Post recovery manifestations encountered following COVID 19 infection is quite common now. Among these respiratory manifestations like oppression in chest, dyspnoea, dry cough etc. are the most common presentations. Homoeopathy is found to be effective in COVID 19 infection and post COVID 19 syndrome. Literatures have shown the beneficial effect of homoeopathic medicine Arsenicum iodatum in influenza like illness and post viral diseases. This article has managed to present a series of seven cases showing the effectiveness of Arsenicum iodatum in post COVID 19 respiratory illness.
COVID 19, post COVID 19 syndrome, severe acute respiratory syndrome, homoeopathy, Arsenicum album, Arsenicum iodatum
ARDS- acute respiratory distress syndrome
COVID 19- corona virus disease 2019
SARS- severe acute respiratory syndrome
Ars iod – Arsenicum iodatum
Since late November 2019, COVID 19 has become a global health pandemic. The incidence of acute respiratory distress syndrome (ARDS) in COVID 19 patients is reported to be between 17% and 67%, and critical illness that requires intensive care unit (ICU) admission is between 20% and 32% in different studies.1 Post COVID 19 syndrome occurs in most of the people who have recovered from COVID 19 and many of the symptomatology showed similarity to that of the post‐severe acute respiratory syndrome (SARS). The symptoms occurring after recovery from COVID 19 differs from those occurring during COVID 19. Post recovery manifestations were studied after SARS attack in 2003 and the major symptoms were fatigue, myalgia, depression, anxiety, joint pain, headache and weakness. The same symptoms are noted in post COVID 19 conditions, occurring after recovery from acute illnesses. Either the symptoms fade away without much of medical intervention or some of these manifestations become chronic and last for a long period of time requiring long term monitoring.2
Post COVID 19 syndrome also happens to differ from long COVID 19 in which people continue to experience a range of effects lasting for months after recovery.3 In a longitudinal prospective cohort study conducted on non-hospitalised COVID 19 patients, the on-going presence of either shortness of breath, anosmia, ageusia or fatigue as long-lasting symptoms was observed at four and seven months post-infection.4
A prospective observational study conducted in Northern India between October 2020 and February 2021 shows that around 40% of patients had the symptoms in the first month, 22% between 1-3 months and in 10% symptoms occur after 3 months. The severity of post-COVID 19 manifestations was correlated to the severity of the infection which also was in turn related to the presence of comorbidities.5 Post COVID 19 symptoms may vary from patient to patient. The symptoms show equal prevalence in patients ranging from asymptomatic to severe cases. These can range from respiratory symptoms to wide-ranging psychological and multisystem related symptoms.6 Common symptoms, such as cough, fever, dyspnoea, musculoskeletal symptoms, and anosmia have been seen in a large proportion of patients. Respiratory manifestations include dyspnoea, oppression in chest, cough, anxiety and fatigue of which dyspnoea and fatigue are the most commonly complained of. Development of pneumonia or pulmonary fibrosis is seen to be the commonest complication of post COVID 19 respiratory syndrome. 7
As per guidelines issued by Ministry of Ayush for COVID 19, Medicines indicated in mild illnesses are mainly Aconitum napellus, Arsenicum album, Bryonia alba, Gelsemium sempervirens, Rhus toxicodendron, Eupatorium perfoliatum, Ipecacaucunha, Belladonna, Camphora, which may be used depending upon the symptom similarity. Severe forms of disease but not in critical condition: Medicines like Phosphorus, Chelidonium, Veratrum viride, Iodium, Camphora, Cinchona officinalis, Lycopodium clavatum, Arsenicum iodatum, Antimonium arsenicosum, Stannum metallicum, Carbo vegetabilis, can be prescribed on symptomatic indication.8
Arsenicum iodatum is clinically proven in influenza like diseases and post viral infections and our literature confirms it. A series of cases on post COVID 19 respiratory syndrome without complications treated successfully with Arsenicum iodatum has been presented here.
Materials and methods
Common symptoms of post COVID 19 respiratory syndrome was repertorised with Radar opus 2.0 using Synthesis Repertory. Arsenicum album and Arsenicum iodatum (Ars iod) came in the first position of the repertorial analysis. Arsenicum iodatum was selected for the purpose of treatment after referring materia medica.
Many patients visited the OPD of NHRIMH with post COVID 19 respiratory syndrome without pneumonia. Out of these, 7 cases, both males and females of different ages, had similar symptoms of Arsenicum iodatum . It was prescribed to them in suitable potencies and doses.
. Table 1 presents the demographic characteristics of patients, symptomatology, homoeopathic regimen used for treatment and outcome.
Table 1: Demographic characteristics, symptoms, prescription and outcome of the patients
|01||14/09/2020||59years/F||Dyspnoea on exertion,weakness||Weak and lethargic, Anxious||Arsenicum iodatum 200/ alternate days /2doses||Recovered in 4 days|
|02||10/11/2020||48years/F||Dyspnoea,oppression in chest, coughwith scanty expectoration||Weak and anxious||Arsenicum iodatum 200/once in 3 days/2doses||Recovered in 3 days|
|03||10/11/2020||53years/F||Dyspnoea,oppression in chest, dry cough, weakness||Weak, placing hands over chest, dryness of lips and tongue||Arsenicum iodatum 200/once in 3 days/2doses||Recovered in 7 days|
|04||16/02/2021||17years/M||Weakness, dyspnoea, oppression in chest, cough with scanty expectoration,||Unwell, Disappointed appearance||Arsenicum iodatum 200/once in 3 days/2doses||Recovered in 4 days|
|05||15/05/2021||43years/F||Weakness, dyspnoea, oppression in chest, dry cough||Weak and lethargic||Arsenicum iodatum 200/once in 3 days/ 2doses||Recovered in 7 days|
|06||27/05/2021||35years/M||Dyspnoea and cough with little expectoration||Pursed lip breathing, looking anxious||Arsenicum iodatum 1M/ once in 4th day/ 2doses||Recovered in 4 days|
|07||29/06/2021||50years/F||Dyspnoea, cough with white expectoration, yellow thick scanty sputum , Anxiety||Weak, flying of sputum from mouth on expectoration||Arsenicum iodatum 200/ once in 3rd day/ 2 doses||Recovered in 4 days|
figure 1. Repertory chart
Total 7 patients who were treated with Arsenicum iodatum , were taken for evaluation. There were 5 females and 2 males. Speedy recovery was observed in those cases treated with Arsenicum iodatum when compared to other patients who were not taking medicines or under other medicines.
Homoeopathy has been used in the treatment of epidemic diseases since the time of Hahnemann. Since then, several approaches using homoeopathy for epidemic diseases have been proposed, including individualisation, genus epidemicus, and isopathic immunotherapy. In Organon of Medicine, Hahnemann explained, “ all those affected with the disease prevailing at a given time have certainly contracted it from one and the same source and hence are suffering from the same disease; but the whole extent of such an epidemic disease and the totality of its symptoms (the knowledge whereof, which is essential for enabling us to choose the most suitable homoeopathic remedy for this array of symptoms, is obtained by a complete survey of the morbid picture) cannot be learned from one single patient, but is only to be perfectly deduced (abstracted) and ascertained from the sufferings of several patients of different constitutions”.9 Thus, the symptoms of post COVID 19 respiratory syndrome were collected earlier and repertorised to obtain the suitable remedy as it is in sequelae of an epidemic disease. Arsenicum album and Arsenicum iodatum secured the topmost position in the repertory chart. Most of the homoeopathic literature supports the usefulness of homoeopathic medicine Arsenicum iodatum in post viral diseases especially upper and lower respiratory tract.
Ars iod has special affinity in both upper and lower respiratory tract. It helps in early resolution of lung diseases. Its beneficial effect is seen in influenza like illnesses and post viral infections.10,11
The present results show the positive effect of homoeopathic dilution Arsenicum iodatum on post COVID 19 respiratory syndrome. Here most of the patients were asymptomatic during COVID 19 infection and only two patients suffered with mild upper respiratory tract infection. Post COVID 19 respiratory illness started during the first week after they were tested negative for COVID 19. Patients presented with breathing difficulty, dry cough, oppression in chest and weakness. Chest X ray of all patients were taken prior to treatment and it was found normal. After the administration of Ars iod, the symptoms were resolved in 3-4 days. The speedy uneventful recovery was obtained in these cases with the help of Arsenicum iodatum .
To the author’s knowledge this is the first case series report typically focussed on effect of homoeopathic medicine Arsenicum iodatum in the management of post COVID 19 respiratory illness. As this case series presents only 7 cases, it cannot definitely prove the relationship between the medicine and the disease condition, even though a beneficial result was obtained. The mechanism of action of Arsenicum iodatum on such condition is to be studied further in a controlled trial with larger sample size.
- Chen et al., 2020; Feng et al., 2020; Huang et al., 2020; Rodriguez-Morales et al., 2020; Wang et al., 2020; Yang et al., 2020.
- Moldofsky, H. and J.J.B.n. Patcai, Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. 2011. 11(1): p. 37.
- Yelin D, Margalit I, Yahav D, Runold M, Bruchfeld J. Long COVID-19—it’s not over until?. Clinical Microbiology and Infection. 2020 Dec 11.
- Augustin M, Schommers P, Stecher M, Dewald F, Gieselmann L, Gruell H, Horn C, Vanshylla K, Cristanziano VD, Osebold L, Roventa M, Riaz T, Tschernoster N, Altmueller J, Rose L, Salomon S, Priesner V, Luers JC, Albus C, Rosenkranz S, Gathof B, Fätkenheuer G, Hallek M, Klein F, Suárez I, Lehmann C. Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur. 2021 Jul;6:100122
- Kamal M, Abo Omirah M, Hussein A, Saeed H. Assessment and characterisation of post-COVID 19-19 manifestations. Int J Clin Pract. 2021;75(3):e13746. doi:10.1111/ijcp.13746
- Oronsky B, Larson C, Hammond TC, Oronsky A, Kesari S, Lybeck M, Reid TR. A review of persistent post-COVID syndrome (PPCS). Clinical reviews in allergy & immunology. 2021 Feb 20:1-9.
- Mardani M. Post COVID syndrome. Arch. Clin. Infect. Dis. 2020 Apr 1;15:e108819.
- Boger CM. A Synoptic Key to the Materia Medica:(a Treatise for Homoeopathic Students). B. Jain publishers; 2002.
- Chakraborty PS, Lamba CD, Nayak D, John MD, Sarkar DB, Poddar A, Arya JS, Raju K, Prusty AK. Effect of individualized homoeopathic treatment in influenza like illness: A multicenter, single blind, randomized, placebo controlled study.
About the authors:
Dr BINURAJ S R*, Assistant Professor, Department of Practice of Medicine, National Homoeopathy Research Institute in Mental Health, Kottayam, Kerala
Dr VISHNUPRIYA S V, PG Scholar, Department of Practice of Medicine, National Homoeopathy Research Institute in Mental Health, Kottayam, Kerala
Dr HAFSA MUHAMMED, PG Scholar, Department of Practice of Medicine, National Homoeopathy Research Institute in Mental Health, Kottayam, Kerala