COVID-19 has affected people worldwide and sickened millions. It is no coincidence that people are looking for unconventional ways to stay or become healthy. As Family Medicine physicians who also practice integrative medicine, we are accustomed to being asked questions about wellness. Lately, the most common questions are:

• How can I deal with the stress of staying home/ possible illness/ concern for family and friends/ childcare?
• How do I improve my immune system and stay healthy?
• How can I get well faster if I do get COVID-19?

Integrative medicine looks at interventions with the best evidence and least harm, then combines these with conventional medicine. This approach allows us to take better control of our personal health and well-being. Fortunately, there are many modalities we can tap into that will improve our chances of staying healthy or help us recover.

How can we deal with the added stress of the pandemic?

Managing stress and improving resilience are critical to our immune system, as well as our physical and emotional well-being. We know that eating healthy, moderate exercise, and adequate sleep are crucial to managing stress, but these are challenging to do consistently. If nothing else can persuade us to turn off our screens (phones, computers, iPads, televisions), maybe this crisis can spur us to develop better habits. There are many ways to improve sleep that we won’t detail here, but the bottom line is that good sleep needs to become a priority.

Further, stress management techniques like breathing exercises and meditation can lower our physiologic arousal level and also help with sleep. When the out-breath is twice as long as the in-breath, the body shifts from “fight or flight” mode to a more relaxed (parasympathetic) state. Try this:

Breathe in for a count of 4, hold for a count of 4, then breathe out for a count of 4. Work up to breathing in for 4, holding for 7, and exhaling for 8. Practice this for 3-4 cycles and notice how you feel.

This kind of breathing is a reset for your nervous system. It is a valuable tool always available to you, and it’s free!

Journaling is another accessible and inexpensive way to improve your health… just write about anything that comes to mind. There’s no wrong way to do it. The only important element is that you write with the freedom of knowing no one else will read it. You don’t even have to re-read it—just the act of writing benefits your health. If you prefer other modes of expression, then draw or paint—whatever lets you express what is inside.

There is also ample evidence that social support helps us stay healthier and live longer. To stay healthy during the pandemic, follow physical distancing guidelines. But remember, physical distancing does not mean social isolation. Consider writing a letter, talking on the phone, or engaging in other online interactions. Like sleep, we must make this a priority. These self-care approaches are tools that serve us well throughout the pandemic, as well as our non-pandemic work-life balancing act.

How can we boost our immune systems to stay healthy? 

Stress management and self-care techniques are the most important ways to benefit our immune systems. Once these core elements are in place, we can consider supplements, herbs, and other modalities.

First, focus on eating healthy foods that already contain the nutrients our bodies need. Flavonoids are antioxidants found in many fruits and vegetables. Good sources include parsley, celery, onions, tomatoes, berries, apples, and nuts. Spices also offer antiviral and anti-inflammatory activity, particularly oregano, sage, garlic, turmeric, and holy basil (tulsi). Oregano and tulsi can also be taken as extracts in order to get higher doses.

Supplements can also improve the immune response. Vitamin D is crucial for white blood cells to effectively function, which are the cells that fight infection. Research demonstrates that vitamin D supplementation, especially for those who are deficient, decreases risk for respiratory infections. The daily dose for most people is 1000-4000 IU (international units).

Further, coronavirus seems to be susceptible to the antiviral effects of zinc. The suggested dose is 15-30 mg daily. It is also possible that zinc lozenges may have direct protective effects in the throat.

Melatonin has also been shown to inhibit inflammation and reduce oxidative lung injury during viral infections. Dosing varies widely, but 1-3 mg nightly is safe.

As integrative medicine physicians, many patients ask us about elderberry. Though there is some evidence elderberry can inhibit other viruses in the same family as COVID-19, it also increases inflammatory chemical messengers called cytokines. Because COVID-19 is well known to provoke “cytokine storms,” thereby increasing inflammation, elderberry should be immediately stopped if there is any sign of potential COVID-19 infection.

How can we get well faster if we are sick?

Stop taking elderberry and vitamin D at the first signs of potential COVID-19 infection. Do not use echinacea, which is typically used for other infections. Zinc can be continued.

Further, research shows that starting vitamin C at the beginning of viral illnesses can shorten the duration and has also shown some benefit in critically ill COVID patients, with the most common dose of 4000 mg daily. High doses of vitamin C can cause side effects, but for those who do not have a tendency towards kidney stones, it is safe to take 1000 mg 3-4 times per day.

Though this pandemic is frightening, it also serves as a reminder that we are in charge of many aspects of our health. We must focus on the fundamentals of self-care and develop habits that improve resilience. These skills will payoff repeatedly regardless of what the future holds.

**Feature photo obtained with standard license on Shutterstock.

Interested in contributing to the Harvard Primary Care Blog? Review our submission guidelines

Interested in other articles like this? Subscribe to the Center's newsletter

Andrea Gordon, MD, is Director of Integrative Medicine at the Tufts University Family Medicine Residency Program at Cambridge Health Alliance and Associate Professor of Family Medicine at Tufts University School of Medicine. She is fellowship trained in Integrative Medicine, which she teaches residents and medical students, as well as provides integrative medicine patient care and consultations. A founding member of the organization Integrative Medicine for the Underserved (IM4US), she continues to work to bring these modalities to all who can benefit. 

Elena Rosenbaum, MD, is Director of Integrative Medicine and Associate Professor of Family and Community Medicine at Albany Medical College. She is fellowship trained in Integrative Medicine, which she teaches residents and medical students, as well as provides integrative medicine patient care to those with poor access. During the COVID-19 pandemic, she has continued to offer integrative medicine via telehealth.