key: cord-0839680-rv5zw972 authors: Reihani, Hamidreza; Ghassemi, Mateen; Mazer-Amirshahi, Maryann; Aljohani, Bandar; Pourmand, Ali title: Non-evidenced based treatment: An unintended cause of morbidity and mortality related to COVID-19 date: 2020-05-06 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2020.05.001 sha: 2eb4872af3813b7f54a5167a1af6bb74cae6a78f doc_id: 839680 cord_uid: rv5zw972 nan Nonevidence-based remedies are spreading across different populations and endangering the lives of individuals, particularly those with low health literacy. For example, given the sacredness of cows in India, some Hindus are drinking cow urine to prevent COVID-19, a practice backed by government officials [4] . In Iran, social media accounts circulated false stories of curing COVID-19 by drinking high-proof alcohol, poisoning over 2,000 people due to the inadvertent consumption of methanol with bleach to hide its color [5] . The quick spread of misinformation regarding nonevidence-based treatments for COVID-19 may be due to feelings of fear, helplessness, and hope. Because there is no definitive treatment for COVID-19, people J o u r n a l P r e -p r o o f seek remedies based on their level of knowledge and personal or popular beliefs, which is detrimental to both their own health and the public's health. In the United States, President Donald Trump suggested the possibility of injecting a disinfectant into patients with SARS-CoV-2 infection or treating them with ultraviolet rays [6] . These remarks are not only dangerous because disinfectants are poisonous when mishandled, but when these statements are circulated to populations with low health literacy, people may poison themselves from self-administration. Of note, even before this statement, there had been a 20% increase in calls to U.S. poison centers related to disinfectants and cleaning products compared to last year [7] . While some of these calls are related to accidental pediatric exposures, others involve inadvertent misuse of the product [7] . There were notable increases in inhalational exposures, as well as exposures to bleach products and alcohol-based sanitizers [7] . Even though chloroquine derivates are not approved treatments for COVID-19, President Trump has tweeted and publicly suggested the therapeutic benefit of the drugs. Due to the media attention surrounding chloroquine, an Arizona man died after ingesting chloroquine phosphate (an additive to household products meant to treat fish parasites) in an effort to prevent himself from getting infected with coronavirus. [8] . In Madagascar, President Andry Rojoelina launched an herbal coronavirus "cure" produced from the artemisia plant, yet the WHO stated that the tonic is not evidence-based and is potentially toxic [9] . Touting unproven COVID-19 treatments will only worsen the current healthcare crisis, as people will certainly experiment with these remedies. As a result, health care systems will become overwhelmed with many critically ill patients, from both COVID-19 and those with toxicity from nonevidence-based treatments. There has also been increased media coverage for "alternative" remedies to prevent and treat SARS-CoV-2 infection. For example, the Chinese government encourages the use of herbal J o u r n a l P r e -p r o o f plants to fight the virus including jinhua qinggan capsules, lianhua qinwen capsules, and shufeng jiedu capsules [10] . These herbal formulas contain a combination of many herbs and the exact proprietary mixture is not available, posing a major health risk to patients due to their potential toxicity, contamination, or adulteration [10] . Although traditional medicine techniques were widely used during past epidemics such as severe acute respiratory syndrome (SARS) and H1N1 influenza, a Cochran Review found that Chinese herbs combined with western medicine did not decrease mortality versus western medicine alone [11] . Use of Chinese herbal products for treating viruses is not guided by viral pathology, rather herbs are prescribed by herbalists according to Chinese diagnostic patterns (inspection, listening, smelling, inquiry, and palpitation) [12, 13] . The implications of medicating with herbal-based formulas is serious and dangerous because there is no scientific evidence suggesting that these alternative remedies can prevent or cure COVID-19. There are several adverse effects noted with herbal medications, such as hepatotoxicity, and there have been numerous reports of toxic contaminants, including pesticides and heavy metals [14] . Furthermore, although supplementing with vitamins and minerals may improve immune function, there is no evidence to suggest that the use of any supplement will prevent or cure COVID-19. Similarly, "cures" spread by Iranian social media accounts (which include gargling vinegar and rosewater or salt, and drinking concoctions of mint or white willow with saffron, turmeric, and cinnamon) are not evidence-based, though they may have other nutritional benefits [15] . Medicating with these herbal formulas or supplements may lead to adverse health effects due to imprecise dosing of the supplement or herb, inherent toxicity of the herb itself, or toxicity of the contaminants in the product, thus complicating the clinical picture. The spread of nonevidence-based COVID-19 treatments or cures will undoubtedly worsen the magnitude of the pandemic. As people turn to traditional and nonevidence-based Therapeutic Options for COVID-19 Patients A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Hindu group offers cow urine in a bid to ward off coronavirus [Internet]. Reuters Iran, false belief a poison fights virus kills hundreds Public Broadcasting Service Trump suggests 'injection' of disinfectant to beat coronavirus and 'clean' the lungs NBCUniversal News Group Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 -National Poison Data System Fearing coronavirus, Arizona man dies after taking a form of chloroquine used in aquariums Cable News Network Coronavirus: Caution urged over Madagascar's 'herbal cure China is encouraging herbal remedies to treat COVID-19. But scientists warn against it NBCUniversal News Group Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS) In silico screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus Traditional Chinese herbal medicine for treating novel coronavirus (COVID-19) pneumonia: protocol for a systematic review and meta-analysis Toxicities by herbal medicines with emphasis to traditional Chinese medicine Misinformation and false medical advice spreads in Iran Risk Communication: EPI-WIN World Health Organization. World Health Organization