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Homoeopathy For Coronavirus Prevention: Factsheet

 
 

Background


On 31 December 2019, WHO was alerted about outbreak of several cases of pneumonia in Wuhan City, Hubei Province of China which raised concern because when a virus is new, we do not know how it affects people. Affected patients were geographically linked with a local wet market as a potential source. One week later, on 7 January 2020, Chinese authorities confirmed that they had identified a novel coronavirus, named “2019-n CoV” from the family of viruses that include Severe Acute Respiratory Syndrome coronavirus SARS-CoV) and Middle East Respiratory Syndrome coronavirus (MERS-CoV). Coronaviruses are zoonotic and detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. The genetic sequence of the 2019 novel coronavirus (2019-nCoV) enabled the rapid development of point-of-care real-time RT-PCR diagnostic tests specific for 2019-nCoV which is based on full genome sequence data on the Global Initiative on Sharing All Influenza Data [GISAID] platform. Scientist in China have shared its genome sequence, but the Australian scientists have for the first time recreated the virus.


About the Epidemic


A World Health Organization (WHO) senior leadership team, led by Director General Dr Tedros Adhanom Ghebreyesus, met President Xi Jinping of the People’s Republic of China in Beijing, who shared the latest information on the outbreak and reiterated their commitment to bring it under control. The discussions focused on continued collaboration to improve containment measures in Wuhan, to strengthen public health measures in other cities and provinces, to conduct further studies and transmissibility of the virus, to continue to share data, and for China to share biological material with WHO. WHO is continually monitoring developments and the Director-General can reconvene the Emergency Committee on very short notice. Consequently, WHO is convening a bi-weekly call with clinical experts around the globe, to better understand, in real-time, the clinical presentation and treatment interventions. So far, 4593 globally confirmed cases are reported and 4537 confirmed cases from China but 56 confirmed cases from outside China


  • WHO. Novel Coronavirus (2019-nCoV). Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed on: 29 Jan 2020.
  • Hongying Li, Emma Mendelsohn, Chen Zong, Wei Zhang, Peter Daszak et al. Human-animal interactions and bat coronavirus spillover potential among rural residents in Southern China. Biosafety and Health 1(2) 2019: 84-90.
  • Wang C, Horby PW, Hayden FG, Gao GF. A novel cornonavirus outbreak of global health concern. Lancet. 2020 Jan 24. pii: S0140-6736(20)30185-9. doi: 10.1016/S0140-6736(20)30185-9. [Epub ahead of print] No abstract available. PMID: 31986257 making China “Very High” under WHO risk assessment
  • As of Jan 23, 2020, a total of 835 cases with laboratory-confirmed 2019-nCoV infection have been detected in China, of whom 25 have died and 93% remain in hospital. Person-to-person transmission of this novel coronavirus in hospital and family settings may be suggested, as reports of infected travellers in other geographical regions surface
  • In India, 9150 passengers have been screened so far, according to Ministry of Health and no case of novel coronavirus detected. The Indian Health Ministry has asked travellers from China to immediately report to nearest health facility in case they do not feel well.

Pathogenesis


There are six known human coronaviruses which were first identified in the 1960s from noses of patients with the common cold. Two human coronaviruses that are responsible for a large proportion of common colds OC43(beta) and 229E(alpha). Following the entry of coronavirus into the cell, the uncoated particle and the RNA genome is deposited into the cytoplasm. The coronavirus RNA genome has a 5′ methylated cap and a 3′ polyadenylated tail, which allows the RNA to attach to ribosomes for translation. Coronaviruses also have a protein known as a replicase encoded in its genome which allows the RNA viral genome to be transcribed into new RNA copies using the host cell's machinery. The replicase is the first protein to be made; once the monocistronic gene encoding the replicase is translated, the translation is stopped by a stop codon. A coronavirus non-structural protein provides extra fidelity to replication since it confers a proofreading function, which lacks in RNA-dependent RNA polymerase enzymes alone. Coronaviruses have a non-structural protein – a protease – which can separate the proteins in the chain.


Case Definition


Severe Acute Respiratory Infection suspected of 2019-CoV infection may be defined as-


WHO. Novel Coronavirus (2019-nCoV). Available from: https://www.who.int/news-room/detail/28-01-2020-who-china-leadersdiscuss-next-steps-in-battle-against-coronavirus-outbreak. Accessed on: 29 Jan. 2020


Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Jan 24. pii: S0140-6736(20)30154-9. doi: 10.1016/S0140-6736(20)30154-9. [Epub ahead of print] PMID: 31986261


The Economic Times. ET Explains: All you need to know about the deadly novel coronavirus. Available from: https://economictimes.indiatimes.com/https://economictimes.indiatimes.com/news/et-explains/all-you-need-to-know-about-the-deadly-novel coronavirus/articleshow/73542980.cms. Accessed on: 29 Jan 2020.


Medical News Today. What’s to know about coronaviruses? Available from: https://www.medicalnewstoday.com/articles/256521.php. Accessed on: 29 Jan 2020.


Sexton NR, Smith EC, Blanc H, Vignuzzi M, Peersen OB, Denison MR (August 2016). "Homology-Based Identification of a Mutation in the Coronavirus RNA-Dependent RNA Polymerase That Confers Resistance to Multiple Mutagens". Journal of Virology. 90 (16): 7415–7428. doi:10.1128/JVI.00080-16. PMC 4984655. PMID 27279608.


Fehr AR, Perlman S (2015). "Coronaviruses: an overview of their replication and pathogenesis". Coronaviruses. Methods in Molecular Biology. 1282. pp. 1–23. doi:10.1007/978-1-4939-2438-7_1. ISBN 978-1-4939-2437-0. PMC 4369385. PMID 25720466.


2019-20 Wuhan coronavirus outbreak. Available from: https://en.wikipedia.org/wiki/2019%E2%80%9320_Wuhan_coronavirus_outbreak. Accessed on: 29 Jan 2020.


WHO. Clinical management of severe acute respiratory infection when Novel coronavirus (2019-nCoV) infection is suspected: Interim Guidance. 28 January 2020. WHO/nCoV/Clinical/2020.2. Available from: Accessed on: 29 January 2020.


Patients with severe acute respiratory infection (fever, cough, and requiring admission to hospital), AND with no other aetiology that fully explains the clinical presentation AND at least one of the following:


  • a history of travel to or residence in the city of Wuhan, Hubei Province, China in the 14 days prior to symptom onset,
  • patient is a health care worker who has been working in an environment where severe acute respiratory infections of unknown aetiology are being cared for.
  • Patients with any acute respiratory illness AND at least one of the following:
  • close contact* with a confirmed or probable case of 2019-nCoV in the 14 days prior to illness onset, or
  • visiting or working in a live animal market in Wuhan, Hubei Province, China in the 14 days prior to symptom onset, or
  • worked or attended a health care facility in the 14 days prior to onset of symptoms where patients with hospital associated 2019-nCov infections have been reported.
  • Close contact is defined as:
  • Health care associated exposure, including providing direct care for nCoV patients, working with health care workers infected with novel coronavirus, visiting patients or staying in the same close environment as a nCoV patient.
  • Working together in proximity or sharing the same classroom environment with a nCoV patient - Traveling together with a nCoV patient in any kind of conveyance.
  • Living in the same household as a nCoV patient.

Clinical Syndromes associated with 2019-nCoV infection

Syndrome Definition
Uncomplicated illness Patients with uncomplicated upper respiratory tract viral infection, may have non-specific symptoms such as fever, cough, sore throat, nasal congestion, malaise, headache, muscle pain or malaise. The elderly and immunosuppressed may present with atypical symptoms. These patients do not have any signs of dehydration, sepsis or shortness of breath.
Mild pneumonia Patient with pneumonia and no signs of severe pneumonia. Child with non-severe pneumonia has cough or difficulty breathing + fast breathing: fast breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40 and no signs of severe pneumonia.
Severe pneumonia Adolescent or adult: fever or suspected respiratory infection, plus one of respiratory rate >30 breaths/min, severe respiratory distress, or SpO2 <90% on room air.Child with cough or difficulty in breathing, plus at least one of the following: central cyanosis or SpO2 <90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions. Other signs of pneumonia may be present: chest indrawing, fast breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40. The diagnosis is clinical; chest imaging can exclude complications.
Acute Respiratory Distress Syndrome Onset: new or worsening respiratory symptoms within one week of known clinical insult. Chest imaging (radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by effusions, lobar or lung collapse, or nodules. Origin of oedema: respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (e.g.echocardiography) to exclude hydrostatic cause of oedema if no risk factor present. Oxygenation (adults): • Mild ARDS: 200 mmHg < PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥5 cmH2O, or non-ventilated) • Moderate ARDS: 100 mmHg < PaO2/FiO2 ≤200 mmHg with PEEP ≥5 cmH2O, or non-ventilated) • Severe ARDS: PaO2/FiO2 ≤ 100 mmHg with PEEP ≥5 cmH2O, or non-ventilated) • When PaO2 is not available, SpO2/FiO2 ≤315 suggests ARDS (including in non-ventilated patients) Oxygenation (children; note OI = Oxygenation Index and OSI = Oxygenation Index using SpO2): • Bilevel NIV or CPAP ≥5 cmH2O via full face mask: PaO2/FiO2 ≤ 300 mmHg or SpO2/FiO2 ≤264 • Mild ARDS (invasively ventilated): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5 • Moderate ARDS (invasively ventilated): 8 ≤ OI < 16 or 7.5 ≤ OSI < 12.3 • Severe ARDS (invasively ventilated): OI ≥ 16 or OSI ≥ 12.3
Sepsis Adults: life-threatening organ dysfunction caused by a dysregulated host response to suspected or proven infection, with organ dysfunction. Children: suspected or proven infection and ≥2 SIRS criteria, of which one must be abnormal temperature or white blood cell count.
Septic Shock Adults: persisting hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate level >2 mmol/L. Children: any hypotension (SBP 2 SD below normal for age) or 2-3 of the following: altered mental state; tachycardia or bradycardia (HR 160 bpm in infants and HR 150 bpm in children); prolonged capillary refill (>2 sec) or warm vasodilation with bounding pulses; tachypnea; mottled skin or petechial or purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia.

Clinical features


The first fatal case of 2019-nCoV infection had continuous exposure to Wuhan Market, China was admitted with a 7-day history of fever, cough and dyspnoea. After 5 days of onset of illness, the wife of the patient who had no known history of exposure to the market, also had pneumonia and hospitalized in the isolation ward. The 2019-nCoV infection has so far caused clusters of severe respiratory illness like severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality in China. In a first-hand data reported from Hospital of China, it was found that, by Jan 2, 2020, 41 laboratory- confirmed 2019-CoV infection admitted hospital patients had a higher plasma level of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Fever, cough, myalgia or fatigue is most common symptoms reported whereas less common symptoms include sputum production, headache, haemoptysis and diarrhoea.


Diagnosis


Multiplex RT-PCR, whole genome sequencing done in in-patient department cases in China.


Clinical Management


Patients with 2019-nCoV infection are exhibiting a wide range of symptoms. Most cases reported have mild disease, and nearly 20% appear to progress to severe disease, including pneumonia, respiratory failure and in some cases death. Currently, there is no evidence from RCTs to recommend any specific anti-nCoV treatment for suspected or confirmed 2019-nCoV infection.


Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Jan 24. pii: S0140-6736(20)30183-5. doi: 10.1016/S0140-6736(20)30183-5. [Epub ahead of print] PMID: 31986264.


Centres for Disease Control and Prevention. 2019 Novel Coronavirus (2019-nCoV) Outbreak Information. Available from: https://www.cdc.gov/coronavirus/about/symptoms.html. Accessed on: 29 Jan 2020.


WHO. Novel Coronavirus (2019-nCoV). Situation Report-8 *As reported by 28 January 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200128-sitrep-8-ncov-cleared.pdf?sfvrsn=8b671ce5_2. Accessed on: 29 Jan. 2020.


Health Advisory


WHO encourages all countries to continue epidemic preparedness. WHO’s standard recommendations for the general public to reduce exposure to and transmission of a range of illnesses are as follows, which include hand and respiratory hygiene, and safe food practices:


1. Frequently clean hands by using alcohol-based hand rub or soap and water;


2. When coughing and sneezing cover mouth and nose with flexed elbow or tissue – throw tissue away immediately and wash hands;


3. Avoid close contact with anyone who has fever and cough;


4. If you have fever, cough and difficulty breathing seek medical care early and share previous travel history with your health care provider;


5. When visiting live markets in areas currently experiencing cases of novel coronavirus, avoid direct unprotected contact with live animals and surfaces in contact with animals;


6. The consumption of raw or undercooked animal products should be avoided. Raw meat, milk or animal organs should be handled with care, to avoid cross-contamination with uncooked foods, as per good food safety practices.


Homoeopathic Genus Epidemicus


The preventive aspect of Homoeopathy is well known, and historically, Homoeopathy has reportedly been used for prevention during the epidemics of Cholera, Spanish Influenza, Yellow fever, Scarlet fever, Diphtheria, Typhoid etc. Homoeoprophylaxis or, prevention through Homoeopathy, can be met through using individualised medicine or Genus Epidemicus,(GE) which means a remedy which is found to be curative in most cases of the same disease is also the most likely preventive for that disease. The GE is considered whenever a specific area has been invaded by an epidemic outbreak.


As in all collective diseases, the image of the pathological picture emerges after observing a considerable number of patients, Hahnemann suggests to observe several cases in order to paint “the full picture of the disease”, “totality of characteristic signs and symptoms” or “epidemic genius”, according to the homeopathic connotation of this term. The Genus Epidemicus is identified through observation of several cases of an epidemic disease, and analysing the symptomatology of those cases for the most indicated medicine. This medicine is the preventive medicine for the ongoing epidemic of that disease.


It was reported that, during recent past GE had been used during various disease outbreak for preventing the spreading of diseases like Chikungunya, Dengue Fever, Japanese Encephalitis and Cholera with good results.


Chikungunya


Central Council for research in Homoeopathy (Council) endeavored to find usefulness of homoeopathic genus epidemicus (Bryonia alba 30C) for the prevention of chikungunya during its epidemic outbreak in the state of Kerala, India. The result reflects a 19.76% relative risk reduction in medicine group compared to placebo.


Dengue


During 2016 in Delhi there was severe outbreak of both Dengue and Chikungunya. CCRH had undertook preventive study with Eupatorium perfoliatum as genus epidemicus in Mayapuri JJ clusters. Eight five percent (85%) of population were protected in homoeopathic group compared to no intervention cohort.


Japanese Encephalitis (JE)


In Japanese Encephalitis, (JE) positive role of Belladonna in prevention of JE was assessed in preclinical , studies in collaboration with school of tropical Medicine, Kolkata. Further to assess the effectiveness of Belladonna in clinical trial initial exploratory 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 trial 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.


Corona virus


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 in meeting held on 28.1.2020 discussed to find out possible genus epidemicus for recent outbreak of corona virus in China. The sign 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”.


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