A deadly infectious disease of unknown etiology earlier referred to as ‘Wuhan pneumonia’ was reported in Wuhan city of the Peoples Republic of China in December 2019, and by January 7, 2020, it was confirmed as a new type of coronavirus called “Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)”.
In February, 2020, the World Health Organization (WHO) named the pneumonia as Coronavirus Disease 2019 (Covid-19). The sudden and rapid unexpected spread of Covid-19 from China to several other countries compelled the WHO to officially declare a global pandemic on March 11, 2020. People infected with SARS-CoV-2 usually show respiratory symptoms of cough, fever and lung damage, and other related two conditions such as fatigue, myalgia and diarrhea.
As of April 29, 2020, a total of 1,671 cases of SARS-CoV-2 infections had been confirmed and reported in Ghana, and over 3,100,000 cases across the globe. The reported cases continue to rise because of the rapid spread of SARS-CoV-2 via human-to-human transmission. The SARS-CoV-2 is an enveloped single stranded RNA-type beta-coronavirus and its genome sequences shared 79.5% sequence identity to severe acute respiratory syndrome-related coronaviruses (SARS-CoV) .
The Covid-19 can be diagnosed by either laboratory testing (real-time Reverse Transcription Polymerase Chain Reaction, rRT-PCR; Enzyme-linked immunosorbent assay, ELIZA) or chest computed tomography scan (CT scan), but sadly, as of now, there are no approved specific antiviral drugs or vaccines available for its treatment or prevention. The general case management/treatment and prevention plans globally involve supportive care, hygienic practices, lifestyle modification and healthy diet.
The present clinical protocols for Covid-19 treatment in Ghana are solely orthodox and are yet to fully incorporate Ghanaian Herbal Medicine (GHM) regimen. It is expected that in the wake of Covid-19 pandemic, mandatory institutions, such as the Centre for Plant Medicine Research (CPMR), Traditional and Alternative Medicines Directorate (TAMD), Ghana, Food and Drugs Authority (FDA), Ghana Federation of Traditional Medicine (GHAFTRAM) and medicinal plants and natural product drug discovery experts in research institutions across Ghana would team up to develop a concerted framework and suitable natural product remedies towards integration of GHM into both current and future therapeutic options for the management/treatment of Covid-19.
Ghana is endowed with experienced and accomplished researchers in medicinal plant and natural product resources across universities and research institutes. In addition, the country has a rich diversity of medicinal plants with a large group of herbal and folk medicine practitioners.
Therefore, collaborative effort in harnessing the diverse expertise, scientific knowledge and anecdotal reports of the teams earlier mentioned can provide the required synergies to make strides in the discovery and development of plant medicine against Covid-19. It is considered that the time to act is now!
Ethnobotanical and pharmacological studies on some indigenous medicinal plants (Paullinia pinnata, Solanum torvum, Alstonia boonei, Sutherlandia frutescens, Celtis mildbraedii, Acacia kameruneensis) have effectively been used to treat a plethora of viral infections such as common cold, pneumonia, measles, small pox, hepatitis and human immunodeficiency virus (HIV) in Ghana [2-5].
Unfortunately, the clinical application of these potential antiviral medicinal plants has not been sufficiently explored partly due to lack of standardized product development and reasonable scientific data on traditional formulations to support safety and efficacy in humans. However, studies have demonstrated that the aforementioned medicinal plants are capable of preventing or destroying viral replication.
The objective of this write up therefore is to sensitize a national discourse on the development and use of standardized herbal medicines as complementary therapy in public health diseases including Covid-19. For this purpose, the experience of China (home of traditional medicine) in the development of traditional medical practice and the therapeutic benefits of herbal medicines can inform a national strategic agenda towards the effective integration of GHM into the health delivery system.
As earlier mentioned, the main treatment protocol for Covid-19 has been a supportive care package, which includes the combination of broad-spectrum antibiotics, antivirals, corticosteroids and convalescent plasma . HIV protease inhibitors such as ritonavir and lopinavir have also been used, and very often in combination with other appropriate antibiotics to treat Covid-19 patients [7, 8].
Nucleoside analog, favipiravir (T-705) has demonstrated to effectively inhibit the activity of RNA polymerase of RNA viruses such as influenza . A recent report revealed that favipiravir had significant in vitro anti-SARS-CoV-2 activity , but the in vivo effect remains elusive. It has been reported that remdesivir may be the most promising antiviral drug for treating Covid-19 since it has both in vitro and in vivo antiviral activity against a wide array of RNA viruses including SARS, Middle East respiratory syndrome (MERS) , and Ebola virus, and could decrease viral loads and pathology of lungs in animal models .
Currently, it is under clinical trial to evaluate the safety and efficacy of intravenous remdesivir for patients with SARS-CoV-2 infection. Similarly, host-targeted small molecules approved for other human diseases may modulate the virus-host interactions of SARS-CoV-2. Recently, hydroxychloroquine/chloroquine, a potential broad-spectrum antiviral drug [13,14], demonstrated anti-SARS-CoV-2 activity , however, a preliminary study on its use on Covid-19 patients in the US revealed 16.4% higher death rate than in control patients .
The aforementioned data support the assertion by the World Health Organization (WHO) that there is currently no specific recommended medicine for the prevention or treatment of Covid-19. In this regard, there is a great opportunity for Ghana to explore the immense potential of GHM as a complementary therapy for Covid-19 patients. There is no gainsaying the fact that some Ghanaians might have started using GHM as treatment option for complaints consistent with Covid-19 symptoms with some success.
It is therefore time for researchers, herbal medical practitioners, regulators, other relevant scientists, the private sector and policy makers to come on board to valorize medicinal plant research and plant resources in order to find local solutions with global impact for treatment of Covid-19 in Ghana. This clarion call is underpinned by the success story of medicinal plant products utilization in the treatment of Covid-19 in China .
The Chinese have been pacesetters in the use of natural products in treating deadly coronavirus diseases such as SARS, MERS and Covid-19. The Health Commission in 26 provinces of China has officially declared that Traditional Chinese Medicine (TCM) should be used in combination with conventional medicine therapies for Covid-19 patients . In February 2020, the National Health Commission (NHC) of China also reported that 60,107 confirmed Covid-19 patients (85.20% of total confirmed cases) had been treated with TCM .
As of March 1, 2020, a total of 303 ongoing clinical trials aimed at evaluating the efficacy and safety of treatments for Covid-19 patients had been launched in China with 50 of the trials (16.5%) assessing TCM . According to the report of the National Administration of Traditional Chinese Medicine, by February 5, 2020, over two-hundred (214) Covid-19 patients had been treated with a polyherbal formulation (Qing Fei Pai Du Tang) in Shanxi, Hebei, Heilongjiang and Shaanxi Provinces with excellent efficacy (≥ 90%) .
Over the years, natural products continue to provide antiviral agents that selectively kill the pathogenic organism in the presence of other living organisms. There are sufficient biochemical differences that exist between the metabolism of bacterial and mammalian cells that enable selectivity to be achieved, leading to the early development of antibacterial agents, which were safe for clinical application. However, viruses, despite their apparent simplicity, present a challenging situation in anti-viral drug design efforts due to their replicative cycle.
In this replicative cycle, viruses become physically and functionally incorporated into the host cells. Consequently, it becomes very difficult to distinguish unique biochemical features of the pathogen from the host cell to serve as drug targets for selective activity. The competitive advantage in using antiviral medicinal plants is enshrined in their multitarget and broad-spectrum activities which include attacking the viral components (envelop, nucleic acid and proteins) and viral life cycle (entry, replication, assembling and release) . These medicinal plants may also stimulate the defense mechanism of the host via their immunomodulation, antioxidant, antiinflamatory and bronchodilatory properties in destroying the deadly viruses.
There are sufficient scientific data to show that antiviral Ghanaian medicinal plants possess such mechanistic features which can be unearthed to combat Covid-19. It is possible that some biomedical natural product scientists have already commenced investigation into the effect of GHM products or its components on SARS-CoV-2 in the laboratories. The diverse research efforts towards Covid-19 should be brought to a common platform by policy makers and stakeholders in order to have a unified direction and purpose for optimal utilization of research funds, research infrastructure and social uptake of research.
This therefore places a call on the government to consider substantial research support to interdisciplinary research teams in terms of funds and material resources in its ‘Covid-19 combat plan’ for now and the future. For a start, the government can dedicate 5% -20% of the proceeds of the Covid-19 National Trust Fund to Covid-19 priority research needs and invite applications from local interdisciplinary research teams in collaboration with CMPR and FDA, Ghana. In a couple of months, it is envisaged that outstanding indigenous polyherbal medicines suitable for clinical trials would be developed as antiviral agents for the treatment of Covid-19 patients.
Caleb K. Firempong (PhD),
Medicinal Plant Biochemist,
Department of Biochemistry and Biotechnology,
Faculty of Biosciences,
College of Science,
Email: [email protected]
- Zhou, P., Yang, X.L., Wang, X.G., Hu, B., Zhang, L., Zhang, W., Si, H.R., Zhu, Y., Li, B., Huang, C.L. and Chen, H.D., 2020. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 579(7798), pp.270-273.
- Addo-Fordjour, P., Anning, A.K., Belford, E.J.D. and Akonnor, D., 2008. Diversity and conservation of medicinal plants in the Bomaa community of the Brong Ahafo region, Ghana. Journal of medicinal plants research, 2(9), pp.226-233.
- Appiah, K.S., Oppong, C.P., Mardani, H.K., Omari, R.A., Kpabitey, S., Amoatey, C.A., Onwona-Agyeman, S., Oikawa, Y., Katsura, K. and Fujii, Y., 2019. Medicinal Plants Used in the Ejisu-Juaben Municipality, Southern Ghana: An Ethnobotanical Study. Medicines, 6(1), p.1.
- Boadu, A.A. and Asase, A., 2017. Documentation of herbal medicines used for the treatment and management of human diseases by some communities in southern Ghana. Evidence-Based Complementary and Alternative Medicine, 2017.
- Koffuor, G.A., Dickson, R., Gbedema, S.Y., Ekuadzi, E., Dapaah, G. and Otoo, L.F., 2014. The immunostimulatory and antimicrobial property of two herbal decoctions used in the management of HIV/AIDS in Ghana. African Journal of Traditional, Complementary and Alternative Medicines, 11(3), pp.166-172.
- Jin, Y.H., Cai, L., Cheng, Z.S., Cheng, H., Deng, T., Fan, Y.P., Fang, C., Huang, D., Huang, L.Q., Huang, Q. and Han, Y., 2020. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Medical Research, 7(1), p.4.
- Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y. and Yu, T., 2020. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), pp.507-513.
- Habibzadeh, P. and Stoneman, E.K., 2020. The novel coronavirus: a bird’s eye view. Int J Occup Environ Med (The IJOEM), 11(2 April), pp.1921-65.
- De Clercq, E., 2019. New Nucleoside Analogues for the Treatment of Hemorrhagic Fever Virus Infections. Chemistry–An Asian Journal, 14(22), pp.3962-3968.
- Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., Shi, Z., Hu, Z., Zhong, W. and Xiao, G., 2020. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell research, 30(3), pp.269-271.
- Sheahan, T.P., Sims, A.C., Graham, R.L., Menachery, V.D., Gralinski, L.E., Case, J.B., Leist, S.R., Pyrc, K., Feng, J.Y., Trantcheva, I. and Bannister, R., 2017. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Science translational medicine, 9(396).
- Zhang, L. and Liu, Y., 2020. Potential interventions for novel coronavirus in China: a systemic review. Journal of medical virology.
- Savarino, A., Di Trani, L., Donatelli, I., Cauda, R. and Cassone, A., 2006. New insights into the antiviral effects of chloroquine. The Lancet infectious diseases, 6(2), pp.67-69.
- Yan, Y., Zou, Z., Sun, Y., Li, X., Xu, K.F., Wei, Y., Jin, N. and Jiang, C., 2013. Anti-malaria drug chloroquine is highly effective in treating avian influenza A H5N1 virus infection in an animal model. Cell research, 23(2), pp.300-302.
- Cohen Elizabeth and Nigam Minali. Study finds no benefit, higher death rate in patients taking hydroxychloroquine for COVID-19. April 22, 2020. https://edition.cnn.com/2020/04/21/health/hydroxychloroquine-veterans-study/index.html.
- Yang, Y., Islam, M.S., Wang, J., Li, Y. and Chen, X., 2020. Traditional Chinese medicine in the treatment of patients infected with 2019-new coronavirus (SARS-CoV-2): a review and perspective. International journal of biological sciences, 16(10), p.1708.
- National Health Commission (NHC) of the People’s Republic of China. Transcript of press conference in 17, February, 2020. http://www.nhc.gov.cn/xcs/s3574/ 202002/f12a62d10c2a48c6895cedf2faea6e1f. shtml. 2020.
- Zhao, J., Tian, S.S., Yang, J., Liu, J.F. and Zhang, W.D., 2020. Investigating the mechanism of Qing-Fei-Pai-Du-Tang for the treatment of Novel Coronavirus Pneumonia by network pharmacology. Chinese Traditional and Herbal Drugs, http://kns. cnki. net/kcms/detail/12.1108, 20200216, p.002.
- Mukhtar, M., Arshad, M., Ahmad, M., Pomerantz, R.J., Wigdahl, B. and Parveen, Z., 2008. Antiviral potentials of medicinal plants. Virus research, 131(2), pp.111-120.