key: cord-1021741-z1je8mfv
authors: Kim, Tae-Hun; Kang, Jung Won; Jeon, Sae-Rom; Ang, Lin; Lee, Hye Won; Lee, Myeong Soo
title: Use of Traditional, Complementary and Integrative Medicine During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis
date: 2022-05-09
journal: Front Med (Lausanne)
DOI: 10.3389/fmed.2022.884573
sha: 1e143325ecf6f4645e9d0f2ffb7f808dc7c9efe1
doc_id: 1021741
cord_uid: z1je8mfv

BACKGROUND: Traditional, Complementary and Integrative Medicine (TCIM) has been reported to use for symptom management of coronavirus disease 2019 (COVID-19). The objective of this review was to identify the overall usage prevalence of TCIM interventions for COVID-19. METHODS: Surveys on the general population and observational studies on the COVID-19 patient chart review were located in the search of PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases in September 2021. Observational studies, such as cross-sectional studies, surveys, cohort studies and hospital-based patient case reviews, published in any language, reporting the usage of TCIM in the patients with COVID-19 or the general population during the COVID-19 pandemic were included in this review. Data screening and extraction were performed independently by two reviewers. The reporting quality of the included studies was assessed with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. To conduct a meta-analysis of the usage prevalence of various TCIM interventions, the effect size of the proportion for each intervention was calculated with the inverse variance method. The main outcome was usage prevalence of TCIM interventions among patients with COVID-19 or the general population during the COVID-19 pandemic. RESULTS: A total of 62 studies were included in this review. The overall TCIM usage prevalence was estimated to be 0.64 (95% CI 0.54–0.73). The overall prevalence did not differ between the population-based survey (0.65, 95% CI 0.48–0.81) and the hospital-based patient case review (0.63, 95% CI 0.52–0.73). Statistical heterogeneity and comparatively low quality in reporting were observed, which should be cautiously considered when interpreting the results. CONCLUSION: Various TCIM interventions were reported to be used with comparatively high frequency. Future international collaborative research might overcome the main limitation of this study, i.e., the heterogeneity of the included data. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278452, identifier: CRD42021278452.

Background: Traditional, Complementary and Integrative Medicine (TCIM) has been reported to use for symptom management of coronavirus disease 2019 . The objective of this review was to identify the overall usage prevalence of TCIM interventions for COVID-19.

Methods: Surveys on the general population and observational studies on the COVID-19 patient chart review were located in the search of PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases in September 2021. Observational studies, such as cross-sectional studies, surveys, cohort studies and hospital-based patient case reviews, published in any language, reporting the usage of TCIM in the patients with COVID-19 or the general population during the COVID-19 pandemic were included in this review. Data screening and extraction were performed independently by two reviewers. The reporting quality of the included studies was assessed with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. To conduct a meta-analysis of the usage prevalence of various TCIM interventions, the effect size of the proportion for each intervention was calculated with the inverse variance method. The main outcome was usage prevalence of TCIM interventions among patients with COVID-19 or the general population during the COVID-19 pandemic.

Results: A total of 62 studies were included in this review. The overall TCIM usage prevalence was estimated to be 0.64 (95% CI 0.54-0.73). The overall prevalence did not differ between the population-based survey (0.65, 95% CI 0.48-0.81) and the hospital-based patient case review (0.63, 95% CI 0.52-0.73). Statistical heterogeneity and comparatively low quality in reporting were observed, which should be cautiously considered when interpreting the results.

Conclusion: Various TCIM interventions were reported to be used with comparatively high frequency. Future international collaborative research might overcome the main limitation of this study, i.e., the heterogeneity of the included data.

Coronavirus disease 2019 (COVID- 19) is an acute upper respiratory tract infection which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) newly identified in 2019 (1) . Since the World Health Organization (WHO) declared a pandemic in March 2020, several variants have been appearing, and the pandemic continues. Treatment strategies have been gradually established based on accumulated clinical evidence for the acute treatment of COVID- 19 . In addition to the basic management principle that prioritizes the prevention of complications such as thrombosis, along with adequate oxygenation and hemodynamic support, antiviral agents such as remdesivir, antibody therapy and drug treatments such as dexamethasone are being used in clinical practice (2, 3) . However, since knowledge about this disease is still incomplete and new mutated viruses continue to emerge, uncertainty is rising about the basis of treatment from a medical point of view. Additionally, symptoms that persist after the acute manifestation of COVID-19, called long COVID-19, should not be overlooked (4) . Patients with severe clinical presentation of COVID-19 are likely to experience long-term respiratory system dysfunction or sequelae of complications, but the real problem is that a significant number of mild infections or asymptomatic COVID-19 patients have been presenting with long COVID symptoms for a long time (5) . In addition, long COVID patients complain of symptoms of various spectra, such as fatigue, cognitive decline, respiratory difficulty, joint pain, loss of taste/smell and hair loss (4) . From this perspective, a multidisciplinary approach is required for the prevention and management of COVID-19 from the acute stage through long COVID (3, 4) .

Since the outbreak of COVID, Traditional, Complementary and Alternative Medicine (TCIM) has been adopted as an alternative strategy for the prevention and treatment of COVID-19 as the entire medical capacity of a country is mobilized at a national level to promote immunity and to protect against viral infection at both the national and individual levels. Clinical practice guidelines (CPGs) or therapeutic protocols for the management of COVID-19 have been published in various fields of TCIM, such as Traditional Chinese Medicine (TCM) (6, 7), Korean Medicine (8) , and Ayurveda (9) . In addition, according to a survey conducted on patients in quarantine in India, 25% of patients responded that they had experiences with TCIM-related products or home remedies (10) . Judging from these data and recently published bibliometric studies (11) (12) (13) . TCIM interventions are being used quite actively for the management of COVID-19 worldwide, although usage status might variations across countries might depending on the country's medical system.

Considering each country's situation, reviewing the utilization prevalence of overall TCIM interventions by country and the utilization status of each intervention may provide insight into the impact of TCIM on global health in the COVID-19 pandemic period.

Therefore, we investigated the prevalence of TCIM use to prevent and treat COVID-19 around the world, identified the most frequently used specific TCIM treatments per country and suggested the overall proportion of CAM use worldwide to treat COVID-19 using systematic review methods.

This was a systematic review (SR) for observational studies that assessed the usage status of TCIM interventions worldwide. We located surveys of the general population to assess the usage status of TCIM interventions and hospital-based COVID patients' case review studies through electronic database searches. Overall and individual usage prevalence of diverse TCIM interventions were estimated through meta-analysis. This review protocol was registered in PROSPERO (https://www.crd.york.ac. uk/prospero/display_record.php?RecordID=278452).

Review questions 1. How frequent are TCIM interventions used in the general population and COVID-19 patients worldwide? 2. How much is the difference in usage prevalence between different TCIM interventions?

We did not impose any limitations on the population if the study assessed the usage prevalence of TCIM interventions during the COVID-19 pandemic. Both healthy individuals and COVID-19 patients were included in this review.

In this review, we allowed any type of TCIM intervention based on the definition of the U.S. National Center for Complementary and Integrative Health (14) . Interventions included nutrition (e.g., special diets, dietary supplements, herbs, probiotics, microbial-based therapies and botanical drugs), psychological treatment (e.g., meditation, hypnosis, music therapies, relaxation therapies, qigong, hypnotherapy, Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration), physical therapies (e.g., acupuncture, massage and spinal manipulation), combinations such as psychological and physical methods (e.g., yoga, tai chi, dance therapies and some forms of art therapy), psychological and nutritional combinations (e.g., mindful eating), chiropractic and osteopathic manipulation or traditional medicine (e.g., Ayurvedic Medicine, Traditional Chinese Medicine, homeopathy, naturopathy and functional medicine).

We included observational studies, so most studies were not expected to have comparator groups. However, any kind of comparator intervention was allowed.

Usage prevalence of TCIM interventions among patients with COVID-19 or the general population during the COVID-19 pandemic was included.

Observational studies, such as cross-sectional studies, surveys, cohort studies and hospital-based patient case reviews, were included in this review. Screening and selection of the studies for inclusion in this review were conducted manually by two authors (THK and SRJ) independently. Any disagreement was arbitrated by the third author (JWK). EndNote 20 (Philadelphia, PA) was used for the screening stage of this review. We uploaded a list of located publications and conducted a screening process with this software. The predefined extraction form included data regarding the type of study, population (healthy individuals or COVID-19 patients), type of TCIM interventions, country, time point for acquiring study data, information on the study population (age and sex), purpose of the usage of TCIM interventions and numbers of patients in hospital-based case reviews and survey respondents (numbers in the total population and those who used TCIM interventions).

For this review, observational patient case reviews for COVID-19 patients and surveys for the general population or COVID-19 patients were included. Therefore, items from the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement were selectively used for assessing the reporting quality of the included studies. We evaluated appropriateness of reporting for items including title and abstract, objectives, participants, variable, data sources, bias, study size, statistical methods, number of participants in each stage of the result section, result analysis, key results, limitations and funding (including conflicts of interest). Each item was evaluated with "A" if all the necessary points were appropriately suggested in the publication of the study and "I" if not. Two authors (THK and SRJ) independently assessed STROBE items and discussed them until they reached agreement.

To conduct a meta-analysis of the usage prevalence of various TCIM interventions, the effect size of the proportion for each intervention was calculated with the inverse variance method. When calculating the estimated proportion of TCIM usage, we used double arcsine transformation and back transformation methods, because some studies showed extreme proportions, such as close 0 or 1, which meant that the dataset was skewed and not normally distributed (15) . A random effects model was adopted to calculate summary effect estimates of usage prevalence, because there could be potential clinical heterogeneity in the study methods and study population. Based on the study types (survey vs. hospital-based COVID patient case review), intervention types, study population (general population vs. hospitalized patients) and the country where the intervention was used, subgroup analysis was conducted. I 2 statistics were used to assess statistical heterogeneity. In the subgroup analysis, the R 2 index was calculated to quantify the amount of variance or how much of the total variance in the meta-analysis could be explained by the suspicious effect modifier (16) . Publication bias was assessed through visual evaluation of funnel plots and Egger's test. The package "meta" and the function "metaprop" in R (ver 4.0.2) were used for meta-analysis of proportions in this study. The overall usage prevalence of TCIM interventions in each country was presented in the form of a world map using the "ggplot2" package.

From the electronic database search, a total of 62 studies were enrolled in this review (Figure 1 ) (10, . Thirty-nine studies were population-based surveys, and twenty-three studies were hospital-based COVID-19 patient case reviews. One study was a survey that included patient data from two regions, Hong Kong and mainland China, separately, so we analyzed the data separately (71) . Twenty-two studies were conducted in China (27, 31-34, 37, 39, 40, 44, 47, 55, 62-65, 67, 69-73, 75-77) , six in Saudi Arabia (18, 21-23, 25, 26) , five in India (10, 41, 46, 60, 61) , three in the United States (35, 42, 45) and three in Turkey (38, 49, 66) , and these were the most frequent countries included in this review. Among the population-based survey studies, thirty-one were conducted through online surveys only (17, 18, 20, 22, 23, 25, 26, 28-31, 35, 42, 43, 45, 48-54, 57-62, 66, 68, 74) , one was an in-person interview (56), three were telephone interviews (10, 21, 38) , and two were both in-person and online surveys (19, 36) . Among the included studies, usage status of the interventions, including TCM (n = 22) (27, 32-34, 37, 39, 40, 44, 47, 55, 63-65, 67, 69-73, 75-77) , functional food (supplements) or herbs (n = 20) (17-24, 29, 36, 38, 43, 49-52, 57-59) , mind-body practice or spiritual practice (n = 9) (28, 35, 42, 45, 48, 54, 60, 61, 74) , Ayurveda (n = 2) (10, 41), homeopathy (n = 1) (46) and Ethiopian traditional medicine (n = 1) (56) was suggested. Only one study was conducted in 2021 (57) . Most of the data for surveys or patient chart reviews were collected during 2020. In approximately half of the studies, TCIM interventions were used for prophylactic 

When assessing reporting quality with STROBE statement items, most studies did not appropriately address all the necessary contents in the publications. The most poorly reported items are variables (including effect modifiers and confounders), potential bias, sample size calculation, statistical methods with adjustments of potential effect modifiers and detailed information on excluded participant numbers at each stage of the study (Supplementary Table 2 ).

From the included studies, 53 studies (n = 61,831) suggested a total number of respondents or patients who used TCIM interventions during the COVID pandemic period. The overall pooled prevalence of TCIM usage was estimated to be 0.64 (95% CI 0.54-0.73). The I 2 statistic was 99.88%, which implied severe statistical heterogeneity among the included studies (Figure 2) . In screening for outliers by evaluating the studentized residuals of the included studies, one study (71) was identified as a potential outlier (z = −2.6827, Supplementary Figure 1) . When this study was excluded, the pooled prevalence was estimated to be 0.65 (95% CI 0.56-0.74). In the population-based survey, the overall prevalence of TCIM usage was 0.63 (95% CI 0.52-0.73), which did not show a severe difference when compared with findings from the hospital-based patient case review (overall prevalence 0.65, 95% CI 0.48-0.81, Figure 2 ).

To analyze statistical heterogeneity among the included studies, subgroup analysis was conducted based on potential effect modifiers, including the type of studies (population-based survey vs. hospital-based COVID-19 patient case reviews), study population (general population vs. COVID-19 patients) and country of the study population (China vs. other countries). The R 2 score for a potential effect modifier and the type of study was estimated to be 0%, which indicated that study type was not a strong effect modifier in this review. The study population (R 2 score = 0%, Supplementary Figure 2 ) and country (R 2 score = 1.03%, Supplementary Figure 3) could not explain the heterogeneity. In addition, a meta-regression test for the sample size of the included studies did not suggest that study size was an effect modifier (intercept: 0, P-value: 0.9108).

When comparing prevalence between countries, the country with the highest usage proportion of TCIM interventions was Ecuador (estimated proportion 0.9614, 95% CI 0.9471-0.9735), and Ethiopia showed the lowest proportion (0.1136, 95% CI 0.0931-0.1358, Table 2 ). There were no definitive regional trends in the usage proportion of TCIM interventions visually observed from the world map of proportion distribution (Supplementary Figure 4) .

Twenty-five studies assessed the usage prevalence of TCM medication, and the synthesized proportion was estimated to be 0.62 (95% CI 0.45-0.78), which showed severe statistical heterogeneity (I 2 = 100%, Supplementary Figure 5A) . The usage proportions of Ayurveda (n = 2) and homeopathy (n 

To assess potential publication bias, visual inspection of funnel plots was conducted, and no obvious asymmetry was observed (Supplementary Figure 6) . Egger's test results suggested that there was no significant publication bias (P = 0.6856).

From 62 studies, the overall prevalence of TCIM usage during the COVID-19 pandemic was estimated to be 0.64 (95% CI 0.54-0.73), which also showed severe statistical heterogeneity and poor reporting quality. When comparing the rates of TCIM use across countries, the estimated proportion showed very large differences from 0.6914 (95% CI 0.9471-0.9735) in Ecuador to 0.1136 (95% CI 0.0931 to 0.1358) in Ethiopia. Study types for data acquisition did not affect the overall prevalence of TCIM usage 0.63 (95% CI 0.52-0.73) in the population-based survey and 0.65 (95% CI 0.48-0.81) in the hospital-based patient case review (R 2 index = 0%). Although we explored potential effect modifiers for assessing statistical heterogeneity of this review, we failed to identify any meaningful reasons. Type of studies, study population and country of the population could not explain the considerable statistical heterogeneity of this study result.

From this review, it was found that TCIM interventions have been used for preventive and therapeutic purposes. Why do people use TCIM interventions for COVID-19? Disease burden, previous TCIM experience and perception of TCIM efficacy are well-known determinants for the usage of TCIM interventions for disease management (78, 79) . During the COVID-19 pandemic when some underdeveloped countries experienced shortage of medical resources and restricted access to medical institutions, TCIM interventions tended to be accepted as a panacea, and this kind of attitude is based on healthrelated beliefs and the desire for self-care to improve immunity from the viral infection with a holistic approach (26, 80, 81) . China published TCM guidelines for COVID-19, which might be related to the high usage rate of TCM interventions for therapeutic purposes during the pandemic period (7, (82) (83) (84) . Meanwhile, the prevalence of TCIM usage in Western countries, such as the United States, was as high as that in underdeveloped countries. This might be due to different reasons, including dissatisfaction with the quality of conventional healthcare services (85) . In addition, TCIM interventions such as mind-body practice have been used to maintain psychosocial health in many countries during the pandemic (35, 42, 45) . Regarding reasons for the use of TCIM interventions during the COVID-19 pandemic, it is necessary to evaluate the underlying reasons by region in future research in detail. This study has limitations. First, we failed to identify meaningful effect modifiers to explain the statistical heterogeneity. The reasons for using TCIM interventions such as prophylactic purpose or therapeutic purpose might be related to the potential heterogeneity of this review result. Different economic statuses and the medical systems of each country might be closely related to the diverse usage status of TCIM interventions, but these factors could not be assessed due to the limited numbers of included studies. In addition, one of the most powerful suspicious factors is the study population of the included studies. Online surveys, which are the most frequent data acquisition methods for the general population, usually adopt convenient sampling or snowballing sampling methods; these methods are commonly used due to easy execution, but they cannot generate unbiased results due to generalizability issues (86) . When looking at the process of online surveys in general, a link to the survey questionnaire is posted through the social network services, and interested people primarily participate in the survey. Since people interested in the interventions are more likely to participate in the survey, it is natural that the proportion of end users is high. As a way to solve this problem, it is necessary to use a survey that captures the entire population of interest or probability sampling methods, so that the overall opinion of the general population of interest can be reflected. Hospital-based COVID patient chart review data could also be biased because most studies were conducted in China, which is one of the few countries with published TCIM CPGs for COVID-19 (84, 87, 88) . International cooperative surveys on the usage of TCIM interventions would be helpful to overcome the bias introduced by these limitations. Second, the definition of TCIM interventions varied from study to study, so the estimated usage prevalence derived from the meta-analysis of these studies could be inevitably biased. In addition, various study populations, such as the general population, COVID patients, physicians or practitioners of TCIM interventions, could have different perceptions and experiences of TCIM usage during the COVID-19 response. The initial purpose of this study was to suggest a crude prevalence of TCIM usage, so we did not consider these factors when conducting the meta-analysis, which is a critical limitation of this study. In this study, we did not search non-English DBs including China and Korea where TCIM is one of the main medical systems and many relevant studies are published. Therefore, we cannot be confident about locating all relevant data on this topic. Finally, data from the studies conducted mainly in the first half of 2020, shortly after the outbreak of COVID-19, were included in the analysis. The COVID-19 pandemic has been ongoing for nearly 2 years as of November 2021, and current TCIM usage patterns might be different than the initial patterns. An updated review that includes 2021 data is needed. Currently, an international survey on the prevention of and treatments for COVID-19 has been conducted, which might suggest more reliable data on the prevalence of TCIM interventions used worldwide (89) .

In conclusion, various TCIM interventions were reported to be used at a comparatively high frequency, but this result should be interpreted carefully due to the heterogeneity and low reporting quality of the included studies. Future studies need to be updated to include global data through international collaborative research, which might overcome the main limitation of this study, i.e., the heterogeneity of the included data.

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s. 

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed. 2022.884573/full#supplementary-material

Preliminary prediction of the basic reproduction number of the Wuhan novel coronavirus 2019-nCoV

SARS-CoV-2 virus infection: targets and antiviral pharmacological strategies

World Health Organization. COVID-19 Clinical Management: Living Guidance

Long covid-mechanisms, risk factors, and management

Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

Traditional Chinese medicine guidelines for coronavirus disease 2019

Integrating Chinese and western medicine for COVID-19: a living evidence-based guideline (version 1)

A. consensus guideline of herbal medicine for coronavirus disease 2019

COVID-19 Ayurveda treatment protocol of governments of Nepal and India: a review and perspective

Use of complementary and alternative medicine (CAM) and home remedies by COVID-19 patients: a telephonic survey

Randomized controlled trials of traditional, complementary, and integrative medicine-based interventions for coronavirus disease 2019 (COVID-19): a bibliometric analysis and review of study designs

Herbal medicine for the treatment of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis of randomized controlled trials

Global research trends at the intersection of coronavirus disease 2019 (COVID-19) and traditional, integrative, and complementary and alternative medicine: a bibliometric analysis

Alternative, or Integrative Health: What's In a Name?

Transformations related to the angular and the square root

Introduction to Meta-Analysis

COVID-19 severity in relation to sociodemographics and vitamin D use

Prevalence of using herbs and natural products as a protective measure during the COVID-19 pandemic among the Saudi population: an online cross-sectional survey

Behavioral preventive measures and the use of medicines and herbal products among the public in response to Covid-19 in Bangladesh: a cross-sectional study

Patients' behavior regarding dietary or herbal supplements before and during COVID-19 in Saudi Arabia

Dietary intake and mental health among Saudi adults during COVID-19 lockdown

The Commonly utilized natural products during the COVID-19 pandemic in saudi arabia: a cross-sectional online survey

Self-treatment and adverse reactions with herbal products for treating symptoms associated with anxiety and depression in adults from the central-western region of Mexico during the Covid-19 pandemic

Knowledge, attitude, and practice (Kap) toward the novel coronavirus (covid-19) pandemic in a saudi population-based survey

Knowledge about COVID-19 and beliefs about and use of herbal products during the COVID-19 pandemic: a cross-sectional study in Saudi Arabia

Clinical characteristics and impacts of traditional Chinese medicine treatment on the convalescents of COVID-19

Knowledge, attitude and practices among the inhabitants of lahore, pakistan towards the COVID-19 pandemic: an immediate online based cross-sectional survey while people are under the lockdown

Prevalence, attitude and knowledge of self medication during Covid-19 disease pandemic

Medication adherence and complementary therapy usage in inflammatory bowel disease patients during the coronavirus disease 2019 pandemic

The association of being in quarantine and related COVID-19 recommended and non-recommended behaviors with psychological distress in Chinese population

Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019-a multi-centre observational study

Chinese herbal medicine reduces mortality in patients with severe and critical Coronavirus disease 2019: a retrospective cohort study

Analysis of influencing factors and pharmaceutical care of patients with COVID-19 in Fangcang Shelter Hospital

Coping with the COVID-19 pandemic: contemplative practice behaviors are associated with better mental health outcomes and compliance with shelter-in-place orders in a prospective cohort study

Herbal medicine as prevention and treatment against Covid-19

Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status

Awareness and perceptions related to COVID-19 among cancer patients: a survey in oncology department

Clinical features of COVID-19 patients in Xiaogan City

Clinical characteristics and short-term outcomes of severe patients with COVID-19 in Wuhan

Awareness of self-quarantine-a survey

The effect of meditation and physical activity on the mental health impact of covid-19-related stress and attention to news among mobile app users in the united states: cross-sectional survey

Une étude fondée sur une enquête dans le nord de l'Algérie Phytothérapie

Epidemiological and clinical characteristics of 35 children with COVID-19 in Beijing

National internet-based survey of the use, barriers, reasons and beliefs of mind-body practices during the early months of the COVID-19 pandemic

Clinical characteristics and remedy profiles of patients with COVID-19: a retrospective cohort study

Clinical characteristics and treatment outcome of COVID-19 patients with stroke in China: a multicenter retrospective study

Psychological impact of COVID-19 confinement and its relationship with meditation

Evaluation of dietary supplement, functional food and herbal medicine use by dietitians during the COVID-19 pandemic

Health-, medication-and dietary supplement-related behaviors and beliefs relatively unchanged during the COVID-19 pandemic lockdown

The use of medicinal plants to prevent COVID-19 in Nepal

Food consumption patterns of male and female undergraduate students in indonesia during new normal implementation of pandemic Covid-19 Era. Open Access Maced

public survey of traditional, complementary and integrative medicine use during the COVID-19 outbreak in Hong Kong

Vitamin nature: how coronavirus disease 2019 has highlighted factors contributing to the frequency of nature visits in flanders

Characteristics of 1738 patients with coronavirus disease 2019 (COVID-19) in Wuhan, China

Knowledge, attitude, and utilization of drugs toward COVID-19 pandemic among Bale Zone residents, Southeast Ethiopia

Knowledge, attitudes, and practices related to dietary supplementation, before and during the COVID-19 pandemic: findings from a cross-sectional survey in the lebanese population

Use of and attitudes towards herbal medicine during the COVID-19 pandemic: a cross-sectional study in Vietnam

How will the way we live look different in the wake of the COVID-19 pandemic? A nutrition survey in Greece

Association between yogic breathing practice with perceived impact of COVID-19: a cross-sectional study from India

Yoga an effective strategy for self-management of stress-related problems and wellbeing during COVID19 lockdown: a cross-sectional study

Anxiety and depression levels of the general population during the rapid progressing stage in the coronavirus disease 2019 outbreak: a cross-sectional online investigation in China

Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases

An analytical study of drug utilization, disease progression, and adverse events among 165 COVID-19 patients

Traditional chinese medicine decoctions significantly reduce the mortality in severe and critically Ill patients with COVID-19: a retrospective cohort study

Analysis of health care personnel's attitudes toward complementary and alternative medicine and life satisfaction due to COVID-19 pandemic

Clinical characteristics and reasons for differences in duration from symptom onset to release from quarantine among patients with COVID-19 in Liaocheng

Clinical features and treatment of COVID-19 patients in northeast Chongqing

Clinical characteristics of 199 discharged patients with COVID-19 in Fujian Province: a multicenter retrospective study between

Clinical outcomes of different therapeutic options for COVID-19 in two Chinese case cohorts: a propensity-score analysis

Clinical characteristics of imported cases of coronavirus Disease 2019 (COVID-19) in Jiangsu Province: a multicenter descriptive study

Clinical characteristics and prognosis of 218 patients with COVID-19: a retrospective study based on clinical classification

Physical activity of Poles in the care for their health potential before and during the COVID-19 pandemic

Analysis of drug therapy of 53 patients with Corona Virus Disease-2019

Clinical features and prognostic factors of patients with COVID-19 in Henan Province

Clinical analysis of seven pediatric patients with coronavirus disease

China: a retrospective study

Factors determining choice of complementary and alternative medicine in acute and chronic diseases

Utilization of complementary and alternative medicine for the prevention of COVID-19 infection in Ghana: a national cross-sectional online survey

We are nothing without herbs': a story of herbal remedies use during pregnancy in rural Ghana

COVID-19): Potential implications for weak health systems and conflict zones in the Middle East and North Africa region

Herbal medicine for the management of COVID-19 during the medical observation period: a review of guidelines

Multimode participation of traditional Chinese medicine in the treatment of COVID-19

Traditional Chinese medicine for COVID-19 pandemic and emerging challenges: an online cross-sectional survey in China

Characteristics and health perceptions of complementary and alternative medicine users in the United States

More than just convenient: the scientific merits of homogeneous convenience samples

Herbal medicine and pattern identification for treating COVID-19: a rapid review of guidelines

National Health Commission & National Administration of Traditional Chinese Medicine. Diagnosis and treatment protocol for COVID-19 patients (Tentative 8th Edition)

Retrospective Survey of Prevention, Treatment, Occurrence and Outcomes of Covid-19 in the Community

Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest