Conventional Therapeutic Drugs and Traditional Herbal Medicine in Prevention and Treatment of Novel Corona Virus (COVID-19): An Update

Background: Since December 2019, severe acute respiratory syndrome coronavirus to developing severe acute respiratory disease originated from Wuhan, China, and further spread rapidly all over the world except very few counties. On 30th January 2020, The WHO confirmed the epidemic as a community health crisis all over world. No drug was approved for treatment but some conventional and traditional medicinal plants are being used against COVID-19 infections. Objective: The present review is to illustrate current updates on conventional and traditional herbal medicine used for deterrent and treatment of SARS-CoV-2 infection. Methods: Search engines like Scopus, Pubmed, and World Health Organization (WHO) literature on current advances about novel coronavirus (COVID-19) were reviewed. Discussion and Conclusion: Current research data indicated that the outbreaks caused by SARS MERS and COVID-19 have produced substantial community health problems. Currently, there are no vaccines for prevention or specific treatments however it can be managed by using oxygen therapy, convalescent plasma therapy, antimalarial drugs, and broad-spectrum antiviral drugs. Many traditional herbal and Chinese medicines may be useful. DOI: 10.18311/jnr/2020/25720


SHORT REVIEW
speedily spread via droplet and physical contact 7 . SARS-CoV-2 is associated with nursing engulfed singlestranded ribonucleic acid (ssRNA) 8 . Coronaviruses have prominent Ribonucleic Acid (RNA) genome and their normal size ranges from 27 to 34 kilobases 9 . It may be recognized by using RTPCR (real-time polymerase chain reaction) and some extent by chest computed tomography scan. Presently, there is no medicine that has proven to be the cure for COVID-19 patients 10,11 . In the present review we have discussed the efficiency of drugs in clinical management of novel corona virus infected patients and about some medications that are recommended for curing such patients however; their efficacy has not been proven via clinical trials.

Clinical Manifestations
The clinical features are inconsistent from person to person. It may be symptomatic or asymptomatic. The symptoms can be found within three to fourteen days after infection. It includes high body temperature, shortness of breath, dry cough, joints pain, diarrhea, etc. 14 . In an advanced stage, many clinical symptoms may appear like shortness of breath, persistent pressure with chest pain, blue-black lips or face, metabolism syndrome, and renal failure 15 . However, some cases may be observed as asymptomatic.

Diagnosis
COVID-19 patients suffer a deficiency of lymphocytes level. Whereas, many blood parameters like clotting factor time, creatinine and liver function parameters may be in high levels. Chest X-ray of COVID-19 patient usually shows bilateral infiltrates. CT scan is sensitive and specific than X-ray for the same observation. CT scans are utilized to identify symptomless COVID-19 infected patients 17 .
Suspected COVID-19 patient samples are collected from the upper and lower respiratory tract by a healthcare provider. These samples are analyzed by real time reverse transcription enzyme chain reaction (rRT-PCR) 18,19 method to detect COVID-19.

Prevention
Coronavirus can be prevented by using many measures that include washing hands by soap for 20 to 40 seconds and by using alcohol-based sanitizer for cleaning hands. People should avoid touching eyes, nose, and mouth with unclean hands. People should avoid contact with the infected patient and should follow the social distance rule (about two meters distance). People should cover their face with tissue paper during a cough or sneeze. Disinfection should be practiced on a daily routine basis. People should home quarantine themselves when they feel unwell. If they feel feverish, are coughing or sneezing, and experience shortness of breath, they must consult general practitioners 20 .

Treatment with Predictable Medical Care and Medicines
No drug has been discovered to cure COVID-19, however, some drugs can be used to manage COVID-19 patients. Due to the deficiency of precise antiviral drug or immunizing agent, the core treatment approach for this infection can treatment with broad-spectrum antimicrobial agents, medical care, convalescent plasma, antiviral, and corticosteroids (as shown in Table 1).

Oxygen Therapy
Oxygen therapy is a first-line medical care during hypoxia condition of respiratory illness of COVID-19 patients. The aim of clinical management is to maintenance saturation >90% 21 .

Convalescent Plasma Medical Care
Yoo (2020) has reported that convalescent plasma could also be used for management of Corona Virus -19 22 .

Chloroquine
Chloroquine, an antimalarial drug is also used in the treatment. In-vitro studies have suggested that chloroquine might inhibit COVID-19 23 . On 21 st March 2020, the Indian Council of Medical Research has suggested that hydroxychloroquine can be used as prophylaxis.

Remdesivir
It is mainly to treat the Ebola virus. Many studies have reported that remdesivir is highly effective against the novel coronavirus in isolated cells 24 .

Lopinavir and Protease Inhibitor
They are used for HIV positive patient management. Lopinavir, protease inhibitor, and ribavirin combination have a synergistic impact. Recently, it was reported that lopinavir and protease inhibitor or alone had no significant efficacy. However, a combination of these three drugs showed good efficacy 25 .

Favilavir
In China, favilavir has been approved for the treatment of COVID-19. It was mainly used in the treatment of nose and throat inflammation. It may interrupt the transcription SARS-CoV-2 virus because it has an RNA genome. Recently it was accepted for the treatment of COVID-19 in some counties 26 .

Steroids
Most patients recovered with steroid therapy unless critical. Steroids can be prescribed as a preventive impact at an initial stage of infection. Dexamethasone reduces fluid accumulation in the body at a normal therapeutic dose 27 .

Tocilizumab
It is a monoclonal antibody and is used for treating rheumatoid arthritis. It blocks the functions of interleukin-6. It has been well documented that interleukin-6 participates as an inflammation mediator and further leading to chronic disease. Thus, this drug may be used to manage cytokine mediated respiratory diseases. Therefore, tocilizumab can make a significant effect in COVID-19 patients 28 .

Treatment with Traditional Herbal Medicine
Out of some traditional herbal medicines, thirteen were reported to have a significant effect on COVID-19 29 and twenty-six herbs were significantly effective for the treatment of virus causing respiration metastasis infections 30 . Twenty-two, herbal extracts were analyzed and reported to have significant inhibition against Mouse Infectious disease Virus (MHV). These products might be used as anti-COVID medicine 31 . It was well documented that Litchi seed flavonoids could exploit or inhibit SARS-CoV protease because this flavonoid inhibits the peptidase activity of coronavirus 32 Table 2).
As we know, COVID-19 is modified from SARS-CoV, so these drugs may also be used for the treatment. It was found that 3-chymotrypsin-like proteolytic enzyme (3CLpro) plays a significant role in virus replication. So, this enzyme has been targeted by using some natural products for clinical management of SARS-CoV. Many scientific studies indicated that traditional Chinese medicines extract has significant potential to reduce the proteolytic enzyme 3CLpro activity 53 . Houttuynia cordata extract 54, 55 and litchi seeds were used for the extraction of flavonoids which have significantly inhibited respiratory syndrome 56,57 . These natural products are significantly inhibiting 3CLpro enzyme leading to the treatment against respiratory infections 58,59 . It has also been reported that many flavonoids specifically like isobavaschalcone, herbacetin, 3-β-D-glucoside, and quercetin significantly impair the proteolytic enzyme 3CL activity of MERS-CoV 60 . Yu et al. have documented well about natural product scutellarein and myricetin, which

Conclusion
It is concluded that the novel coronavirus (COVID-19) is extremely infectious and it spreads via droplets from person to person. It may be prevented by personal quarantine and maintaining social distance to break the cycle. Currently, there are no specific vaccines reported till now, but this infection might well be treated by predicable medical aid, drugs, some traditional flavoring medication.