Helminthic therapy and COVID-19

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    Helminths may confer protection against COVID-19

    Someone who contracts SARS-CoV-2 and develops COVID-19 may recover from the illness more quickly and face a reduced risk of fatality if they are hosting helminths.

    ... we believe that chronic helminth infection provides infected people with an unexpected wealth of protective mechanisms against the Covid-19 disease and its lethal complications. [1]
    The most severe symptoms (of COVID-19) are associated with overactive inflammatory immune responses, leading to a cytokine storm, tissue damage, and death, if not balanced and controlled… Soil transmitted helminths stimulate the immunosuppressive and regulatory T-helper 2 (TH2) branch of the immune system, which decreases ACE2-receptor expression (i.e., receptors SARS-CoV-2 uses to infect host cells), balances the inflammatory TH1/TH17 branches of the immune system triggered by SARS-CoV-2 infection, and reduces inflammation through the release of anti-inflammatory/regulatory cytokines.” [2]

    Hookworm antigens are known to up-regulate genes belonging to certain families, including P53, that are responsible for programmed cell death. [3] In other research, it was found that P53 reduces replication of the SARS-CoV by 65%. [4]

    The emerging science

    These results demonstrate that lung-migrating helminths reprogram lung immune homeostasis, leading to enhanced protection against subsequent SARS-CoV-2 infection. (The species used in this research was Nippostrongylus brasiliensis, which is similar to Necator americanus, the hookworm used in helminthic therapy which is also a lung-migrating worm.)
    … chronic helminth infections may reduce the severity of SARS-CoV-2 infection by reducing hyperinflammation and exaggerated immune response.
    … COVID-19 severity in patients with chronic helminth infections (CHIs) is mild, as immuno-suppressive anti-inflammatory cytokines counterbalance the risk of cytokine storm. Here, an overview of the interplay between helminths and COVID-19 severity is given.
    … it is now apparent that 'biome reconstitution', defined as the artificial re-introduction of benign, symbiotic helminths or protists into the ecosystem of the human body, is important not only for alleviation of chronic immune disease, but likely also for pandemic preparedness.
    This study shows that lung remodelling from a prior helminth infection promotes recovery and less severe outcomes in mice challenged with SARS-CoV-2.
    Our data offer a plausible explanation for the moderate incidence of COVID-19 in Africa and support the hypothesis that helper T cell-mediated immune responses to SARS-CoV-2 are mitigated in the presence of helminth antigens, while virus-specific cytotoxic T cell responses are maintained.
    We argue that helminth-derived products and molecules that can potentially induce a Th2-biased immune response may provide a contributory role in preventing severe COVID-19 by restricting the cytokine storm associated with ARDS… Another unanswered question is whether a well-controlled low level concomitant infection with a live helminth, such as hookworm, can achieve an equivalent or superior effect to an immunomodulator or vaccine in preventing serious outcomes of COVID-19. It would be valuable to test such helminthic-based therapies as these may represent a safe and cost-effective anti-inflammation approach to reducing COVID-19 severity.
    We postulate that helminth infection may be beneficial in preventing cytokine storms and severe COVID-19…
    A significant amount of the tragic clinical outcome of the COVID pandemic in high-income countries might arguably have been mitigated had timely investigations been carried out into the effects of the loss of helminths and protists in these countries and into the reintroduction of benign species capable of safely modulating immune function.
    The authors call for more studies looking at pre-existing helminth and SARS-CoV-2 co-infection, with a view to informing the management of COVID-19 in areas where helminth infections are co-endemic.
    The results support the hypothesis that soil-transmitted helminths inhibit the cytokine response to viruses and bacteria by dampening the proinflammatory cytokine phenotype, suggesting that the helminth-induced anti-inflammatory immunomodulatory network may attenuate some of the most severe symptoms of viral infections such as SARS-CoV-2.
    This study showed a significant inverse correlation between the presence of intestinal parasites and COVID-19 severity, suggesting that parasite co-infection, with both protozoa and helminths, may protect against progression to severe COVID-19.
    A growing body of studies suggests COVID-19 emulates many aspects of systemic autoimmune disorders, including the release of a flurry of overactive immune cells that produce toxic webs of proteins and DNA called neutrophil extracellular traps, or NETs.
    Therapeutic administration of helminth excretory/secretory factors has been shown to modulate these neutrophil responses, abolishing NET formation and reducing the ensuing inflammation. [5]
    This study demonstrated that hospitalized patients with moderate and severe COVID-19 have microbial signatures of gut dysbiosis. Since helminths are known to engender beneficial changes in the gut microbiota [6] this study’s findings may suggest a beneficial role for helminths in reducing COVID-19 severity.
    The number of SARS-CoV-2 cases was not the only predictor of deaths, with countries with a high prevalence of hookworm and malaria experiencing fewer SARS-CoV-2 deaths compared to those with lower hookworm and malaria prevalence.
    The present review focused on the epidemiology of SARS-CoV-2, helminths and fine particulate matter air pollution exposure in helminth endemic regions, the possible immunomodulatory activity of helminths against SARS-CoV-2 hyper-inflammatory immune response, and whether air and water pollutants can further exacerbate SARS-CoV-2 related cytokine storm and in the process hinder helminths immunomodulatory functionality.
    Reviews current knowledge about the relationships between a wide range of parasitic infections and COVID-19.
    The implications of the immunomodulation effect of helminths in endemic areas must be considered in the context of COVID-19 mass vaccination.
    It is essential to remember the manifold negative effects of intestinal parasitosis... In regions where undernutrition rather than overnutrition is a dominating concern, nutritional and metabolic compromise may present a greater hazard in persons at risk for SARS-CoV-2 infection.
    Here, we propose that the interplay between intestinal parasites and microbiome may have a potential direct or indirect effects on the pathogenesis of SARS-CoV-2 infection, in particular in the context of Low- and Middle-Income Countries.
    Evidence not only points to humans’ need of helminths for effective immune function, but also for an effective immune response against SARS-CoV-2 and other viral infections.
    Pre-existing infection with either protozoan parasites or helminths appears to be associated with reduced COVID-19 severity.
    (Related media article: Research shows intestinal parasite infestations reduce COVID-19 severity - Liji Thomas, News Medical)
    An evolutionary perspective is required to understand the global impact and various presentations of COVID-19. We consider how coinfection with soil-transmitted helminths (common parasitic worms that coevolved with humans) may suppress inflammatory immune activity, thereby potentially reducing COVID-19 disease severity.
    (Related media article: Cepon-Robins illustrates how immune responses to intestinal parasites could reduce severity of COVID-19 - Anna Squires, Communique.)
    Helminth parasites could change the outcome of COVID-19 infections, in areas of the world where helminthic infections are still prevalent, by inducing a modified Th2 response with a controlled inflammatory component. Notably, in countries of Africa and Latin America, where helminth infections are still common, the numbers of reported COVID-19 deaths are substantially lower than those reported in high-income countries.
    … we argue that helminth coinfection… may be related to the low lethality of COVID-19 in Sub-Saharan Africa.
    The hygiene hypothesis, which posited that children exposed to certain environments and enteric organisms such as helminths were less likely to develop allergies and autoimmune diseases than those who experienced a more hygienic upbringing, may apply to COVID-19 susceptibility and severity.
    We believe… that any interaction between pre-existing helminth infection and the subsequent severity of COVID-19 need not necessarily be a negative one, and theoretical and empirical evidence suggests that helminths may indeed have a mitigating effect.
    Our main hypothesis therefore is that chronic helminth infection, and the immune consequences thereof, is the main reason why the Covid-19 pandemic have a relatively much lower presence in the millenarian global helminth belt than in the modern urban "dewormed" world...
    We report a consistent inverse correlation between the incidence of COVID-19 and parasitic infections observed across WHO regions. These preliminary findings from an ecological analysis, support our hypothesis of a possible immune-modulatory mechanism induced by parasitic infections, which is protective against COVID-19 and warrants further investigation.
    Explores the possible factors, including parasites, that may be contributing to the lower number of COVID-19 deaths reported in Africa.
    We call on the research community to investigate the influence of helminth co-infection on COVID-19 outcomes as the pandemic spreads through the helminth-endemic regions of the word. Potential negative effects may influence recommendations on deworming.
    Finally, we could also speculate that the high prevalence of parasitic diseases and therefore the pervasiveness of (blood or tissue) eosinophilia and the relatively low incidence of the (COVID-19) pandemic in areas like Tropical Africa or the Indian subcontinent, could be somehow linked. Only time and further research will tell us if there is a relevant connection here.
    In conclusion, we show that intestinal helminth infection can be beneficial in viral respiratory tract infections… we hypothesize that helminth infection in the gut triggers type I interferon production through bacterial interactions, which leads to systemic type I interferon induction, thus raising preparedness of remote sites, such as the lung, to mount an effective innate response against incoming unrelated viral pathogens.

    The experience of Brazil

    Brazil has been one of the countries most severely affected by the pandemic, with SARS-CoV-2 spreading particularly rapidly in the pandemic’s early stages in Maranhao State in the Northeast region of the country. However, this state’s fatality rate peaked in May and fell consistently thereafter. [8]

    By April 2021, Maranhao State had Brazil’s lowest covid-19 caseload (9 per 100,000) and almost the lowest death rate (0.61 per 100,000) per population. [9]

    Researchers reporting from Maranhao in September 2020 had estimated that the prevalence of detectable antibodies (seroprevalence) in the state was already the highest, and the closest reported at that point to the herd immunity threshold, [10] in spite of the population’s generally low economic and nutritional status.

    Soil-transmitted helminths (STH) are still endemic in Brazil’s Northeast region, [11] and a national survey carried out in 2016 had found the region’s highest STH prevalence was in Maranhao State, which also had the highest hookworm rate in Brazil. [12]

    The experience among helminthic therapy self-treaters

    Reactions to COVID-19

    There have been very few reports from self-treaters describing the experience of COVID-19. Most comments from those in this community have described how they began to show signs of what appeared to be a viral infection but which soon resolved, or followed a course very similar to that of a bout of influenza, leaving most of these individuals uncertain as to whether they had had COVID-19 or not. The marked absence from this community of reports of severe illness attributed to COVID-19 may, itself, be suggestive of a beneficial role for helminths.

    I had a CONFIRMED case of Covid-19 and I am hosting about 15-20 NA. The virus came like a quick storm for me. Day 1, I had a fever of 101-2 degrees all day and severe body aches. Day 2, my fever completely subsided and I've been slowly recovering ever since. I'm not sure if my NA had any role to play. I'm 7 days from onset and still dealing with some fatigue and loss of smell/taste. [13]
    I came down with COVID but I wouldn’t consider my aches more severe than I usually get when I’m ill. I’m generally all aches, no fever. I had a lingering odd feeling in my respiratory tract but nothing severe. Also a headache after the first two days, followed by total loss of smell that has still not completely returned. I was never super fatigued but the aches lingered a bit. I only host 5 NA and it’s time to redose. [14]
    It lasted 5-6 days total. I still have a mild sore throat but otherwise I’m recovered. My symptoms (per the usual with NA) were quite different from others. Two friends of mine, who are both considered healthy, are still having symptoms. (One of them infected me). They are coping with a continued cough & congestion. [15]
    Had covid (confirmed by positive PCR test). Light cold symptoms for couple of days. No meds, just vitamins. I’d inoculated with 25 NA (3 months previously). [16] [17]
    Day 1 was a really rough start, and I was still feeling bad on day 2, but the fever had gone. By day 3, I was doing almost everything as normal, and, on day 4, I can honestly say I'm fine again. Out of 8 friends of mine - all in their 30s - that had COVID two weeks before, or at the same time as me, 6 took 2 weeks to start feeling normal and they were really sick. One took 1 week and one recovered in 3 days. I used to be the one that was sick for weeks and took forever to recover. (Edited from several posts in this thread: [18])
    Both my husband and I host NA and we have both had COVID - a very mild dose for both of us, not even a sore throat. [19]
    I just recovered from Covid after being infected last week while visiting a hospital that was suffering an outbreak. My experience was pretty much identical to my brother and the family friend who got infected at the same time. They had the same symptoms, the same timeline as I. My helminths didn't appear to alter the course of my illness one way or another. This was my 3rd bout of Covid and this time was similar or slightly worse than my second, just a bad cold lasting 5-6 days. My first Covid infection in 2020 was horrible, life-threatening. Perhaps hookworms might have spared me some impact with that much more serious illness, but unfortunately I wasn't hosting NA during that time. [20]
    I have had COVID multiple times, and I have been hosting NA for years. My symptoms were less severe than my wife's, who is not hosting NA. Very mild symptoms most of the time - light cough, headache for several days, and a dizziness for maybe one or two days. I was not as tired and did not seem to have as long of recovery. [21]
    I had fever for 4 days. Temporarily lost the sense of taste and smell, etc. I was somewhat tired for 10 days and it all came back to normal afterward. I take TSO for Ulcerative Colitis. I have been in remission for almost 3 years now. I was in Mexico when I got COVID. The variant was named Xibalba. This particular variant had a strong affinity with the digestive track. So I had intestinal symptoms like others but at no time did the Ulcerative Colitis symptoms reappear. The remission held well. I believe this is because I keep taking a lower regular dose of TSO to keep the immunity in my digestive track in good balance. [22]

    Someone who uses TSO to keep his ulcerative colitis in remission was able to weather a bout of the diarrhea-causing Xibalba COVID variant without it exacerbating his intestinal disease.

    I have been without Ulcerative Colitis symptoms now for more than 1.5 years - thanks to taking 1,250 TSO every 2 weeks. My body has recovered largely from the previous flare and has rebuilt itself well even if I am now 71 years old. So I figured it was time to travel again. I went to Yucatan Mexico, an area of the world that I know well. I spent the first 10 days in a small Mayan village of 300 people surrounded by the jungle. Then I moved for another 10 days to a small city in the heart of the Mayan world.

    I began feeling ill on Day 2. I had a bout of intense diarrhea for one day - reminiscent of colitis of course - followed with fever. My wife suggested I do a Covid test. I agreed but I was certain it was a reaction caused by lots of unusual foods including gluten foods which I avoid at home. The test came out positive! We got the Xibalba Covid variant which is common now in the Yucatan peninsula. That variant is known to affect the intestinal tract and provoke diarrhea.

    For 5 days I was ill with fever, cough, loss of smell, skin sensitivities etc. My intestines were hurting, my stools had mucus in them. I came back home to Canada testing negative but with my intestines still dysfunctional. The inflammation created pressure on my lower back and I have been feeling pain for several days.

    One week later, while it is not entirely resolved at this time, I feel 95% OK. I realized today that in spite of the Covid and its effect on my fragile intestinal tract, at no time I had blood in my stool and no sense of urgency either. In other words, it held well and I seem to do no worse than others with this variant. It did NOT trigger Ulcerative Colitis (which was my biggest fear), so all is well. [23]

    Reactions to a COVID-19 vaccine

    Several members of the helminthic therapy self-treatment community have reported significant health issues following receipt of COVID-19 vaccines.

    • Someone working in an educational institution has reported that he was pressured by his employer into getting a COVID vaccine, which he described as a standard “virus plus aluminum adjuvant” version rather than an mRNA one. He had expressed concerns to his institution’s doctor about possible adverse effects from the vaccine, and requested exemption based on his history of autoimmune issues, and his concern about “rocking the boat” with his health, which had been much more stable since hosting helminths. He also referenced his experience with influenza, which he had always coped with well, unlike some others he knew who had had a flu vaccine. However, the institution’s medic had dismissed all his concerns and expressed total confidence in the safety of the vaccine, which the individual reluctantly accepted.
    After getting the vaccine, he experienced what he has described as “some scary autoimmune symptoms” and was still having difficulty getting his health back on track, in spite of hosting helminths, 6 months later.
    I've been struggling with a severe vax reaction the past 6 months with which my existing NA colony of maybe around 40, plus 2 top-ups of 20 (one 20 weeks ago, one 8) have seemingly not helped much. [24]
    And even at 9 months post vaccination.
    Still having problems with vax side effects 9 months after one dose of Sinovac. [25]
    • Someone else has reported significant issues following the Moderna vaccine.
    I developed my first autoimmune disease shortly after my 2 shot Moderna shot. I went into remission 9 months later after changing my diet and practicing intermittent fasting. After my booster shot, I developed 2 more autoimmune diseases and the first one came back. Itis diet seems to be helping and I have high hopes for NA (but currently on day 6 with HT). [26]
    • And a third helminthic therapy self-treater has reported a possible adverse effect following vaccination.
    My health has been declining slowly since April, which is coincidentally when I got vaccinated. Other variables are at play, so I definitely can't say with confidence that it's the vaccine that's caused it. It's just a tad confusing/disconcerting that I've had two (helminth) inoculations since April, but things seem to continue trending worse. [27]

    Timing of vaccine doses and helminth inoculations

    Until more is known about possible interactions, the cautious approach might be to leave an interval of two or three weeks between helminth doses and vaccinations. [28] [29]

    Although one NA user had no issues when only leaving a couple of days between the two.

    I am a long term user (of hookworms). I put in about 30 worms and had a (COVID vaccine) booster a few days after with no issues. [30]

    Treating COVID-19 while hosting helminths

    Anyone hosting helminths who does develop this illness will want to use therapies that will not have any detrimental effect on their helminth colony. A comprehensive list of effective, helminth-friendly, natural antiviral therapies can be found here.

    Can the corticosteroids used to treat COVID-19 cause helminth colonies to increase?

    There have been several reports of Strongyloides stercoralis hyperinfection in COVID-19 patients treated with corticosteroids. [31] [32] [33] [34] [35] However, while this particular nematode species is of special concern in immunosuppressed persons due to the possibility of potentially life-threatening systemic hyperinfection, [36] [37] TSO, TTO, HDC and NA do not present the same risk due to their inability to multiply within a host.

    Can the mRNA and spike proteins from COVID vaccines pass into hookworm larvae?

    This question, which was asked in the Helminthic Therapy Support group, [38] appeared to have arisen as a result of concern about the possibility of the vaccine mRNA or reverse transcribed spike protein DNA persisting in the cells of human vaccinees - a fiercely debated issue. The concern in the mind of the NA self-treater who asked the question was perhaps about whether any spike protein genetic material in the blood ingested by a hookworm might then be integrated into that worm’s genome, and passed, first, to the worm’s progeny, and then to their next human host, where it might be integrated into that host’s genome.

    This possibility is thought to be vanishingly improbable because, firstly, the blood ingested by an adult hookworm will be broken down by the digestive enzymes and microbiota of the worm’s gut. And, secondly, because, even if an intact strand of the spike protein gene were to survive the digestive process, it would need to be absorbed, and then - the toughest challenge of all - would need to get into the worm’s ovary or testis, and into the chromosome of a germ cell. And this exceedingly improbable journey would need to be followed by another, in which a gene in the new generation of hookworms would need to be transmitted to the next human host.

    This is therefore not something that hookworm self-treaters need to worry about. [39]

    Helminthic therapy and Long COVID

    Since Long COVID has many similarities with ME/CFS, also see Helminthic therapy and ME/CFS.

    Using helminths to treat long COVID

    One hookworm user who has reported that introducing 3 NA had very quickly led to full remission from their "pretty severe", ME/CFS-related post-exertional malaise, has said that this therapy also worked for them on Long COVID.

    For me, it worked on long covid... after less than two months of hosting, I am essentially cured. [40]

    Another NA user reported a similar success with Long COVID.

    Had ongoing long-covid symptoms following covid infection in August 2022: debilitating fatigue, severe joint pain, and extreme post-exercise muscle soreness. After inoculating with 3 NA on 5 November 2022, I had a huge improvement, almost back to my prior baseline. Super healthy and feeling great. I continued to top up my NA colony and, by the summer and fall of 2023, I was the healthiest, fittest and strongest I’ve ever been! (Edited from a private message.)

    And an HDC user has reported as follows.

    Long Covid since October 2021 (i.e. for the past two years). POTS/PEM standard symptoms. Started HDC at lowest dose a month or so ago. Started at 10 HDC and it felt good for a few days. Then up to 20 and things got even better. I'm still in that window of 20. Now I've placed an order for 30. This is the ONLY thing that has helped. I've tried EVERYTHING from therapeutics to supplements and treatments like HBOT (helped the rest of me but not LC), red light, SGB, etc. This past week, I've had to walk a half mile (100 yards usually kills me with PEM) for a dinner with my son, played 18 holes of golf - loaded up on steroids - , and totally did unplanned physical activity (my boat was stranded and I had to wrestle it). While I still get some PEM, it goes away and I take meclizine for that. I also take dexamethasone, but in smaller doses. Plus, I fast 16/8 + OMAD. Now, maybe it's just time, but NOTHING has moved the needle this much except the HDC!! Even if this feeling ends tomorrow, I truly believe I'm on the right path!!! I NEVER thought I would be able to do the kind of physical activity that I've done over the last week or so. It feels miraculous. [41]

    A nurse specialising in helminthic therapy has reported her experience of assisting patients with Long COVID, as follows.

    Sticking to very low doses is key, as those with long covid and CFS seem particularly sensitive. Even just 2 NA. Or small doses of TSO, but this really is individual. Most seem ok on 250 TSO each fortnight. Some only a quarter of that. We really just have to go on how sensitive they are to any treatment, if they have other issues as well, and how concerned they are about side effects. But one can never tell who will ultimately need big doses and who will only tolerate small. Starting small and working up is really the only solution. (Edited from three posts: [42] [43] [44].)

    Treating long COVID while hosting helminths

    Treatment protocols have been, and are continuing to be, developed to address Long COVID, for example, those mentioned below.

    However, care should be taken if using Long COVID treatment protocols while hosting helminths because these can include the use of anthelmintics such as ivermectin, which may obviously have a potentially harmful effect on therapeutic worms.