Integrative Interventions for COVID-19

A Chopra Library Brief

COVID-19’s True Danger

  • COVID-19 has an approximate mortality rate of 3%, which is heavily dependent on age and preexisting conditions. This rate is very serious, but the true danger lies in its threat to healthcare systems.
  • COVID-19 is highly contagious, with an R0 of 2.2 (meaning any infected person is likely to infect 2.2 other people). For comparison, the flu has an R0 of 1.3. Up to 20% of Americans catch the flu each year; vaccines keep that rate from being 40-60% higher2. Now imagine the impact of a virus that has no vaccine and is 70% more contagious than the flu. Despite containment measures, it is highly likely more than 60% of the American population will contract COVID-19.
  • Almost no country’s healthcare system is prepared to deal with a disease that infects 60% of the population and puts 26% of the infected into the hospital. The US has enough hospital beds for 0.3% of the population3, while the current track of this pandemic predicts up to 15% of the population requiring hospitalization4. The results are catastrophic.
  • An average of 26% of those infected by COVID-19 require hospitalization, and approximately 8% go into critical condition. Unlike the mortality rate, these rates are NOT heavily dependent on age, nearly all age groups experienced significant rates of lengthy hospitalization.1

COVID-19’s Mechanisms

Part of what makes COVID-19 so debilitating is that it is not just the virus that harms the infected, but their own immune systems. The pneumonia which accompanies COVID-19 is not directly caused by the virus but rather through fibrosis caused by runaway cytokine storms within the respiratory system5.

  • The virus sabotages the infected person’s normal immune response with a scorched earth strategy, destroying antibody cells while it is being destroyed itself. The resulting chaos elicits an ever-increasing intensity of inflammatory immune reactions, which eventually begin damaging the person in addition to the virus.6
  • The cyclical nature of the infection/inflammation feedback loop means that recovery from the virus can take many weeks until the immune system succeeds at clearing the viral load, and during that time the inflammatory response can spiral out of control at any time. Recovery from COVID-19 is not necessarily gradual progress, especially in the most severe cases. A cytokine storm resulting in respiratory damage can occur at the end of the infection as easily as the beginning.7
  • Acute respiratory distress syndrome (ARDS) and septic shock ensue. These potentially fatal conditions are not caused by the virus itself, but rather the immune system’s inflammatory response to the virus.

Role of Systemic Inflammation

  • Systemic inflammation results from an immune response to a persistent stressor (chronic illness/injury, anxiety, tumors, etc), but the inflammation is not limited to that particular stressor. Low levels of inflammatory markers circulate throughout the entire system, straining it over time.
  • Preexisting conditions mean the person has a chronically elevated inflammatory load (systemic inflammation) prior to infection and is already further along the track toward a cytokine storm stimulated by COVID-19. It is likely this helps explain the differences in incidence rates between infection, hospitalization, critical condition, and mortality.8
  • Infection rates are widespread among all demographic groups, reflecting the virus’ high contagiousness. Chronic inflammation does not have a large influence on the initial infection stage.
  • Hospitalization is likewise spread among all demographic groups, though with a moderate increase in older groups and those with preexisting conditions. This is in line with the initial immune response being similar for most people, with older groups possessing more chronic conditions that increase inflammatory load, thus more rapidly spiraling into complications that require hospitalization.
  • Critical condition rates are also spread among demographic groups, with a significant increase in older groups and those with preexisting conditions. This is likely because higher rates of inflammation accelerate the progression to cytokine storms that damage the respiratory system and require critical care.
  • Mortality rates are dramatically skewed toward the elderly and those with preexisting conditions, which is in keeping with the premise that a heightened inflammatory load is the deciding factor in whether the patient’s immune system is able to rebalance and clear the virus without fatally damaging the patient. Those with systemic inflammation are the most likely to die because their systems are already out of homeostasis. It is like trying to walk a tightrope with a dumbbell attached to one end of the balancing pole.
  • Importantly, the specific diseases that are most often associated with severe or fatal cases of COVID-19 are extremely informative. Despite the vast majority of deaths being a result of respiratory failure, the majority of preexisting conditions are NOT respiratory illnesses.
  • The most common comorbidities with COVID-19 are:
    • Hypertension
    • Heart disease
    • Diabetes
    • Cancer
    • COPD
  • Only one of those comorbidities is related to the respiratory system (COPD) and it is not one of the most common comorbidities. What all these illnesses DO have in common is that they are strongly linked to systemic inflammation.9 Levels of systemic inflammation also increase with age, which helps explain why the very young rarely suffer any complications.
  • COVID-19 was initially linked closely to age until it began to spread in Western countries, where it began affecting much younger demographics.10 Perhaps not coincidentally, Western societies have much higher rates of systemic inflammation relating to stress and lifestyle.
  • Levels of systemic inflammation are the common thread between COVID-19’s hospitalization rate, rate of critical condition, mortality rates, comorbidities, and prevalence among different demographics.

Those with systemic inflammation are the most likely to die because their systems are already out of homeostasis. It is like trying to walk a tightrope with a dumbbell attached to one end of the balancing pole.

Complications with Drugs and Isolation

  • Initial treatments have ranged from respiratory assistance to pharmaceuticals. Drugs like chloroquine have had no confirmed efficacy11, while powerful anti-inflammatories like IFNrec have dangerous side-effects that are prohibitive in a highly comorbid population.12
  • While necessary to slow the spread of the pandemic, quarantining and isolating individuals is terrible for them mentally and physically. There is extensive evidence that isolation actively worsens immune system efficiency, deteriorates morale, and decreases adherence to health regimens.13

A Motley Task Force

There are teams all over the planet attempting to address the COVID-19 threat, each with a slightly different focus. This task force has assembled to pursue a non-pharmaceutical approach to lowering systemic inflammation that is accessible, effective, and supported by scientific evidence. The highly multidisciplinary task force so far includes:

  • Deepak Chopra, MD is the leading figure in integrative medicine and head of the Chopra Foundation.14
  • Michelle Williams, SM, ScD is the Dean of Harvard’s School of Public Health and a renowned epidemiologist and public health scientist.15
  • William C. Bushell, PhD is a noted medical anthropologist and the research director of the Chopra Library.16
  • Paul Mills, PhD is chief of behavioral medicine at UCSD and a professor of family medicine and public health.17
  • Ryan Castle is executive director of the Chopra Library and focuses on systems dynamics relating to public health.18
  • Rudy Tanzi, PhD is a professor of neurology at Harvard University and Director of Genetics and Aging research unit at Massachusetts General Hospital, renowned for his research into Alzheimer’s, aging, and inflammation.19

Relationship of Meditation with Inflammation

While meditation is widely considered to be an overall healthy activity, its role in combatting systemic inflammation is unique and powerful. Persistent, low-grade inflammation is part of a dynamic system that disrupts homeostasis, and dynamic systems are difficult to address with targeted solutions like drugs because homeostasis can be a delicate balance. However, meditation improves homeostasis on a systems level, making it disproportionately effective at addressing systemic inflammation.

  • Meditation lowers levels of inflammatory markers, interrupting the vicious cycle of inflammation and allowing the body to downregulate to homeostasis.20
  • Meditation has clinical efficacy at improving the duration and/or severity of diseases.21
  • Though any meditation is beneficial, active meditation that involves visualizations or guided imagery has significantly greater impact than simple mindfulness practice.22
  • Meditation has beneficial effects on multiple immune functions and inflammatory processes, suggesting a truly systemic effect.23 24
  • Meditation, especially when incorporating visualization and compassion components, has clinically significant effects on reducing the physiological and psychological damage of isolation and loneliness.25
  • Visualization meditation has also been shown to improve production of the powerful immune modulator melatonin.26

Meditation’s Unique Applicability

While meditation is a healthy activity for any person regardless of health, the overlaps between the detriments of COVID-19 and the benefits of meditation, especially visualization meditation, are dramatic and uniquely promising.

Some of the major aspects of COVID-19 that are difficult for the healthcare field to address include: dangerous inflammation, complex immune reactions, lengthy hospitalizations, pharmaceutical complications, and risks of isolation.

Meditation has been demonstrated to counteract at least 60% of the inflammatory mechanisms that COVID-19 triggers.

Dangerous Inflammation

  • Meditation has been demonstrated to counteract at least 60% of the inflammatory mechanisms that COVID-19 triggers.27 This could lower the likelihood and severity of inflammatory cytokine storms.28
  • Proper meditative practices not only lower inflammatory load but boost healthy immune response. This diminishes the damage the body takes and accelerates the clearing of the virus.

Complex Immune Reactions

  • Meditation is not isolated to the brain, but is in fact an activity that affects the entire body, modulated by the vagal network.29 In relation to inflammation, meditation’s systemic benefits can balance out the systemic detriments of COVID-19.The melatonin produced by meditative practices significantly boosts that homeostasis. Melatonin is a highly complex immune buffer, capable of acting as an immune booster when viral loads are high, and an anti-inflammatory when cytokine storms loom.30

Lengthy Hospitalizations

  • Arguably the greatest danger of COVID-19 is the overwhelming and collapse of the healthcare system, which would endanger millions more than the virus itself would. This is due to the quantity of people experiencing runaway inflammation and the length of time it takes to overcome it.
  • The Chopra Library is currently building systems models to more accurately predict the effects of a widespread meditation treatment, but early projections of even a 10% reduction in severity have a disproportionately enormous benefit on the hospital system and might make the difference in its survival.
  • It is impossible to precisely predict the impact of meditation on COVID-19’s severity and duration, but given that systematic reviews show meditation reducing the severity and duration of chronic inflammatory diseases and the fact meditation directly addresses most of the active factors of COVID-19, a significant reduction is expected.

Pharmaceutical Complications

  • Pharmaceutical interventions are certainly essential and warranted, but whether as an adjunctive treatment or an option where drug interactions are dangerous, meditation could be a highly valuable intervention.
  • In general meditation has no drug interactions or significant contraindications.

Risks of Isolation

  • An issue that is currently not being addressed at all, the negative immune system effects of loneliness and isolation have been proven to be improved by specific meditative practices.31
  • Improving the resilience and recovery rates of the sick in quarantine reduces the duration of their stay in the hospital, while improving the immune efficiency of the healthy in isolation reducing their likelihood of requiring hospitalization in the first place. Both factors reduce the strain on the healthcare system.

It is impossible to precisely predict the impact of meditation on COVID-19’s severity and duration, but given that systematic reviews show meditation reducing the severity and duration of chronic inflammatory diseases and the fact meditation directly addresses most of the active factors of COVID-19, a significant reduction is expected.

Little Steps and Big Changes

It is not enough to simply encourage the public to meditate more. It is common knowledge that meditation is healthy, much like exercise and fresh vegetables. However, just like exercising and eating vegetables, the passive awareness of healthiness does not always translate to action.

This task force recommends an active engagement of the public and medical professionals alike to instill an awareness of visualization meditation as a legitimate, free adjunct treatment for COVID-19. The steps to accomplish this include:

  1. Creating an ideal version of the meditative practice, whether through a video of a guided meditation or audio via an app. The ideal combination of meditative factors would include elements of mindfulness, visualization, and compassion training. There should be multiple stages of meditations of increasingly complexity to encourage continuation and avoid monotony.
  2. Upload to a medium that is easily and universally accessible, whether YouTube or a free app.
  3. The initial hurdle will be overcoming the assumption that meditation is simply “all in your head” and the outraged claims that it is a pseudoscience. Despite the evidence to the contrary, these protests are likely to provoke anger and accusations of pushing an ineffective treatment. This can be addressed by using evidence and modeling to build a strong coalition beforehand.
    • Obtain the endorsements and legitimization of reputable bodies such as the WHO, CDC, Harvard, prominent doctors, etc. This will require reviewing of evidence and long-term efficacy.
    • Obtain the endorsements and patronization of well-known figures such as celebrities, politicians, scientific leaders, etc. This will require clear explanation of basic mechanisms and implementation.
  4. Put out public statements, articles, videos, and social media pushes to raise awareness of the viability of this approach.
  5. Reach out to medical institutions, doctor’s associations, prominent hospitals, etc. to encourage them to actively promote this approach for the patients in their care.
  6. Work with international organizations like the WHO to create customized programs for individual countries and cultures. Repeat the above steps for each society introduced to the

Moral Imperative

“When you can do the things that [we] can, but you don’t, and then the bad things happen? They happen because of you.” Peter Parker

Those at the crossroads of integrative medicine, public health, systems dynamics, and mind-body research have a unique perspective on an approach that could improve hundreds of millions of lives. Those in such a position should move heaven and earth to see that perspective made reality.

Additional Resources

Videos

ChopraWell Corona Virus Video Playlist – updated regularly

Articles

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