Eastern Medicine On The Western Frontier Of The COVID-19 Pandemic
Editors' Note: The U.S. Food and Drug Administration has not approved the products mentioned in this article for prevention or treatment of COVID-19. KPCC/LAist is an independent news source; this article does not provide medical recommendations or endorse products of any kind.
On April 11, as the coronavirus pandemic was in full swing, Sinong Lin received a package at her apartment in L.A.'s Chinatown. Sent by her family back in China, it contained 50 small boxes of Lianhua Qingwen capsules, a Chinese herb commonly used to relieve fever and other flu symptoms.
Lin soon got another shipment from her family; this time it was a Chinese herb called Qishen Gubiao Keli, which is mixed with hot water to supposedly prevent COVID-19. All of these herbal remedies had been recommended by the Jiangsu Province Medical Products Administration, a local agency equivalent to a state medical department in the U.S.
Having lived through SARS and MERS in China, the 30-year-old USC student knew how devastating COVID-19 could become. Like many Angelenos — including many Chinese people they know — Lin had stocked up on food, stayed home as much as possible, worn masks outdoors, and sanitized everything in the days leading up to the citywide stay-at-home order.
The only items that seemed to be missing from their pandemic survival regimen were over-the-counter Western medicines such as Tylenol and ibuprofen. The thought of buying them, she told me, never crossed her mind.
"If there is any symptom, the first thought is taking Qishen Gubiao Keli beverage for a day then observing the body's condition," Lin said in Mandarin. "I didn't even think about taking American medicine."
Lin is far from alone. She had received those packages from China because medicinal herbs had already become scarce in Los Angeles — and they still are. As several Chinese herbalists told me, a document released by the Chinese government in June, which claimed that 92% of that country's COVID-19 cases were successfully treated with Chinese herbal formulas, was followed by a surge in demand for those remedies in Southern California.
"Chinese people rely on Chinese medicine," said Wen Yang Lu, speaking in Mandarin as he stood behind the counter of Chinese Herbal Tang in Monterey Park. "There's thousands of years of history using Chinese herbal medicine, so they understand how it works and they trust it. If it's not for critical illnesses, they prefer going to Chinese herbalists."
Lu's tiny Monterey Park herb shop is squeezed in with a bunch of other stores selling everything from handbags to baby products to liquor.
Since the COVID-19 outbreak in March, Lu says the number of customers asking for cold and fever remedies has jumped from one or two per day to as many as 20. They come for herbs that are supposed to strengthen immunity or treat symptoms such as fever, sore throat, headache and shortness of breath.
"Due to the seriousness of the virus, a lot of restaurants were closed, and many workers came back to Monterey Park from other states," Lu said. He said he follows the prescription guidelines of the prestigious Shanxi Province Chinese Medicine Hospital.
During peak hours, Lu said he has six-to-10 customers waiting in line. The store's doorway is blocked to enforce social distancing, and Lu wears blue latex gloves and a surgical mask. He sprays a plastic bag of herbal medicine with Lysol before handing it to a customer and then disinfects dollar bills.
He told me customers are buying in bulk, often walking out with five or 10 boxes of their favorite remedies. Since April, Lu estimates he has sold nearly triple the amount of Lianhua Qingwen capsules he typically would in a year. He also has out-of-state customers, including one in New York who ordered 120 pounds of "antiviral herbs."
Similar Chinese medicines — banlangen, forsythia, dried ginger — are flying off shelves. Lu told me that although he stocked at least 100 pounds of each of these in early April, he had run out by June.
As demand has risen, so have prices. In Lu's store, the cost of honeysuckle flower, an herb used for cold symptoms, went from $20 per pound to $50 or even $60 per pound. "I sold more than 200 pounds in the past three months," Lu said. He usually sells 20 pounds per year.
Lu said he is making more money than usual because of the increase in demand — but not that much more. Wholesale costs have also gone up.
TCM IN THE TIME OF COVID-19
Despite many Americans' skepticism toward medicinal herbs and traditional Chinese medicine, plenty of people — native and foreign-born — rely on them.
Lilly Chiu Pelletier, a 49-year-old Chinese American resident of Manhattan Beach, is one of them. On March 30, shortly after her twins' seventh birthday, she came down with a fever. When she tested positive for COVID-19, Pelletier quarantined in a bedroom. Her husband left meals at the door.
"I now understand what jail is like," Pelletier said with a laugh.
Her symptoms got worse. "I couldn't breath," she said. "I felt like I was [underwater]."
After they called an ambulance and the EMTs who showed up dissuaded her from going to the hospital, Pelletier felt helpless and scared. If she wanted to go to the hospital, her husband, who has asthma, would have to drive her there, and her young daughters would be left home alone.
Pelletier said Tylenol helped her fever, but other symptoms — diarrhea, fatigue, body aches — persisted.
Out of desperation, she turned to Xiaoxiong Shen, an acupuncturist and practitioner of traditional Chinese medicine in Gardena.
Shen sent her one-week doses of herbs based on the recommended formula by China's Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7). After taking them for a few days, Pelletier said she started to recover. After a week, she said, the other symptoms were gone. She can't be sure, but she told me, "I do think that the herb helped."
Outside the Chinese community, people are also giving herbal remedies a try. Among them is 28-year-old South Gate resident Monzerratt Patino.
Patino is a youth counselor at a psychiatric hospital in Torrance. She said that by early June, seven patients and 28 of her co-workers had tested positive for COVID-19. She was one of them.
She was disheartened by her doctor's suggestion to "take Tylenol and don't take ibuprofen," so she turned to her friend Jennifer Garcia, an acupuncturist in Los Angeles. Garcia connected her to a professor at Emperor's College of Traditional Oriental Medicine in Santa Monica, Changqing Yang, who also operates an acupuncture clinic. Together, Yang and Garcia treated Patino.
Patino had never tried traditional Chinese medicine before, but her friends had, so she was amenable. "I felt pretty motivated and positive that this would help," she said.
Yang sent her a formula of herbs, including Chai Hu and Huang Qin, to ease her sore throat and body aches. She didn't follow her doctor's instruction to take Tylenol, she said, because she prefers not to take pharmaceuticals and had heard mixed reports about their effectiveness for treating COVID-19 symptoms.
"After the first night of drinking the tea, my throat pain had gone away a bit; the body aches were lessening," Patino said.
Yang said the Chinese herbs he prescribed followed an herbal formula chart for COVID-19 compiled by two experts in traditional Chinese medicine and were based on formulas used by Hubei Provincial Hospital and Wuhan Union Hospital.
"In China, many doctors in the group that worked on herbal medicine played a big role," Yang said. "They almost cleaned up all the moderate to mild cases [of COVID-19]."
Yang said he hopes people in the U.S. can make use of herbal remedies to treat COVID-19, but: "The very difficult barrier is that biochemical researchers don't believe traditional Chinese medicine's theories."
'A GREAT BIAS'
Despite a steady growth in popularity in the past few decades, and some studies pointing to its effectiveness, traditional Chinese medicine isn't widely accepted in the United States.
Robert Newman, Dean of Clinical Training at Emperor's College, remembers how Chinese medicine was perceived in the late 1980s, when he began studying it in San Francisco.
"All of the news articles, news reports or interviews with supposed experts were always negative about Eastern medicine," Newman said. "There was a great bias against it."
Attitudes began shifting in the '90s, as acupuncture became a more common treatment for pain relief.
In 1993, the New England Journal of Medicine released a report pointing to a substantial number of Americans using alternative and natural remedies. Four years later, the National Institute of Health accepted studies suggesting the effectiveness of acupuncture in relieving nausea and vomiting in adults after surgery or chemotherapy, and as an adjunct treatment in cases such as addiction and stroke rehabilitation.
Today, 47 states have laws regulating acupuncture and there are more than 35,000 state-licensed practitioners in the U.S. In 2012, the National Institutes of Health reported that a quarter of Americans who use acupuncture could bill their insurance for it.
However, the acceptance of Chinese medicine seemed to stop there. Herbs such as banlangen and forsythia were mostly seen as dietary supplements, and until now, only two herbal medicines have been approved by the FDA as prescription drugs: a green tea extract used to treat genital warts and an extract of Sangre de Drago, an herb from the Amazon that's used to treat diarrhea associated with HIV and AIDS.
"Most people in this country only relay the idea that Chinese medicine is acupuncture and acupuncture is pain control," said Dr. Ka-Kit Hui, the director of UCLA's Center for East-West Medicine at the David Geffen School of Medicine. "A lot of people do not realize that Chinese herbal medicine can be used to treat infections [such as SARS]."
In early March, Hui proposed that UCLA's medical school set up an herbal medicine trial for COVID-19 patients. The first step is to secure FDA approval. It's a difficult process since traditional Chinese herbal medicines are not FDA-approved and Western medical journals have not published any data related to Chinese herbs and the treatment of COVID-19. According to Hui, his proposal is still being considered by the FDA's Institutional Review Board.
To Gardena acupuncturist Shen, the lack of FDA approval has pros and cons. "[Herbal remedies are] easily available to American residents who believe in it," Shen told me in Mandarin. "However, the disadvantage is that they cannot be claimed as treatment for any illness."
As for their effectiveness in treating the symptoms of COVID-19, Shen said, "It's not scientific to claim certain Chinese herbal medicines as treatment to COVID-19, but it's also undeniable that they are helpful in improving some symptoms."
Newman, of Emperor's College, added: "There are worries about how it works and what amounts are safe and effective. [The FDA is] very dependent on double blind type research studies," and this type of research is in short supply.
Licensed medical doctors are not allowed to prescribe traditional Chinese herbs because almost all of these remedies are not approved by the FDA and they can present safety issues.
In 1993, after taking a particular brand of Chinese herbal weight-loss supplements imported from Hong Kong, 105 Belgian women developed kidney disease and rapid kidney failure. Researchers attributed the problem to a substance called aristolochic acid, which can be extracted from herbs of the Aristolochia family.
Soon, herbs containing aristolochic acid were banned in the U.S., Canada, Australia and many European countries. A ban in China was implemented in the early 2000s.
While safety concerns and FDA hurdles have created roadblocks for traditional Chinese medicine in the U.S., some practitioners believe the opposition is more deeply rooted. "Asians are culturally different in their lifestyle, in the belief system and so on," Hui said. "That's why it's been very difficult for a Western medical giant to allow Chinese medicine to be used, because it was thought to be quackery."
Besides general skepticism, Hui said, profit margins aren't as high for herbal remedies as they are for Western pharmaceuticals, many of which are patented and sold at a premium. Chinese medicine, Hui said, "is not good for money making."
'NEVER A SURGE'
Los Angeles County has logged nearly a quarter-million COVID-19 cases and more than 5,000 deaths from the virus, according to the latest data from the Department of Public Health. In the San Gabriel Valley, where the population of cities such as Monterey Park and San Gabriel is nearly half Chinese or Chinese American, coronavirus infection and hospitalization rates remain comparatively low.
Patrick Petre, the CEO of Garfield Medical Center in Monterey Park, told me COVID-19 cases at his hospital have been consistently low compared to other facilities around L.A. The number of COVID-19 patients in the hospital peaked at 40, back in July, when infections spiked around the county. On August 18, the hospital had 15 COVID-19 patients and that number is going down daily, according to John Zhuo, Senior Administrative Director at Garfield.
"When the COVID crisis began in early March, we prepared for a surge because Monterey Park is obviously an Asian community with a lot of folks going back and forth to China," Petre said in early June. "We expected the worst. Here we are, three-and-a-half months later, we've had a number of COVID patients, but never a surge."
No studies suggest these low case numbers are directly linked to traditional Chinese medicine. Petre attributes them to an elevated awareness of coronavirus and more rigorous adherence to quarantine protocol within the Asian community.
"We all remember that here in Monterey Park, the citizens and the restaurants started practicing social distancing, wearing masks and taking temperatures in late December," he said. "The fact that [in] the western San Gabriel Valley, the citizens locked down early kept the number of cases, at least in the Monterey Park area, way down."
Petre also said that among Chinese patients admitted to Garfield, many wanted to continue taking Chinese herbal remedies. They couldn't because the hospital doesn't permit their use.
Another possible reason for the low numbers of COVID-19 cases in the San Gabriel Valley: testing — or the lack of it. In L.A. County, approximately 20,000 tests have been administered for every 100,000 residents — a testing rate of about 20%. In the city of San Gabriel, that number is approximately 14,900 tests per 100,000 residents — a rate of just under 15%. Based on an analysis of the most recent data provided by the Los Angeles Department of Health, in cities with a high percentage of Chinese residents, testing rates are in the bottom third of all cities in the county.
In the West San Gabriel Valley, the only testing center offering service in Mandarin and Cantonese was launched at Herald Christian Health Center on May 19, nearly two months after officials opened most testing centers throughout the county. It requires over-the-phone registration and patients must also sign a consent form.
"I think one of the biggest challenges is language," said Pollyanna Lee, the operations director at Herald. "Most of the testing sites from the county or the state are conducted in English. And the instructions are probably only in English or Spanish. It could be intimidating. They want to do it, but they don't know how to access it, so that creates a barrier."
As of July 31, the Herald Christian testing center had conducted 2,333 tests, among which 101 were confirmed positive, a rate of 4.3%, a relatively low number compared to L.A. county's current average rate of 7.3%.
It's also possible that many San Gabriel Valley residents, especially Chinese immigrants, aren't getting tested because they don't have insurance and can't afford it, or because they fear deportation. And perhaps it's not widely known that testing at L.A. County sites is free, and that the county's online Covid testing guide is translated into Chinese.
According to Petre, Garfield hospital receives about 140 patients every day and "about 10% of them are uninsured."
Lu, the owner of Chinese Herbal Tang, said that many Chinese workers simply prefer the convenience and low cost of Chinese herbal remedies.
Yang, the Santa Monica acupuncturist, said the low numbers are about more than just money or testing. They're about self-sufficiency. Chinese people, he said, "are not waiting at home and doing nothing. They do a lot of self-healing."
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