Getting ready for the 3rd wave of COVID-19: The silver lining

Dr Nitin P. Ghonge, Senior Consultant Radiologist and Academic Coordinator, Department of Radiology, Indraprastha Apollo Hospitals talks about third wave of COVID-19 

The pathogen for COVID-19; SARS-CoV-2 initially involves the mucosal surfaces of upper respiratory tract and possibly aero-digestive tract. Mucosal immunity therefore plays a vital role in prevention of respiratory disease which may be quantified in terms of circulating IgA levels ^[1]The majority of studies on COVID-19 and the available vaccines are only focused on serum antibodies and systemic immunity and may not offer prevention against COVID-19 disease. The mucosal immune responses are expected to be induced in the nasopharynx, nasal cavity, tonsils and adenoids.

The respiratory mucosa has an intrinsic microenvironment, which depends upon the degree of acidity / alkalinity, temperature, humidity and normal bacterial flora. These factors need to remain in balance for the perfect mucosal immunity. The inciting factors like excessive exposure to cold temperature may lead to their imbalance. The body may incite inflammatory response – ‘mucositis’, which may manifest as soreness of throat, running nose or cough. During altered state, the mucosa becomes vulnerable to attacks of respiratory pathogens including COVID-19 and the clinical disease may manifest.

Creating a non-specific ‘virus-hostile’ local mucosal environment is likely to be a promising approach to build a strong mucosal immunity against COVID-19. Healthy mucosal microenvironment with strong mucosal immunity will offer best natural resistance to invasion by COVID-19 infection during the possible 3^rd wave.

 Routine practices to create ‘virus-hostile’ environment in the respiratory mucosa

1. Saline warm water gargles and steam inhalation: The upper respiratory mucosa is sensitive to temperature and humidity. The regular practice of saline warm water gargles and steam inhalation regulates the local temperature and humidity with increased muco-ciliary movements ^[2] This ensures perfect health of mucosal microenvironment and may prevent COVID-19 infection.
2. Drinking warm water: Drinking warm water is revered in Ayurveda. Studies have shown that warm water intake increases nasal mucus velocity and nasal airflow resistance to remove pathogens ^[3] The regular practice of drinking warm water will restore the mucosal microenvironment and may enhance mucosal barrier to COVID-19, apart from providing the essential hydration to the body.
3. Apple Cider Vinegar / fresh lemon mixed with honey and warm water: Normal nasopharyngeal mucus is slightly acid with a physiological pH-value of 5.5–6.5 which increases to 7.2-8.3 during nasal inflammation. Several respiratory viruses are known to be sensitive to low pH. A study has described the role of nasal irrigation for temporary lowering of nasal pH as a mode of treatment for common cold ^[4] Apple Cider Vinegar (20-25ml) mixed with honey and warm water should be consumed. Apple Cider Vinegar may be replaced by few drops of fresh lemon, which again provides a mildly acidic solution and is a great way to start the day. These household remedies may offer strong mucosal resistance against respiratory viruses including COVID-19.
4. Nasal Lubrication: Nasal application of herbal oils [Nasya] provides lubrication of the nasal mucosa and offers protection against respiratory pathogens ^[5]. Modern Medicine also accepts the importance of nasal route for trans-mucosal drug and vaccine delivery. Few studies are currently evaluating the role, efficacy and safety of intra-nasal vaccines for prevention of COVID-19. Nasya should be performed only after consultation with Ayurvedic experts to decide the herbal oil, based on the body constitution and the allergic tests. Coconut oil or ghee are likely to be safer alternatives. Regular practice of Nasya may ensure perfect mucosal health with enhanced mucosal immunity against COVID-19.
5. Herbs and Spices: India is the land of spices and herbs which are routinely used in Indian households. Black pepper (Kali Mirch), turmeric (haldi), Garlic (Lahsun), Ginger (Adrak), Cumin (Jeera), Black Cumin (Kalonji); Cinnamon (Dalchinni), Liquorice (Mulethi), Carrom (Ajwain); Fenugreek (Methi), Asafoetida ((Hing), Cardamom (Elaichi), Cloves (Long), Fennel seed (Saunf), Bay leaf (Tej Patta), Nutmeg (Jayaphal), Curry leaves, Mint (Pudina), Mustard seed (Sarso) and Moringa stem (drumstick) are commonly used in Indian kitchen for cooking. These herbs and spices offer enormous health benefits due to their additive and synergistic impact on the biological functions which may enhance mucosal immunity.

The above-mentioned practices are based on home remedies and are usually safe. Moderation is the key to adopt these practices in our routine lives and should not be consumed in excessive quantities. ‘Herb vacation’ is also a good practice to minimize the risk of side-effects related to continuous consumption of any particular herb.  The ancient wisdom of Ayurveda is often viewed with suspicion by Modern Medicine, as these practices are often not examined in a scientific manner. The health benefits of these practices cannot be ignored during the present crisis, as they are backed with science and common-sense reasoning. The indirect evidences in the available literature and the common-sense reasoning certainly support the role of these practices in prevention of respiratory infections including COVID-19. The Indian healthcare is in a unique position to validate, adopt and integrate the best medical practices from the treasure trove of Ayurveda and the clinical excellence of Modern Medicine.

Amidst fears of a looming third wave of COVID-19 pandemic in India, the stated home remedies and practices may be truly a silver lining…

References:

1. Michael W. Russell, Zina Moldoveanu , Pearay L. Ogra and Jiri Mestecky. Mucosal Immunity in COVID-19: A Neglected but Critical Aspect of SARS-CoV-2 Infection. Frontiers in Immunology. 2020, 11:611337.
2. Tiina M.Mäkinen; Raija Juvonen, Jari Jokelainen, Terttu H.Harju^;, Ari Peitso, Aini Bloigu, Sylvi Silvennoinen-Kassinen, Maija Leinonen, Juhani Hassi. Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections Respiratory Medicine. Volume 103, Issue 3, March 2009, 456-462.
3. Saketkhoo K, Januszkiewicz A, Sackner MA. Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance. 1978 Oct;74(4):408-10.
4. D Hull, P Rennie, A Noronha, C Poore, N Harrington, V Fearnley, and D Passàli. Effect of creating a non-specific virus hostile environment in the naso-pharynx on symptoms and duration of common cold. Effects of creating a non-specific, virus-hostile environment in the nasopharynx on symptoms and duration of Common CoEffects of creating a non-specific, virus-hostile environment in the nasopharynx on symptoms and duration of Common ColdActa Otorhinolaryngol Ital. 2007 Apr; 27(2): 73–77.
5. Anura P. Bale, Viraj M. Manerikar, Vaishnavi G. Tengse. Review on Pharmaco-dynamics of Nasya. International Ayurvedic Medical Journal. ISSN:2320.