Journal of Ayurveda Case Reports

EDITORIAL
Year
: 2021  |  Volume : 4  |  Issue : 2  |  Page : 37--40

Holistic Ayurveda approach to face the post-COVID challenges ahead


Tanuja Manoj Nesari 
 Director, All India Institute of Ayurveda, Sarita Vihar, New Delhi, India

Correspondence Address:
Prof. Tanuja Manoj Nesari
All India Institute of Ayurveda, Sarita Vihar, New Delhi
India




How to cite this article:
Nesari TM. Holistic Ayurveda approach to face the post-COVID challenges ahead.J Ayurveda Case Rep 2021;4:37-40


How to cite this URL:
Nesari TM. Holistic Ayurveda approach to face the post-COVID challenges ahead. J Ayurveda Case Rep [serial online] 2021 [cited 2021 Dec 1 ];4:37-40
Available from: http://www.ayucare.org/text.asp?2021/4/2/37/323907


Full Text



Coronavirus disease 2019 (COVID-19), the highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a catastrophic effect on the world's demographics, resulting in more than 3.77 million deaths worldwide, emerging as the most consequential global health crisis since the era of the influenza pandemic of 1918. Since being declared a global pandemic, COVID-19 has ravaged many countries worldwide, overwhelming many healthcare systems. Even though substantial progress in clinical research has led to a better understanding of SARS-CoV-2 and the management of COVID-19, limiting the continuing spread of this virus has become an issue of increasing concern, as SARS-CoV-2 continues to cause a great damage across the world, with many countries enduring a second or third wave of outbreaks of this viral illness attributed mainly due to the emergence of mutant variants of the virus.

To return to a normal routine after COVID-19 infection is a gradual process. Generally, COVID-19 patients take 2–3 weeks to recover completely. Following a general health routine, involving a nutritious diet, exercise, stress-relieving measures, and yoga often aid early recovery. Some patients who have been infected with SARS-CoV-2 have new, recurring, or ongoing symptoms and clinical findings more than 4 weeks after infection, sometimes after initial symptom recovery. Post-COVID conditions can occur in patients who had varying degrees of illness during acute infection, including mild or asymptomatic infections. Medical and research communities are still learning about these postacute symptoms and clinical findings.

These complications can affect both mental and physical health. After acute COVID-19 illness, recovered patients may continue to report a wide variety of signs and symptoms, most commonly cough, low-grade fever, and fatigue, all of which may relapse and remit. Other reported symptoms include shortness of breath, chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thromboembolic conditions, and depression and other mental health conditions.[1] As of now, there is limited evidence of post-COVID sequelae and further research is required and is being actively pursued. A holistic approach is required for follow-up care and well-being of all post-COVID–recovering patients.[2] Overall, postacute COVID-19 seems to be a multisystem disease. Clinical management requires a whole-patient perspective. Persistent viremia due to weak or absent antibody response,[3] relapse or reinfection,[4] inflammatory and other immune reactions,[5] deconditioning, and mental factors such as posttraumatic stress[6] may all contribute in prolonged recovery.

It can be difficult to distinguish symptoms caused by post-COVID conditions from symptoms that occur for other reasons. Patients experiencing the acute and postacute effects of COVID-19, along with social isolation resulting from pandemic mitigation measures, frequently suffer from symptoms of depression, anxiety, or mood changes. It is also possible that some patients with post-COVID conditions will not have had positive tests for SARS-CoV-2 because of a lack of testing or inaccurate testing during the acute period or because of waning antibody levels or false-negative antibody testing during follow-up.

The natural history of SARS-CoV-2 infection is currently being investigated. Researchers are actively studying the prevalence, mechanism, duration, and severity of symptoms following acute SARS-CoV-2 infection, as well as risk factors associated with post-COVID conditions. Whereas older patients and those with underlying health conditions might have an increased risk for severe disease, young people, including those who were physically fit before SARS-CoV-2 infection, have also reported symptoms lasting several months after acute illness.

Postacute COVID care clinics are being established at various medical centers, bringing together multidisciplinary teams to provide a comprehensive and coordinated treatment approach to COVID-19 aftercare. Survivor support groups are connecting people, providing support, and sharing resources with survivors and others affected by COVID-19.

Centers for Disease Control and Prevention continues active investigation into the full spectrum of COVID-19 illness, from the acute phase to longer term effects and conditions. This work will help establish a more complete understanding of the natural history of SARS-CoV-2 infection and related post-COVID complications, which can inform healthcare strategies, clinical decision-making, and the public health response to this virus.[7]

Till date, children have relatively been spared of serious disease and poor outcomes. As per the available ICMR serosurvey data, before launch of vaccination drive, children aged 10–17 years had seropositivity similar to that in adults, i.e., 25.3%.[8] However, the proportion of <20-year-olds among confirmed COVID-19 cases is lower than expected. It means that children are as susceptible as adults to infection, but a large majority remains asymptomatic. Even among the symptomatics, vast majority have mild disease only. As has been seen in countries where a significant proportion of adults have received COVID-19 vaccines, the proportion of children among new cases increases gradually (in the US, the proportion has increase from 14% to 24% as in May 2nd week and changed to 19.8% in the 3rd week).[9] Various experts are predicting a third wave with a disproportionately high burden among the pediatric population. Therefore, there is a need to prepare for any future sudden surge of COVID-19 cases in the pediatric age group. It is important to augment existing health facilities for children, particularly intensive care unit (ICU) and High Dependency Units (HDU) facilities, while also strengthening community level care, i.e. PHCs/HWCs. Ministry of Health and Family Welfare under Government of India has released Guidelines on Operationalization of COVID Care Services for Children and Adolescents.[10] Considering the importance, Ministry of AYUSH, Government of India, also released Home Care Guidelines for Children and Advisory for AYUSH Practitioners about Prophylactic in Children during the COVID-19 Pandemic.[11]

Concept of immunity in Ayurveda is highlighted under Vyadhikshamatva, for which Ojas and Bala are essential factors. Oja is considered as Bala or biological strength of an individual. Immune disorders are broadly classified into Oja visramsa, Oja vyapat, and Oja kshaya in Ayurveda.[12] Oja is responsible for resistance to degeneration of body and immunity against diseases. Oja when present in sufficient quantity maintains health and when deficient (Oja kshaya) leads to diseases similar to concept of immunity in the body.[13]

Being vulnerable group, it becomes a necessity to be prepared for addressing the diagnostic and therapeutic challenges unique to the pediatric population before the third wave, irrespective of whether it happens or not. Hence, increasing the immunity in children, in addition to the diet-centeric and medicine-complemented approach in adults, requires age-specific recommendations. Traditional pediatric treatises, both mainstream (such as Kāśyapa Samhitā and Hārīta Samhitā) and vernacular (such as Ārogyakalpadruma) contain prototypes of these aspects. Bhojyopakramaṇīya adhyāya and Yūṣanirdeśīya adhyāya of Kāśyapa Samhitā contain theoretical framework and practical applications of dietary modification, respectively. Ārogyakalpadruma contains pragmatic immunomodulatory measures such as Prākāra formulations. The home quarantine guidelines for children published by the Ministry of AYUSH, Government of India, recently are effective, practical and contain both the traditional and contemporary knowledge. In addition, oil massage, nasal medication, oil pulling, and herbal paste patch in the vertex (tailaṃ) in accordance with the geographical and seasonal variations, if implemented, will ensure not only prevention from diseases but also proper growth and development of the children, which is crucial to the society's future.

 Management



Ayurveda including Yoga focuses on upon dimensions of physical, mental, and spiritual health through various holistic protocols. The standard protocol for management of the disease is performing Panchavidha shodhanam (~Panchakarma), administration of Rasayana (~immunomodulatory supplements), and specific therapies. Further, adopting Sadvritta (ethical code of conduct), wholesome food habits, as well as lifestyle and administration of other supportive physiological therapeutic measures, will help in managing COVID-19.

The Rasayana therapy is a clinical specialty of Ayurveda that helps nourish the whole body by strengthening the Rasa dhatu. Ashwagandha (Withania somnifera Linn.), Guduchi (Tinospora cordifolia [Thunb.] Miers), Kalamegha (Andrographis paniculata [Burm. f.] Nees), Amalaki (Phyllanthus emblica L.), Tulasi (Ocimum tenuiflorum Linn.), and Haridra (Curcuma longa Linn.) are potential herbs and can be proven to be useful in post-COVID management. It is also suggested by the Ministry of AYUSH that the use of Chyawanprash in the morning with luke warm water/milk is highly recommended (under the direction of qualified Ayurveda physician) as in the clinical practice Chyawanprash is believed to be effective in postrecovery period.[14]

It has been scientifically proved that the medicated fumes coming out from ghee and other substances put in fire during Homa have bactericidal effects. Fumigation with natural plant products is effective in reducing air-borne bacteria and in disinfecting inanimate surfaces. The traditional fumigation with herbal products has huge potential to address the problem of nosocomial infections.[15] Fumes of the plants such as C. longa, Terminalia chebula, Cyperus rotundus, Elettaria cardamomum, Saussurea lappa, Cinnamomum camphora, Cedrus deodara, Santalum album, Shorea robusta, Azadirachta indica, and Commiphora mukul are beneficial in disinfecting the atmosphere.[16] Pratimarsha nasya with Anu taila should be done before going out and after coming back from outside to prevent air borne infections. Respiratory hygiene, or respiratory etiquette, including turning away and covering the mouth or nose when coughing or sneezing, together with appropriate disposal of tissues, and staying home when ill with a cough and fever are vital in such pandemic times.

All India Institute of Ayurveda (AIIA), New Delhi, being the tertiary care center for Ayurveda has been identified as a dedicated COVID-19 health center (CHC) by the Government of NCT Delhi and rendering services under the guidance of Ministry of AYUSH, Government of India. It is observing all such measures explained in the classical literature of Ayurveda. All the health workers team deployed in the CHC who were having the high risk of infection with COVID-19 have been following preventive measures and Ayurvedic medications (Samshamani vati, AYUSH kadha, Chyawanprash, and Anu taila). Till now, majority of the healthcare workers were tested negative and observed without any health complications. AIIA has developed the infrastructure for providing modern diagnostic facilities, central oxygen supply under one roof with the co-location of expert panels from both Ayurveda and conventional systems to manage emergency conditions with distinctly and well-executable referral system.

After getting approval from the Ethics Committee and registration in CTRI, AIIA has completed population-based observational study in a large-scale cohort of 80,000 Delhi Police to generate evidence against Ayurvedic interventions in improving immunity through a preventive AYURAKSHA kit, holding a few formulations of scientific rigor, significant reduction in mortality rate, and decrease incidence of infection. Result showed that age-specific mortality rate of Delhi Police versus Delhi population was significantly reduced. There was a decreasing trend in the incidence of COVID-19 cases in Delhi Police Personnel from June 15 onward (after intervention) whereas Delhi population had increasing trend during the same time which witnessed its peak number of cases during intervention period, when compared to other state, total number of cases in Delhi Police was low. Similarly, mortality rate among Delhi Police Personnel was also much less as compared to other states police personnel. In addition to this, the AIIA is also involved in the developing advisories on the management various levels of COVID-19 infection like post-COVID management.

AIIA has started post-COVID management wing and is looking forward to expanding its services and is soon going to make functional an ICU with integrative protocol. A number of projects have been initiated in association with national and international MoU partners. Formal collaboration with London School of Hygiene and Tropical Medicine, London, UK, with AIIA on behalf of Ministry of AYUSH, Government of India is an opportunity to assess the efficacy of Ayurveda immunomodulators such as Ashwagandha in post-COVID/long COVID management in the western ecosystem as well. Many more international collaborative efforts are in pipeline through diplomate challenges to repurpose Ayurveda medicines scientifically to serve the humanity across the globe in this challenging time. Post-COVID complications such as mucormycosis, a fungal infection that mainly affects people who are on medication for other and late complications such as allergic aspergillosis that has yet to be reported and many more as post-COVID complication and long COVID cases, also need proper Ayurvedic intervention to reduce mortality and betterment of quality of life. ICMR has released diagnosis and management guidelines for COVID-19–associated mucormycosis.[17]

Ayurveda can play significant role in post-COVID management. This has been emphasized in the post-COVID management protocol released by the Ministry of Health and Family Welfare, Government of India. These AYUSH measures can also be used as adjuvants after vaccination and or along with conventional management. Being a tertiary care center for Ayurveda, AIIA has a dedicated CHC to manage mild and moderate cases of COVID-19 with integrated protocol. The CHC of AIIA is observing all measures for the management of the disease. The skills of the healthcare professionals at AIIA are upgraded through exclusive training in basic life support and advanced life support.

Monitoring of post-COVID symptoms through self-observation, adequate rest, healthy diet, and light exercise regimen helps COVID-19 patients to recover from the post-COVID syndrome. The post-COVID symptoms should be timely and effectively managed to avoid the progression of complications. Creating awareness about COVID-19 appropriate behavior along with Ayurveda appropriate behavior is the key of prevention.

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