MANAGEMENT OF CORONAVIRUS DISEASE 2019 (COVID - 19) – IS THERE A ROLE FOR COMPLEMENTARY AND HERBAL MEDICINAL PRODUCTS?

Coronaviruses (CoVs) constitute a large family of enveloped positive sense single-stranded RNA viruses, which, due to spiky projections on their surfaces, have crown-like appearance when viewed under the electron microscope. They are divided into four genera, namely, alpha-, beta-, gamma-, and delta-coronaviruses. These viruses, in general, can infect different types of animals as well as humans causing respiratory, gastrointestinal, and nervous system diseases (Huang et al, 2020). Prior to the recent CoV disease outbreak, six species of the viruses that infect humans were known, prominent among which are Severe Acute Respiratory Syndrome-CoV (SARS-CoV) and Middle East Respiratory Syndrome-CoV (MERS-CoV). The other four species (229E, HKU1, OC43, NL63 ) usually cause common cold symptoms (Rothana and Byrared, 2020). Thus, they are pathogens with the human respiratory system as their primary target. Coronaviruses have peculiarity in the sense that they have large genetic diversity and their genomes frequently undergo recombination or mutation. These characteristics result in the periodic emergence of new strains of the virus that have different virulence characteristics. In December 2019, the appearance of a novel coronavirus was reported in Wuhan, Hubei Province of China. This new CoV, just like the earlier known SARS-CoV and MERS-CoV, is zoonotic and belongs to the genus beta-coronavirus. It was identified and called severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2), and also named Coronavirus Disease 2019 (abbreviated COVID19) by World Health Organization (WHO). The symptoms in patients with SARS-CoV-2 include fever, cough, fatigue, dyspnea, runny nose, other upper respiratory symptoms and pneumonia, and these symptoms manifest after an incubation period which ranges from 2 to 14 days. The disease is asymptomatic in many people, mild to moderate in most cases, while it may be severe in the elderly and those with comorbidities resulting in severe pneumonia, acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. The virus is more contagious and spreads faster than its predecessors (SARS-CoA and MERS-CoA) and its fatality rate has been estimated to range from 2 to 5% (Huang et al, 2020; Rothan and Byrared, 2020).