Dr. Rammanohar. P*
Thiruvananthapuram (ISJ): The next days will be crucial for India as the outbreak of the COVID-19 could very well explode into a catastrophic epidemic. As far as India is concerned, the large population, high population density, poor doctor to population ratio and shortage of medical facilities are all critical factors that can be the tipping point in triggering a calamity.
If we go by numbers, we are still in the Stage 2 of the epidemic but keeping in mind that we have tested people at risk only in the thousands, the statistics may be misleading. It is heartening that efforts are underway to increase the capacity for testing more people, but we don't know if we can meet the challenge of handling large numbers of people in a short time frame. It is just a so far so good situation.
Indian Health Care system is pluralistic and we have conventional modern medicine and AYUSH systems of medicine regulated by two independent ministries. How should the health regulatory system of a country like India respond to the outbreak of a disease like COVID-19? Definitely in this time of crisis, the full resources of the health care system must be harnessed in preparedness to face and curb the epidemic.
In these circumstances, it is a massive disappointment to see that modern medical community and AYUSH community are working in silos, even contradicting each other when it comes to working out strategies and guidelines to deal with the epidemic. We simply cannot have guidelines and advisories coming from two sources in parallel to deal with a public health challenge.
A first step would be to set up a COVID-19 Response Team from the AYUSH Sector that would become the platform to work out the strategy for AYUSH interventions both for prevention and management of the disease. This COVID-19 Response Team should become the reference point for advisories and guidelines which must be harmonised with the overall strategy for handling the epidemic.
When we say that systems like Ayurveda should be deployed to deal with the epidemic, it is often misunderstood that this should happen at the level of individual practitioners. We certainly do not want the public to be overwhelmed by prescriptions and formulations conjured by individual Ayurvedic physicians across the length and breadth of the country. This would create absolute chaos. All advertisements and sale of medicines claiming efficacy to treat COVID-19 from the AYUSH Sector must be prohibited and penalised. We cannot deal with an epidemic with this kind of a response.
That is why a COVID-19 response team should be set up consisting of experts from AYUSH who can formulate a well thought out strategy for management of COVID-19 that can be integrated into the guideline for prevention and management of the outbreak issued by the Ministry of Health and Family Welfare.
COVID-19 is a new disease and we do not have any evidence based interventions for its prevention or management in any system of medicine. Research and learning is part of the strategy to contain and manage the epidemic from point of view of Public Health as well as medical management of the disease. Recommendations should be based on best rationale available and in this spirit, Ayurvedic interventions should certainly be incorporated where there is sound rationale and backing of tradition.
The Chinese experience is a pointer in this direction. The Chinese incorporated a Traditional Chinese Medicine (TCM) classification of the disease as well as treatment guidelines based on this classification into the official handbook being used by doctors to treat patients with COVID-19.
A search on PubMed with keyword COVID-19 returns 1146 research papers already. At least two papers are related to TCM. An article published in Nature points out that China has more than 80-running or pending clinical trials on potential treatments for COVID-19 including interventions from traditional Chinese medicine. In fact, 15 trials listed in China's registry expect to enroll a total of more than 2000 people in studies assessing the efficacy of TCM.
Dr. Soumya Swaminathan, Chief Scientist at WHO says the world body is working with Chinese researchers to bring strict quality into the study so that the data generated would be rigorous enough to draw reliable conclusions about the efficacy of TCM. The National Administration of TCM in China says that TCM has been widely used to treat COVID-19. At least 85 percent of patients received TCM interventions. A careful study of this data is awaited to understand the benefits of integration of TCM into the treatment for COVID-19.
Epidemics have scourged the world from time immemorial. The tradition of Ayurveda has been witness to epidemics of big magnitude. Classical texts have documented the features and mechanisms of epidemics as well as strategies to manage them. We know that a clue from TCM led to the discovery of artemesinin that revolutionised the management of Plasmodium falciparum malaria. It would be very non-progressive and unscientific to dismiss systems of medicine like Ayurveda as unworthy of investigation in the wake of the emergence of COVID-19 as a pandemic.
*The author is Research Director at Amrita School of Ayurveda, Kerala (The views expressed in the article is that of the author)