The coronavirus outbreak has no vaccine or anti-viral treatment. Herbal tonics contain anti-viral, immune enhancing and anti-influenza properties. Protect and prepare for a potential pandemic.
Regarding the current coronavirus a lot remains to be seen at this early stage. There is no vaccine or no anti-viral treatment for this disease at present. Constituents in herbs exhibit a diverse array of anti-viral, virostatic, immune enhancing and anti-influenza activities and may present a solution.
Whether the outbreak will remain an epidemic and cofined to China or will cross international borders and persist to become a global pandemic depends upon a number of factors. (1) Certainly the increased global travel and integration, urbanisation, modern farming techniques that change the use of and exploit the natural environment increases the likelihood of pandemics. What has been recognised is that the coronavirus can spreads before symptoms show, thus increasing the likelihood of a pandemic. (2) What remains to be seen is to understand the transmission rates, morbidity and mortality rates, although we are aware that the death toll is rising rapidly and deaths appear to be in the elderly with associated age related diseases. (3)
Expected Global Deaths
The WHO have estimated in a very roundabout way that the Ebola virus resulted in 11 300 deaths and that the expected death toll from a severe influenza pandemic might be 2500 times higher. This is a figure of 28,750,000. The WHO has clearly stated that another global pandemic is likely and the world remains woefully unprepared. (4)
Likelihood of pandemic
Pandemics ignore borders, social class, economic status and age. Globalisation, urbanisation, mass migration and overcrowding accelerate spread. Since 1918 Pandemic Influenza outbreaks have been predictably unpredictable; but always global and needing a global response. (5) The Spanish Flu infected one-third of the Earth’s population (500 million people) and is estimated to have killed between 50-100 million. (6) The WHO Global Influenza Surveillance and Response System (GISRS) comprises of 153 institutions in 114 countries. (7) The WHO and partners are developing a “Global Influenza Strategy” launched in 2018. (8)
Types of pandemic influenza
- Avian Flu: 2003 The A (H1N1) Severe Acute Respiratory Syndrome (SARS), started in China. (9)
- Swine Flu: 2009 The A (H1N1) Swine Flu started in Mexico, pandemic spread to 214 countries. “The world was lucky” WHO.
- Camel Flu: New Global Threat coroavirus Middle East Respiratory Syndrome (MERS) is reported from Saudi Arabia and the Republic of Korea. (10)
- Cornovirus: 2020 is the latest threat for a global pandemic.
Medical Treatment Options
Neuraminidase inhibitors (NA inhibition)
The influenza A virus possesses two surface glycoproteins known as hemagglutinin (HA) and neuraminidase (NA). Balanced HA-NA functions are necessary for efficient influenza virus replication. Inhibiting HA and NA slows down viral replication. (11) Three classes of antiviral drugs are available for the prevention and/or treatment of influenza. These drugs are known as neuraminidase inhibitors. Resistance to neuraminidase inhibitors exists and is growing. (12) Herbal medicine has been shown to inhibit both NA and HA.
Medical options for seasonal influenza
There is no vaccine for this current coronavirus. Regarding seasonal influenza, the WHO recommends that annual influenza vaccination as the most effective way to prevent influenza. Flu vaccine effectiveness however is a hotly debated with a broad range of estimates. According to Public Health England (PHE) and Eurosurveillance regarding the 2017/18 flu season, the influenza Type B Yamagata lineage was circulating which was contained in the quadrivalent but not in last season’s trivalent 2017/18 vaccine. (13, 14) It is known that older people (over 50) have weaker immune systems so may not produce antibodies against the disease, giving a low protective immune response after vaccination. (15)
CDC Eurosurveillance estimates
CDC state flu vaccine effectiveness in reducing risk of flu between 2005 and 2018 ranges from between 10-60% among the overall population. (16) Eurosurveillance indicated 2017/18 flu vaccine effectiveness ranged between 25 and 52%. (14)
Netherlands prospective observational cohort study
A study in older adults found influenza vaccination effective at reducing laboratory confirmed influenza virus infections but not influenza-like illness (ILI). ILI, also known as acute respiratory infection (ARI) is the reason for hospitalisations. The incidence of ILI was similar between vaccinated and non-vaccinated. (17)
A 2014 Cochrane flu vaccine review in 88,000 participants had much lower estimates concluding influenza vaccines “probably have a small protective effect against influenza and ILI”, concluding 71 people needing to be vaccinated to avoid one influenza case. 1.4% effective. (18)
Rice university study
According to Clinical Infectious Disease Journal, the Rice Uni study predicted the
2018/2019 influenza vaccine to be only 20% effective. The 2019 influenza vaccine is new H3N2 formulation, first time since 2015, and will likely have same reduced effect as the 2016 and 2017 vaccine due to viral mutations related to vaccine production in eggs. (19)
Natural medicine to prepare for a global pandemic
Until effective medical treatments are available, herbal immune stimulants and antivirals are worth consideration. Coronavirus appears to use haemagglutinin only and increasing intereron and preventing the inflammatory cascade (cytokine storm) are useful therapeutic aims.
Constituents in herbs exhibit a diverse array of anti-viral, virostatic, antimicrobial, immune enhancing and anti-influenza activities. (20)
Herbal actions required
- Haemagglutinin (HA) inhibition
- Neuraminidase (NA) inhibition
- Increasing interferon (IFN)
- Preventing the inflammatory cascade (cytokine storm)
Haemagglutinin (HA) inhibition
Influenza haemagglutinin (HA) is a glycoprotein found on the influenza virus surface, along with neuraminidase assists viral replication. (21) The following herbs have been shown to display HA inhibitory effects;
• Catechins isolated from green tea, like EGCG, were found to exhibit mild anti-influenza effect. (61)
• Elderberry (Sambucus nigra) has been traditionally used for treating influenza and colds in western countries. The highly active flavonoids extracted from elderberry inhibit H1N1 infection, comparable to the anti-influenza drug of Oseltamivir. (62) Flavonoids from elderberry extract block viral entry by binding to H1N1 virions. Elderberry inhibits several strains of influenza virus in vitro. (22)
• The constituent curcumin in Turmeric (Curcumin longa) targets HA to inhibit virus entry.
• The constituent andrographolide from Andrographis (Andrographis paniculata) displayed inhibitory activity against avian influenza A (H9N2 and H5N1) and human H1N1 influenza A viruses in vitro and in vivo. (64) Andrographolide interferes with HA to prevent the virus from binding to cellular receptors. (65)
• The constituent rosmaranic acid from Rosemary (Rosmarinus officinalis) inhibits HA. (23)
Neuraminidase (NA) inhibition
Viral neuraminidase is found on influenza virus surfaces and enables viral release from host cells. (24) The following herbs have been shown to display NA inhibitory effects;
• The principle active ingredient of the first oral NA inhibitor Oseltamivir is derived from Star anise (Illicium verum). (25)
• Berberine containing herbs such as Barberry (Berberis vulgaris) are antibacterial, antimicrobial, antifungal and antiviral. (26) NA inhibition activity of berberines is comparative with Oseltamivir. (27)
• Ganoderma triterpenoids from Reishi (Ganoderma lucidum) display NA inhibition against H5N1 and H1N1. (51)
• Elderberry is also a natural NA inhibitor. (28) The compound cyanidin-3sambubiocide, an anthocyanin flavonoid displays potent NA inhibition. (29) The extract displays inhibitory potential on H5N1-type influenza A virus (avian influenza). (28)
Interferons (IFN) are proteins called cytokines produced by white blood cells.
IFN "interferes" with viral replication to protect cells from virus infections by triggering an increase in natural killer cells, macrophages, phagocytes and other immune cells to eradicate pathogens, not only viruses, but also bacteria, fungus, parasites and tumours. (30) IFN up-regulates antigen presentation by increasing the expression of major histocompatibility complex (MHC) antigens.which allow T cells to differentiate foreign antigens from self peptides so as to avoid auto-immunity. (30) Fever is mediated by the release of endogenous pyrogens, cytokines such as tumour necrosis factor (TNF), interleukin (IL)-1, IL-6, and IFN into the bloodstream. (31)
The following herbs have been shown to increase IFN;
• Elderberry (Sambuccus nigra) fruit extracts enhance IFN-β response. (32)
• Astragalus (Astragalus membranaceus) root extract enhances IFN-β response. (32) Astragalus polysaccharide enhances immunity and inhibits H9N2 avian influenza virus in vitro and in vivo. (33)
• Echinacea’s (Echinacea angustifolia) anti-viral properties are contributed to its action to increase IFN. (34-36) These anti-viral properties are comparable with Oseltamivir. (37)
• Curcuma in Turmeric’s (Curcuma longa) immune-stimulatory and anti-inflammatory activities are in part contributed to its ability to increase IFN. (63)
Preventing the inflammatory cascade (cytokine storm)
The cytokine storm is when immune cells and their activating compounds (cytokines)are overproduced. During influenza infection it is this surge of activated immune cells into the lungs that leads to high mortality rates. (38) Suppression of the cytokine release correlates with reduced death rates in clinical diseases such as pandemic influenza where a cytokine storm plays a significant role in high mortality rates. (61, 62) The following herbs have been shown to inhibit the inflammatory cascade;
• The immune-modulatory activities of Echinacea (Echinacea angustifolia) comprise of stimulation of macrophages phagocytic activity and suppression of the proinflammatory cytokines and chemokine responses of epithelial cells to viruses and bacteria. (39)
• The active constituent andrographolide in Andrographis (Andrographis paniculata) inhibits influenza A virus and reduces inflammatory cytokine expression induced by infection. (40)
• Curcumin (Curcuma longa) a polyphenol in turmeric, inhibits key pro-inflammatory cytokines, interleukin (IL) IL-1, IL-6 and tumour necrosis factor (TNF) TNF-α. (41)
Protect yourself with Carahealth Immune Tonic
Contains herbal medicines that have been shown to have the desired action in influenza, to inhibit haemagglutinin (HA), inhibit neuraminidase (NA), increasing interferon (IFN) and prevent the inflammatory cascade (cytokine storm).
Echinacea Echinacea angustifolia
Barberry Berberis vulgaris
Astragalus Astragalus membranaceus
Andrographis Andrographis paniculata
Elderberry Sambucus Nigra
Turmeric Carcuma Longa
Vitamin D as an alternative flu prophylactic
Vitamin D deficiency is described as a European pandemic, (42) with deficiency in the Irish well established. (43) Vitamin D is known to treat colds and results in treating flu like symptoms have been described a dramatic. (44) A 2017 meta-analysis of over 11,000 participants found Vitamin D protected against ARI/ILI among all participants and that supplementation was safe. Results were greater in vitamin D deficient participants. (45) Investigators found in vitamin D deficient individuals, daily or weekly supplementation cut risk of ARI in half. (46) In addition, a meta-analysis concluded that long-term vitamin D supplementation prevents overall mortality. (47)
Acute respiratory infection (ARI)
Influenza-like illness (ILI)
Major histocompatibility complex (MHC)
Tumour necrosis factor (TNF)
World Health Organisation WHO
1. Madhav N OB, Gallivan M, et al. . Pandemics: Risks, Impacts, and Mitigation In: Disease Control Priorities: Improving Health and Reducing Poverty. . In: Jamison DT GH, Horton S, et al, editor. Disease Control Priorities: Improving Health and Reducing Poverty. Chapter 17. 3rd edition ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27.
2. China coronavirus 'spreads before symptoms show' [press release]. BBC News 2020 Jan 26.
3. Leung H. A 36-Year-Old Man Is the Youngest Fatality of the Wuhan Coronavirus Outbreak So Far. Time. 2020.
4. Pandemic risk: how large are the expected losses? [press release]. Geneva Switzerland2020.
5. WHO. Pandemic influenza: an evolving challenge [Internet]. 2018 [updated 2018 May 22. Available from: http://www.who.int/influenza/pandemic-influenza-an-evolving-challenge/en/.
6. Taubenberger JK. The origin and virulence of the 1918 "Spanish" influenza virus. Proc Am Philos Soc. 2006;150(1):86-112.
7. WHO. Pandemic influenza: an evolving challenge 2018 [Available from: https://www.who.int/influenza/pandemic-influenza-an-evolving-challenge/en/.
8. WHO. WHO launches new global influenza strategy 2019 Mar 11 [Available from: https://www.who.int/news-room/detail/11-03-2019-who-launches-new-global-influenza-strategy.
9. Xu R-H, He J-F, Evans MR, Peng G-W, Field HE, Yu D-W, et al. Epidemiologic clues to SARS origin in China. Emerging infectious diseases. 2004;10(6):1030-7.
10. Bhatia PK, Sethi P, Gupta N, Biyani G. Middle East respiratory syndrome: A new global threat. Indian journal of anaesthesia. 2016;60(2):85-8.
11. Mitnaul LJ, Matrosovich MN, Castrucci MR, Tuzikov AB, Bovin NV, Kobasa D, et al. Balanced hemagglutinin and neuraminidase activities are critical for efficient replication of influenza A virus. Journal of virology. 2000;74(13):6015-20.
12. Nitsch-Osuch A, Brydak LB. Influenza viruses resistant to neuraminidase inhibitors. Acta biochimica Polonica. 2014;61(3):505-8.
13. Cosford P. Flu and flu vaccines: Expert interview: Public Heath UK 2018 [Available from: https://publichealthmatters.blog.gov.uk/2018/01/11/flu-and-flu-vaccines-expert-interview/.
14. Marc Rondy EK, Hanne-Dorthe Emborg, Alin Gherasim, Richard Pebody, Ramona Trebbien, Francisco Pozo et al. Interim 2017/18 influenza seasonal vaccine effectiveness: combined results from five European studies. Eurosurveillance. 2018 Mar 01;Volume 23(9).
15. CDC. Vaccine Effectiveness - How Well Does the Flu Vaccine Work? [Internet]. 2018 [updated 2018 Sept 06.
16. CDC. Seasonal Influenza Vaccine Effectiveness, 2005-2018 [Internet]. 2018 [updated 2018 Feb 15. Available from: https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm.
17. van Beek J, Veenhoven RH, Bruin JP, van Boxtel RAJ, de Lange MMA, Meijer A, et al. Influenza-like Illness Incidence Is Not Reduced by Influenza Vaccination in a Cohort of Older Adults, Despite Effectively Reducing Laboratory-Confirmed Influenza Virus Infections. The Journal of infectious diseases. 2017;216(4):415-24.
18. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2018;2:CD001269.
19. Bonomo ME, Deem MW. Predicting Influenza H3N2 Vaccine Efficacy From Evolution of the Dominant Epitope. Clinical Infectious Diseases. 2018;67(7):1129-31.
20. Arora R, Chawla R, Marwah R, Arora P, Sharma RK, Kaushik V, et al. Potential of Complementary and Alternative Medicine in Preventive Management of Novel H1N1 Flu (Swine Flu) Pandemic: Thwarting Potential Disasters in the Bud. Evidence-based complementary and alternative medicine : eCAM. 2011;2011:586506.
21. Wilks S, de Graaf M, Smith DJ, Burke DF. A review of influenza haemagglutinin receptor binding as it relates to pandemic properties. Vaccine. 2012;30(29):4369-76.
22. Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361-9.
23. Shen X, Zhang X, Liu S. Novel hemagglutinin-based influenza virus inhibitors. Journal of thoracic disease. 2013;5 Suppl 2(Suppl 2):S149-S59.
24. Contributors W. Viral neuraminidase. Wikipedia2-19.
25. Oseltamivir. 2018.
26. Wu Y, Li JQ, Kim YJ, Wu J, Wang Q, Hao Y. In vivo and in vitro antiviral effects of berberine on influenza virus. Chinese journal of integrative medicine. 2011;17(6):444-52.
27. Enkhtaivan G, Muthuraman P, Kim DH, Mistry B. Discovery of berberine based derivatives as anti-influenza agent through blocking of neuraminidase. Bioorganic & medicinal chemistry. 2017;25(20):5185-93.
28. Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011;11:16.
29. Swaminathan K, Dyason J, Maggioni A, von Itzstein M, M Downard K. Binding of a natural anthocyanin inhibitor to influenza neuraminidase by mass spectrometry2013.
30. Wikipedia. Interferon. Wikipedia2018.
31. Netea MG, Kullberg BJ, Van der Meer JWM. Circulating Cytokines as Mediators of Fever. Clinical Infectious Diseases. 2000;31(Supplement_5):S178-S84.
32. Frokiaer H, Henningsen L, Metzdorff SB, Weiss G, Roller M, Flanagan J, et al. Astragalus root and elderberry fruit extracts enhance the IFN-beta stimulatory effects of Lactobacillus acidophilus in murine-derived dendritic cells. PLoS One. 2012;7(10):e47878.
33. Kallon S, Li X, Ji J, Chen C, Xi Q, Chang S, et al. Astragalus polysaccharide enhances immunity and inhibits H9N2 avian influenza virus in vitro and in vivo. Journal of animal science and biotechnology. 2013;4(1):22-.
34. McCann DA, Solco A, Liu Y, Macaluso F, Murphy PA, Kohut ML, et al. Cytokine- and interferon-modulating properties of Echinacea spp. root tinctures stored at -20 degrees C for 2 years. J Interferon Cytokine Res. 2007;27(5):425-36.
35. Wu H, Nardone A, Lacetera N. Effects of a standardized purified dry extract from Echinacea angustifolia on proliferation and interferon gamma secretion of peripheral blood mononuclear cells in dairy heifers. Res Vet Sci. 2009;87(3):396-8.
36. Zhai Z, Liu Y, Wu L, Senchina DS, Wurtele ES, Murphy PA, et al. Enhancement of innate and adaptive immune functions by multiple Echinacea species. J Med Food. 2007;10(3):423-34.
37. Karel Rauš SP, Peter Klein, Roland Schoop and Peter Fisher. Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double-Dummy, Multicenter, Noninferiority Clinical Trial
Curr Ther Res Clin Exp. 2015;77:66–72.
38. Aida Sivro DRS, Lyle R. McKinnon. The Role of Cytokine Storm in Influenza Pathogenesis. Purple Paper. 2011(23).
39. Hudson JB. Applications of the phytomedicine Echinacea purpurea (Purple Coneflower) in infectious diseases. Journal of biomedicine & biotechnology. 2012;2012:769896-.
40. Ding Y, Chen L, Wu W, Yang J, Yang Z, Liu S. Andrographolide inhibits influenza A virus-induced inflammation in a murine model through NF-kappaB and JAK-STAT signaling pathway. Microbes and infection. 2017;19(12):605-15.
41. Sordillo PP, Helson L. Curcumin suppression of cytokine release and cytokine storm. A potential therapy for patients with Ebola and other severe viral infections. In vivo (Athens, Greece). 2015;29(1):1-4.
42. Cashman KD DK, Skrabakova Z, Gonzalez-Gross M, Valtuena J, De Henauw S, , et al. Vitamin D deficiency in Europe: pandemic? . Am J Clin Nutr. 2016;103:1033–44.
43. Fiona O'sullivan EL, Dervla Kelly, Jos van Geffen, Michiel van Weele, Helene McNulty et al. Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. The Journal of Nutrition. 2017 May;147(5):858–68,.
44. Schwalfenberg G. Vitamin D for influenza. Can Fam Physician. 2015 61(6):507.
45. Adrian R Martineau DAJ, Richard L Hooper, Lauren Greenberg, John F Aloia, Peter Bergman et al., . Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356(16).
46. Morrison SMaM. Study confirms vitamin D protects against colds and flu [Internet ]. Harvard Gazette; 2017 [Available from: https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/.
47. Yayuan Zheng JZ, Manru Zhou, Liao Cui, Weimin Yao , Yuyu Liu Meta-Analysis of Long-Term Vitamin D Supplementation on Overall Mortality PLOS ONE. 2013;8(12):1-13.