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Summary knowledge of the underlying immunology should inform
Four Phases of COVID-19 the clinician’s strategy and tactics. It is therefore essential
Clinicians will encounter patients in one of four that the clinician understand the underling immunology
phases of COVID-19, each requiring its own focus. that informs clinical decisions in order to react
appropriately to the unfolding clinical course.
• Prevention - support is focused on immune Five Targets of Support are presented in this paper.
surveillance efficiency and reduction of baseline The following table summarizes the five Targets of Support
levels of inflammation, to improve outcomes if the (rows) that function across four Phases of COVID-19 (the
patient becomes infected, columns). These Phases and Targets, and the knowledge
• Infection - support emphasizes immune activity that undergirds them, can be used to form an optimized
against infection, clinical approach to patient care. The first table describes
• Escalating Inflammation - support is focused on the basic structure. The second populates that structure
anti-inflammatory measures, and with specific tactics. We encourage the reader to read the
• Recovery - support is focused on resolving paper in full, rather than only using the tables.
inflammation, inhibiting fibrosis and other forms The following table summarizes the main features of
of tissue damage, curtailing losses of function, and the clinical strategies and tactics outlined in this paper.
restoring and reoptimizing function. Because Clinicians are cautioned to apply these approaches in the
patients have been observed to relapse into the context of ongoing discernment as to the patient’s
Escalating Inflammation Phase, it is essential for unfolding case and to make course corrections as necessary,
clinical surveillance to continue well into what may as is inherent to the nature of clinical practice. In particular,
appear to be the Recovery Phase. it is essential for those clinicians who have been accustomed
to working with patients whose illnesses are chronic to
Determination of the proper clinical targets (the recognize the inherently different pattern and process of
strategy) and assessment of the merits of tools to address acute illness, and have a low threshold for seeking acute
those targets (the tactics) are critical for optimizing clinical care support.
outcomes. In each of the four phases of COVID-19,

Figure 1. Five Targets of Support as they apply to the four Phases in the time course of disease. It’s essential that if
the patient moves from the Infection Phase to the Escalating Inflammation Phase, the emphasis shifts to
downregulation of the potentially life-threatening inflammatory process.

Yanuck—Immuno-physiological Approach to COVID-19 Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print 7