Since early civilisation human race has suffered from infectious diseases and has struggled to minimize its impact by efforts such as changing to accessory circumstances and life style modifications. Epidemics have troubled the human race time to time and now it is COVID-19 the infectious disease caused by the most recently discovered corona virus. History shows that homoeopathy reflects its potentiality in epidemic management since its inception. As India is the global leader in the field of homoeopathy, almost every new emerging disease was successfully tackled by the veteran homoeopathic physicians of India. Initiatives in government level were taken from time to time to generate evidences. It is need of the hour to build the evidence based data and present it before the sceptics.
Keywords- epidemic, containment, COVID, homoeopathy, India
Human race has suffered from infectious diseases (e.g. by pathogens like- bacteria viruses, parasites etc.) and from diseases caused by ageing and degeneration of the body for millions of years. For nearly four million years, humans lived in widely dispersed, nomadic, small populations that minimized the effect of infectious diseases. First epidemiological transition about ten thousand years ago occurred due to sedentary life style and increasing population as a result of agricultural revolution. With the improvement of public health measures, nutrition and discovery of antibiotics, the developed countries underwent to second transition where infectious diseases declined but rise of the non-infectious chronic & degenerative diseases was seen. The third epidemiological transition where reemergence of infectious diseases again is faced by human civilization with the pathogens that are antibiotic resistance and have the potential to be transmitted on a global scale.1 Epidemics have troubled the human race from time to time. In middle age Europe was flooded by plague. America was witness of devastating smallpox, & yellow fever. In 1918-1919 the world faced the infamous flu pandemic with the mortality ranging between 50–100 million people. To add on, recently, there have been epidemics of swine flu, zika, encephalitis, ebola, influenza, chikungunya, dengue, etc. and now it is COVID-19 the infectious disease caused by the most recently discovered corona virus.2
COVID -19 Pandemic
This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which was declared a global pandemic by the World Health Organization on 11th March 2020.The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhoea. Few patients have loss of smell and taste also. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with co-morbidities like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention. Till penning down this paper there are 15014348 confirmed cases and total 489456 confirmed deaths all over world3. In India so far 2,156,443 cases have tested positive for the corona virus. 6,28,747 cases are active whereas number of discharged cases is 1,480,884 and deaths due to COVID are 43,379 till date4. The treatment guidelines for COVID-19 vary between countries, yet there is no approved treatment to date. The first systematic review conducted by M. Tobaiqy et al related to medication used to treat patients with COVID-19. Only 41 studies out of 449 were eligible for inclusion and most of which were conducted in China. Corticosteroid treatment was reported most frequently in the literature followed by lopinavir and oseltamivir5.
Homoeopathy in previous epidemics
History shows that homoeopathy has potentiality in epidemic management since its inception. Hahnemann successfully saved many human lives during the outbreak of Scarlet fever (1799) and miliary fever (1808) with Belladonna and Aconite respectively with Government of Prussia making the use of Belladonna for scarlet fever mandatory 1838. In 1831 Asiatic cholera was prevented with Camphor, Cuprum, Veratrum alb. There is anecdotal evidence that homeopathy was successful during the Spanish flu epidemic of 1918 to 1919, in which at least 20 million people died worldwide, more than 500,000 in the United States alone. According to the historian Julian Winston, the death rates for patients treated with homeopathy (genus epidemicus) were 1 to 2% compared with a 30 to 60% mortality for those treated by conventional methods.6, 7 During an outbreak of meningococcal meningitis in 1974 at Guaratingueta, Sao Paulo, Brazil, Meningococcinum nosode (medicine prepared from biological material of a disease) was administered to 18,640 people as homeo prophylaxis. This study showed 95% effectiveness in terms of protection over a period of over 6 months.8 In Cuba, they have used nosodes for various diseases such as hepatitis A, cholera, dengue, leptospirosis, swine flu, pneumococcal diseases and viral conjunctivitis.9 Some research studies in the recent past showing the beneficial role of homoeopathy in preventing the spread of diseases in various disease outbreaks such as chikungunya, dengue fever, japanese encephalitis and cholera. For a series of dengue fever outbreaks over the years in Brazil (2001–2012), identified Genus Epidemicus (GE) Eupatorium perfoliatum or a combination of remedies based on the epidemic picture could significantly control the occurrence by 80%–90%2. Therefore two ways of homoeopathic prophylaxis emerge: one by identifying a medicine as Genus Epidemicus and another by developing a nosode.
Combating epidemic with homoeopathic intervention: Indian Scenario
As India is the global leader in the field of homoeopathy, almost every new emerging disease was successfully tackled by the veteran homoeopathic physicians of India. Initiatives at the government level were taken from time to time to generate evidences.
The Belladonna, Calcarea carbonicum, Tuberculinum (BCT) regime adopted in a phased manner as a preventive for Japanese encephalitis (JE) in 1999 for a period of 3 years brought down the mortality and morbidity rates of JE significantly in the state of Andhra Pradesh. A study by Rejikumar et al. in 2006 on 1061 people living in parts of Kerala badly affected by Chikungunya epidemic showed prevention in 82.19% people after administration of homoeopathic medicine Eupatorium perfoliatum 200C (three doses daily for 5 consecutive days). Further, a 19.76% relative risk reduction in medicinal group (on GE Bryonia alba) compared to placebo was observed in the double-blind, placebo-controlled trial conducted by the Central Council for Research in Homoeopathy (CCRH) during the chikungunya epidemic outbreak in the State of Kerala, India, in 20072. It was reported that, during recent past GE had been used during various disease outbreaks for preventing the spread of diseases like Chikungunya, Dengue Fever, Japanese Encephalitis and Cholera with good results.10 Central Council for research in Homoeopathy conducted a double blind placebo controlled trial in 2007 to assess the usefulness of homoeopathic genus epidemicus (Bryonia alba 30C) for the prevention of chikungunya during epidemic outbreak in the state of Kerala, India. The result reflects a 19.76% relative risk reduction in medicine group compared to placebo.11
During 2016 in Delhi there was severe outbreak of both Dengue and Chikungunya. CCRH had undertaken a preventive study with Eupatorium perfoliatum as genus epidemicus in Mayapuri JJ clusters. Eighty five percent (85%) of population were protected in homoeopathic group compared to no intervention cohort.12
In Japanese Encephalitis, (JE) positive role of Belladonna in prevention of JE was assessed in preclinical,13, 14 studies in collaboration with school of tropical Medicine, Kolkata. Further to assess the effectiveness of Belladonna in clinical trial initial exploratory15 observational comparative study of JE was conducted wherein there was reduction of mortality and morbidity with add-on homoeopathic medicine. To validate these results Council conducted randomised controlled trial16 on the evaluation of homoeopathic medicines as add-on to institutional management protocol in acute encephalitis syndrome which concluded Adjunctive homeopathic medicines may improve clinical outcomes associated with Acute Encephalitis Syndrome.
Table no. 1: Activities undertaken by CCRH 17
Activities undertaken by CCRH to combat COVID-19 Pandemic
For Combating any epidemic disease previous experience and experiment is very important though each epidemic is different. Keeping in view the positive results from the genus epidemicus as prophylactic during epidemic outbreaks of various diseases during recent past, Scientific Advisory Board of the Council met on 28.1.2020 to find out possible genus epidemicus for COVID-19. The signs and symptoms of the patients were referred from the recent publication from the clinical history of patients of Wuhan, China in Lancet titled, "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China".18 After Analysing these symptoms Arsenicum album 30 was recommended as prophylactic medicine against coronavirus infection, one dose (4 pills of size 30 by adults and 2 pills by children) daily on empty stomach for 03 days. It was recommended to be repeated after one month by following the same schedule in case Coronavirus infection prevails in the community.
Rationale behind Arsenicum album 30 - Its special organ affinity for respiratory system, coverage of all stages of COVID-19 disease, previous validation of Ars. Alb. in ILIs studies and the immunological response it has generated in previously reported study also strengthened its choice as GE. It is imperative to ascertain the usefulness of Arsenicum album 30 through well planned research studies to boost the evidence in favour of the medicine.19
Council also actively contributed in drafting of Integrated AYUSH guidelines for management of COVID-19 as well as guidelines for Homoeopathy practioners. Council published factsheet on Homoeopathy perspective in Covid 19 for coronavirus infection in March 2020.20
Council has further planned to utilize preclinical evidence for undertaking field trials both in public health and clinical settings for efficacy of the homoeopathic interventions as preventive as well as curative in epidemic diseases, respectively. On 7th May Council has undertaken Population based study amongst the 1,50,000 police personnel of Maharashtra Police with Homoeopathy preventive Arsenic album. Council has also distributed the same to more than 1 lakh healthy population through Institutes/ Units of Council and approx 2.5 lakh population through homoeopathic medical colleges. In the first week of June, 2020 approx. 14,000 inmates in Delhi prisons (Tihar jail, Rohini and Mandoli) were also beneficiaries of homoeopathic prophylaxis. Council has initiated adjuvant homoeopathic studies and preventive studies in Pune, Agra, Bhopal, containment zones of Delhi and different institutes/ units of Council.
Support from Ministry of AYUSH (MOA)
The recommendation made by Scientific Advisory Board (SAB), CCRH was communicated to Ministry & Public health advisory which was published by MOA on 29.1.2020 in Press Information Bureau.21
AYUSH ministry also on 6th March 2020 D.O. No. S. 16030/18/2019-NAM published advisory for meeting the challenge arising out of spread of corona virus (COVID-19) in India. Various medicines found useful in treating flu like illness are Arsenic album, Bryonia alba, Rhus tox, Belladonna, Gelsemium, Eupatorium perf.
Ministry of AYUSH arranged the COVID warrior training programme to train the participants from Homoeopathy through peripheral units of CCRH. Participants were trained about the role of the COVID Warriors (AYUSH Students) in COVID-19. They were also explained about the pathogenesis of COVID-19, prevention practices in the community and households, by providing a checklist of preventive actions to be taken at home and in public places to avoid spread of COVID-19. They were also taught as to who is a Suspect and who is a Contact, types of contacts and their risk levels, why COVID-19 causes a stigma in society, demonstrate self-protection measures, a checklist of safety measures to be taken during home visits and contact tracing procedures.
Ministry of AYUSH published Gazette notification on 21st April 2020 on the consultation of CDSCO that scientists, researchers, clinicians of any of recognized systems of medicine can undertake research on COVID through AYUSH systems including prophylactic measures, intervention during the quarantine, asymptomatic and symptomatic cases of COVID-19, public health research, survey, lab based research etc. to generate evidence.
Launch of Short–term research projects- Mechanism to support short-term research projects for evaluating the impact of AYUSH interventions cum medicines in the prophylaxis and clinical management of COVID-19, modified EMR scheme22 was launched by Ministry of AYUSH.
Initiatives implemented by State Governments following by Advisory of MOA-
7 states of India – Kerala, Manipur, Goa, Karnataka, Madhya Pradesh, Rajasthan and Gujarat –have distributed preventive medicine Arsenic album 30 to its people.23
Initiatives implemented by Gujarat Govt. in particular- While the four registered clinical trials pertaining to AYUSH remedies in Gujarat are yet to be completed, the state claims that 99.6 per cent of those who availed AYUSH remedies as prophylaxis during their quarantine period tested negative. Of the total 33,264 quarantined AYUSH beneficiaries, 14,184 of these quarantined people availed homeopathic treatment. The state has engaged the district legal services authorities as well, to conduct camps for distribution of Arsenicum Album-30, while also making it available in several government offices, health institutions and prisons. In its presentation made before the World Health Organisation on August 20 on Gujarat's Covid-19 prevention strategy, the health department of Gujarat Govt. said it distributed Arsenicum Album-30 to 3.48 crore people, which is more than half of the state's population of 6.6 crore. There is no scientific evidence that the drug works against Covid-19, a fact stressed not only by medical scientists but by some homeopathic practitioners themselves. The state government also claimed that 99.6 per cent of people who availed AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) remedies as prophylaxis during their quarantine period tested negative for coronavirus.24 According to Jayanti Ravi, Principal Secretary, Health and Family Welfare, Office of Director of AYUSH, Health & Family Welfare The state is planning to start the third round of distribution of AYUSH remedies.
Emerging infectious epidemic diseases were tackled by homoeopathy in India from time to time. It is the need hour to build the evidence based data before the sceptics. Validate the available data on epidemics and build an evidence base for future interventions through systemic and standardized research models.
The authors acknowledge Dr. Anil Khurana, Director General, CCRH for his guidance.
Financial support and sponsorship- Nil.
Conflicts of interest- None declared.
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