Covid-19 is spread through dust particles and fomites, as well as through close, unsafe contact between the infector and the infected individual. Covid-19’s airborne distribution has not been recorded, and it is not known to be a significant transmission engine; however, it can be imagined if such aerosol-generating practices are carried out in medical facilities. The active virus has been reported in a small number of clinical studies, and faecal spreading has been observed in some patients.1
Coronaviruses are positive-sense RNA viruses that affect multiple systems and have a wide and promiscuous range of natural hosts. Coronaviruses can cause clinical diseases in humans ranging from the common cold to more serious respiratory diseases such as SARS and MERS.
Less common symptoms at the time of hospitalisation include diarrhoea, hemoptysis, and shortness of breath. Individuals with asymptomatic infections have recently been suspected of transmitting infections, adding to the complexity of disease transmission dynamics in Covid-19 infections. Such effective responses necessitate in-depth knowledge of the virus, which is currently a novel agent; consequently, additional research is required.2
Symptoms of Covid-19 include cough, weakness, dyspnea, myalgia, fever, fatigue and sputum.
Patients, especially those with other underlying diseases, may have respiratory failure, arrhythmias, shock, kidney failure, cardiovascular damage, or liver failure.
LONG TIME COVID-19
Patients who have recovered from the condition or had a mild version of it but continue to experience symptoms after their initial recovery. The syndrome has been dubbed ‘post-Covid-19 syndrome’ or ‘Long Covid-19’. These health problems are sometimes referred to as post-Covid-19 conditions. They are generally thought to be Covid-19 side effects that last for more than four weeks after you’ve been diagnosed with the virus. Although older people and subjects with serious medical conditions are more likely to have lingering Covid-19 symptoms, even young, otherwise healthy people can feel ill for weeks to months after infection.3
SYMPTOMS PRESENTED DURING LONG COVID-19
Long Covid-19 symptoms are comprised following symptoms: Difficulty in breathing or shortness of breath, tiredness or fatigue, symptoms that get worse after physical or mental activities (also known as post- exertional malaise), difficulty thinking or concentrating (sometimes referred to as ‘brain fog’), cough, chest or stomach pain, headache, fast-beating or pounding heart (also known as heart palpitations), joint or muscle pain, pins-and-needles feeling, diarrhoea, sleep problems, fever, dizziness when standing (light-headedness), rashes, mood changes, change in smell or taste and changes in menstrual period cycles.4
Humans have used Nutraceuticals as a source of medicine since ancient times. Currently, a sizable portion of the global population relies on botanical remedies to meet their health needs.
NICE GUIDELINES FOR LONG COVID-19 SYMPTOMS:
Guidelines from the National Institute for Health and Care Excellence (NICE) recommend how to identify, refer, and treat patients with long covid. Various guidelines focus on treating and managing long covid or have included recommendations for long covid in their guidelines for treating Covid-19. They include holistic assessment, investigation, and management approaches suggested by NICE.
NUTRACEUTICALS IN LONG COVID-19 SYMPTOMS
Humans have used nutraceuticals as a source of medicine since ancient times. Currently, a sizable portion of the global population relies on botanical remedies to meet their health needs. Now, there is a growing interest in and use of botanical therapies in the formulation of healthcare products. To summarise, herbal sales in the United States increased by 8.5 percent from 2016 to 2017, recently reaching a likely total of around 10 billion USD per year. The growing public interest in botanicals has sparked an increase in scientific awareness aimed at better understanding the pharmacological activity of medicinal plants.
Ginger has anti-inflammatory and antiviral properties, making it useful in the treatment of Covid-19 symptoms. Honey, for example, has antibacterial, anti-inflammatory, antiviral, and antioxidant properties. Enzymes, vitamins, phenolic acids, amino acids, flavonoids, and minerals are all found in honey. Broccoli sprouts have antioxidant activity, which aids in virus RNA downregulation and infection management.5
Glutathione: Glutathione (GSH) exerts anti-inflammatory effects by inhibiting ACE activity, decreasing reactive oxygen species (ROS) production, and inhibiting NF-kB activation. The oxidised form of glutathione (GSSG), renin (the circled arrows pointing upwards indicate ACE induction), and viral infection shift the ACE/ACE2 balance toward ACE. In two Covid-19 patients, a trial of 2 g of PO or IV glutathione improved their dyspnea within 1 hour of use. The use of 2000 mg of PO and IV glutathione regularly was effective in alleviating respiratory symptoms.
Astaxanthin: Astaxanthin exhibits anti- inflammatory and antioxidant action. Astaxanthin acts as a Janus kinase/signal transducer and activator of transcription (JAK/STAT) in the initiation of interferon- stimulated response elements (ISRE) and inhibiting the pathway would be critical in avoiding inflammation in Covid-19.6
Curcumin: It is Turmeric’s active ingredient that has anti-inflammatory properties. Curcumin has been shown in clinical trials to be an effective treatment for Covid-19.7
Andrographis paniculata: The active ingredient, andrographolide, has a strong inhibitory effect on Covid-19. Andrographolide binds to the spike glycoprotein of SARS-CoV-2, limiting viral entry into host cells.8
Vitamin D3: In addition to known antimicrobial and anti-inflammatory effects, vitamin D metabolites have a direct effect on angiotensin-converting enzyme 2 (ACE2), which serves as the cell surface entry receptor for SARS coronavirus 2. (SARS-CoV-2). In animal models of acute lung injury, vitamin D metabolites increase ACE2 expression in pulmonary microvascular endothelial cells. Although increased ACE2 expression may theoretically increase viral entry into cells, it may have a beneficial effect in patients who are already infected because SARS-CoV-2– mediated downregulation of ACE2 may perpetuate lung injury.9
Vitamin C: Vitamin C or ascorbic acid is a water-soluble vitamin that possesses antioxidant, anti-inflammatory, and immunomodulatory properties. It acts as an enzyme cofactor for several biosynthetic processes and may increase the endogenous synthesis of catecholamines.5
Zinc is beneficial in the treatment of upper respiratory tract viral infections and may thus be useful in the management of Covid-19.
Nutraceuticals for Long Covid Symptoms:
| Nutraceutical | Actions on the body |
|---|---|
| Turmeric | Anti-inflammatory, antioxidant, immunomodulator, antiviral |
| Garlic | Production of antibody, Anti-inflammatory, antioxidant, Immunoboosters, modulator, antiviral |
| Ginger | Production of antibody, antioxidant, immune booster, immunomodulator, antiviral |
| Coconut oil | Anti-inflammatory, antioxidant |
| Glutathione | Common cold, Production of antibody, Anti-inflammatory, antioxidant, Immunoboosters, immunomodulator |
| NAC | Common cold, Anti-inflammatory, antioxidant,immunomodulator |
Selenium: Selenite, a type of selenium stops the entrance of viruses into healthy cells. Hence, selenium can be effectively used in the treatment of Covid-19.10
Zinc: It is the second most abundant trace element and an important dietary supplement used to maintain immunity. Zinc is beneficial in the treatment of upper respiratory tract viral infections and may thus be useful in the management of Covid-19. Zinc may also inhibit virus attachment to the nasopharyngeal mucosa, thereby halting viral replication. Zinc has been shown in vitro to inhibit template binding and elongation of SARS-COV-1 RNA-dependent polymerase, which aids in viral replication prevention. Another study found that patients with Covid-19 who were zinc deficient needed more corticosteroids to be managed and had a longer hospital stay.11
Melatonin: It has anti-oxidative, anti-inflammatory, and immunomodulatory properties that can help treat Covid-19 infection. Melatonin is effective in reducing acute oxidative injury and inflammation in the lungs. Melatonin’s immunomodulatory effects are achieved by increasing Lymphocyte maturation and proliferation.5
Ashwagandha: Ashwagandha has immune-modulatory, antistress, and antiviral properties. In-silico studies have revealed that it has a high affinity for the ACE2–RBD interface, which may prevent SARS-COV-2 entry into cells. The WS root extract has shown promising results against long term social isolation-induced stress and anxiety, making it an excellent medicine for prevention. Furthermore, the medication has a very good pulmonary protective function, making it useful in post-covid care.12
Plants beneficial in the treatment of respiratory illnesses13:
| Clinical significance | Plants |
|---|---|
| Shown activity in the human respiratory syncytial virus (HRSV) and can be used in the treatment of SARSCOV-2 induced respiratory distress | Zingiber officinale (Ginger), Terminaliachebula (Myrobalan), Olea europaea(Olive) |
| Flavonoids have proven helpful againstviral infection. | Hibiscus sabdariffa (Roselle),Azadirachta indica (Neem), Ocimumsanctum (Holy basil) |
| Anti-inflammatory activities can beinvestigated for support of treatment in Covid-19 patients. | Withania somnifera (Ashwagandha),Camellia Sinensis (Tea), Moringaoleifera (Drumstick tree), Zingiberofficinale (Ginger), Nigella sativa (Blackseed oil) |
| These are edible herbs that protectthe body from various infections byboosting your immunity. | Zingiber officinale (Ginger), Camellia Sinensis (Tea), Cicer arietinum(Chickpeas), Olea europaea (Olive) |
To summarise, nutraceuticals have paved the way for the management of long Covid-19 symptoms. Multiple nutraceuticals have already proved their activity against viral infections and other species of coronaviruses. Only a few nutraceuticals have been clinically studied in Covid-19. They may be beneficial in reducing the severity of illness. Further research and good quality clinical trials need to be conducted. Clinical data regarding efficacy and safety will help physicians in better clinical decision-making.
Multiple Nutraceuticals have already proved their activity against viral infections and other species of coronaviruses.
References:
Fong, S. J., Dey, N., & Chaki, J. (2020). An Introduction to Covid-19. Artificial Intelligence for Coronavirus Outbreak, 1–22
Dhama, K., Khan, S., Tiwari, R., Sircar, S., Bhat, S., Malik, Y. S., Singh, K. P., Chaicumpa, W., Bonilla- Aldana, D. K., & Rodriguez-Morales, A. J. (2020). Coronavirus Disease 2019-Covid-19. Clinical microbiology reviews, 33(4), e00028-20. https:// doi.org/10.1128/CMR.00028-20
https://www.mayoclinic.org/diseases-conditions/ coronavirus/in-depth/coronavirus-long-term- effects/art-20490351
https://www.cdc.gov/coronavirus/2019-ncov/long- term-effects/index.html
Subedi L, Tchen S, Gaire BP, Hu B, Hu K. Adjunctive Nutraceutical Therapies for Covid-19. International Journal of Molecular Sciences. 2021 Jan;22(4):1963.
Fakhri S, Nouri Z, Moradi SZ, Farzaei MH. Astaxanthin, Covid-19-19 and immune response: Focus on oxidative stress, apoptosis, and autophagy. Phytotherapy Research. 2020 Nov 1.
Babaei F, Nassiri-Asl M, Hosseinzadeh H. Curcumin (a constituent of turmeric): New treatment option against Covid-19-19. Food science & nutrition. 2020 Oct;8(10):5215-27.
Sa-ngiamsuntorn K, Suksatu A, et al.. The anti- SARS-CoV-2 activity of Andrographis paniculata extract and its major component Andrographolide in human lung epithelial cells and cytotoxicity evaluation in major organ cell representatives. bioRxiv. 2020 Jan 1.
Leaf DE, Ginde AA. Vitamin D3 to Treat Covid-19: Different Disease, Same Answer. JAMA. 2021;325(11):1047–1048
Kieliszek M, Lipinski B. Selenium supplementation in the prevention of coronavirus infections (Covid-19). Medical hypotheses. 2020 Oct 1;143:109878.
Wessels I, Rolles B, Rink L. The Potential Impact of Zinc Supplementation on Covid-19 Pathogenesis. Front Immunol. 2020 Jul 10;11:1712.
https://www.ayush.gov.in/docs/FAQs-covid- protocol.pdf
Patel B, Sharma S, Nair N, Majeed J, Goyal RK, Dhobi M. Therapeutic opportunities of edible antiviral plants for Covid-19. Molecular and Cellular Biochemistry. 2021 Feb 15:1-20.
