SUDANESE EXPERIENCE OF HERBAL FORMULAS USED DURING COVID-19 INFECTION
AzzaAbdelilah Ahmed Mohamed1, Mai Abdalla Humaida2, Ali Awadallah Saeed3
1Directorate General of Pharmacy, Ministry of Health, Sudan.
2Pharmacy practice department, Faculty of clinical and industrial pharmacy, National University, Sudan.
3Pharmacology and therapeutics department, Pharmacy program, Napata college, Sudan.
Objectives: Corona virus disease 2019 (COVID-19) outbreak is recent worldwide disaster which is considered by the WHO as Public Health Emergency of International Concern (PHEIC).
Method: A quick survey was done in Khartoum state for the commonly utilize herbs and the succeeded formulas, 652 people participated in this survey either they use these herbs for themselves or their relative use it during the symptoms of COVID-19.
Results: A 652 people participated in the quick survey for the commonly utilized herbs & the succeeded formulas either they use these herbs for themselves or their relative use it during the symptoms of COVID-19. Other products used as additives include (honey, vinegar, sesame oil, olive oil and salt).
Conclusion: Sudanese experience that various traditional herbs, usage and different route of administration can effectively alleviate primary symptoms e.g. fever, cough, fatigue and reduce probability of developing severe Conditions.
Keywords: COVID-19, formula, herbs, Khartoum.
The Novel corona virus disease 2019 (COVID-19) outbreak is the recent worldwide disaster which is considered by the WHO as Public Health Emergency of International Concern (PHEIC)1. First case was discovered in Wuhan City, China2,3 and then after few weeks spread as a global pandemic4,5.
The novel corona virus can live on hands, surfaces, objects, mucus membranes, body fluids, respiratory secretions, and spread through direct contact from person to person6,7, which makes the most effective preventive measures are avoiding close contact with people, hand hygiene, clean and disinfect surfaces8, as there is no specific treatment or vaccine for this virus until writing of this paper9,10. The first case of COVID -19 infection in Sudan was confirmed in 13th March 2020, but now the confirmed cases reached 11.496 case,with death 725 and 6001 recovered cases (29th July 2020 update), unfortunately there is about four thousand active cases. While worldwide totals cases reached 16.7m confirmed, 9.71m recovered and about six thousand deaths (July 2020 update). There are four defined stages of COVID -19 infection in communities:
Stage 1: Imported cases in the community.
Stage 2: Local transmissions.
Stage 3: Transmissions among the community.
Stage 4: Epidemic and uncontrolled infections.
According to Sudan FMoH records and statistics we achieve stage 3 now.
Different people in different ways can be affected by COVID-19. Wide range of symptoms may be represented by infected people but they all declare that there are mild, moderate and severe symptoms. Mild and moderate symptoms appear generally after 2 to 14 days of exposure to virus and the symptoms like: cough, headache, fever or chills, runny nose or congestion, shortness of breath or difficult breathing, fatigue, muscle or body aches, new loss of taste or smell, nausea or vomiting, sore throat, diarrhea. Emergency signs and symptoms for COVID-19 includes: confusion, trouble breathing, persistent pain or pressure in chest, inability to arouse or stimulate, bluish lips or face.
Clinical manifestations demonstrate moreover three phases of patient infections:
Phase 1: Infection phase: (symptoms similar to cold and flu).
Phase 2: Pulmonary phase: (immune system strongly infected causing respiratory symptoms including low oxygen levels and formation of blood clots)
Phase 3: Hyper inflammatory phase: (causing injury to vital organs, cytokine storm where body attacks its own tissue)6,7
SUBJECTS AND METHODS
According to this pandemic infection many medicines were used wide world but unfortunately no definite treatment was subscribed till now, and only symptomatic treatments were used. Though many people seek for experienced herbs used to overcome the first signs of infection. A quick survey was done in Khartoum state for the commonly utilize herbs & the succeeded formulas, 652 people participated in this survey either they use these herbs for themselves or their relative use it during the symptoms of COVID-19.
In the following databases: PubMed, Science direct and google scholar up to date search was made (August 2020) with the key words: Acacia nilotica, Nigella sativa, Zingiber officinale, Syzygium aromaticum, Boswellia carterii, Hisbiscus sabdariffa, Citrus aurantiifolia, Camellia sinensis, Allium sativum, Adansonia digitata, Pimpinella anisum, Citrus aurantiifolia and/or ‘Virus’ and ‘Anti-virus effect’ to investigate the anti-viral effects of these herbs.
Table 1: Herbs used for relieving COVID-19 symptoms.
A 652 people participated in the quick survey for the commonly utilized herbs & the succeeded formulas either they use these herbs for themselves or used by their relative during the symptoms of COVID-19. The Table 1 represents the herbs used for relieving COVID-19 symptoms as stated by people participated in the survey and the formula used. Other products used as additives include (honey, vinegar, sesame oil, olive oil and salt)
Literature review about pharmacological effect of herbs on viruses:
1. Acacia nilotica: A. nilotica belonging to family fabaceae, distributed mainly in tropical and subtropical region of the world, having ~1300 species worldwide. A. nilotica is a species native to Africa and the Indian subcontinent. Different parts (leaves, root, bark, pods, seeds, flowers)of A. nilotica have been recommended for treatment of cancer, congestion, colds, coughs, diarrhea, dysentery, gallbladder, fever, hemorrhage, hemorrhoids, leucorrhea, small box, ophthalmia, sclerosis, tuberculosis and leprosy.7In addition it also possess anti-diabetic, anti-scorbutic, astringent, anticancer, antioxidant and antimicrobial properties11. Mona and et al., found that Acacia nilotica has anti-influenza-virus activity and the extract inhibit viral replication and attachment12.
2. Nigella sativa: Dicotyledon of the Ranunculaceae family, employed as a spice, food preservative, protective, curative for numerous disorders and have many medicinal properties in traditional medicine. In review article conducted by Shamim Moolla et al., seeds have wide therapeutic effects and have significant effects against many ailments such as skin diseases, asthma, jaundice, gastrointestinal problems, hypertension, anorexia, conjunctivitis, headache, dyspepsia, rheumatism, cough, intrinsic hemorrhage, diabetes, paralysis, bronchitis, amenorrhea, anorexia, influenza, fever and eczema. Most active constituent is Thymoquinone (TQ). Different extracts of N. sativa as well as TQ, have a broad antimicrobial spectrum, including Gram-negative, Gram-positive bacteria, viruses, parasites, schist soma and fungi.13
3. Zingiber officinale: By blocking viral attachment and internalization Jung San Chang and et al., found fresh, but not dried, ginger is effective against human respiratory syncytial virus (HRSV)-induced plaque formation on airway epithelium14.
4. Citrus aurantiifolia: Limon had the most antiviral activity and could reduce viral pathogenicity as 100 fold as stated by Seyedeh, three out of four of these extracts were found effective.15
5. Syzygium aromaticum: Clove (Syzygium aromatic-um, Myrtaceae) oil contains eugenol which oily liquid proven as analgesic and antiseptic. Viral envelopes of freshly formed vironscan be damaged by eugenol which cause inhibition of viral replication at the initial stage, active against Herpes simplex virus and demonstrated synergistic action with acyclovir. Herpes virus induced keratitis in mouse suppressed by eugenol.16 The antiviral activity against HSV-1 and HSV-2 viruses were 25.6 μg/mL and 16.2 μg/mL for HSV-1 and HSV-2, respectively which are 50% inhibitory concentration values3,8.
6. Hisbiscus sabdariffa
Anthocyanins, polyphenols, organic acids, and flavonoids bioactive compounds found in Hibiscus tea. The pH of hibiscus tea extract is acidic in vitro, and its rapid and potent antiviral activity17.
7. Adansonia digitata
Symptoms of infectious diseases can be treated by Adansoniadigitata (Baobab) which is a traditional African medicinal plant.
Commercial standardized preparations of leaves, fruit-pulp and seeds of Adansonia digitata were acquired and extracted with three different solvents, water, methanol and DMSO. The leaf extracts had the most potent antiviral properties, especially the DMSO extracts and influenza virus was the most susceptible virus. Pulp and seed extracts were less active but significant when the extracts compared quantitatively for antiviral MIC (100) (minimal inhibitory concentration) values against influenza virus, herpes simplex virus and respiratory syncytial virus and for their effects on cytokine secretion (IL-6 and IL-8) in human epithelial cell cultures18.
8. Camellia sinensis: Green tea is made from leaves of the Camellia sinensis plant with antibacterial and antiviral effects which attributed to polyphenols known as catechins which act by interfering with its replication cycle and formed by several isomers including (-) - epigallocatechin gallate (EGCG), (-) - epigallocatechin, (-) – epicatechin gallate, (-) -epicatechin, and (+) - catechin.19
9. Artemisia absinthium: Coronavirus infections during the Sars-CoV and Mers-CoV outbreaks Artemisia absinthium used as traditional Chinese medicine.
The second most potent herbal medicine used on the 2005 Sars-CoV wasthe alcoholic extract of sweet wormwood (Artemisia annua)20
10. Allium sativum: Garlic has antiviral activity. Activity determined against herpes simplex virus type 1, herpes simplex virus type 2, parainfluenza virus type 3, vaccinia virus, vesicular stomatitis virus, and human rhinovirus type 2. Using direct pre-infection incubation assays found to have veridical effects for fresh garlic extract21.
11. Pimpinella anisum: The oil obtained is Anisiaetheroleumby steam distillation and have pharmacological (antimicrobial, hepatoprotective, anticonvulsant, anti-inflammatory, antispasmodic, bronchodilator, estrogenic, expectorant and insecticidal) effects and clinical effects on nausea, constipation, menopausal period, virus, diabetes, obesity and sedative action22.
12. Boswellia carterii: Boswellia resins which known as frankincense/olibanum obtained from trees of Boswellia. In laboratory Boswellia serrata gum resin showed antiviral activity against the mosquito-transmitted chikungunya virus (CHIKV) and vesicular stomatitis virus23.
Fortunately, Sudanese experience that various traditional herbs usage and different route of administration effectively relieve fever, cough and fatigue which are primary symptoms and reduce the probability of developing severe conditions in the patients. Herbal therapy and herbal medicines are effective and preventive agents against Covid-19 which is supported by current pharmacological literature. Application of herbs and succeeded formulas has potential approaches to prevent infection and strength immunity revealing the Antiviral and Antimicrobial effects of many herbs against corona viruses. Different herbal extracts aligned with natural additives conclude effective herbal formulas assisting in reducing local transmission e.g. Herbal aerosols and herbal sanitizers.
The anti-influenza virus activity of essential oil vapors of Citrus, Anise Nigella, Eucalyptus and Syzygium have been confirmed by numerous studies. More social experienced investigate the effect of powdered dry herbs orally e.g. Hibiscus, Adansonia, Camellia and Artemsia, others like zinger and garlic are trailed fresh. Whereas other herbs administered in different forms gargle, smoke, lozenges and paste are shown in the table above.
Sudanese experience that various traditional herbs usage by different route of administration can relieve effectively fever, cough and fatigue primary symptoms and reduce probability of developing severe conditions in patients.
Azza and Mai participate in survey; all authors make the hypothesis and participate in the manuscript writing.
CONFLICT OF INTEREST
No conflict of interest associated with this work.