COVID 19 or Coronavirus disease of 2019-2020 is a global pandemic which threatened millions of lives in almost all countries of the world. It is caused by a variety of SARS virus - SARS Cov-2. The exact origin of the virus is doubtful and scholars think that it is transmitted from bats to pangolins and then to humans via direct consumption of its meat. It is said to have originated in the wild meat market in the Province of Wuhan, China. However, the cause for the rise of this viral pandemic is still under speculation.

Incubation Period:

5-6 days or 2-14 days, highly variable.

The infection spreads via airborne droplets (within 2-3m distance from the subject) and contact surfaces and possibly via faeces. Airborne droplets which arise from the bodily fluids such as saliva, mucous, etc from the affected person is said to be highly infective.

Vertical spread (spread from the pregnant to the infant in the womb) is still not identified.

Signs and Symptoms:

  • Fever
  • Dry cough
  • Fatigue
  • Productive cough (cough with sputum), rarely
  • Headache
  • Loss of smell
  • Shortness of breath
  • Muscle/ joint pain
  • Sore throat

Progression:

Day 1- Fever, dry cough, occasional shortness of breath, occasional fatigue, muscle pain, diarrhoea/ nausea/ vomiting

Day 5- Difficulty breathing

Day 8- Shortness of breath, Pneumonia, Acute Respiratory Distress Syndrome. Pneumonia is a condition in which the air sacs in the lungs inflame followed by filling up with fluid. Acute Respiratory Distress Syndrome is a condition in which the body is deprived of oxygen due to the inability of the lungs to take in air as a result of the fluid accumulation.

Day 10- Above symptoms + Pain abdomen, loss of appetite.

Elderly people or those with a compromised immunity (as in AIDS, TB, etc.) or other chronic ailments are at risk for developing more severe symptoms of the disease.

Mortality in the elderly is higher probably due to the following reasons:

  • Changes in Lung anatomy, Muscle atrophy (reduction in mass and strength), resulting in changes in the physiology of the respiratory system.
  • Reduced airway clearance.
    • (build-up of phlegm in the tract, which is cleared with a lot of difficulty)
  • Reduced lung reserve.
    • (extra volume of air in the lung, breathed in apart from the normal inhalation which is exhaled only during a forceful expiration)
  • Reduced lung defence function.
    • (the lungs contain a number of tiny hair-like projections called cilia which trap foreign bodies; in addition to this, the lung has many macrophages and white blood cells in the air sacs which help in engulfing the pathogens which enter)
  • Increased CRP levels.
    • (CRP- C-Reactive Protein is a protein released in the liver usually during inflammation in any part of the body. This helps in the activation of an inflammatory response against the pathogens. Elevated levels increase the risk of cardiovascular disease, diabetes and hypertension)
  • Defects in T-cell & B-cell functions. (T-cells and B-cells are a major part of the immune system in the body)
  • Multilobe lesions in Pneumonia, unlike in younger people who have only about 1-2 lobes involved.
  • The already degenerating organs are worst hit by inflammatory response chemicals in the body (TNF, Interleukins, etc) which may result in multi-organ dysfunction.
    • [Interleukins & Tumor Necrosis Factor are a group of Cytokines (refer below) which play an important role in the immune system.]
  • Weaker Immunity and reduced T-cells may lead to secondary bacterial infections leading to septic shock.
  • Coronavirus also has active sites that bind to some regions on the T-cells, inhibiting their function.

Mortality in Diabetics may be due to:

  • SARS CoV-2 induced stress causes the release of Hyperglycaemic Hormones (like Glucocorticoids, Catecholamines) which causes increased blood sugar levels.
  • Low blood sugar levels in Diabetics mobilizes proinflammatory monocytes, which increase platelet reactivity which in turn increases the risk of cardiovascular disease. (monocytes are a type of immune cells)
  • High blood glucose levels associated with Insulin resistance increases the AGEs and Proinflammatory Cytokines, Oxidative stress & adhesion molecules which mediate tissue inflammation. this increases the propensity to infection.
    • (AGE- Advanced Glycated End products are biomarkers indicative of ageing and chronic degenerative diseases. These molecules are proteins or fat molecules which bind with the sugar molecules to form glycated residues which are pathological and have low clearance from the system. They promote ageing by increasing the oxidative stress and stiffening of tissues.)
    • (Oxidative stress- The body is an environment where continuous oxidation and reduction reactions take place. In the process, unstable reactions intermediates are formed which are cleared off under normal conditions. In case of disturbances in the Oxidative reactions, toxic and unstable reaction intermediates like peroxides and free radicals are produced and are not cleared from the system. These peroxides and free radicals cause severe damage like DNA strand breaks, protein damage, cell membrane damage, etc. to the biomolecules.)
    • (Adhesion Molecules- These molecules are present on the cell surface & assist the cell in binding with other neighbouring cells. This plays a major role in Immune mediation.)
  • Poor control of diabetes inhibits Lymphocyte proliferation response and impairment of monocyte, macrophage and neutrophil function.
    • (Monocytes, Macrophages, Neutrophils - types of immune cells)
  • Diabetics are observed to have delayed Hypersensitivity and complement activation reaction.
    • (Hypersensitivity is the overreaction of the normal immune system which is often damaging to the body. This includes common allergies.)
    • (Complement activation system- It is a part of the immune system which promotes inflammation and attack against the pathogens along with providing support to the antibodies and phagocytic cells.)
  • In-vitro studies suggest that increased lung glucose concentrations promote viral infection and replication.
  • Patients with increased plasma glucose concentration are observed to have reduced expiratory lung volume.
  • Diabetics are also observed to have increased clotting factors and decrease in fibrin lysis which may lead to bleeding/clotting disorders, hypercoagulable state, etc.
  • Coronavirus may bind to the ACE2 receptors in the Pancreas and damage the Insulin secreting cells resulting in Acute Insulin Dependent Diabetes.

The end-stage is characterised by Viral Pneumonia with ARDS which may result in death. Further, it is also observed that the disease might affect other organs like- atrophy of the spleen (reduction in size), enlarged liver with inflammatory cells, Haemorrhage (bleeding) in the kidneys, swelling, scattered neuronal degeneration on the brain, Multiple Organ Dysfunction (MODS) (due to Cytokine release storm) in few patients.

The reduction in T-lymphocytes in later stages of the disease may also lead to secondary bacterial infection and result in sepsis/ septic shock.

  • (Cytokines are a group of immune messenger molecules which are released on the initiation of an inflammatory reaction. When a large number of immune cells are activated in a short period, it causes a storm of cytokine release which further instigates the release of immune cells.)
  • (T-lymphocytes are a type of immune cells which initiate and coordinate a number of inflammatory reactions against pathogens. They especially fight against viruses; However, their reduction in this disease is still being researched.)
  • (Sepsis/ Septic Shock is a state in which the various inflammatory chemicals released, flood the circulation of the body and affect healthy organs resulting in their failure and threatening life.)

Each patient has to be monitored closely, as the pattern of progression observed is highly variable from person to person.

It takes about 20-27 days to be cured and discharged from a facility.

What is a Virus?

A virus is an infective entity which is inert in the external environment but exhibits features of a living organism only after entering a host organism. They are usually smaller than bacteria and other microorganisms. Hence Viruses are called as “The link between the living and the non-living”. So technically, any virus cannot die outside a host and can only be denatured. They have DNA or RNA as their genetic material. There are a wide variety of viruses affecting both animals and humans.

SARS CoV-2 (Severe Acute Respiratory Syndrome related Coronavirus) is a species of viruses which cause respiratory tract disease in mammals and birds. It is a positive single-stranded RNA virus measuring about 50-200nm in diameter. The virus has a number of projections from its surface membrane extending outwards, making the virus appear like a ‘crown’ under the microscope. Hence the name “Coronavirus”.

These projections called Spike proteins are responsible for the attachment of the virus to the proteins on the membranes of the host cells. These proteins have a high affinity towards ACE2 receptors and also Basegin proteins (essential receptors on red blood cells for P. falciparum, the malarial parasite).

  • (ACE2 is an enzyme present on the outer surface of the cells present in lungs, arteries, heart, kidneys and intestines. On activation, this enzyme reduces the blood pressure and hence it is used as an Anti-hypertensive drug. Hence it is important to know if the patient has any history of hypertension or cardiac ailments, as it may increase the risk of infection and severity manyfold. The fact that the virus attaches to the cells in the Kidneys and Intestines may suggest the occurrence of Gastrointestinal symptoms or sepsis.)
  • (Basegin is an enzyme associated with intracellular recognition, spermatogenesis, the responsiveness of lymphocytes, etc. Hence binding to this protein may cause a widespread disturbance in homeostasis.)

The mechanism underlying the occurrence of the symptoms are not yet clearly understood.

AYURVEDIC PERSPECTIVE:

Coronavirus in Ayurveda

For any life form to exist, there needs to be a combination of Prakrti and Purusha. Prakrti- matter for creation, Purusha- Transformation/ consciousness/ life form.

But in the case of viruses, only the presence of Prakrti is observed, but not Purusha. Viruses are not observed to perform any activity of a living being like- growth, reproduction, etc., independently. Hence this entity has not evolved higher functions and remains inert outside the host. It only performs life-like functions after entering the host due to the presence of Chaitanya (life form) in the host. It can hence be considered as a Visha which seems to have its origin in the unhygienic wild meat market of Wuhan, China.

Concept of Fever and associated symptoms

According to Acharya Sushruta, jwara/ fever is a communicable disease.

The symptoms witnessed in Covid 19 outbreak are consistent with those of Tridoshaja/ Sannipata jwara mentioned by Charaka (Cha. Chi. 3).

  • Jwara (fever)
  • Kaasa (cough)
  • Shwaasa (breathlessness)
  • Sarvanga vedana (body pain)
  • Shoola (pain abdomen)
  • Anannabhilasha (loss of appetite)
  • Atisara (diarrhoea)
  • Utklesha (nausea)

The highly contagious nature of this disease and its spread to the entire world denotes Abhishangaja jwara :

vishavrkshaanilasparshaat tatha anyairvishasambhavaih | abhishaktasya chapyaahuh jwarameke abhishangajam ||

(Cha. Chi. 3)

Visha anila- contaminated/ poisonous air

Though Abhishangaja jwara is a jwara caused by extrinsic factors, it still results in Sannipata jwara.

When SARS CoC-2 is considered as a visha, its incubation period and behaviour in the body can be supported by the concept of “Dushi visha”. Dushi Visha is a type of visha (poison/ that which causes misery) which stays in the body for long periods and suddenly vitiates when it finds a conducive environment in the host.

The fact that this disease has asymptomatic carriers points in the direction of dushi visha.

The virus in some cases has not been found in the sputum even after the onset of Gastrointestinal symptoms like diarrhoea, loss of appetite, etc., which denotes the sthana (location) of the visha in the body.

“jeernam vishaghnoushadhibhirhatam va davagnivatatapashoshitam va | svabhavato va na gunaih suyuktam dushivishakhyam vishamabhyupaiti ||

viryalpabhavat avibhavyam etat kaphavrtam varshagananubandhi | tenardito bhinnapurishavarno dushtasrarogi trdarochakartah ||

murchan vaman gadgadavak vimuhyan bhaveccha dushyodaralingajushtah | amashayasthe kaphavatarogi pakvashayasthe anilapittarogi ||

bhavennaro dhwastashiroruhango vilunapakshah sa yatha vihangah | sthitam rasadishvathava vichitran karoti dhatuprabhavan vikaran ||”

(A. H. U. 35⁄33-36)

If visha is lodged in the amashaya (upper part of the body) - kaphavata lakshana (respiratory symptoms)

If visha is lodged in the pakvashaya (lower part of the body) - vatapitta lakshana (gastrointestinal symptoms)

Symptoms are also observed to progress from amashaya to pakvashaya.

Some more evidences to support SARS CoV-2 as as Visha:

  • Morbidity is higher in people with Cardiovascular diseases than respiratory diseases due to Hrdayavarana (covering/enveloping/ obstructing of the hrdaya) by visha. Hrdaya being one among the 3 marmas or vital organs, causes death when affected. Hrdaya is also Rasavaha srotomula, which when affected, causes symptoms like fever, etc.
    • (Hrdaya is an organ which receives, holds and transmits. Commonly taken as the organ Heart, but in fact, it is much more than that.)
    • (Rasavaha Srotas- It is the group of channels/ pathways through which the nutrients obtained from food circulates all over the body. Hrdaya is the mula/ origin of the Rasavaha srotas.)
  • The viability of SARS CoV-2 varies on different surfaces and is observed to be least on copper (at room temperature). Copper is mentioned as a Vishaghna dravya/ antidote in Sushruta samhita (Su. Su. 38⁄62).

Evidence of a Pandemic:

The concept of Jnapadodhvamsa is explained in Ayurveda in Su. Su. 6 and Cha. Vi. 3.

It says the population is an entire area may be affected by the disease due to wrongdoings, etc., by the people even when there is not much variation in the weather. This may occur via poisoned/ contaminated air, medicine, pollen, food, etc. The symptoms occur in people who have weaker immune systems due to their improper lifestyle, food habits, etc.

Air will be the first factor to become contaminated, followed by water.

The qualities of these contaminated factors are explained in detail in Cha. Vi. 3⁄8.

Finally, place and time are affected, meaning that the disease has spread over a larger area and has become difficult to eradicate and might recur in the future or might prevail for a long time.

All these pieces of evidence imply that a COVID 19 like illness is likely to have existed in the past. This might not be an exact diagnosis of the disease but the symptoms are consistent with the evidence found.

Ayurveda does not believe in naming every disease, rather focuses on the curative and preventive aspects of the disease. This serves as an advantage in treating as no disease is out of the radar of the Tridosha theory, and ultimately all diseases, new or old, can be analysed and treated successfully based on this, rather than speculating on the diagnosis.

Probable treatment:

  • As this disease is a pandemic, the environment has to be cleansed first by fumigating the rooms with the smoke of various herbs.
  • In symptomatic patients, treatment must be based on the stage of the disease and location of the visha.
  • A combination of vishaghna dravya along with drugs having cardioprotective property may be given.
  • Any jwara is Ama pradhana, hence deepana-pachana-anulomana must be given.
    • (Ama is the partially digested/ undigested part obtained from improper digestion which is circulating in the body.)
    • (Deepana- Pachana are the drugs which possess the property of increasing the metabolism and capable of digesting the Ama)
    • (Anulomana is the property of drugs having the quality of establishing the normal direction of movement of Doshas in the body.)
  • Ultimately, each person’s condition must be analysed as per dosha and personalised treatment must be given.
  • For patients who do not show symptoms, efforts to correct the food and lifestyle must be made. One must put efforts for not just physical, but also mental, emotional, social and spiritual well-being.