Homeopathy in the Covid-19 Pandemic: Opportunities, Challenges and the Road Ahead

Abstract

COVID-19 is a new disease and no proven preventive and treatment modalities are available, even in homeopathy. Homeopathic medicines, based on the unique symptoms of the patient and the general features of the disease have been used in preventing and managing diseases in the past, irrespective of their causative organism.

There is a globally coordinated effort to obtain experience and identify the homeopathic remedies that are most promising in the treatment and prevention of COVID-19 related symptoms.

An effective, evidence-based, multidisciplinary strategy needs to be put in place to investigate homeopathic drugs for this pandemic and to validate their indications.  This will be conveyed to practitioners for wide application, to mitigate the impact of the pandemic.

Also, new homoeopathic drugs may be prepared from the biological material and immunological signalling molecules specific to COVID-19, followed by safety and clinical trials.

Keywords: Homeopathy, COVID-19

COVID-19 PANDEMIC

Corona Virus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome novel coronavirus 2 (SARS-nCoV-2). It is named “novel” as it has not been previously identified.

The clinical presentation is that of a severe acute respiratory infection (SARI) ranging from a mild common cold like illness, to a severe viral pneumonia leading to potentially fatal acute respiratory distress syndrome.^1,2 The World Health Organization (WHO) was informed of an outbreak of pneumonia of unknown aetiology in Wuhan City, Hubei Province, China on 31 December 2019. Since then, it assumed an epidemic proportion, deteriorating rapidly and spreading within a month to many countries, with the WHO declaring it a pandemic.³

SARS-nCoV-2 belongs to the Sarbecovirus subgenus of the Coronaviridae family and is the seventh coronavirus known to infect humans. The animal reservoir(s) and intermediary host(s) are not known at this point. Transmission dynamics of the virus are also not clearly understood though person-to-person spread among close contacts in family, community and healthcare settings has been confirmed.

Human transmission occurs through respiratory droplets when a person sneezes or coughs, although transmission through hand-to-hand contact, other personal contact, and even fomites may take place. The elderly above the age of 50 years with underlying diseases like diabetes, hypertension, cardiovascular diseases and health care workers caring for patients with the COVID-19 are at high risk.³

COVID-19 may present with the following symptoms in order of their frequency: Fever (87.9%), Dry cough (67.7%), Fatigue (38.1%), Sputum production (33.4%), Shortness of breath (18.6%), Myalgia or arthralgia (14.8%), Sore throat (13.9%), Headache (13.6%), Chills (11.4%), Nausea or vomiting (5%), Nasal congestion (4.8%), Diarrhoea (3.7%), Haemoptysis (0.9%), Conjunctival congestion (0.8%), ARDS (severe cases) (3%).

Investigative findings include radiological findings on chest CT scan (86%) and abnormalities on Chest X-Ray (59%).^3,4 Severity of COVID-19 is classified as Mild (81% – Non-pneumonia and mild pneumonia), Severe (14% – Dyspnoea, respiratory frequency ≥30/min, blood oxygen saturation ≤93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, and/or lung infiltrates >50% within 24 to 48 hours), Critical (5% – Respiratory failure, septic shock, and/or multiple organ dysfunction or failure).⁵

ROLE OF HOMEOPATHY IN EPIDEMICS

Homeopathy has an old association with treating epidemic conditions successfully, thus reducing both morbidity and mortality. Homeopathy has reportedly been used both for prevention and management during the epidemics of Cholera, Spanish Influenza, Yellow fever, Scarlet fever, Diphtheria, Typhoid etc. during pre-antibiotic, pre-vaccination eras.⁶

With the evolved understanding of modern microbiology and preventive medicine, and introduction of vaccines, the incidence of the old-world epidemics has substantially reduced.

The benefits of Homeopathy in the past are also being questioned by certain critics^7,8 Various studies have been conducted worldwide, including India, specifically on Influenza and Influenza like Illness.

The most relevant examples related COVID -19 is the use of homeopathy in the pandemic of Spanish Flu in 1918-20. 20% of the entire world population was infected and 20-40 million people died.

During this epidemic it is said that homeopathic medicines were widely used worldwide, both for treatment and prevention. The average mortality under standard treatment was about 30%, while 1-2% or fewer patients died under homeopathic treatment. Beside commonly used homeopathic medicines, such as Gelsemium, Bryonia alba, Eupatorium perf., Arsenic album, Phosphorus, etc., “Influenzinum”, a nosode prepared from the swab of a patient, was been widely used for the prevention and treatment.^9,10

Subsequently, a randomised, double-blind, placebo controlled clinical trial was reported in France (1984-87) to evaluate the efficacy of a homeopathic preparation in the treatment of influenza-like syndromes. 237 cases received the test drug (Oscillococcinum) and 241 received placebo. Cases who recovered within 48 hours of treatment were more in the active drug group than the placebo group. Most cases recovered early before the end of the week after entry. The number of patients who had favourable outcomes was greater among the active drug group.¹¹

Another double-blind placebo controlled clinical trial was conducted to assess the effectiveness of Oscillococcinum in the treatment of patients with influenza-like syndromes (1998). 188 patients received the test drug and 184 received placebo. The treatment of influenza-like syndromes with Oscillococcinum was found to have a positive effect on the decline of symptoms and on the duration of disease.¹²

A prospective, multi-centre, data collection survey of homeopathic practice in treatment of influenza-like illness in India was conducted during the 2009 pandemic of A/H1N1 influenza.

The survey examined the practice of homeopathic practitioners in India in the management of influenza with respect to patients’ symptoms at presentation and at follow-up consultation, when homeopathic medicines were prescribed. Forty-four different remedies (or combinations of remedies) were used at first appointments. Arsenicum album was the most popular choice of prescription followed by Bryonia alba.¹³

A multi-center, prospective, randomized, triple arm placebo-controlled trial was conducted in India from June 2009 to December 2010 to evaluate the effect of homeopathic medicines in the treatment of influenza-like illness and to compare the complication rate among patients receiving homeopathic medicines with those receiving placebo.

There was significant effect of individualized homeopathic treatment in the medicine group as compared to placebo group on the symptom complex. The complications/sequel rate was also significantly less in the medicine group as compared to placebo group. The top three indicated medicines, in order, were Arsenic album, Bryonia alba, Rhus toxicodendron.¹⁴

A pragmatic clinical trial was conducted in 2009-10 in Brazil with children between 1 to 5 years of age. The medicines used were mainly selected based on in vitro experiments (InfluBio), and in successful qualitative clinical experiences (homeopathic complex). The results indicated that the use of homeopathic medicines minimized the number of flu and acute respiratory infection symptomatic episodes in children.¹⁵

A Prospective Outcome Study with homeopathy and Polarity Analysis was conducted in the treatment of swine flu virus A/H1N1 influenza during the pandemic of 2010-11.  It involved 52 patients with influenza-like disease followed over four weeks: 62% of patients were cured by the first remedy within two days of the start of treatment; 25% received a second remedy and were cured within four days. 13% did not react to treatment and needed a follow-up consultation. Severe outcomes with respiratory failure did not occur.¹⁶

A study was conducted to develop a biotherapy (nosode) prepared from the infectious influenza A virus and to verify its in-vitro response (2013). The homeopathic dilution 30dH, (Influenzinum RC) was prepared from a pure sample of influenza A/Aichi/2/68 (H3N2) virus. Results showed that Influenzinum RC did not cause cytotoxic effects but altered cellular and biochemical features of MDCK and J774G8 cells.¹⁷

A study was conducted to analyse the effects of two homeopathic preparations (influenza biotherapies and thymulin) following two different rationales: isotherapy and endo-isotherapy models (2016). The biotherapies were prepared using purified H3N2 influenza virus samples (A/AICHI/2/68). The homeopathic effects were evaluated individually for inflammatory and behavioral responses against influenza virus antigen in BALB/c mice. It was found that both homeopathic treatments induced subtle changes in acquired immune anti-viral response regulation.¹⁸

The above references reflect that homoeopathy can play an important role in this pandemic provided it is investigated on scientific parameters.

APPROACHES TO HOMEOPATHIC MANAGEMENT OF EPIDEMICS¹⁹

Individualization

Individualization is a ‘Gold Standard’ in homeopathic practice, i.e. a specific remedy for each person, based on the totality of physical, emotional and mental symptoms.

There has been evidence from successful treatment of children with acute diarrhoea in both Nicaragua and Nepal, using individualized single homeopathic remedies. In Nicaragua, 18 different remedies were used, while 14 were prescribed individually in Nepal. Other homeopathic researchers have reported treating other epidemic diseases, such as Chikungunya fever, pulmonary tuberculosis, and malaria, using individualized prescribing.

Combination Remedies

Combination remedies is not a remarkably successful approach as the composition of the combination remedy does not accurately match the symptoms of patients in the epidemic being treated.

A clinical trial in Honduras used a combination of five remedies in diarrhoea. These were Arsenicum album, Calcarea carb., Chamomilla, Podophyllum, and Sulphur. There was no difference between those who received the homeopathic combination and those with placebo.

A team in Pakistan reported results of a trial of a homeopathic combination remedy for dengue fever. Ten remedies used were Bryonia alba, Rhus tox., Gelsemium, Aconitum napellus, Eupatorium perf., China, Hamamelis, Citrullus colocynthis, Crotalus horridus, and Phosphorus. At the end of 6 days, there were statistically significant improvements in blood platelet levels, hematocrit, and white blood cell counts but no information was given about the the clinical course of the disease in the two treatment groups.

Another study compared a combination of six remedies with placebo in dengue fever in Honduras. The remedies were Aconitum napellus, Belladonna, Bryonia alba, Eupatorium perfoliatum, Gelsemium, and Rhus toxicodendron. There were no differences in the resolution of pain and fever or the use of analgesics between the two groups. Viral testing revealed that only 3 of the 60 patients had laboratory-confirmed dengue.

Genus Epidemicus

The concept of Genus Epidemicus was first described by Samuel Hahnemann in Aphorism-241 in the Organon of Medicine, as “…each single epidemic is of a peculiar, uniform character common to all the individuals attacked, and when this character/is found in the totality of the symptoms common to all, it guides us to the discovery of a homeopathic (specific) remedy suitable for all the cases, which is almost universally serviceable in those patients who enjoyed tolerable health before the occurrence of the epidemic….”

There is anecdotal evidence that homeopathy was successful during the Spanish flu epidemic of 1918 to 1919, in which the Genus Epidemicus was Gelsemium.

A most recent example of the use of Genus Epidemicus was reported by CCRH that performed a double-blind placebo-controlled trial using Bryonia alba to prevent Chikungunya fever during an epidemic of this viral disease in 2007. Out of nearly 20,000 healthy individuals in each group, 12.8% of those receiving Bryonia developed the illness compared with 15.8% of those taking the placebo.

Process of identifying the of Genus Epidemicus in COVID-19: There is need to combine the traditional knowledge with the modern parameters of clinical trials to identify the Genus Epidemicus. Various steps are:

• Data collection of COVID -19 patients
• Identification of groups of remedies based on the above data.
• Application of the above group of remedies on actual patients of COVID-19 having mild symptoms using single arm observational studies. The objective should be to further short list the drugs and also identify their useful prescribing indications.
• The short-listed remedies may be further tested using double blind add on treatment on mild to moderate COVID-19 patients. If we can complete this step and identify a remedy or a group of remedies, this will be the most rigorous experimental design to arrive at a Genus Epidemicus. Otherwise the most frequently used remedy/remedies based on observational study during epidemic can be the Genus Epidemicus provided there is consensus among experts.
• The Genus Epidemicus is then further distributed to the healthy population as a preventive remedy. If possible, this preventive trial would be further undertaken using double blind cluster randomisation design, else it should be given to a at risk group population and hot spots of diseases and the outcome can be compared with the hot spots where no drug was given, so comparative pragmatic design may be used.
• In the case of pandemics, networking across the nation for the validation and revalidation of Genus Epidemicus is required.

Isopathy/Nosode/Biotherapy

Isopathic remedies are made from the actual cause of the illness, or from its by-products, to treat that same condition. It is somewhat akin to conventional vaccination, although the preparation is in accordance with homeopathic pharmacy guidelines.

A striking example for disease prevention occurred in Cuba during an epidemic of Leptospirosis from 2007 to 2008. The entire population over 1 year of age was treated with a nosode that comprised four strains of inactivated Leptospira. Disease surveillance statistics revealed an 84% decreased incidence of the disease in these provinces in 2008 compared with previous years. In contrast, the incidence of leptospirosis in the other, untreated, provinces of Cuba rose by 21.7%.²⁰

Challenges of Specific Nosodes:

• Standardization of source of medicine: ²¹

1. From collection till preparation of base material / mother potency.
2. Use of modern technology/ methods.
3. Reproducible quality needs to be checked.
4. Use of in-vitro & in-vivo models for standardization.

• Safety and Efficacy: ²²

1. Safety / toxicity studies for human consumption.
2. Preclinical effectiveness.
3. Stability of product for effectiveness.
4. Preclinical comparative effectiveness studies.

Use of Signalling Molecules:

No vaccine or specific anti-viral drug regime is currently available to treat critically ill patients. Interferons have shown to play a crucial role in the defence against coronavirus diseases. Coronaviruses can impede the interferon induction in humans, and antagonize STAT1, a key protein in the interferon-mediated immune response.²³

The possibility of using drugs from immunological signalling molecules such as Interleukins (IL) and Interferons (IFN), prepared according to the scientific procedures laid down in various homoeopathic  pharmacopoeias, in moderate cases of COVID -19 should be explored to mitigate the cytokines storm and prevent mortality.

GLOBAL INITIATIVES FOR COVID-19

Liga Medicorum Homeopathica Internationalis (LMHI), is a world umbrella organisation for homeopathic doctors and homeopathic associations with members from 76 countries. LMHI is coordinating with the experts for collecting and analysing the data of suspected and COVID-19 positive cases.  The objective is to collect high-quality case reports of practical experience with treating patients from all over the world to develop a strategy for spreading information about the possible role of homeopathy in this crisis.

The preliminary analysis of cases has been discussed in the position paper of LMHI  http://www.lmhi.org/Home/Corona

Practitioners can submit cases to LMHI in any of the following ways:

• Via Vithoulkas Compass (contact ‘Lefteris Tapakis’ <[email protected]>).
• Via Clificol (contact ‘Frederik Schroyens’ <[email protected]>).
• Via the spreadsheet of the American Institute of Homeopathy (contact ‘Peter Gold’ <[email protected]>).
• In text format using Robbert van Haselen’s form. (Send it to ‘Robert van Haselen’ <[email protected]>).

PROSPECTS OF COVID-19 RESEARCH

Despite the latest advances in medicine and technology having given physicians potent tools for diagnosing and treating diseases, the health system is facing challenges of re-emerging and new-emerging diseases such as COVID-19.

Vaccines are not available for many diseases. Moreover, drug resistance, especially in cases of bacterial and viral infections, has reached alarming levels, challenging the progress of conventional medicine.

Other approaches are being explored. There is a need to further explore the role of homeopathy in prevention and control of communicable diseases. This becomes even more significant in tropical countries like India where the environment is conducive to disease outbreaks that occur with seasonal regularity (e.g. dengue, chikungunya during rainy season, influenza like illnesses during winters, and gastroenteritis during summers), and where there are no vaccines or limited treatment modalities.

Prospective, Randomized, Parallel-groups and Placebo-controlled trials may be conducted to explore the efficacy of homeopathy both in prevention and treatment of COVID-19 such as:

• Trials may be conducted to evaluate the efficacy of homeopathic medicine(s) (Genus Epidemicus) in preventing the occurrence of COVID-19 and in positively influencing the clinical course of those who develop COVID-19.
• Adjuvant homeopathic treatment, along with standard conventional treatment in COVID-19 patients to assess the efficacy of homeopathic treatment as add-on to standard conventional treatment of patients with COVID-19 infection, and to compare if add-on homeopathic treatment can reduce the duration and severity of symptoms, length of stay in hospital, and occurrence of complications and mortality.
• Comparative effectiveness study of different indicated Genus Epidemicus or Genus Epidemicus vis-à-vis Nosode.
• Longitudinal time series study as a public health measure.

INDIAN SCENARIO AND ADVANTAGES

Homeopathy is an integral part of treatment in many countries. It is gaining popularity with increasing numbers of users worldwide, despite scepticism and the negative propaganda. As per the WHO Global Report on Traditional and Complementary Medicine 2019, homeopathy is “second among prominent medical professions after allopathy in the world, with practitioners in 100 countries”.

In India, it has recognition by the Government in the form of educational institutions, research organizations, drug manufacturers, professional associations, inclusion of homeopathy in the drugs and cosmetics act and other laws related to practice.

Above all it has public acceptance. At the National level, there is a huge manpower base of institutionally qualified physicians in the system (about 3 lakhs from about 235 medical colleges). 80% of homoeopaths are working privately and are providing services at the Primary Health Care level.

Some are associated with homeopathic institutions in teaching / OPD / IPD patient care and research centres conducting high quality research in homeopathy. This enabling environment will be particularly useful for undertaking research in COVID-19.

STRATEGIC INITIATIVES

There is opportunity for the homeopathic medical institutes to reform to become centres of excellence and hubs of research. The faculty should focus on COVID-19 research by utilization of all their resources. In the long run, curriculum should focus on critical thinking, modern research and biostatistics tools.

Industry should consider adopting college(s) of India and strengthen research infrastructure and support independent researchers. This hand holding will ensure infrastructure and improvement in quality of human resources from India for a better future of homeopathy.

A multidisciplinary team of government representatives, medical colleges, research councils, pharmaceutical industry and virology institutes should focus on the development of new homoeopathic drugs from the biological material of SARS-nCOV-2 virus and immunological signalling molecules specific to COVID-19, and undertake appropriate safety, efficacy and clinical trials at war footing.

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