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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 11-15

COVID-19 – An Ayurvedic perspective toward the prevention of a pandemic


Department of Kaya Chikitsa, RG Government PG Ayurvedic College, Paprola, Himachal Pradesh, India

Date of Submission15-Aug-2020
Date of Decision21-Sep-2020
Date of Acceptance26-Sep-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Anjana Mishra
Department of Kaya Chikitsa, RG Government PG Ayurvedic College, Paprola, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_123_20

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  Abstract 


Introduction: COVID 19, a viral disease, which is caused by SARS CoV-2 is posing a serious threat to health worldwide. The disease emerged from Wuhan, a province in China, in December 2019 and rapidly spread worldwide making it a global concern. It is not only imposing an unprecedented challenge to the global health care system but also taking a toll on the social and economic front. Hundred of thousands of people have fallen severely ill, many have died and many more are economically and socially devastated by this pandemic. Several efforts are being pursued throughout the world to find treatment for people suffering from this highly contagious virus. Objectives: Ayurvedic perspective towards prevention of pandemic COVID-19. Data Source: Ayurvedic literature, Different Ayurvedic & Medical journals. Discussion: Principles of Ayurveda have been given due importance and are highlighted in containing the COVID-19 Pandemic. Conclusion: We believe that Ayurveda, the Indian medicine system has an answer to this problem. In this review, we provide an understanding of preventing COVID-19 using the Ayurveda concept of immunity (Vyadhikshamatva). Adopting Dincharya (Daily Regimen), Ritucharya (Seasonal Regimen) as advised in classical texts and paying close attention to the quality of food and appropriate ways of taking food help in maintaing health of an individual. Consumption of few herbal drugs having Rasayana quality, Pranayama and Yoga can prevent this devastating disease.

Keywords: Ayurveda, COVID-19, immunity, Ojas, Rasayana, Vyadhikshamatva


How to cite this article:
Mishra A, Soni M. COVID-19 – An Ayurvedic perspective toward the prevention of a pandemic. J Ayurveda 2020;14:11-5

How to cite this URL:
Mishra A, Soni M. COVID-19 – An Ayurvedic perspective toward the prevention of a pandemic. J Ayurveda [serial online] 2020 [cited 2021 Apr 13];14:11-5. Available from: http://www.journayu.in/text.asp?2020/14/4/11/304886




  Introduction Top


Coronavirus disease 2019 (COVID-19) pandemic caused by the novel coronavirus or severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) is a new challenge to the medical fraternity and the whole world. This dreaded virus belongs to the family of Coronaviridae. Coronavirus was initially identified in the mid-1960s. It mainly caused mild respiratory illnesses in human beings, for instance common cold. However, the outbreak of SARS in 2002 and Middle East respiratory syndrome in 2012 revealed the devastating side of the virus. Further, the emergence of the novel coronavirus (SARS-CoV-2) that caused COVID-19 brought coronavirus in the spotlight again. Human SARS-CoV identified previously was associated with severe illness in young, elderly, and immunocompromised individuals, which led to the exacerbation of preexisting conditions, such as asthma and chronic obstructive pulmonary disorder (COPD), resulting in hospitalization.[1] However, SARS-CoV-2 surprised the world with its high transmissibility but decreased pathogenicity when compared to SARS-CoV.[1] SARS-CoV-2 affects elderly and immunocompromised individuals, leading to exacerbation of preexisting conditions, such as asthma, COPD, coronary artery disease, and cardiac manifestations that affect the cardiovascular system, requiring hospitalization. These clinical features indicate that SARS-CoV-2 patients suffer a prolonged illness, as the virus evades immune surveillance more effectively than SARS-CoV.[2] Although SARS-CoV has a higher mortality rate than SARS-CoV-2, the rapid spread of the SARS-CoV-2 has resulted in higher infection and death across the globe.[3] SARS-CoV-2 emerged from Wuhan, a province in China, in December 2019 and rapidly spread worldwide making it a global concern.[4]

Novel coronavirus attaches to the cell surface of the receptors via S (viral spike) proteins, which are present on the surface of the virus and shorter spike-like proteins, also known as hemagglutinin esterase proteins. After attachment, the virus enters the cell and replicates in the cytoplasm. Angiotensin-converting enzyme 2 is the main entry receptor for SARS-CoV-2, which is expressed in the tissues, including respiratory, nasal, intestinal epithelial cells, blood vessels, and kidney.[5] It has been reported that SARS-CoV-2 replicates efficiently in the tissue, with the peak replication after 2 days of infection. The virus replicates in the ciliated cells and thereafter releases apically.[6] Furthermore, SARS-CoV-2 spreads through droplets, and reports indicate that the virus particles spread up to a distance of 6 feet.[7] The mode of transmission seems to be the respiratory route, and the infected individuals suffer mostly from upper respiratory infection.[8]

Humans have had to fight against diseases and furies of nature for their existence since ages, as various epidemics struck human civilization on and off. In ayurvedic texts, such diseases that affect the whole population of an area are termed as Janpadodhwansa[9] (epidemics). According to Samhitas, the root cause of Janpadodhwansa is the vitiation of common factors such as Jala (water), Vayu (air), Desha (place), and Kaala (season/time).[10] If one or more aforementioned factors get vitiated, it results in Janpadodhwansa (epidemic). The concept of Janapadodhwansa[9] has been mentioned in Charak Samhita that is written 3000 years ago. Means of transportation were limited in those days; hence, diseases that manifested remained confined mostly to the districts or states.


  Manifestation of the Disease Top


The incubation period of coronavirus ranges from 1 to 14 days with a mean period of around 5 days. Within 12.5 days of contact, 95% of the patients most likely experience the symptoms. Therefore, 14 days quarantine and/or medical observation period is a must for the person who is exposed and the people who are in close contact with the exposed individual. Importantly, an asymptomatic carrier was reported to have an incubation period of 19 days, posing a challenge worldwide to control and contain the pandemic.[11]

Individuals manifest the symptoms within 2–14 days of contracting the virus, and severity depends on many factors, such as the viral genome, virulence, viral load, and host factors. Fever is one of the most common sign, and around 83%–99% of the patients suffer from it. Similarly, there are other features, including cough (59%–82%), fatigue (44%–70%), anorexia (40%–84%), shortness of breath (31%–40%), and myalgias (11%–35%). Other nonspecific symptoms, such as sore throat, nasal congestion, headache, diarrhea, nausea, and vomiting have also been reported.[12],[13],[14] Loss of smell (anosmia) or loss of taste (ageusia) preceding the onset of respiratory symptoms has also been reported.[15],[16],[17] Older people and immunosuppressed patients, in particular, may present with atypical symptoms, such as fatigue, reduced alertness, reduced mobility, diarrhea, loss of appetite, delirium, and absence of fever.[18],[19] Symptoms, such as dyspnea, fever, gastrointestinal (GI) symptoms or fatigue due to physiologic adaptations in pregnant women, adverse pregnancy events, or other diseases such as malaria, may overlap with symptoms of COVID-19.[20],[21]

Shortness of breath is reported in some set of patients at a median of 5–8 days of presenting illness, suggesting the complications of the disease.[22] Although contact tracing helps in containing the disease, asymptomatic carriers present a complicated challenge, and therefore, the World Health Organization (WHO) is emphasizing greatly on the testing. Real-time polymerase chain reaction efficiently detects the SARS-CoV-2 virus. Rapid antigen detection test is another method to diagnose the disease, however, the chances of false negative are high.[23]

Further, SARS-CoV-2, in addition to pulmonary complications, is also associated with various extrapulmonary manifestations, including neurological illness, dermatological complications, myocardial dysfunction, thrombotic complications, acute coronary syndromes, arrhythmia, acute kidney injury, hepatocellular injury, GI symptoms, ketosis, hyperglycemia, and ocular symptoms. It is imperative to comprehend the organ-specific pathophysiology and clinical manifestation of the disease for prevention and cure. Elucidating the mechanism by which the virus is disseminated to extrapulmonary tissues would help in understanding the pathogenesis of COVID-19.[24]


  Interventions Top


Several intervention strategies against the COVID-19 pandemic are being investigated. Antiviral drugs, such as remdesivir, cytokine-targeting therapies, including tocilizumab against interleukin-6, and neutralizing antibodies, including manufactured antibodies, animal-sourced antibodies, or plasma therapy, are the major interventions that are being extensively studied.[25]

There are two aspects to tackle any disease – curative and preventive. As SARS-Cov-2 is a novel disease with variable manifestations, the curative aspect is under investigation. Hydroxychloroquine, a derivative of chloroquine, initially believed to be effective did not stand the test of time. Recently, remdesivir and plasma therapy are considered life-saving therapies in serious patients. Furthermore, dexamethasone, a common corticosteroid, is accepted in patients with COVID-19 in some circumstances. However, effective and proven therapy for COVID-19 is not established yet. Further, symptomatic treatment is most acceptable in individuals with mild-to-moderate symptoms. Currently, several vaccines are being tested in Phase III clinical trials to prevent the novel coronavirus. However, considering the increase in the number of infections per day globally, safe, curative, and preventive measures are extremely necessary to reduce the impact of the infection and disease.

The WHO and Centers for Disease Control and Prevention have issued guidelines to contain the disease that need to be strictly implemented. Ayurveda focuses on preventive as well as curative aspects.[26],[27] Results of curative therapy need to be established, however, the emerging trends of affected individuals, cured patients, and mortality rate with COVID-19 indicate that preventive therapy seems to be effective. It has been noticed that the directives of the AYUSH ministry are practiced in almost every household in India. The preventive aspect incorporates a broad understanding. The WHO and AYUSH ministry have shed light on the immediate prevention of the virus by focusing on how to build immunity of the body, which may be achieved by the elimination of stress or stress-causing factors.

Here comes the role of Ayurveda, as the immunity aspect or Vyadhikshamatva is emphasized in the ayurvedic texts. It has been mentioned that each individual has the power to fight against the disease and the power varies in different individuals.[28] This power in Ayurveda is denoted as Bala.

Bala is of three types, including Sahaj, Kalaj, and Yuktikrita.[29] Sahaj Bala is the power of an individual to fight against the disease, which is attained by birth[29] depending on many factors (Bhavas), a few of them being Matrij and Pitrij (Beej, Artav, and Prakriti). Kalaj Bala is the strength of the body according to Kala, i.e., time/season or age.[29] The response of individuals to withstand the disease varies in different seasons. During Adana Kala, Bala is not very efficient to fight against the disease in comparison to Visarga Kala. Furthermore, during old age, a decline in Bala is noticed, making a person prone to diseases. Hence, extra care and attention are required in the case of older people and individuals with comorbidity in this pandemic. Yuktikrita Bala can be attained by the efforts of human beings[29] as Yukti means Yojna or planning based on the knowledge and experience. Yuktikrita Bala needs to be explained, as it can be attained and can aid in fighting against the diseases, including COVID-19.

For immediate prevention of COVID-19, the WHO has issued the guidelines and the AYUSH ministry has advised a few cautionary tips. Wearing a mask, social distancing, i.e., keeping a distance of 6 feet from another individual, avoiding crowded places, and washing hands with soap and water for at least 40s or using alcohol-based hand sanitizer frequently are a few preventive measures. These measures to prevent the spread of the virus are very similar to what Ayurveda classics have described in Swasthavritta. Dhoopan or fumigation is advised to prevent and treat vitiated-air causing disease. The AYUSH ministry has also advocated some remedies and procedures to prevent the infection, which includes sipping of hot water frequently, keeping oneself hydrated, taking a decoction of Giloy (Tinospora cordifolia), Tulsi (Ocimum), Dalchini (Cinnamomum), and Pepper (Piper nigrum), etc., and consumption of milk by adding turmeric (Curcuma longa) powder to it. Pranayama and Yoga asana as well as the application of medicated oil or Ghee in the nose (Nasya) and oil pulling (Kawal) are also advised by the Ministry of AYUSH, Government of India.[30] In addition, steam inhalation and gargles are also considered to have some preventive effect.

For long-term prevention, Yuktikrita Bala should be given careful attention. It is the Yuktikrita Bala that builds up immunity. Immunity and Bala can be correlated, or immunity in modern science can be equated with Bala in Ayurveda. Sahaj Bala is correlated with innate immunity, while Kalaj and Yuktikrita Bala is correlated with acquired immunity. Yuktikrita Bala encompasses a broad understanding and can be attained by balanced nutritional diet,[29] exercise, Pranayama, and following the rules and regulations as advocated in Samhitas. Rasayana drugs are also beneficial in promoting Yuktikrita Bala. Vyadhikshamatva in Ayurveda is considered of two types: one that prevents the disease and the other that fights against the disease after it affects the body.[28] Notably, the concept of immunity in Ayurveda is comprised of both preventive and therapeutic measures. Rasayana drugs are immunomodulatory, help in the prevention of diseases, and treating specific diseases. Rasayana drugs, which are used to treat diseases, are kept under the heading of Naimittika Rasayana by Acharaya Dalhan. Naimittika Rasayana is the use of general immunomodulatory drugs to treat specific diseases.[31] It is an example of the use of Bala Vardhaka Rasayana drugs in the management of the diseases. Rasayana drugs like Guduchi[32] (Tinospora cordifolia), Chavanprasha[33] are Bala Vardhaka, i.e., maintain and promote health, thus help in the prevention of diseases.

Tridosha and Sapta Dhatu are functional and structural units of the human body. Tridosha in the state of homeostasis along with well-nourished Sapta Dhatu result in the best quality of Ojas. Ojas is the final essence of Sapta Dhatu. Dhatu from Rasa to Shukra maintain themselves and provide nutrition to successive Dhatus, and finally, Ojas is the product that depends on the state of Dhatus.[34]


  Factors Responsible for Maintaining the Best Quality Ojas Top


Ahara, Nidra, and Brhamcharya are referred to as Tryopastambha.[35] It means human life and Bala or immunity also depend on these three factors.

Ahara

Dietetics as advised in Ayurveda should be followed to get the best results. The first and foremost principle is that while eating, due consideration should be given on the quantity and digestive capacity.[36] While planning a diet, one must pay attention to Desha, Kala, and Prakriti. Taking a balanced diet and Sarva Rasa Abhyasa is the most important factor for getting the best Bala.[37] The role of a balanced diet in preventing COVID-19 and fighting against the disease cannot be undermined. Proper nutrition and hydration are vital for the adequate functioning of the immune system in addition to other factors. It is emphasized that well-balanced diet leads to healthy life with stronger immune systems and which ultimately results in a lower risk of infectious diseases and chronic illnesses.[38]

Nidra

Adequate sleep at an appropriate time is the basis of a healthy life.[39] Sleep of 7h is advocated in modern science also.

Brhamcharya

Celibacy is also incorporated for maintaining the Bala.

Dincharya[40] and Ritucharya[41] are important aspects to be understood and followed. Planning the daily routine as per the principles of Ayurveda and adopting lifestyle according to the seasonal variations are important to maintain the Bala or the ability to fight against the diseases. Ritusandhi is another important concept that needs to be followed to keep the strength of the body at an optimum level. Ritusandhi is the period in-between two seasons and is of 14 days when the routine is changed slowly from the previous season to the next season.[42]

Vyayama and Pranayama are the two modalities that enhance and maintain the strength of the body. Homeostasis is maintained, and the interior milieu of the body remains in equilibrium by practicing Vyayama and Pranayama. It has been seen that regular Pranayama/Yoga improves the endocrine and metabolic functions of the body and improves the functioning of the heart and lungs.[43] Disturbance in metabolism leads to various diseases and also makes a person prone to infections. It is seen that people with metabolic disorders are at a greater risk of severe COVID-19 infection.

Prakriti Pareeksha is another component that helps in planning all the above factors. Seven types of Prakriti are mentioned in the texts, and it is said that out of the seven types, Samdoshaj Prakriti is the best,[44] as they have the best immunity; therefore, these people do not fall ill easily.[45] In general, it is rare to find such Prakriti; hence, Prakriti Prakeesha is an important tool to assess the Bala of an individual, which helps in planning the diet and medication.


  Conclusion Top


Ayurvedic interventions would help in controlling and preventing the pandemic owing to their great potential. The need of the hour is to understand, establish, and disseminate the knowledge in masses. Lifestyle, diet, exercise, Yoga, and Pranayama play a vital role in maintaining health and preventing diseases. Preventive measures as advocated by the AYUSH ministry are of great help in the prevention of COVID-19. By adopting the principles of Ayurveda, we can prevent the deadly COVID-19 pandemic and thereby help to reduce economic hardships globally.

Acknowledgment

We thank Dr. Malvika Sharma (Georgia State University, US) for critical reading and improvisation of the manuscript.

We thank Dr. Deepika Bhardwaj (M. D Scholar K. C, R. G. G. P. G. Ayu. College, Paprola) for technical help and writing assistance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.







 
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