Herbal products are commonly used worldwide to treat diseases, and they contain active ingredients present in natural plants, which can be used to relieve certain symptoms. Herbal products are cheap, which supports its use by the general population (GP).1,2 The manufacturing regulations and commercialization of medicinal herbs and natural products vary between countries without specific control on marketing.3 More than one-third of the elderly population in the United States has used ≥1 herbal supplements for different conditions.4 Although 23–80% of the population in Middle Eastern countries reportedly use herbal medicine, >80% of the GP in Saudi Arabia do, most of whom are women who are interested in herbal and traditional medicine.5,6
In general, the GP uses herbal and natural products as a first-line treatment and believes in the safety thereof.7,8 For this reason, among others, herbs have been used for conditions such as a cough and chronic diseases such as rheumatic diseases or cancer.9 Further, caregivers reportedly often give herbal products to their children because they believe in its safety and they lack awareness about the possible harmful effects of herbs or drug interactions that could be fatal.10 This lack of knowledge of the usage of herbs and natural products can lead to unexpected side effects or life-threatening drug interactions.11,12 Natural products can also cause toxicity if used excessively without prescription or proper supervision.7,13
Healthcare workers (HCWs) who studied modern medicine have limited exposure to herbal medicine in their course curriculum, and most HCWs lack training in this branch of medicine unless pursued out of self-interest.14,15 In such cases, HCWs show interest if they are supported by quality knowledge16 and guidelines.17 Although courses on herbal medicine are being implemented in a few colleges,18 more research and training are needed.
Interestingly, herbal medicine played a significant role during the first severe acute respiratory syndrome epidemic in some countries such as China.19 Previous studies reported traditional Chinese medicines may have an antiviral and a symptom-relieving effect, which may delay or reduce the development of mild diseases into severe ones. However, more validation studies with high-quality evidence are required to support safety and efficacy.20,21
During the initial coronavirus disease (COVID-19) phases, the rapid spread of the virus, its high infection rate, and lack of evidence-based medicine and effective vaccines prompted the use of natural products to enhance the immune system and protect against viral infection.22,23 A review on the use of herbs as adjuvant treatment for patients with COVID-19 was recently published,24 but the safe dosage is based on expert consensus reported mainly from Eastern countries.25 Additionally, several randomized controlled trials on the safety of herbal products as a cotreatment for COVID-19 are still being conducted, thus the results are not yet available.26 Although various regulations have been established, they have not been well implemented because of the lack of randomized control trials and the vast differences in plant species used between countries.1 Despite their lack of knowledge, both the GP and HCWs continue to use herbal medicine to strengthen their immune system and protect themselves against …….