Even three years after the COVID-19 pandemic initially appeared in December of the year 2019, it is still raging over the globe. There have been numerous attempts to use well-known medications in new ways to treat COVID-19 infection. Despite the early hoopla, it has since been discovered that hydroxychloroquine is ineffective against SARS-CoV-2. Clinical investigations of hydroxychloroquine (HCQ) for recovery and post-exposure prophylaxis (PeP) did not yield encouraging results. 1, 2 For treating patients infected with the SARS-CoV-2 virus, no one antiviral medication has been shown to be particularly effective. Patients with mild to severe COVID-19 infections have participated in clinical studies for well-known antiviral medications like Remdesivir. The findings, however, were inconclusive, indicating that Remdesivir may not be the most effective treatment for COVID-19. 3, 4, 5 There is a need for intervention from alternative medical systems because there is no known cure. For mild to moderate cases, the typical recovery time is two to three weeks. Even though patients are rigorously sequestered after being identified, there is a 14–30day window during which they could potentially transfer the infection. Unfortunately, because the incubation and illness progression phases are difficult to discern in asymptomatic individuals, this has greatly increased the likelihood of viral dispersion. In light of the current dire state of medical problems throughout the world, 3 weeks is a considerable amount of time. Additionally, greater community transmission from this silent viral spread would greatly raise the likelihood that the already overburdened medical infrastructure and services would collapse.

Many nations, including India, implemented a series of lock downs in an effort to limit the pandemic. Sanitation practices, social seclusion, routine mask wearing, testing, and quarantining of suspected carriers were among the recommended methods for limiting the illness. 6 Numerous treatment strategies have also been used to prevent and treat the illness, but no formal studies using well-known polyherbal combination have been conducted. In reality, the Indian government's ministry of health did not include Ayurvedic remedies in its advice on how to treat COVID 19 clinically. 7 Key study fields had been chosen by the Indian Council of Medical Research (ICMR) to produce vital information for preventative and control activities. 8 The Ministry of AYUSH (Ayurveda, Yoga, Unani, Siddha & Homeopathy) has developed suggestions for the disease's symptomatic treatment and prevention (through strengthening immunity). 9

Results from epidemiological research carried out by the Ministry of Health & Family Welfare, Government of India (GoI), are consistent with those discovered elsewhere. 10 According to the Centres for Disease Control and prevention (CDC), 81% of COVID patients who were hospitalised had significant symptoms. 11 It has been established that the new coronavirus mostly affects the upper and lower respiratory tracts. 12 A range of herbs are suggested by the Ayurvedic medical system for the treatment of illnesses of the respiratory tract; therefore, a clinical study was planned to test the noble polyherbal combination containing Withania somnifera, Tinospora cordifolia, Moringa oleifera, Adhatoda vasica, Piper longum, Glycyrrhiza glabra, Ocimum sanctum and Curcuma longa. The study was planned to check the rate of symptom remission in individuals receiving the polyherbal combination in addition to standard of care (SoC) to that in patients with mild and moderate symptoms of COVID-19 infections receiving SoC alone.

The demographic makeup of the treatment and control groups was comparable. Table 3 displays the biochemical and haematological values at baseline.

The treatment group's median day of admission following the onset of symptoms was the sixth (range: 1–12), whereas the control group's median day was the fifth (range: 1–23). 82.35% of patients had co-morbid conditions like diabetes and hypertension. Other co-morbidities that were noted included hypothyroidism and asthma.

The symptoms that were noted throughout the trial included fever, shortness of breath, cough, ageusia and headache. Table 4 lists the number of patients who had each of these conditions on days 1, 3, 7 and 15 of treatment. Fever was the most prevalent symptom, whereas shortness of breath was reported by least number of patients. On days 1, 3, 7 and 15 in the treatment group, the percentage of patients experiencing breathlessness decreased from 46.15% to 15.38% to 7.69% to 3.84%, whereas in the control group, the percentage decreased from 48% to 36% to 26% to 12%.

Ageusia is regarded as a prominent symptom of COVID 19; on days 1, 3, 7 and 15 the percentage of patients experiencing it declined from 69.23% to 65.38 % to 46.15% to 3.84% in the treatment group and from 68% to 64% to 56% to 16% in the control group. There was a similar decline in the proportion of feverish people in both groups. At days 7 and 15, there was a statistically significant decrease in headache, fever and dyspnoea. On days 1, 3, 7 and 15 the percentage of patients having fever declined from 92.30% to 76.92% to 69.23% to 00% in the treatment group and from 88% to 76% to 64% to 4% in the control group. Fever subsided after 7 days in all the patients of treatment group, whereas in control group one patient got fever after 15 days of treatment.

Cough was the second most prominent symptom and on days 1, 3, 7 and 15 it reduced from 76.92% to 69.23% to 38.46% to 7.69% in the treatment group and from 88% to 84% to 64% to 24 % in control group. Headache was complained by the least number of patient and the symptom was reduced by 53.84% to 26.92% to 7.69% to 00% in treatment group whereas in control group symptom reduced from 56% to 36% to 20% to 00% on days 1, 3, 7 and 15 respectively.

On days 5 of the treatment, 4 patients complained of hiccups, which was self-limiting. Three patients in the study group reported salty taste (Lavanasyata) and polydipsia (Talushoosha) on days 3 and 5, respectively.

Patients with COVID pharyngitis in the study group had a median hospital stay of 5 days, compared to 7 days in the control group. In the study group, individuals with COVID pneumonia spent an average of 7 days in the hospital, compared to 8 days in the control group.

Few patients had their chest digital roentgenograms (X-rays) compared. By day 5, the patchy opacities on the follow-up chest X-ray in the study group were decreased without the use of antiviral medications. Although statistical analysis was not done, the observed alterations were clinically significant.

One participant in the trial arm was symptom-free from days 3 to 7, but on day 7 developed symptoms. The patient continued to receive the same add-on regimen until day 15, when he stopped exhibiting symptoms. One patient in the control group who later required intensive care had a protracted stay of 23 days due to enhanced untoward symptoms.

Even though, the study group had a higher percentage of co-morbidities, only one out of 26 patients in that group needed Remdesivir whereas, three out of 25 in the control group.

The goal of this study was to examine a polyherbal combination’s potential using evidence rather than just personal experience. After lengthy discussions among the medical professionals within this institute this study was planned. Patients with COVID 19 had low-grade fever, dry cough, ache in their muscle, and malaise. Sore throat and headache were noted in several patients. At presentation, there were no symptom of acute pneumonia other than cough and shortness of breath. Ageusia along with anosmia was primarily seen. According to European research, 88% of patients with mild to moderate COVID 19 infection reported gustatory impairment. 14, 15 It was discovered that a dry cough frequently accompanied respiratory problems. Bilateral multifocal alveolar opacities were visible on the chest X-ray. Radiological improvement was observed on fifth day of the treatment. Few individuals showed elevated levels of d-dimer while the majority of patients had elevated levels of C-reactive protein.16 Scientific studies on all the herbs suggested that they had immunomodulatory, analgesic, antipyretic, anti-platelet aggregation, and antiviral properties. The patients' hospital stay was cut short due to the add-on arm's considerable improvement in ageusia and dyspnea. Due to a lack of beds with oxygen, an early hospital discharge was crucial. Only 3.2 hospital beds were available per 10,000 people in India, while only 2 hospital beds were available per 10,000 people in Maharashtra. 17 India's metropolitan areas have a higher concentration of beds than its rural areas. 18 The shorter hospital stay might directly correlate with more beds being available to accommodate more patients in need. Although much effort has been put into trying to discover factors linked with increased morbidity or death, consensus is yet anticipated. COVID 19 has exhibited a varying natural course throughout the world. Given these uncertainties, calculating statistical significance in such small population is challenging.

Important positives and negatives of this research are described below:

With the current add-on polyherbal combination regimen, an early clinical improvement in breathlessness was seen along with early ageusia and cough reduction when compared with conventional treatment. Given the lack of hospital beds in India, the median length of hospital stays was shortened; this development is significant. The possibility of Ayurvedic therapy in treating COVID 19 is what can be learned from this study.