Homeopathy and Covid: A Case Series

Date: 12^th  Oct 2020

S.M: A 32 years old female; Hx of twice curettage on Feb 2020, anemic (Hb: 10 g/dl), got covid in April 2020, and positive PCR. No CT was obtained.

(COVID‐19 patients with anemia showed a higher rate of comorbidities, more severe inflammatory responses, and organ injuries when compared with the non-anaemic controls. The degree of inflammatory responses in COVID‐19 patients was positively associated with the severity of anemia. Moreover, anemia was an independent risk factor associated with severe illness in COVID‐19 and earlier and more vigilant self-isolation compared to the general population.*⁴)

PCR this time has turned out positive and in the CT scan lungs were very insignificantly infiltrated, having in mind that it was obtained just 2 days after the symptoms started. But clinically she is extremely ill. She has breathing issues with SpO2 85%, and severe coughs and is strictly advised to be hospitalized and receive Remdesivir, but there is not an empty bed in the hospital hence on waiting list.

The case was taken over the course of 3-4 hours as she didn’t have any energy to do a video call or speak. So, the questions were asked and she would write down answers as text messages at long intervals. The information is given very inconsistently and summed up in an easy to grasp and coherent way.

“10 days ago, I caught cold, had severe sore throat. I went to doctor and received a penicillin injection and IV serum, Dexamethasone, plus Co-amoxiclav. On Friday 2nd Oct, the medications were over. On Sunday 4th October suddenly at my workplace I got severe general body ache, I didn’t have sore throat but had very severe body ache. Fever was 39 degrees Celsius. My chest was burning. Again, I received penicillin and Dexamethasone IV and Azithromycin. On 6th October I was extremely sick. I was so sick I could not walk anymore.”

D: Suddenly means? “In a second everything started. One minute I was well, working in the clinic and suddenly I got severe general body ache and in two hours I was extremely sick.”

“Since 6th October I have fever and chill continuously. Daytime and night time. The moment that I leave the house to go to inject medications, my fever and chill increase. Again, the doctor prescribed Dexamethasone and Azithromycin.”

“I have severe headache. All over the head, back of the neck, my eyes, everywhere. My headache is much when I want to rise from my bed or from my seat especially on my forehead the pain is extreme, as if the head is an egg and with every movement the yolk shakes inside. When I cough the headache is intolerable. I want to switch the lights off. My eyes are sensitive to the light.“

“My fever is not decreasing; I am constantly taking Naproxen and Acetaminophen.  Eyes injected. You can see my eyes’ capillaries very prominently when I have fever. Cough is less than the previous episode of Covid. Coughs are dry.  I have nausea. The first two days I had diarrhea and vomiting; but it is gone now. I don’t feel tastes or smells for the last 3 weeks. I don’t have any appetite; within last three days I have just had a bowl of soup in total. “

“I have severe abdominal pain, kind of pain all over the abdomen as if you have caught cold inside, like if you sit on something cold; I usually get such abdominal pains when I sit on something cold or when a cold wind hits my body. Now the pain is like usual. It is aggravated by cough. Even though I have fever but I feel cold. When you touch my body it is cold, my head is very hot only.  Generally, cannot tolerate cold. “

“No thirst. Only if I am taking a tablet, I drink something. I am generally very thirstless. When I am not sick I drink a lot of tea. Now it is easier to have poison than drinking or eating anything, I am so thirstless and not a pinch of appetite. I just want to lie down; my sleep is decreased so much. I want to sleep but it is impossible to sleep.”

“When I wake up my throat is very, very dry as if there is a thorn inside and I cannot swallow.  Nose is obstructed. I have to breathe from my mouth.  Inside ears especially the left one has pain. As of 12thOct the fever is 38 degrees of Celsius. I have burning in my nostrils and throat and the eyes. “

“My hands and feet are icy cold; even when I am covered under blankets still they are too cold to touch.  My stomach feels too full. I have constant nausea, even when I drink a sip of water I get nausea.  Everything tastes extremely bitter even water. In sleep my body gets drenched with sweat. When I get IV injections, for 2 hours I feel better and then everything starts. “

“My knees pain. I feel so extremely miserable. Even though I am daily getting Dexamethasone injection, it only holds for 2 hours and afterwards my body pain, headache reappear.”

“I have coryza but not much. Also I have bland discharge from my eyes but it is so scanty.  My legs do not have any strength left. Fever is all the time but it increases in the evenings and nights.”

Analysis:

Rx: Bell 1M every 6 hours

Follow up:

Before taking the second dose: “ my headache is much less, my body pain is a little bit less and I have this small rashes on my body (trunk and especially the legs) which are itchy.”

(Still communication is by texting)

After 24 hours: “ Headache is subsided over 50%, coughs are many, my perspiration has much lessened. I just was sweaty when I woke up in the morning. I am still tired. My abdominal pain is gone. I don’t feel any pain any more. The rashes stayed for a few hours and subsided.  I don‎’t feel cold anymore. “

(Calls to report the rest of the follow up)

After 72 hours: “ I don’t need oxygen therapy now. I have vomited once only due to a severe episode of cough and after that vomiting also the cough has subsided. Body pain is much still. My headache is only when I was coughing not otherwise. My hands and feet are not cold anymore. I have not had any IV injection for the last two nights.”

“I ate breakfast today very willingly. My chest pain has also reduced. Coughs are very occasional.”

The improvement happened steady since then and she recovered from all Covid symptoms in 5 days.

Note:

“Patience” is the key element for any successful medical practice; Knowing how to exercise our patience in dealing with any given case, knowing when to wait, how to wait and what to wait for is crucial to handle a case successfully.

In treating such acute episodes, we expect some immediate positive change after the first dose which follows Hering’s set of observations. Like what happened in her case, when immediately or quite soon after the dose, the patient experiences any exteriorization like skin rashes, or discharges unlike anything he has experienced before.

We can consider that as healing reaction and consider the course of our treatment and the remedy choice to be correct. Obviously no new prescription is needed and only the meticulous application of the same remedy will enhance the progress further. In her case, after almost 9 Dexamethasone Injections, appearance of the rashes was a relief.

Phosphorus 

Case 4

Date: 20th Oct 2020

V.A: A 36 years old male; history of contact allergy; freelancer

“Five days ago, on the evening of 16^th Oct, I was exposed to draft of air in the garden and the same night I felt I have caught cold. I injected a dose of Dexamethasone IV and also started Azithromycin. In the morning I was feeling unwell but I didn’t have any specific symptom. I had slight headache in my temporal and frontal areas. I was extremely sleepy, extremely tired, general soreness. I again injected a dose of Dexamethasone and IV serum; the doctor said it is Covid but advised to stay home and if things went wrong breathing wise take a CT. I couldn’t wait so I obtained a CT and it was negative. But CRP turned out to be +2.”

On 20^th Oct, the patient called from the rest room as he was not able to leave there due to the intensity of nausea and body pain.  Diarrhoea for the last 2 days, several times a day.

“I am trying to vomit out but I am not able to. I thrust my finger into my throat if maybe I vomit it would alleviate me, but it doesn’t. Thermal inclination: In my healthy times, I am a chilly person, I seek for heat always. But now within I feel burning. I am sitting wearing the least and I need to pour cold water on my legs. If I could I would put a huge piece of ice on my belly; everything in my stomach is burning. “

Any thirst? “No thirst at all, but if I would drink anything I prefer it to be cold. I just know I don’t want to touch anything warm, or drink anything warm.  My brother gives me fruit juices. I drink but I cannot drink orange juice at all, the heat and burning within becomes too much. I prefer sweeter ones like carrot juice.”

Analysis:

Rx: Phos 1M; every 6 hours

Follow up: The first dose was given late at night, the first follow up was obtained in the morning, before having the second dose: “I took the dose and in a few minutes I felt the heat within decreasing. I have slept for 7 hours without interruption. I don’t feel nausea now. I am just extremely weak.”

Day 2: “I am eating well, no nausea, I feel a little bit chilly. I need to wear more clothes. No cough. I only have had two bowel motions, with loose consistency. My energy level is better. If it was 2 on the scale of 10, now it is around 5-6.”

Rx: Phos 1M continued every 8 hours 

Day 5: “I am totally fine. My energy level is almost normal.”

Treatment continued for 7 days.

CRP on day 8^th is negative.

Pulsatilla 

Case 5

Date: 26th Oct 2020

L.H: A 49 year-old female; Hx of Migraine; Obesity (BMI=38.3 ), housewife; consumes iron supplements regularly and in the latest test, Hb was 12 g/dl and Ferritin 21.96 ng/ml.

I received the patient on 26th Oct, the 3rd day after the symptoms started. The CT scan obtained on day 2 after the commencement of the symptoms turned out to be insignificantly infiltrated. CRP was 2+ and D-Dimer measure was 3.31 Micg/ml (Normal range: 0-0.5) (The serum concentrations of D-dimer, a fibrin degradation product that is used to diagnose the presence of a prothrombotic state, are significantly higher in patients with severe COVID-19 when compared to those with non-severe forms. This suggests that D-dimer concentrations might be helpful to rapidly identify COVID-19 patients with high risk of pulmonary complications and venous thromboembolism, facilitating the early initiation of effective therapies. D-Dimer levels higher than 0.5 micgr/ml are correlated with severe forms of Covid infection and lungs’ infiltration*⁵)

“First symptom was ache all over the body; every bit is painful. I didn’t have any pain in my throat but I felt something got swollen up in my throat. I had kind of suffocative feeling in the throat, as a reaction, I tried to cough it out and then I got hoarseness. “

“There is a spot painful on my chest between the breasts and exactly the same point on my back is painful. All by itself, around 10-11 p.m., swelling on the back of left ear, itching, swelling on both knees with itching, and swelling on the face on the left side of the mouth without itching appeared stayed until the next day’s noon time and disappeared.”

“Since morning today swelling on the lower lid of the right eye. No itching.  Severe dryness in throat and mouth, so that every hour during the night wakes me up to drink some normal room temperature water. During the day the same amount of dryness is there.”

“Thermally, in general I dislike heat and now it is the same, only frequently I get the bouts of chill and internal shivering so I need to wear something warm or cover myself. Still, despite covering my body I have to leave my feet out. The room temperature is quite normal. I have not switched on any heater. Then I wear something warm when I get chilly and cover myself up and then feel I am hot because of the covering and I get perspiration which I cannot recognize it because of the heat of covering myself or it is a part of the chill that happens, which when I uncover myself as the sweat is cold, makes me shiver again and I need to cover myself up.”

Little dry cough; no significant time of aggravation or aggravating factor.

No dyspnoea

“I don’t feel even like sitting. I prefer lying down and like always on the left side. (Energy level is estimated 4 out of 10)

No sense of smell

No appetite

“No increased thirst despite I need to take sips of water to alleviate the dryness in my mouth or my throat.”

“As I am a fat person, I love sweet taste to my core, but now I absolutely dislike sweet things; like apple juice or carrot juice. I prefer more mandarin or lemon juice but I have no specific affinity towards any taste, I just know I cannot take sweets at all.”

“The burning in throat in most when I drink water or fruit juice. “

Analysis:

Rx: Puls 200C every 8 hours

Follow up: The recovery was steady with a flare up of generalized body pain for a few hours on day 5 of treatment. Puls 200 TDS was continued for 7 days and BID for 3 more days. No complications and full recovery happened in 10 days.  The patient only used a few doses of Hydroxychloroquine Sulfate.

Note:

Association Between COVID-19 and Thromboembolism:

Infection with the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the resulting syndrome, COVID-19, has been associated with inflammation and a prothrombotic state, with increases in fibrin, fibrin degradation products, fibrinogen, and D-dimers. In some studies, elevations in these markers has been associated with worse clinical outcomes.^*6

How should an elevated D-dimer be interpreted in a patient with COVID-19?

The increase in d-dimer was the most significant change in coagulation parameters in COVID-19 patients and occurred more frequently than other coagulation parameters such as prothrombin time (PT) or PTT. ^*7

Because D-dimer is a product of cross-linked fibrin, it is a sensitive biomarker to rule out venous thromboembolism. However, while a normal level of D-dimer excludes VTE in patients with a low clinical probability, an elevated D-dimer does not necessarily indicate that a patient has VTE.

In addition, an elevated D-dimer in a patient with COVID-19 should not be used as a sole criterion for hospital admission or mandate imaging for DVT/PE unless other signs or symptoms of VTE are present. VTE may be suspected if D-dimer levels change from normal to abnormal, there is a rapid increase in D-dimer on serial monitoring, and/or clinical signs or symptoms occur. Imaging studies to diagnose PE or DVT should be pursued in these scenarios.^*8

Severe complications of COVID-19 occur more frequently in older patients with comorbidities, and this group of individuals also have an age-related increased risk of thrombosis. The high risk of thrombosis in COVID-19 is demonstrated by the increase in d-dimer, which was found to be the most significant change in coagulation parameters in COVID-19 patients, suggesting increased thrombin production and activation of fibrinolysis.^*7

Despite D-Dimer>2x normal with immobility, prior VTE history, hormone use, obesity (BMI >30), history of cancer, Cardiovasular disease and Diabetes are considered as high risk for coagulopathy in covid cases. However, there have been several reported cases who were old, had comorbidities  and very high D-Dimer levels who had significant lungs infiltration but didn’t progress to any coagulopathy even without anti-coagulation treatment in the western medical system setting.