Herbal approach for the management of C0VID-19: an overview

Sana Fatima; Nafis Haider; Md Anzar Alam; Mohd Abdul Gani; Rafeeque Ahmad; Murtada Taha

doi:10.1515/dmpt-2020-0150

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Herbal approach for the management of C0VID-19: an overview

Sana Fatima , Nafis Haider , Md Anzar Alam , Mohd Abdul Gani , Rafeeque Ahmad and Murtada Taha

Published/Copyright: November 2, 2020

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From the journal Drug Metabolism and Personalized Therapy Volume 36 Issue 1

Abstract

COVID-19 is the most recently discovered coronavirus infectious disease and leads to pandemic all over the world. The clinical continuum of COVID-19 varies from mild illness with non-specific signs and symptoms of acute respiratory disease to extreme respiratory pneumonia and septic shock. It can transmit from animal to human in the form of touch, through the air, water, utensils, fomite and feco-oral route blood. The pathogenesis and clinical features of COVID-19 be the same as the clinical manifestation associated epidemic Fever. In Unani medicine, various herbal drugs are described under the caption of epidemic disease. Great Unani scholar also Avicenna (980–1037 AD) recommended that during epidemic condition movement should be restricted, self-isolation, fumigation around the habitant with perfumed herbs (Ood, Kafoor, Sumbuluttib, Saad Kofi, Loban, etc.), and use of appropriate antidotes (Tiryaqe Wabai) and vinegar (Sirka) as prophylaxis. Herbal approach is based on single (Unnab—Ziziphus jujuba, Sapistan—Cordia myxa, Bahidana—Cydonia oblonga, Khatmi—Althea officinalis, Khubazi—Malva sylvestris, Zafran—Crocus sativus, Sibr—Aloe barbedensis, Murmuki—Commiphora myrrha, Darchini—Cinnamomum zeylanicum, Qaranfal—Syzygium aromaticum, Rihan—Oscimum sanctum, Habtus Sauda—Nigella sativa, Aslus Sus—Glycyrrhiza glabra, Maghze Amaltas—Cassia fistula and Adusa—Adhatoda vasica) and compound drugs (Habbe Bukhar, Sharbat Khaksi, Sharbat Zanjabeel, Naqu Nazla, Majoon Chobchini, Jawrish Jalinus and Khamira Marvareed) most of them are claimed for anti-viral, anti-pyretic, blood purifier, cardioprotective and expectorant activities. Traditionally most of the herbal practitioners are using it.

Keywords: COVID-19; complementary medicine; epidemic disease; herbal approach; unani medicine

Introduction

SARS-CoV and MERS-CoV are two extremely communicable and pathogenic viruses that seemed in humans in the early 21st century [1]. Human coronaviruses, first identified in the 1960s, are responsible for a large proportion of childhood upper respiratory tract infections [2]. It has spread rapidly across China and many other countries since the emergence of the 2019 novel coronavirus (2019-nCoV) infection in Wuhan, China in December 2019 [3]. After the first cases of the COVID-19 disease were associated with direct access to the Wuhan Huanan Seafood Wholesale Market, animal-to-human, and human-to-human transmission was assumed to be the key mechanism [4], [5]. On 11 March 2020, the Director-General of WHO described the COVID-19 situation as a pandemic based on “alarming levels of spread and intensity and alarming rates of inaction” [6], [7], [8]. Route of transmission as a droplet, contact, feco-oral and maybe airborne or Trans placental [9], [10], [11], [12]. Genomic characterization has shown that the genetic origins of alpha CoVs and beta CoVs are possibly bats and rodents. Additionally, avian species tend to represent the gene sources of delta CoVs and gamma CoVs [13]. Particularly complex seems the pathogenic process that causes pneumonia. Clinical and preclinical works would need to clarify other factors that underlie the disease’s unique clinical presentations [14]. The area of the lung that is contaminated can be identified as COVID-19. Mild illnesses should be limited to the airways and serious illness will include the gas exchange part of the lung [15]. Most patient symptoms, including fever, cough dyspnoea, muscle soreness and/or fatigue, have taken root after the disease. Some patients have had history of developing sputum, vomiting, haemoptysis and/or diarrhoea. Patients with mild symptoms have heavy fevers and mild fatigue but no signs of pneumonia [16]. Incubation duration is not fixed and varies due to different factors but one study performed by Lauer et al., the mean incubation period was calculated to be 5.1 days (95 percent CI, 4.5–5.8 days), and 97.5 percent of those who experience symptoms will do so within 11.5 days of infection (CI, 8.2–15.6 days) [17], [18]. Treatment with COVID-19 will mainly aim at the rapid absence of symptoms, reducing interpersonal transmission and alleviating extreme forms at risk of death [19]. COVID-19 is not recommended for specific anti-viral therapy, and no vaccine currently available. The diagnosis is symptomatic and oxygen therapy is the first step to address respiratory deficiency [10]. In cases of respiratory failure refractory to oxygen treatment, non-invasive (NIV) and invasive mechanical ventilation (IMV) may be needed [13]. Intensive treatment is once again required to deal with complex types of the disease [14]. Concerning ARDS diagnosis, the development of information about the pathophysiology of lung injury has slowly led clinicians to evaluate approaches to tackle respiratory failure [20]. One of the following strategies may be effective in treating SAR-CoV-2; (i) inhibition of functional enzymes or proteins important to the virus’ survival; (ii) inhibition of viral structural proteins, preventing human cell interaction or virion formation; (iii) stimulation of human host immunity and (iv) inhibition of human proteins acting as receptors for the virus. There are several molecules that could be successful against SARS-CoV-2 coronavirus in cell culture, animal and early human trials for potential treatments for SARS-CoV-2 coronavirus infection [21]. A Systematic Review and meta-analysis of randomized controlled trials performed by Lang et al. (2020) documented combining herbal medicine therapy with Western medicine on efficacy rate and symptom improvement. His findings show the possible role of herbal medicinal products in COVID-19 treatment [22]. Aromatherapy has been in use in Egypt and India for thousands of years to treat different diseases and multiple studies have confirmed the anti-microbial and anti-viral efficacy of essential oils [23]. There are no current effective strategies to prevent spread, other than reducing interaction through social distance, whereas there are no completely effective drugs to prevent or treat COVID-19, although many candidate drugs and repurposed anti-viral and immune-modulating drugs are being tested or used compassionately [24]. Unani medicine has got a set pattern to control epidemic diseases that can also be followed in COVID 19. From its symptoms, it is characterized as Nazla-e-Wabaiya (Epidemic flu like) [25], so various drugs prepared from plants like Mulethi (Glycyrrhiza glabra), Gilo (Tinospora cordifolia), Tulsi (Oscimum sanctum), Kalonji (Nigella sativa), Zanjbeel (Zingiber officinale), Filfil Daraz (Piper lignum), Chiraita (Swertia chirata), Asgand (Withaniasomnifera), Haldi (Curcuma longa), Sibr (Aloe barbedensis), Zafran (Crocus sativus) and Murmukki (Commiphora myrrha) [24], [25].

Common symptoms of COVID-19

The symptoms of the early stages of the disease are non-specific [2]. The common signs of infection include fatigue, muscle pain, sneezing, sore throat, dry cough, high fever, respiratory problems, etc. with some serious cases of pneumonia, severe breathing syndrome, kidney failure and even death [26]. It recorded a case-fatality rate (CFR) of 4.3% and that the most common symptoms were fever, sore throat and muscle soreness or fatigue [27]. Several studies reported that the most common radiological findings in patients with COVID-19 were a ground-glass opacity in the lungs [28]. Besides, SARS-CoV-2 can affect the cardiovascular system and the gastrointestinal tract, and can cause acute renal failure [29].

Mode of transmission of COVID-19

COVID-19 spread through different modes of transmission like; contact, droplet, airborne, fomite, faecal-oral, borne by semen, mother to child and transmission by animal to person. SARS-CoV-2 infection mainly causes respiratory diseases ranging from mild to extreme diseases and death and some people infected with the virus never show any symptoms [30].

Contact and droplet transmission

COVID-19 can be transmitted by open, indirect or near contact with infected individuals by infected secretions such as saliva and respiratory secretions or respiratory droplets formed when a person is coughing, sneezing, talking or singing [29], [30]. Respiratory droplets are >5–10 μm in diameter while droplets <5 μm in diameter are considered droplet nuclei or aerosols [31]. Respiratory droplet transmission may occur when a person is in close contact (within 1 m) with an infected person who has respiratory symptoms (e.g. coughing or sneezing) or who talks or chants; in these cases, respiratory droplets may contain viruses may reach the mouth, nose or eyes of a susceptible person and may result in infection [32].

Airborne transmission

Airborne transmission is characterized as the spread of an infectious agent caused by the spread of droplet nuclei (aerosols) that remain infectious and suspended in the air over long distances [33]. Airborne SARS-CoV-2 transmission can occur during the aerosol generation medical procedures (“aerosol generation processes”) [34].

Fomite transmission

Infected respiratory secretions or droplets may contaminate surfaces and objects, creating fomites [31], [32]. Viable SARS-CoV-2 virus and/or RNA detected by RT-PCR can be found on these surfaces for periods ranging from hours to days, depending on the environment (including temperature and humidity) and surface type, especially at high concentrations in health care facilities where COVID-19 patients have been treated [33], [34]. Given ample evidence of surface contamination with SARS-CoV-2 and virus survival on certain surfaces, there are no unique reports that obviously demonstrate fomite transmission [35].

Other modes of transmission

Coronavirus was also present in several biological samples and in some patients’ urine and faeces. Some researchers reported that SARS-CoV-2 was viable within one patient’s urine and three from stool specimens [36].

Preventive and therapeutic approach

The WHO has confirmed that awareness, separation, prevention, infection control and treatment of infected persons are the main steps in controlling infectious diseases such as COVID-19 [28]. The following strategy will help mitigate the spread of the infection. Staying at home and avoiding close contact with any healthy or sick person referred to as shielding; [37]. Social distance is designed to minimize interactions among people in a wider community where people may be contagious but have not yet been established [38]. High-touch areas such as bedside tables, and door handles should be regularly disinfected with standard household disinfectant which contains a diluted bleach solution or with sanitizers [39], [40]. Divya et al. stated that South Indian medicinal plants inhibit multiple types of viruses and thus spread of infection through convincing anti-viral herbal intervention can control the epidemic. India has a productive and special plant range, with an estimated 45,000 plant species used in traditional medicinal systems [41]. Jahan and Onay (2020) stated the plant-based substance showing antiviral activity, and it would be helpful for COVID-19 to be possibly cured [42]. Nikhat and Fazil (2020) claimed that Unani medicine does not apply as separate entities to epidemics and pandemics, and that a common word “waba” is used for diseases affecting a large geographical area, whereas COVID-19 can be prevented and regulated in the light of Unani medicine [43]. Zakaria Rhazi, Ibn Sina, Ali Ibn Abbas Majusi and Ismail Jurjani listed several single and compound formulations for epidemic disease management under separate heading “Wabai Amraz” [44]. Herbal approach is based on single (Unnab—Ziziphus jujuba, Sapistan—Cordia myxa, Bahidana—Cydonia oblonga, Khatmi—Althea officinalis, Khubazi—Malva sylvestris, Zafran—C. sativus, Sibr—A. barbedensis, Murmuki—C. myrrha, Darchini—Cinnamomum zeylanicum, Qaranfal—Syzygium aromaticum, Rihan—Oscimum sanctum, Habtus Sauda—N. sativa, Aslus Sus—G. glabra, Maghze Amaltas—Cassia fistula and Adusa—Adhatoda vasica) and compound drugs (Habbe Bukhar, Sharbat Khaksi, Sharbat Zanjabeel, Sharbat Khaskhas, Naqu Nazla, Majoon Chobchini, Jawrish Jalinus and Khamira Marvareed) most of them are claimed for anti-viral (Asgand, Chiraita, Tulsi, Unnab etc.) antipyretic and blood purifier (Chiraita, Shahtara, Sarphooka, Unnab, Gilo, Sandal etc.), cardio-protective (Gule Surkh, Gule Gaozaban, Abresham, Saadkofi, Jatamansi, Zafraan, etc.), expectorant (Adhusa, Mulethi, Tulsi, Filfil Daraz, Zanjabeel etc.) activities [44], [45], [46], [47], [48], [49], [50], [51]. Traditionally this is used by most herbal practitioners [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94] [95], [96], [97], [98], [99]. Some are time-tested and secure target focused medication for the specific disorders [100], [101], [102], [103], [104], [105], [106], [107], [108], [109], [110], [111], [112], [113], [114], [115], [116], [117], [118], [119], [120], [121], [122], [123], [124], [125], [126], [127], [128], [129], [130], [131], [132].

Conclusions

COVID-19 was the most destructive pandemic in the course of human history. Notwithstanding the greatest research effort and expenditure, a safe and approved drug to resist or cure this virus is still to be discovered. Under the guidance of the AYUSH program, herbal-based pharmacotherapy should be beneficial for treating COVID-19 symptoms. For thousands of years, aromatherapy has been used in the Unani Medicine Method in Egypt and India to treat various diseases and many studies have confirmed the anti-microbial and anti-viral efficacy of essential oils. Most of these studies, however, only investigated the impact of decoction, limiting their administration to only via the oral route. Under the guidance of AYUSH and ICMR, more work is required to prove the effectiveness of herbal medicine in different models.

Corresponding author: Nafis Haider, Department of Basic Medical Sciences, Prince Sultan Military College of Health Sciences, Dhahran, 34313, Saudi Arabia, E-mail: nafispharma@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.

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Received: 2020-09-02

Accepted: 2020-09-14

Published Online: 2020-11-02

Articles in the same Issue

https://doi.org/10.1515/dmpt-2020-0150

Keywords for this article

COVID-19; complementary medicine; epidemic disease; herbal approach; unani medicine