Alternatives & advisories

The Ministry of AYUSH keeps pushing its treatment and prophylaxis protocols for COVID-19 even though there is no evidence to suggest that they are effective at keeping the virus at bay.

A homoeopathy practitioner distributes medicine that can supposedly help prevent COVID-19, in Hyderabad on March 5 .

ON April 3, in a distinctly curious communication, the Secretary, Ministry of Human Resource Development (HRD), wrote to various educational bodies outlining the measures to deal with the COVID-19 outbreak.

They included the following: installing the Aarogya Setu application developed by the government to help in the fight against COVID-19; following the protocol developed by the Ministry of AYUSH to boost immunity to enhance the body’s natural defence system; and, finally, lighting a candle on April 5 at 9 p.m. as suggested by the Prime Minister to “realise the power of light” and to “highlight the objective for which we are all fighting together”.

The letter included the detailed protocol of the Ministry of AYUSH, titled “Ayurveda’s immunity boosting measures for self care during COVID19 crisis”.

Although AYUSH stands for ayurveda, yoga and naturopathy, unani, siddha and homoeopathy, the protocol the HRD Ministry was promoting and what the Prime Minister himself focussed on in his address on April 14 was ayurveda, yoga and naturopathy.

“Ministry of AYUSH recommends certain self-care guidelines for preventive health measures and boosting immunity with special reference to respiratory health. These are supported by Ayurvedic literature and scientific publications,” the HRD Ministry’s letter stated.

Pictorially depicted, the general measures recommended to enhance the body’s natural defence system involve drinking warm water throughout the day, practising yogasana, pranayama and meditation for at least 30 minutes daily and using turmeric, cumin, coriander and garlic in cooking.

The measures listed, and depicted pictorially, to promote immunity are eating Chyvanprash (10 grams) every morning; drinking kadha, a herbal decoction made from basil, cinnamon, black pepper, dry ginger and raisins, once or twice a day; and, third, drinking “golden milk”, that is, turmeric mixed in milk, once or twice a day. The last part of the protocol pertains to two “simple ayurvedic procedures”: nasal application, that is, applying sesame or coconut oil or clarified butter (ghee) in the nostrils in the morning and evening, and oil pulling therapy, that is, “swishing” a tablespoonful of sesame or coconut oil in the mouth, taking care not to swallow it and then rinsing it out.

As one of the symptoms of COVID-19 is a sore throat and a dry cough, the protocol of the Ministry of AYUSH recommends steam inhalation with mint or caraway seeds and ingestion of clove powder with honey. “It is best to consult a doctor if symptoms of sore throat or dry cough persist,” it states.

The April 3 advisory to educational bodies such as the University Grants Commission and the All India Council for Technical Education was curious because only two days earlier, on April 1, the adviser and head of the AYUSH Drugs Policy Section issued an order expressly asking all those “concerned ASU&H Regulatory Authorities in the States/Union Territories to stop and prevent publicity and advertisement of AYUSH-related claims for COVID-19 treatment in print, TV and electronic media and take necessary action against the persons/agencies involved in contravening the relevant legal provisions and the aforesaid guidelines of NDMA [National Disaster Management Authority]”.

The head of the Drugs Policy Section explained in an earlier paragraph of the order that in view of the “emerging threat in the country due to COVID-19 outbreak”, it was imperative to “implement various measures for maintaining public safety in all aspects and to control dissemination of misleading information about AYUSH drugs and services”.

His order referred to the twin orders that the Ministry of Home Affairs and the NDMA issued on March 24 instructing State governments and Union Territories to take effective measures under the Disaster Management Act, 2005, “including making of false claim as punishable offence”. It was clear that misleading information was not to be disseminated, especially as there is no cure as such for COVID-19. The treatment protocol for the disease as detailed in government documents is that if anyone develops symptoms of a flu accompanied with difficulty in breathing they are to consult a doctor immediately.

On April 10, in contravention of the letter issued on April 1, the AYUSH Ministry reiterated its advisory on “immunity boosting measures for self-care during COVID-19 crisis”.

Interestingly, a press release from the Press Information Bureau said: “In addition to the above advisory, the Ministry of AYUSH has also proposed to include AYUSH solutions in the district level contingency plans being drawn up to contain COVID-19 in all the districts across the country. The Ministry has also put together the draft guidelines for practitioners of different AYUSH systems in the wake of COVID-19, which is expected to be published shortly, after vetting by public health experts.”

People began to question the immune-boosting claims of AYUSH as early as March when the cases began trickling in. On March 23, an Additional Secretary in the AYUSH Ministry wrote an angry letter to the editor of a leading national English daily complaining about a certain columnist who he claimed had used derogatory terms when writing about AYUSH. The affront, he said, was worse as the article was published on the day of the Janata curfew the Prime Minister had asked citizens to follow. The columnist had apparently “devaluated [ sic ] the health care potential of AYUSH” by likening its practitioners to “quacks”. There were more than 702 AYUSH colleges, the Additional Secretary wrote, imparting five-and-a-half-year degree courses and three-year postgraduate courses apart from eight lakh registered practitioners with more than 28,000 public dispensaries and 3,200 hospitals.

Even before the scientific community in India had formulated a position on COVID-19, on March 1, none other than Vaidya Rajesh Kotecha, Secretary, Ministry of AYUSH, confidently wrote to the Chief Secretaries of all States and Union Territories in reference to the 30 positive cases that had been reported at the time in the country. He said that “there was no panic response warranted, AYUSH being one of the important Ministry [ sic ] equipped for providing appropriate response to the circumstances arose [ sic ] due to this public health challenge, it is worthwhile to associate with other stake holders in eliciting AYUSH based public health response considering the strength and evidences of these systems”.

A detailed advisory the Ministry issued on March 3 stated that homoeopathy had been used to prevent epidemics of cholera, Spanish influenza, yellow fever, scarlet fever, diphtheria, typhoid, and so on, and that the Genus Epidemicus (homoeopathic medicine indicated for a majority of patients affected by an epidemic disease) had been used for the prevention and spread of chikungunya, dengue, Japanese encephalitis and cholera with good results. The advisory went on to give details of medicines under the AYUSH systems for the prevention, prophylaxis, symptom management of COVID-19-like illnesses and some other interventions in conventional care. And on April 14, while announcing the extension of the lockdown to May 3, Prime Minister Narendra Modi listed out seven things to be done by citizens, one of which was to follow the AYUSH Ministry’s immunity-boosting instructions.

If there was evidence of the efficacy of the AYUSH Ministry’s treatment and prophylaxis protocols at keeping the virus at bay, the Union Ministry of Health and Family Welfare would have incorporated them in its “Updated Containment Plan for Large Outbreaks”, released on April 17, a copy of which is available with Frontline . The plan clearly states that “due to paucity of scientific literature based on community studies, the available data on host factors is skewed towards hospitalisation”.

Under the section “Clinical Management”, the document specified that the hospitalised cases would require symptomatic treatment for fever. “Paracetamol is the drug of choice,” the document states. It further laid down that for patients with severe acute respiratory illness (SARI), oxygen therapy, pulse oximetry, non-invasive and invasive ventilator therapy would be required. All suspect and confirmed cases would need to be hospitalised and kept in isolation in dedicated COVID-19 hospitals and blocks. Severe cases would require critical care facilities.

In the section titled “Pharmaceutical Interventions”, the document specified that hydroxychloroquine (HCQ) had been recommended as a chemoprophylaxis drug for asymptomatic health workers managing cases or asymptomatic contacts of confirmed cases under medical supervision. A combination of HCQ and the drug azithromycin was advocated for use in severe cases but only under medical supervision. Non-pharmaceutical interventions included quarantine, isolation and respiratory etiquette. There is no mention of any of the preventive treatment measures recommended by the AYUSH Ministry.