and yoga breathing are all viable techniques for improving lung function.

Recovery

For Healthcare Professionals

Preparing to Be Vaccinated: An Integrative Approach