Letter to the President on Containing the Coronavirus Pandemic – Modern Ghana

On March 18, 2020, I watched live via You Tube on how Doctors from China, who served on the front lines in the fight against coronavirus pandemic, share their experience of traditional Chinese medicine (TCM) with U.S. experts via a conference call. TCM has been proven effective in the treatment of an increasing number of COVID-19 cases in China, showing that the ancient system of healing plays a complementary role to western medicine in fighting the infection.

WHO chief said Wuhan provides hope to the world that even the most severe situation of COVID-19 can be turned around. Yang Xiao, a doctor working in the intensive care unit (ICU) of Zhongnan Hospital of Wuhan University, believes that the diagnosis and treatment scheme of COVID-19 plays an important role in the battle. China has updated the diagnosis and treatment scheme six times from Jan. 16 to March 4 based on its accumulating treatment experience. As an effective guide for the medical staff fighting against COVID-19, the scheme contributes to a continuous decline in mortality from the virus.

"Every word in the scheme was written with great caution, which showed a responsibility for the patients' lives," said Yang." The scheme plays a guiding role, especially for hospitals in some counties and cities in central China's Hubei Province."

About 20,000 boxes of the instant TCM mixture, which has proved effective in combating COVID-19 in Wuhan, Hubei province, reached the Netherlands on Tuesday. [Photo provided to chinadaily.com.cn]

China experience in COVID-19 fight

Three kinds of experience are crucial in the country's battle against the virus, said Zhang Boli, an academician of the Chinese Academy of Engineering.

In Hubei, TCM treatment has been given to 90.6 percent of COVID-19 patients.

Clinical observation showed that the TCM has proven to be effective in the treatment of over 90 percent of all confirmed COVID-19 cases on the Chinese mainland, said Yu Yanhong, Party chief of the National Administration of Traditional Chinese Medicine, at a press conference in Wuhan.

In Hubei, TCM treatment has been given to 90.6 percent of COVID-19 patients.

Medical workers massage patients' acupuncture points at the Wuhan pulmonary hospital in Wuhan. Photo: Xinhua

While many scientists are skeptical about its benefits, traditional medicine has official support and has been endorsed by President Xi Jinping. It has been credited with curing tens of thousands of patients during the outbreak and is also being promoted beyond Chinas borders, as an alternative medical solution and a source of national pride.

One of the treatments being used is ephedra, which has been used to treat respiratory complaints since the 13th century, and a special soup in which it is mixed with poria, blackberry lily, apricot kernel and gypsum can help alleviate symptoms, according to official guidelines from the Chinese National Health Commission. The use of Chinese medicine has been supported by the national medical authorities during most recent pandemics, including the H1N1 flu outbreak in 2009 and H7N9 in 2013.

Chinese medicine mostly worked on the human immune system and could not replace invasive forms of treatment such as life support. Chinese health authorities have published a series of figures trying to prove the efficacy of Chinese medicine. Official figures showed that more than 50,000 recovered Covid-19 patients have been prescribed Chinese medicine in their treatment.

According to Hubeis provincial health commission, Chinese medicine has been used on 91.91 per cent of the patients as of mid-March. In the makeshift hospitals built temporarily to treat patients with mild symptoms, between 94 and 99 per cent of people were given Chinese medicine. For instance, Artemisinin is a globally recognized remedy for malaria derived from sweet wormwood, a plant used in TCM. Tu Youyou, the Chinese scientist who turned to ancient Chinese medical texts to find artemisinin, was awarded the Nobel Prize for Medicine in 2015.

The studies:

In a clinical trial of 102 patients with mild symptoms in Wuhan, patients with combined treatments compared with the control group of patients receiving only Western medicine, Yu said. Their recovery rate was 33% higher, she added. In another study of more serious cases, patients receiving combined treatments also left hospital sooner than the control group and had greater levels of oxygen in their blood and a higher lymphocyte count -- an important indicators of the health of recovering patients, according to Yu.

In another study by Wang et al 2020, titled Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment published in the journal BioScience Trends Advance Publication. The authors report the clinical characteristics and therapeutic procedure for four patients with mild or severe 2019-nCoV pneumonia admitted to Shanghai Public Health Clinical Center. All the patients were given antiviral treatment including lopinavir/ritonavir (Kaletra ), arbidol, and Shufeng Jiedu Capsule (SFJDC, a traditional Chinese medicine) and other necessary support care. After treatment, three patients gained significant improvement in pneumonia associated symptoms, two of whom were confirmed 2019-nCoV negative and discharged, and one of whom was virus negative at the first test. The remaining patient with severe pneumonia had shown signs of improvement by the cutoff date for data collection. They concluded that results obtained in the current study may provide clues for treatment of 2019-nCoV pneumonia

In another study by Zhang et al 2020, titled In silicons screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus published in the Journal of Integrative Medicine. The authors concluded that Chinese herbal remedies classically used for treating viral respiratory infection might contain direct anti-2019-nCoV compounds.

Chang et al 2020 study titled An Update on the Epidemiological, Clinical, Preventive and Therapeutic Evidence and Guidelines of Integrative Chinese-Western Medicine for the Management of 2019 Novel Coronavirus Disease published in the journal The American Journal of Chinese Medicine. According to the study authors: In China, Chinese medicine is proposed as a treatment option by national and provincial guidelines with substantial utilization. They had this to say : We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19

Yang et al 2020, study also titled Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective published in the journal International Journal of Biological Sciences the authors also supported the fact that at the top of these conventional therapies, greater than 85% of SARS-CoV-2 infected patients in China are receiving Traditional Chinese Medicine (TCM) treatment.

Ling CQ, 2020 study titled Traditional Chinese medicine is a resource for drug discovery against 2019 novel coronavirus (SARS-CoV-2) published in the Journal of Integrative Medicine also asserted that in 2003, patients with severe acute respiratory syndrome (SARS) who were treated with TCM benefited from shorter hospitalization, decrease in steroid-related side effects, and improvement of symptoms

Some TCM Formulas used

Three formulas and three medicines have proved to be effective in treating the infection, according to the State Administration of Traditional Chinese Medicine. Here is a list of them.

1. Jinhua Qinggan granule

The Jinhua Qinggan granule was developed during the 2009 H1N1 influenza pandemic. It consists of 12 herbal components including honeysuckle, mint and licorice and can remove heat from the body and detoxify lungs. It has a curative effect in treating patients with mild and moderate symptoms and can also improve the recovery rate of lymphocytes and white blood cells as well as lower the rate of worsening conditions.

A comparative experiment showed patients who took Jinhua Qinggan granule tested negative for coronavirus 2.5 days earlier than a group that did not take it. The group treated with the granule also took eight days to show improvement, while the other group took 10.3 days.

2. Lianhua Qingwen capsule/granule

Lianhua Qingwen medicine is a very common TCM used for the treatment of cold and flu. Composed of 13 herbal components, it has a curative effect in patients with mild symptoms and helps to relieve fever, cough and fatigue. It can also help prevent the disease from worsening.

3. Xuebijing injection

This injection was developed and marketed during the SARS epidemic in 2003. It consists of five herbal extracts, and its main function is to detoxify and remove blood stasis. It is typically used to treat sepsis. It is effective in suppressing systemic inflammatory response syndrome induced by infection in the treatment of severe and critically ill patients, as well as repairing impaired organ function. Initial clinical studies have shown the injection, combined with Western medicine, can increase the rate of hospital discharge and reduce the rate of disease deterioration. Basic research has also found it has a certain antiviral effect in vitro that can significantly inhibit inflammatory factors induced by novel coronavirus. A comparative experiment of 710 cases jointly conducted by over 30 hospitals showed the injection, combined with regular treatment, can reduce the mortality rate of severe patients by 8.8 percent and shorten intensive care unit hospitalization by four days.

4. Lung Cleansing and Detoxifying decoction

The lung cleansing and detoxifying decoction is derived from several classic recipes in a TCM book known in English as Treatise on Cold Damage Diseases (Shang Han Za Bing Lun), which was written by doctor Zhang Zhongjing some time before 220 AD. It has 21 herbal components and is mainly effective in improving symptoms of fever, cough and fatigue as well as lung conditions in severe patients, as shown by CT scans. Studies have proved the decoction can regulate multiple cell signaling pathwaysas cells communicate with each other by receiving and processing chemical signals in response to environmental changesto inhibit virus replication. Huang Luqi, president of the China Academy of Chinese Medical Sciences, said 1,264 patients in 10 provinces received the decoction and 1,214 have recovered, accounting for 96.1 percent, and no cases worsening.

5. Huashi Baidu formula

Huashi Baidu formula is a core recipe developed by the national TCM team from the China Academy of Chinese Medical Sciences. Made up of 14 herbal components, the formula is based on the recommendations of the early national diagnosis and treatment plan as well as the experiences from clinical practice at Wuhan Jinyintan Hospital.

Its main use is to detoxify, remove dampness and heat from the body and relieve cough to achieve an inner-body balance. It can be used to treat patients with mild, moderate and severe conditions. This prescription has a comprehensive treatment effect during different stages of novel coronavirus pneumonia. It can significantly shorten the length of hospital stays and improve clinical symptoms and lung conditions, as shown by CT scans and other examinations. Studies on guinea pigs found the formula can reduce lung viral load by 30 percent.

6. Xuanfei Baidu granule

Xuanfei Baidu granule, with 13 herbal components, originates from several classic TCM recipes. It can detoxify the lungs and clear dampness and heat, and is used for treating patients with mild and moderate symptoms. Research has shown the prescription can shorten the time it takes for clinical symptoms to vanish and for temperatures to return to normal. It can also effectively prevent patients with mild and moderate symptoms from deteriorating. -China Daily/ANN

Mr. President, I believe it is time to support the traditional Medicine industry and this is the right time to show your support. You could also invite these practitioners and appeal to them to find remedies to complement the conventional efforts by the Medical industry. This COVID-19 fight is not one sided approach; but needs an integrative approach to handle it. Traditional Medicine Practitioners and their centers are more in number than conventional centers and they also need training in testing in their various centers. In fact, they are the first line health workers patients visit before going to the conventional centers, so any efforts to do away with them could be suicidal in your efforts to deal with the pandemic.

Hibiscus Tea could bring hope

Mr. Prez, Traditional Medicine could support people under quarantine in Ghana. For instance, a well know hibiscus Tea has been proven effective in flu management and could also be incorporated as part of the integrative approach in the disease management for those affected by the disease. We can produce hibiscus Tea in large quantities to support the efforts. In a recent 2019 study by Takeda et al titled Antiviral Activities of Hibiscus sabdariffa L. Tea Extract Against Human Influenza A Virus Rely Largely on Acidic pH but Partially on a Low-pH-Independent Mechanism published in the journal Food and Environmental Virology.

The authors analyzed the antiviral activity of hibiscus (Hibiscus sabdariffa L.) tea extract against human IAV and evaluated its potential as a novel anti-IAV drug and a safe inactivating agent for whole inactivated vaccine. The in vitro study revealed that the pH of hibiscus tea extract is acidic, and its rapid and potent antiviral activity relied largely on the acidic pH. However, hibiscus tea extract and protocatechuic acid, one of the major components of the extract, showed not only potent acid-dependent antiviral activity but also weak low-pH-independent activity. The low-pH-independent activity did not affect the conformation of immunodominant hemagglutinin protein. Although this low-pH-independent activity is very limited, it may be suitable for the application to medication and vaccination because this activity is not affected by the neutral blood environment and does not lose antigenicity of hemagglutinin. Further study of the low-pH-independent antiviral mechanism and attempts to enhance the antiviral activity may establish a novel anti-IAV therapy and vaccination strategy.

Also a 2016 study by High antiviral effects of hibiscus tea extract on the H5 subtypes of low and highly pathogenic avian influenza viruses and published Journal Veterinary Medicine Science.

The authors screened the antiviral effects of 11 herbal tea extracts (hibiscus, black tea, tencha, rosehip tea, burdock tea, green tea, jasmine tea, ginger tea, lavender tea, rose tea and oak tea) against the H5N1 HPAIV in vitro. Among the tested extracts, only the hibiscus extract and its fractionated extract (frHibis) highly and rapidly reduced the titers of all H5 HPAIVs and low pathogenic AIVs (LPAIVs) used in the pre-treatment tests of Madin-Darby canine kidney (MDCK) cells that were inoculated with a mixture of the virus and the extract. Immunogold electron microscopy showed that anti-H5 monoclonal antibodies could not bind to the deformed H5 virus particles pretreated with frHibis. In post-treatment tests of MDCK cells cultured in the presence of frHibis after infection with H5N1 HPAIV, the frHibis inhibited viral replication and the expression of viral antigens and genes. Among the plants tested, hibiscus showed the most prominent antiviral effects against both H5 HPAIV and LPAIV.

Mr. President, taking into conclusion the possibility that hibiscus extract might prevent and treat life-threatening viral infection is all the more encouraging; especially considering that it is also known to have a very high threshold of safety. While the researchers did not speculate too deeply on the mechanism of action behind the observed ant-viral activity of hibiscus, noting only the possibility that its anthnocyanin pigment could be responsible, they suggested further studies should be conducted to identify the effectiveness components contained in hibiscus and to elucidate potential anti-viral mechanism in more detail.

They concluded:

"Our preliminary study showed that, in addition to the H5 subtype, hibiscus inactivated seven other subtypes (data not shown), whereas P. sidoides extracts inactivated human influenza viruses (H1N1 and H3N2) but not H5N1 HPAIV . Thus, hibiscus may be a promising candidate as a potent anti-influenza drug, irrespective of subtype".

Mr. Prez, this is the right time to involve practitioners of Traditional and Alternative medicine and Conventional Medicine Practitioners together to work as an integrative team to deal with the disease. Most of them knows their stuff very well and they may help in the fights against the pandemic. If China had done it, we surely can!

Thank You and God bless our home land Ghana!

The author is a distinguished researcher, practitioner and an honorary Professor of Naturopathic and Holistic Medicine-Vinnytsia State Pedagogical University, Ukraine, President of Nyarkotey Collge of Holistic Medicine and currently LLB Law/MBA student. He is the formulator of FDA approved Mens Formula for Prostate Health & Immune booster, Womens Formula for general wellness Nyarkotey Hibiscus Tea for Cardiovascular Health & wellness. Can be contacted by 0241083423/0541234556.

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Letter to the President on Containing the Coronavirus Pandemic - Modern Ghana