Abstract: The COVID-19 pandemic has brought the world to a standstill. The reported death rate is different for different countries ranging from 0.8% to 3% (majorly dependent on the number of tests performed in the country). It severely affects the older age group and adults with co-morbidities.
The quest for genus epidemicus has given rise to various views. This article intends to lay down the pathogenesis of the disease and tries to reason out how to arrive at a genus epidemicus, errors to avoid and its role in the current pandemic.
The SARS-CoV-2 belongs to a family of single stranded RNA viruses known as coronaviridae. Coronaviruses commonly cause mild infections similar to common cold and accounts for 10-30% of upper respiratory tract infections; it can cause enteric, kidney and neurological diseases.
Although 90-95% of the cases are self-limiting or treatable, COVID-19 severely affects the older age group and individuals with co-morbidities like hypertension, diabetes, ischaemic heart diseases or immuno-compromised patients.
The incubation period on an average is 5 days (range: 2-14 days). The disease progresses gradually as the duration from symptom onset to death is usually from 2 to 8 weeks. Cause of death is attributed to a cascade of inflammatory events and multi-organ failure.
In aphorism 3, Dr Hahnemann mentions the triad of homeopathic prescribing. Foremost, he mentions we need to know what is to be cured in diseases, to understand the disease in the individual.
Here, he mentions that it is more important to focus on individual expressions of the diseased state and to not necessarily go by the diagnostic label. Thus, even in epidemics, it is vital to not miss the individuality of each region and each case.
Next, we need to know what is curative in medicines, to know the materia medica and understand its application through characteristic prescribing. The current pandemic brings forth a list of medicines which could have similar symptoms but not the simillimum. In order to arrive at the correct remedy, we need to understand the sphere of action, its symptomatology and the genus of the remedy.
When these two teachings are applied together with a caution to look out for the obstacles for cure, a homeopath would never fail. Thus, calling out remedies for prevention and cure on superficial symptoms and lack of clinical verification would fail.
The clinical course of SARS-CoV-2 infection can be divided into 3 phases:
- Viremia phase: The virus enters the blood stream from infected tissues; complaints typically last for a few days.
- Acute phase: The virus multiplies in the host causing pneumonia and inflammatory responses. Patients with healthy immune systems and without obvious risk factors, generate effective and adequate immune responses to suppress the virus in the first or second stage without immune over-reaction.
- Severe or recovery phase: One week after the acute phase, there is either recovery or sudden deterioration of health. In the severe stage, uncontrolled viremia affects the vital organs causing failure and sepsis which is life-threatening.
SARS-CoV-2 is a single stranded RNA consisting of structural and non-structural proteins. Research has underlined that non-structural proteins are able to block the host immune response. Structural proteins play a crucial role in virus pathogenicity as it promotes viral assembly and release.
In the lungs, the alveoli contain alveolar cell surfactants which help in protecting the alveoli and allow the transfer of O2 and CO2. The SARS-CoV-2 virus shows extensive attack against target organs with ACE2 receptors – heart, kidney, gastrointestinal tract and the brain stem (which would explain the confusion in some COVID-19 patients).
The virus then self replicates in the alveolar cells and damages them which initiates a primary inflammatory response, releasing interferon, cytokines (TNF-alpha, IL-1, IL-6, IL-8) and intra-cellular components.
Decreased levels of lymphocytes and elevated levels of ferretin, IL-6 and CRP are noted. Immune disturbances start early in COVID-19 as a combination of both direct and by-stander effects, which later amounts to the cytokine storm syndrome. On histopathology, vascular congestion, inflammatory clusters of fibrinoid material and multinucleated giant cells and hyperplasia of pneumocytes has been observed.
Severely ill critical patients have also shown a high proportion of aberrant coagulation featured by prolonged PT, elevated D-dimer and fibrinogen. The pulmonary and peripheral injury due to direct viral attack maybe an important inducer of hypercoagulation or the persistent inflammatory status in critical patients acts as an important trigger for the coagulation cascade.
Role of homeopathy in epidemics:
This pandemic has claimed over 364,000 lives and continues to burden the healthcare system as well as the economy of major countries. Can homeopathy do something? Turns out, pretty much!
Homeopathy has a successful history in treating epidemics, including the 1918 Spanish flu, where homeopathic treatment witnessed a mortality rate of only 1.05%. But, how do we get there? What should a novice homeopath or a professional clinician consider for treatment?
Genus epidemicus (GE):
Renowned Indian Homeopath, Dr J.N. Kanjilal giving two alternatives has mentioned, “It goes without saying that, the best prophylactic remedy is the constitutional simillimum of the individual. It is proved by experience that persons strictly following the homoeopathic line in their medical measures, rarely fall victims to any epidemic disease. The next line of defence is the simillimum of a particular epidemic – the so-called Genus Epidemicus.”
The search for a GE of a particular disease in a particular region must, of necessity, depend on the totality of characteristic symptoms of most of the affected cases in the same region. It is the totality peculiar to the particular epidemic of a particular region.
Thus, what might be the GE of a particular area, doesn’t necessarily mean it will be so globally. It will vary within the country depending on the type of symptoms presented, climate, immune status and mutation of the virus. It would be a folly to state one medicine for all.
I’ve tried to list all possible symptoms observed with COVID-19 from doctors and research papers. This panoramic study of carefully noted symptoms should be considered and symptoms can be added according to what has been observed in a particular region.
Symptom picture/Totality of symptoms
Mild to moderate:
- Fatigue/weakness/muscle aches
- Fever- low to high grade
- Ground glass appearance of the lungs
- Loss of appetite
- Loss of smell and taste
- Nausea, diarrhea with fever and chills
- Scanty/bloody expectoration
- Short, dry cough
- Shortness of breath/deep respiration
- Skin eruptions – maculopapular/ vesicular/pseudo-chilblains/ pustules/urticarial
- Sleepiness with fever and chills
- Sore throat
- White tongue
Symptoms that indicate the disease is progressing to pneumonia: Chest pain, cough, scanty or bloody expectoration, epistaxis, fever with chills, gastric and head complaints with fever, altered taste, vesicles or chilblains on skin.
- Expectoration of coagulated blood
- Fever to hypothermia
- Kidney failure
- Pericarditis/Myocarditis/Dilatation of heart
- Skin- black and purple/livedo or necrosis
- Stertorous/accelerated breathing
- Tachycardia to bradycardia
Clinical findings in severe stage:
Respiratory rate more than 30/minute
SPO2 less than 92%
PaO2/FiO2 ratio more than 300
Lung infiltrates more than 50%
Thus, from the above symptom totality, we come to a group of remedies which can then be differentiated on the basis of individual disease expression in each patient.
Characteristics like onset of disease (rapid or gradual), sphere of action, tongue discoloration, loss of small and taste, fever modalities, type of cough and its modalities, concomitants like sleepiness and weakness etc or specific mental symptoms will be given a higher priority.
From the totality so far, and verified cures from physicians worldwide, I conclude that the remedies Bryonia Alba, Phosphorus, Arsenicum Album, Antimonium Tartaricum, Sulphur, Stannum Metallicum and Carbo Vegetabilis have helped. This is not an exhaustive list, but just a recommendation. Individualization is the key! Once you have investigated the characteristic symptoms of the particular region, you can now narrow down your GE.
It is possible to conceive of more than one GE to act as prophylaxis. For example, in encephalitis, both Apis and Belladonna have proved to be good prophylactics. Similarly, in measles, both Morbillinum and Pulsatilla have been effective prophylactically.
Due caution has to be exercised to see:
(a) that a critical study of each symptom has been made,
(b) that personal bias in the matter of observation, recording, evaluation and interpretation of the stable characteristic symptoms has been eliminated.
Adapting to change:
As the current disease shows varied stages, different stages of disease may need different remedies. From mild fever and loss of taste and smell to diffuse pneumonia and confusion, different phases could need different remedies. (For example, Hyoscyamus is currently suggested for complaints with neurological involvement with COVID19)
If the epidemic continues for some time, there is every possibility that the genus epidemicus may change due to change in the variable factors. Even the genetic pattern of bacteria and viruses may change. A fresh study should then be considered.
A Word of caution:
As stated by Samuel L. Eaton, MD (Hahnemannian Advocate Vol 35), “The navigator who determines his position at sea with the aid of nautical tables is using a device which saves time and labor; and it is no impeachment of his mathematical abilities to admit that he makes his calculations without first working out, in every case, the logarithms on which their accuracy depends. Furthermore, the physician who places undue reliance upon the epidemic remedy will soon discover his error.
Talking from experience, due to lack of symptoms available, I ended up prescribing Bryonia to a potential C19 symptomatic patient with SPO2 89, who experienced complaints after traveling overseas. Bryonia did no good except relieving the cough a little and Alumina was the remedy that helped without oxygen or allopathic support. It is vital to keep our eyes open and mind free of prejudice!
Dr. E.B. Nash warned young practitioners not to put too great stress upon their ability to find and use the GE. He described the GE as the specific, found by gathering a totality of symptoms common to thirty or forty cases of a given epidemic. He pointed out the care needed in cases differing from the type so found, and advocated the totality of symptoms in the individual case, as the best indication for treatment.
Summing it up:
- Homeoprophylaxis is possible, as it has been proved abundantly in many cases in the past.
- Verified constitutional medicine if known is the best prophylactic.
- When not available, arrive at the genus epidemicus through a careful study of the totality of characteristics; do not decide on remedies without a thorough study.
- Every region may have a different GE. What has worked for another doctor in another region may not help. Investigate, study and then move forward with the prophylactic treatment.
- As the type and character of the same epidemic vary with its progress, so we shall not be content with the same prophylactic medicine throughout its course, but change it with the change of the character and type of the epidemic if needed.
- The genus epidemicus will help, but not absolutely in all individuals; thus, in every instance the remedy must be suited to the individual patient, rather than the general form of the prevailing epidemic.
There is something intrinsically powerful about the success of homeopathy in curing large populations that is undeniably attractive to anyone gifted with the power of observation. It was through these early cures with epidemics that Hahnemann was able to quickly and widely spread the word of Homeopathy.