Stages of Acute Illness: An Integrative Perspective

I spend a lot of time wrestling with false binaries, but the one that is particularly annoying during cold and flu season is the idea that natural health modalities  and conventional modern medicine are on opposite ends of a spectrum.  The two modalities can and should be working together to create the best outcomes for people.

I really don’t know what fuels this divide?  I mean some of it is undoubtedly marketing competition and some of it is probably ego driven dogma and a lot of other nonsense.  None of that is in the best interests of the people I serve.

I know some of what I say below will be difficult for some of my colleagues to hear. I know we are not afforded the same respect by the general medical establishment as I am suggesting we exhibit. Ultimately our responsibility is to support our clients to the best of our ability and that means setting our egos aside, even if the physicians don’t.

Maybe that will change, soon? Research scientists are hard at work digging up herbal adjuncts to conventional treatments and alternatives to antibiotic. Maybe  17 years from now (maybe 20 in Iowa) when today’s biomedical research actually filters down to actual clinical practice.[1] we will finally get some respect.

But I’ve got news for you. You have to earn respect and the shoddy excuse for herbalism that proliferates on the Internet, isn’t going to do that for us. We need to do better.

I’ve been working with acute illness and herbs for well over over twenty years now. I admit that I think one of my superpowers is working with herbal interventions to make people more comfortable and to ward off secondary infections.  Neither of my younger kids (18 and 15)  has ever needed antibiotics.  (Note that I said needed.  If I even suspected they had secondary infection, I would take them to a doctor immediately.  There’s no reason a child should suffer due to a parent’s irrational opposition to conventional medicine. )

Due to the  coronavirus scare, I’ve taken a lot of my cold and flu posts down and am going consolidate them in a more cohesive series.

This is the first installment. It is a summary of my integrative view of the stages of acute illness including a look into the emotional needs that a person might  experience during each stage derived from my sociology classes.  This primarily applies to acute illnesses but certain aspects such as sickness behaviour present with chronic illness as well.  I am including a few very simple comfort measures you can take during some stages,  I will be writing more on this later.

Exposure (Incubation Period)If you live around children, or leave your house regularly, you are going to be exposed to pathogens.  Once  you are exposed to a virus it begins replicating in your system.  With influenza, this stage lasts until you begin to experience prodrome symptoms within 24 – 72 hours. Other viruses have a longer incubation period.  Most of the time you won’t experience signs or symptoms during this stage.

Onset (Prodromal Period)

During this stage you begin to experience prodrome symptoms. That means these are signs and symptoms that indicate the immune system is responding to viral replication as opposed to the characteristic symptoms caused by a specific virus.

One of the body’s defense mechanisms is to elevate your body temperature.  Normal fevers between 38° – 40° C (100.4° and 104° F) are a healthy expression of the immune system and do not need to be treated.[2]  Fever is often accompanied by body aches and chills, and it’s nice to provide comfort measures like a hot water bottle at the feet and an icebag tucked behind the neck.   You also might notice fatigue, swollen lymph glands, or aches and pains caused by inflamed mucosal tissue.  I make a topical spray from mint that many people say helps them through this stage

Sometimes a good strong immune response fights off the invading pathogens and you never experience strain specific signs and symptoms. I think most moms have experienced a child running a fever for a day or so, without any other symptoms.

Emotionally people begin to feel “off.”   They might ask questions like “Do I feel feverish to you?” or “Is it cold in here?” They might consult with other people in their social circle to find out what illnesses have been in circulation and what symptoms to expect.  At this point I feel like many people are just looking for confirmation that their symptoms are not specific to them.

As they begin to experience signs and symptoms some people may even seem afraid or anxious. They  might find comfort in reassurance that other people have been recovering quickly without expensive medical care.

This is a time to begin pumping the liquids into people in the form of infusions, decoctions and broths. Some people start frontloading supplements like zinc or Vitamin C.   The signs and symptoms haven’t differentiated enough to turn to specific remedies.

Active Phase (Periods of Illness and Decline)

The active phase of the illness is when the pathogen count in your body climbs to its highest point,  signs and symptoms are most severe, and you are the most contagious.This stage peaks and declines as the number of viral particles start to decrease.  It is during the period of decline that you are particularly susceptible to secondary bacterial infections.

At this stage people might self-medicate with over the counter (OTC) medicine such as decongestants or NSAIDs.  Self-medication accounts for a lion’s share of all healthcare dollars in the United States.The predominant market  of botanical therapeutics practiced in the US focuses on replacing OTC medications with herbal alternatives.

It goes without saying that any time that you feel overwhelmed by an illness, you should seek out medical care. If your medical professional diagnoses you with a secondary infection they will generally prescribe an antibiotic unless they think it is self-limiting. (It’s not very common here in Iowa yet, but many physicians have stopped prescribing antibiotics for childhood ear infections.) Take the prescription. They are less expensive and more accessible than herbal alternatives, and they usually work faster.

What a physician often  doesn’t know is that there are  herbal adjuncts that can increase the effectiveness of your antibiotic prescription often by interfering with communication (quorum sensing) in a bacterial colony and reducing the likelihood of recurring chronic infections[4]

There are also herbal alternatives [5] for people who are told by their physicians they have viruses or self-limiting bacterial infections. I am not going to get into specifics in this post.  The measures are often strain specific and specific to the individual’s constitution. I will not give you  one size fits all answers.

If you speak to an herbal practitioner who questions your physician’s advice or tells you not to finish your prescription, that’s a red flag.  Not finishing a prescription may contribute to the growth of antibiotic resistance bacteria in your body, and it is irresponsible advice. 

When people do seek out professional help  they are looking for validation, explanation of symptoms in simple terms, and preparations that might lessen the intensity and duration of symptoms. That’s why they get so frustrated by doctors who tell them they have a virus and to go home.


Another emotional characteristic of this stage called “sickness behavior”  refers to the physiologically driven withdrawal from activities and social interaction.[3] It is a “normal” expression of the active, contagious stage of the illness.  This is often complicated by the fact that this is the phase when people often are too ill to perform adequate self-care.

Check in on your people. Take them a crockpot of soup or a hot thermos of tea. Because they don’t feel like reaching out at this stage but they may need help.

Recovery and Convalescence:

This is the stage of illness during which one rests and rebuilds strength, after the active stage of the illness has passed.  The duration varies greatly. Some people may experience a post viral rash or a cough that persists for 3-8 weeks.

Unfortunately, not many people have the luxury of taking any significant time off their job to recuperate. We can pay especially close attention to our nutrition during this stage and there are herbal preparations that are beneficial especially for people who have taken antibiotics.

Some people may experience a nagging malaise or feel otherwise emotionally depleted. Physicians call “post viral syndrome.”  The exact etiology is largely unknown although it’s been theorized that its due an overactive immune system and seems to be related to their emotional state at onset.

Prevention or Non-pharmaceutical Intervention (NPI)

It’s worth mentioning that your immune system is weakened at this point, so I will end this the same lecture about prevention my kids get all the time.  Note this goes a little more in depth than the CDC suggestions which are all tied up in red tape, but all of these measures will help you have a less eventful cold-and-flu season.

Sanitation: Frequent, thorough handwashing with soap and water is the most important NPI but that is not the only preventative measure you can take.  The World Health Organization recommends routine cleaning of frequently used surfaces and objects to reduce influenza transmission. Sterilize things everyone touches like toothbrushes, computer equipment, doorknobs, and faucet handles, once weekly during the flu season and daily when people are sick. Also wash your produce, because you don’t know who has touched it.

If you go out when you are sick, take a container of cleaning wipes with you and clean up after yourself. Think about that person who pushes the shopping cart after you who doesn’t have insurance.

Vaccination: The flu vaccination is notoriously ineffective. That doesn’t mean you shouldn’t get it.  I  just assume that it will not work and still take proper preventative measures.  Some vaccinated people may get the flu and barely have any symptoms, but still be able to spread the virus to others. The flu vaccination also does not make you immune to many viruses including adenovirus, rhinovirus, coronavirus, or coxsackievirus.  Basically what I am saying here is having been vaccinated is not an excuse to be an inconsiderate public health risk.

Isolation: Self-imposed quarantines are probably the most effective way to halt the spread of the disease. You are contagious until you are unmedicated and afebrile (without a fever). I like to wait a minimum of 24 hours. I get that we work in an inequitable society where people either don’t  have sick days or are penalized for taking their sick days.  Just do the best you can and try to stay away from people when you are ill.

If you must go out when you are ill, wear a surgical mask to protect other people from illness.  It’s important to note though that masks only stop large-droplet spray. Fine aerosolized droplets still travel through the masks and remain suspended in the air for some time, so even if you are wearing a mask, cough and sneeze into your own arm to try to contain that a little.

My friend who is a surgical nurse also told me I should point out that the masks are much less effective after they get damp from breathing through them so you should be switching them out every half hour or so.

Humidity: Raising the humidity in a room may reduce mobility of these smaller droplets.[6] It’s worth noting that this is not a new discovery, however in the past the concern about bacterial build-up in humidifiers has led hospitals to steer clear of them. While using a crockpot to simmer herbs the way I do is probably a fire hazard, at least I am thoroughly washing the crock every 48 hours.

Stay Hydrated:  The mucosal tissues in your body need  adequate fluid intake to maintain their integrity and to produce mucin in response to increased pathogenic presence.  I recommend drinking a lot of warm herbal beverage teas during the cold winter months.

Stay Warm:   While this advice used to be written off as an old wives’ tail, there is evidence that cold exposure suppress immune function by lowering the innate immune response, especially to rhinovirus.[7] Exposure to cold also constricts the respiratory tract slowing mucociliary clearance of pathogens trapped in mucus which may contribute to developing secondary respiratory infections.[8]

Manage Stress:  I know this is a lot easier said than done.  I hate having to suggest it to people who are struggling to stay afloat in an inequitable, unjust society, but stress does suppress immune function.

Exercise: There’s a school of thought out there that vigorous exercise suppresses immune function, but that’s been dismissed by a lot of researchers and in fact probably improves immunity by directing lymphocytes to the peripheral tissue.[9]

Herbal Preparations:  There are some immunomodulators which prime your immune system to work more efficiently when you are exposed to a pathogen. These are often herbs I think of as food, like astragalus, burdock root, dried mushrooms.  Some of these, like astragalus, aren’t very useful when you are sick unless your system is just too weak to fight a pathogen off.

Immunostimulants like echinacea and elderberry mostly interfere with viral replication or suppress inflammation pathways, so they are more useful after exposure and the long term prophylactic use is contraindicated in people with autoimmune issues or other complicating factors.

I would suggest you talk to an herbal professional about  your particular situation, but not all of herbalists are created equal.  Feel free to email me at stephany@naturallysimple.org for a referral in your area or to talk about my herbal wellness class.  I offer scholarships and work-trade opportunities so don’t let money be a factor in reaching out to me.

References:

[1] 1. Balas EA, Elkin PL. Technology Transfer From Biomedical Research to Clinical Practice. Evaluation & the Health Professions. 2013;36(4):505–517. doi:10.1177/0163278713508135.

[2] Seattle Children’s Hospital. ‘Fever - Myths Versus Facts’. Accessed 2 February 2020. https://www.seattlechildrens.org/conditions/a-z/fever-myths-versus-facts/.

[3] Kelley, Keith W., Rose-Marie Bluthé, Robert Dantzer, Jian-Hua Zhou, Wen-Hong Shen, Rodney W. Johnson, and Suzanne R. Broussard. ‘Cytokine-Induced Sickness Behavior’. Brain, Behavior, and Immunity, Biological Mechanisms of Psychosocial Effects on Disease: Implications for Cancer Control, 17, no. 1, Supplement (15 February 2003): 112–18. https://doi.org/10.1016/S0889-1591(02)00077-6.

[4]Vasudevan, Sahana, Shogan Sugumar Swamy, Gurmeet Kaur, S. Adline Princy, and P. Balamurugan. ‘Synergism Between Quorum Sensing Inhibitors and Antibiotics: Combating the Antibiotic Resistance Crisis’. In Biotechnological Applications of Quorum Sensing Inhibitors, edited by Vipin Chandra Kalia, 209–25. Singapore: Springer Singapore, 2018. https://doi.org/10.1007/978-981-10-9026-4_10. and Moore et al. Microbiological safety of spices and their interaction with antibiotics: implications for antimicrobial resistance and their role as potential antibiotic adjuncts. Food Quality and Safety. 2019;3(2):93–97. doi:10.1093/fqsafe/fyz008.

[5] Humpherys, Brayden, and David D Busath. ‘Anti-Influenza Nutraceuticals: Antiviral and Anti-Inflammatory Effects’ 4, no. 3 (2019): 15.  and Akram, Muhammad, et al. ‘Antiviral Potential of Medicinal Plants against HIV, HSV, Influenza, Hepatitis, and Coxsackievirus: A Systematic Review’. Phytotherapy Research 32, no. 5 (May 2018): 811–22. https://doi.org/10.1002/ptr.6024. and Lee, Ju-Young, et al. ‘Herbal Medicines with Antiviral Activity Against the Influenza Virus, a Systematic Review’. The American Journal of Chinese Medicine 46, no. 08 (January 2018): 1663–1700. https://doi.org/10.1142/S0192415X18500854.

[6] Binder, Leah. ‘This Inexpensive Action Lowers Hospital Infections And Protects Against Flu Season’. Forbes, 17 October 2019. https://www.forbes.com/sites/leahbinder/2019/10/17/harvard-researcher-says-this-inexpensive-action-will-lower-hospital-infection-rates-and-protect-us-for-the-flu-season/#7417a72a1824.

[7] Foxman EF, Storer JA, Fitzgerald ME, et al. Temperature-dependent innate defense against the common cold virus limits viral replication at warm temperature ... Proceedings of the National Academy of Sciences. 2015;112(3):827–832. doi:10.1073/pnas.1411030112.

[8] Mourtzoukou, E. G., and M. E. Falagas. ‘Exposure to Cold and Respiratory Tract Infections’. The International Journal of Tuberculosis and Lung Disease 11, no. 9 (2007): 938–943.

[9] Campbell, John P., and James E. Turner. ‘Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan’. Frontiers in Immunology 9 (2018). https://doi.org/10.3389/fimmu.2018.00648.