The battle against COVID-19 is far from over. So far in Singapore, measures such as the Circuit Breaker, quarantines and safe-distancing — measures undertaken from a public health perspective— have made an important impact on the spread of COVID-19. The newly-released vaccines will certainly add another layer of protection.
While vaccination is offering some light at the end of the tunnel, it will take some time for us to achieve the critical mass needed for herd immunity, not just in Singapore, but in the rest of the world. In the meantime, precautions must still be taken and prevention should still be a key strategy. As infectious diseases go, COVID-19 has proven to be especially virulent because the infected can be largely asymptomatic, contributing to its potential for spread.
When COVID-19 cases started to rise in Singapore, leading to lockdowns and the temporary suspension of all our face-to-face community nursing programmes, I began to look at the problem from a prevention angle and through the lens of community nursing.
Health promotion, disease prevention and building community health resilience for older adults are topics that have always been of professional interest to me. I have worked extensively on driving health literacy, self-management and promoting healthy lifestyle choices — all important upstream approaches in the prevention of illness and chronic disease complications.
As an extension of these interests, I wanted to explore how Traditional Chinese Medicine (TCM) could be deployed to build up the immunity levels of and impart some protection for high-risk groups. The principle of TCM emphasises disease prevention, treating it in the early stages and lowering the risk of deterioration and recurrence by maintaining the balance of qi, which is manifested as cold (yin) energy and heat (yang) energy. Fine-tuning the equilibrium of both energies in the body helps to strengthen immunity to prevent illness, enabling the body to combat disease and to recover from illness.
PROMISING FIELD FOR EXPLORATION
Reviewing and synthesising recent research literature from a wide body of published evidence-based works, I found that TCM has been used in China with a promising level of success for COVID-19 in combination with Western medicine. There is evidence that over-the-counter TCM preparations are useful in the early stages of COVID-19 to shorten the duration of illness for patients with mild symptoms. The clinical evidences indicate that certain herbs such as gancao, dahuang, huangqi and jinyinhua work to both regulate immunity and clear toxins.
In some more severe cases, TCM prescriptions were used — together with antiviral medication — to improve the outcomes for pneumonia. Interestingly and significantly, research indicates that TCM is able to de-regulate excessive immune response and control inflammation — two serious complications that make COVId-19 so fatal.
TCM clinical protocols have in fact been established by the China National Health Commission and two leading hospitals for five identified stages of COVID-19. Treatment is based on the unique characteristics and different clinical manifestations of each stage, from countering the cold-dampness of the lungs in the early stage to boosting yang energy to recover from collapse in the critical stage. The fifth stage of the treatment plan addresses the recovery stage, to replenish the qi and nourish yin.
TCM preparations have also been recommended across 18 provinces in China as a preventive form of supplementation for high-risk populations, such as older people, patients with chronic diseases, and those in close contact with COVID-19 patients.
EXPLORING TCM FOR COVID-19, TOGETHER
Our work in preventive health often takes holistic, human-centred and innovative approaches that put autonomy and participation back into the hands of individuals. If we can work together, we can explore the potential of over-the-counter TCM as a way to boost general immunity and respiratory health.
The identification of effective over-the-counter TCM will be particularly useful. It dovetails neatly into our work in the community and primary healthcare landscape where we take the approach of prevention, self-care and primary / community-based disease management.
Already, TCM is also a mode of alternative medicine that many Singaporeans are culturally comfortable with, and there is a high level of acceptance and trust. Working with herbal remedies that are already available to us would be greatly useful not only in our fight against COVID-19, but likely in other respiratory diseases as well.
Certainly, safety and contraindications with Western medications are areas of concern. Mainstream Western medicine has a long-proven track record and offers the gold standard for treatment. We do not suggest eschewing conventional treatment for TCM. Rather, collaborative research into this area would be greatly useful to explore the use of TCM to see how it can be safely and effectively used in supporting health in tandem with regular regimes.
Singapore has taken an exemplary approach in its infection control measures, and has even made some clinical breakthroughs in the understanding of the SARS-CoV-2 virus. There is potential for all of us in the healthcare profession — researchers, clinician-scientists, TCM experts and more — to likewise pursue research in TCM as a mode of prevention and complementary treatment. It would open a world of application, not just for Singapore, but for ASEAN and beyond.
