Elderberry and COVID-19

covid-19 public health Mar 11, 2020

As the lead author of the only meta-analysis on elderberry for viral infections, my inbox has been exploding with questions and full-text requests related to the potential use of elderberry for COVID-19. I’m enthusiastic in my support of elderberry during the flu season. While the body of scientific evidence supporting elderberry for the flu definitely needs to grow, what does exist in the literature indicates that the botanical, if prepared and dosed correctly, can be a powerful tool in the fight against seasonal influenza.

But…

We have a fair amount of evidence demonstrating that elderberry is highly effective against the seasonal flu. And some decent evidence supporting its use for the common cold. Therefore, given the lack of tools we have for these two viral infections, the conclusions of our meta-analysis state that this botanical is a powerful tool to reduce morbidity and mortality and to reduce the overuse of more powerful pharmaceuticals.

None of that can be applied to COVID-19.

One of the most common mistakes in botanical medicine is to look through texts for lists of herbs or essential oils that exhibit certain types of activity and extrapolate from that a list of treatments for any given condition. COVID-19 is viral? Great. Let's explore all of the herbal books, make a list of anti-viral herbs, and use those. Boom. Cured.

If only the process were that simple. But real medicine just does not work that way. Microbes are a diverse and expansive group of organisms and what works for one may not work for another. It could even make things worse.

Furthermore, preventing/treating illness is not as simple as finding a substance that may exhibit some action against that pathogen in a petri dish. We have to study it within the human body. What's the most effective way of getting it into the body? What dose is required to produce these results? Can we get such a dose in the body safely? How frequently does it need to be administered? What risks are associated with getting that much of this substance into the body? How long does the treatment need to last? And so on and so on...

This is why it takes years and numerous studies to receive authorization to make drug claims. We can't rely on guesswork or assumptions. We have to be certain that a certain dose produces a certain result in the human body time and time again.

Will elderberry cure COVID-19?

We just don't know.

It takes time to conduct clinical trials. Even the fastest, most basic studies require months. Reviewing the literature, putting together the methodology, obtaining the proper ethics authorizations, creating the protocols, training the medical staff, recruiting and screening patients... and we haven't even started actually treating anyone with the test treatment yet! Then we have to administer the intervention and the placebo, collect data, clean the data, analyze the data… there is no shortcut to this process.

Because this is a new disease, we simply haven't had sufficient time to test dietary supplements or botanical medications. Sure, some case studies exist. We expect this any time there is a new outbreak. But case studies are not conclusive evidence. We don't have any conclusive evidence yet that any substance prevents or treats COVID-19.

That's not to say elderberry won't. As time passes and research is conducted, elderberry may be shown to be a powerful tool against this disease. Perhaps elderberry saves the day? Who knows.

What can it hurt to try?

As a scientist, I also have to acknowledge that it is possible that we find that it worsens the symptoms. I've mentioned before how this situation differs from the seasonal flu, particularly when it comes to knowledge about prevention and treatments. In situations like this, where a lack of knowledge exists, it is common for scientists to test a wide range of substances that may be effective. The vast majority will not help. Many will turn out to have been harmful. This is the case time and time again.

COVID-19 is not the same as the seasonal flu. The body responds differently. It has a different set of symptoms, a different mortality rate, and attacks a different demographic. We don’t yet know, for example, why young children appear to be protected from this disease or why young adults tend to only experience mild symptoms. Does that impact how we want to treat the condition? Should  we use the same tools we use for seasonal influenza or will those turn out to be dangerous? It’s just too soon to know with any degree of certainty.

In the absence of any evidence, we are left to grapple with the unknowns. Operating with unknowns is hard. It's the information age. We expect everything to be somewhere in Google if we just keep looking. But science is about identifying those things that are not known, getting comfortable in the lack of knowledge, and figuring out how to fill those knowledge gaps. We can't grow if we don't first acknowledge what isn't known.

 
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