The Cytokine Storm & Herbs for COVID-19

With the recent pandemic of COVID-19 or “Coronavirus,” there’s been some debate about using immune stimulating herbs like Elderberry and Echinacea due to concerns that they may trigger a “cytokine storm.” Cytokine storms (a term that’s gone rather, dare I say, viral), are essentially hyperinflammation that occurs when the immune system releases excessive or uncontrolled proinflammatory cytokines (2). While cytokine storms are associated with fatality, and can occur during a wide variety of infectious and noninfectious diseases, including viruses like influenza and COVID-19, there is not a cohesive understanding of the physiological conditions that precipitate a cytokine storm, of the contribution such a “storm” makes to the progression of disease, or of which therapeutic strategies should be used to prevent a storm or stop it once it’s begun (3).   

While several medical studies have proven that yes, Elderberry and Echinacea do activate the immune system by increasing both inflammatory and anti-inflammatory cytokine production, this is a normal response of a healthy immune system. These same studies found that Elderberry and Echinacea could therefore be beneficial to immune system activation and in the inflammatory immune process (necessary for fighting off viruses, infections, etc) in healthy individuals or patients with various diseases (1). Studies also found that Elderberry and Echinacea could also have immunoprotective and immunomodulating effects—which would actually inhibit the likelihood of a cytokine storm (3). Additionally, cytokine storms are often a kind of last ditch response to underperformance of the immune system while experiencing extreme distress.

It’s important to keep in mind that many, complex factors need to be present for a cytokine storm to occur—including being quite sick for some period of time—and that taking herbs alone will not cause a cytokine storm (4). Both Elderberry and Echinacea are wonderful antiviral and immune boosting herbs; as a trained, clinical herbalist, my opinion (and those of most of my peers) is that taking these herbs preventatively and in the early stages of colds or influenzas is beneficial and safe. We need to keep in mind that there’s a lot of fear mongering going around at this uncertain time; as well, herbal and traditional medicines have long been demonized by our patriarchal, capitalist society for many reasons I won’t get into here (distancing ourselves from our natural world and cultural traditions, disempowering our autonomous healing, monetizing medicine, etc). But this is a time for change!

If you’re still concerned about taking herbs like Elderberry and Echinacea but do want to use herbs during this time, please reach out to a trusted herbalist for advice. Some further recommendations if you are worried about how these herbs interact with COVID-19 is to take these herbs solely preventatively, but to discontinue use if you become ill. Other preventatives like Vitamin C, Zinc, Reishi, Astragalus, and Nigella should be taken at modest, consistent doses. Considering reports from Chinese herbalists of Coronavirus clients, it’s recommended to use warming, aromatic herbs with diaphoretic action once contracting this illness, many of which are also antiviral and immune boosting. According to herbalist Matthew Wood, herbs like Elderflower, Angelica, Elecampane, Helichrysum, Thyme, Yarrow, Garlic, and Boneset are good remedies at this stage, as well as Chai spices like Clove, Ginger, Cinnamon, and Fenugreek (5).

Sources:

1. Hudson, James B. “Applications of the phytomedicine Echinacea purpurea (Purple Coneflower) in infectious diseases.” Journal of biomedicine & biotechnology vol. 2012 (2012): 769896. doi:10.1155/2012/769896
2. Tisoncik, Jennifer R et al. “Into the eye of the cytokine storm.” Microbiology and molecular biology reviews : MMBR vol. 76,1 (2012): 16-32. doi:10.1128/MMBR.05015-11
3. V. Barak, T. Halperin, I. Kalickman. “The effect of Sambucol, a black elderberry-based natural product, on the production of human cytokines: I. Inflammatory cytokines.”. European Cytokine Network. 2001;12(2):290-6.
4. V. Barak, T. Halperin, I. Kalickman. “The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.” Isr Med Assoc J. 2002 Nov;4(11 Suppl):919-22.
5. Wood, Matthew. “Coronavirus: Prevention, clinical observation stage, stages of illness 1-4, throughout, and contraindications.” Matthew Wood Institute of Herbalism. 2020.