Echinacea: Benefits in COVID-19

We all know COVID-19 as the respiratory illness that halted and changed our world, creating a modern-day pandemic. As we learn to adapt and live with this virus, the search for remedies continues.

Herbal remedies and superfoods, such as echinacea, are gaining popularity, although it is important to question to what extent they help and how safe they really are.

What is COVID-19?

COVID-19 stands for “COronaVirus-Induced Disease, 2019”.  According to the WHO, to date, there have been over 540 million confirmed COVID-19 cases, as well as over 6 million deaths as a result of the virus.^1.

Signs and Symptoms

As mentioned, COVID-19 is an illness which affects the respiratory tract. The majority of the population will experience cold-like symptoms as well as other symptoms such as:

• A high temperature
• A new and persistent cough 
• Loss of taste and/or smell
• Shortness of breath
• Exhaustion
• Body aches or chills
• Headaches
• Blocked sinuses or runny nose
• Loss of appetite ²

An affected individual is likely to experience a combination of these or may be asymptomatic.

However, in extreme cases, individuals may develop acute respiratory disease syndrome, which can lead to multiple organ system failures.³

Cause

COVID-19 is caused by a virus that is part of the SARS-CoV-2 family of viruses, which spread via infection through droplets. This virus enters the host and attaches to epithelial and immune cells within the respiratory tract using its ACE-2 receptor.⁴

Focusing on the extreme complications of COVID-19, acute respiratory disease syndrome (ARDs) is caused by a cytokine storm. This involves an overload of cytokines, chemicals involved in the immune response, in the blood, mainly due to infections. ⁵ This cytokine overload results in severe inflammation of tissues, particularly of the lungs, in COVID-19-related cases of ARDs. ³

Current Treatments

For the majority of the population with COVID-19, treatment involves remedies to ease the symptoms, such as rest, fluids and over-the-counter cough and cold relief medications. This treatment plan does not actively target the virus.

Antiviral drugs, which are designed to target the virus, are used in more extreme cases of COVID-19 or to help more vulnerable groups fight against the illness. These antivirals include nirmatrelvir, ritonavir, remdesivir and molnupiravir.  These treatments are more readily available for vulnerable groups who may suffer further complications of the virus, such as those individuals whose symptoms of COVID-19 do not improve. ⁶

Given that COVID-19 caused a modern-day pandemic, the timescale for producing vaccines was significantly shorter due to massive global collaboration. Although vaccination doesn’t prevent infection, it reduces the likelihood of severe symptoms and hospitalisation from COVID-19. In the UK, there are three approved vaccinations against COVID-19: Pfizer-BioNTech, Moderna and Johnson & Johnson.⁷

Currently, in the UK, over 50 million people have completed a primary course of COVID-19 vaccinations.⁸

What is Echinacea?

Echinacea is a purple coneflower that is typically found in North America, where it has been used as a herbal remedy by indigenous tribes. It had a variety of applications ranging from insect bites to toothaches, colds and infections.⁹

How do you Take Echinacea?

Nowadays, this herbal remedy can be found in a variety of forms, such as tea, tablets as well as a liquid ointment.

There are three species of this plant that are used for herbal remedies, of which Echinacea purpurea is the most utilised; the other two species are Echinacea angustifolia and Echinacea pallida.¹⁰

Is Echinacea Safe?

Given its natural origins, echinacea is considered to be safe. However, it should be noted that some liquid forms of echinacea may contain alcohol and are therefore unsuitable for those with alcohol dependencies or liver cirrhosis.¹⁰ 

In rare cases, individuals have reported mild effects as a result of this herbal remedy; these include minor abdominal discomfort, dizziness and nausea.¹¹ 

What Does Echinacea Do to the Immune System?

The effects of echinacea on the immune system have mostly been described as non-specific, hence primarily having an effect on the innate immune system. It aids in the modulation of various cell types involved in the innate immune system:

Granulocytes

Granulocytes are a type of cell that contains enzymes which attack the invading pathogen. Echinacea has been described as a modulator of the granulocyte migration process. This allows granulocytes to move to the site of infection in order to release the different types of enzymes to counter the invading pathogens.

Macrophages

This cell type engulfs the pathogen and breaks it down in a process known as phagocytosis. Echinacea affects this process by increasing the rate of phagocytosis and of cytokine production. 

Natural Killer (NK) Cells

NK cells are cytotoxic and thus can attack and kill pathogens. Echinacea has the potential to enhance NK cells' ability to recognise and attack invading cells.¹²

Are There Any Benefits for COVID-19 Patients?

The benefits of echinacea for COVID-19 patients is a debated topic due to its links with the immune system and fighting cold-like illnesses. 

Viral Load

There have been studies exploring the effect of echinacea on the viral load of COVID-19, as an example of a viral respiratory tract infection. One study found that the use of the herbal remedy significantly decreased the viral load of SARS-CoV-2, hence fewer severe COVID-19 cases. 

However, it is important to note that this study looked at the effects of echinacea usage over a five-month period, specifically as prevention of respiratory tract infections and not just as a treatment at the time of infection. ¹³ 

What are the Implications for COVID-19 Therapy?

The gain in popularity of Echinacea as a herbal remedy for COVID-19 is more so for the more extreme cases which involve ARDs. This is due to the potential role of echinacea in regulating cytokines, which could, therefore, potentially prevent a cytokine storm from occurring, avoiding further complications of COVID-19. 

The effectiveness of this herbal remedy in modulating cytokine levels is currently being investigated, with the majority of research so far suggesting it decreases pro-inflammatory cytokines. This creates a potential knock-out effect by decreasing inflammation in mostly lung tissue; ARDs and their related complications would then be less likely to occur.

With respect to mild and moderate COVID-19 cases, the effectiveness of echinacea as a treatment option is less clear. Due to the cold-like nature of the majority of the illness in these cases, the effect of echinacea on cold treatments may be more representative of its benefits. This would involve looking into echinacea’s antiviral effects and its impact on acute respiratory tract infections.

Recent and Current Research

To reiterate, as echinacea has been used in the past as a cold remedy, it suggests that echinacea is an immune response booster in fighting illnesses, therefore, making it ideal in the fight against COVID-19.

A systematic review analysing the effect of echinacea on cytokine levels suggested that this supplement is likely to have an effect on decreasing the presence of inflammatory agents in the cytokine storm.³ It is important to remember that there are still gaps in the knowledge regarding cytokine storms, as well as a lack of research looking directly at the effect of echinacea and cytokine storms. 

Summary

COVID-19 is still a highly prevalent issue three years after being announced as a pandemic. As we are learning to adapt to a post-pandemic world, research into this virus and treatment options still continues. 

As to the question at hand: is the dietary supplement that has been used for cold-like illnesses for hundreds of years beneficial for sufferers of COVID-19? There are many studies with implications that echinacea has effects on viral respiratory tract infections. Some studies have investigated it as a preventative measure, while others have explored it as a treatment option. Both uses of echinacea have had some positive effects against COVID-19, but they all concluded that further research is warranted.