{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T08:29:55Z","timestamp":1768984195022,"version":"3.49.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Coronaviruses, hence named because of the crown-like spikes on the viral envelope, are members of Coronaviridae family and Order Nidovirales. SARS-CoV-2 is the seventh human pathogenic coronavirus identified after HCoV-229E, HCoV-OC43, SARS-CoV (SARS-CoV-1), HCoV-NL63, CoV-HKU1, and MERS-CoV. SARS-Cov-2 is highly similar to SARS-CoV. COVID-19 is the corresponding acute disease caused by SARS-CoV-2 that was initially reported in Wuhan, China towards the end of 2019 and spread to millions of humans globally. Unfortunately, limited studies were available on the efficacy of antiviral drugs to treat COVID-19 at the time of this study. ZingiVir-H is an Ayurvedic formulation for use in early therapy of viral disease. This clinical trial was planned to investigate (1) the efficacy and safety of ZingiVir-H and (2) the efficacy of ZingiVir-H as an add-on therapy to the standard of care in hospitalized adults diagnosed with COVID-19.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 123 eligible subjects as per inclusion criteria were randomized within the study. Three subjects later declined to participate in the study and four subjects didn\u2019t meet inclusion criteria, which brought the final evaluable subject count to 116 for the efficacy and safety endpoint analysis. Thus, a total of 116 patients were equally randomised into two groups, namely, ZingiVir-H and Placebo for this clinical trial. The study patients were assigned to receive either ZingiVir-H or Placebo along with the standard of care as per the National Indian COVID-19 treatment protocol. The time interval until a negative RT-PCR obtained, was evaluated during treatment with ZingiVir-H or Placebo for ten days. Liver and kidney function tests were regularly assessed to ensure the safety profile of ZingiVir-H.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study found that patients who were administered ZingiVir-H had a median recovery time of 5 days (95% confidence interval (CI) 5\u20135) when compared to 6 days (95% CI 5\u20136) in those who received Placebo. Besides, in Ordinal Scale analysis of all the patients treated with ZingiVir-H demonstrated significant redistribution to a better clinical status from ordinal scale 5 to 6 and 7 within five to seven days when compared to that of placebo treatment. The time required for clinical improvement and the number of days needed for hospitalization was significantly less in the ZingiVir-H treated group when compared to placebo. The absence of liver and kidney function changes affirmed the safety profile of ZingiVir-H. No serious adverse events were reported in ZingiVir-H treated patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>We found that ZingiVir-H is effective and safe in managing COVID-19 infections and delaying the disease progression from mild to moderate and moderate to severe. To the best of our knowledge, this is the first clinical trial report on the efficacy\/safety of a herbo-mineral Ayurvedic drug against COVID-19 as of yet.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Clinical Trial Registry of India <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/pesquisa.bvsalud.org\/global-literature-on-novel-coronavirus-2019-ncov\/resource\/en\/ictrp-CTRI202004024883\" xlink:type=\"simple\">CTRI\/2020\/04\/024883<\/jats:ext-link>. Registered on 28\/04\/2020.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0276773","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T18:40:59Z","timestamp":1670352059000},"page":"e0276773","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["An efficacy and safety report based on randomized controlled single-blinded multi-centre clinical trial of ZingiVir-H, a novel herbo-mineral formulation designed as an add-on therapy in adult patients with mild to moderate COVID-19"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-3638","authenticated-orcid":true,"given":"Shan","family":"Sasidharan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hareendran","family":"Nair J.","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srinivasakumar","family":"K. P.","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerin","family":"Paul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madhu Kumar","family":"R.","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kannan","family":"Rajendran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita Ajit","family":"Saibannavar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonali","family":"Nirali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,12,6]]},"reference":[{"issue":"8","key":"pone.0276773.ref001","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"China Novel Coronavirus Investigating and Research Team","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0276773.ref002","unstructured":"Johns Hopkins University Coronavirus Resource Center. coronavirus.jhu.edu (accessed on 08th April 2021)."},{"key":"pone.0276773.ref003","first-page":"163","volume-title":"Park\u2019s text book of preventive and social medicine","author":"K. Park","year":"2015"},{"key":"pone.0276773.ref004","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1038\/nrmicro2147","article-title":"Coronaviruses post-SARS: update on replication and pathogenesis","volume":"7","author":"S Perlman","year":"2009","journal-title":"Nat Rev Microbiol"},{"key":"pone.0276773.ref005","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.tim.2013.05.005","article-title":"Interspecies transmission and emergence of novel viruses: lessons from bats and birds","volume":"21","author":"JF Chan","year":"2013","journal-title":"Trends Microbiol"},{"issue":"10226","key":"pone.0276773.ref006","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/S0140-6736(20)30360-3","article-title":"Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records","volume":"395","author":"H Chen","year":"2020","journal-title":"Lancet"},{"issue":"3","key":"pone.0276773.ref007","doi-asserted-by":"crossref","first-page":"e2000240","DOI":"10.1002\/bies.202000240","article-title":"The genetic structure of SARS-CoV-2 does not rule out a laboratory origin: SARS-COV-2 chimeric structure and furin cleavage site might be the result of genetic manipulation","volume":"43","author":"R Segreto","year":"2021","journal-title":"Bioessays"},{"issue":"6","key":"pone.0276773.ref008","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1021\/acsmedchemlett.1c00274","article-title":"Molecular Biology Clues Portray SARS-CoV-2 as a Gain-of-Function Laboratory Manipulation of Bat CoV RaTG13","volume":"12","author":"A. Fern\u00e1ndez","year":"2021","journal-title":"ACS Med Chem Lett"},{"key":"pone.0276773.ref009","doi-asserted-by":"crossref","first-page":"834808","DOI":"10.3389\/fviro.2022.834808","article-title":"MSH3 Homology and Potential Recombination Link to SARS-CoV-2 Furin Cleavage Site.","volume":"2","author":"BK Ambati","year":"2022","journal-title":"Front Virol."},{"issue":"12","key":"pone.0276773.ref010","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/j.jgg.2021.12.003","article-title":"Evidence for a mouse origin of the SARS-CoV-2 Omicron variant.","volume":"48","author":"C Wei","year":"2021","journal-title":"J Genet Genomics"},{"key":"pone.0276773.ref011","article-title":"COVID-19: Respiratory Physiotherapy on Call Information and Guidance.","author":"R. Moses","year":"2020","journal-title":"Lancashire Teaching Hospitals."},{"key":"pone.0276773.ref012","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1038\/s41591-021-01261-5","article-title":"COVID-19 vaccines: acting on the evidence.","volume":"27","author":"Editorial","year":"2021","journal-title":"Nat Med"},{"key":"pone.0276773.ref013","doi-asserted-by":"crossref","first-page":"n196","DOI":"10.1136\/bmj.n196","article-title":"Covid-19: India is at centre of global vaccine manufacturing, but opacity threatens public trust","volume":"372","author":"K. Thiagarajan","year":"2021","journal-title":"BMJ"},{"issue":"2","key":"pone.0276773.ref014","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S1473-3099(21)00648-4","article-title":"Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study.","volume":"22","author":"A Singanayagam","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"pone.0276773.ref015","article-title":"Transmission potential of vaccinated and unvaccinated persons infected with the SARS-CoV-2 Delta variant in a federal prison, July\u2014August 2021.","author":"PP Salvatore","year":"2021","journal-title":"medRxiv"},{"key":"pone.0276773.ref016","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa2001191","article-title":"First case of 2019 novel coronavirus in the United States","volume":"382","author":"ML Holshue","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0276773.ref017","article-title":"Features, evaluation and treatment coronavirus (COVID-19).","author":"M Cascella","year":"2021"},{"key":"pone.0276773.ref018","unstructured":"O\u2019Hare. COVID-19 human challenge study reveals detailed insights into infection. Imperial University college 2022. Available from: https:\/\/www.imperial.ac.uk\/news\/233514\/covid-19-human-challenge-study-reveals-detailed"},{"issue":"10236","key":"pone.0276773.ref019","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/S0140-6736(20)31022-9","article-title":"Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial","volume":"395","author":"Y Wang","year":"2020","journal-title":"Lancet"},{"key":"pone.0276773.ref020","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/s41421-020-0156-0","article-title":"Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro","volume":"6","author":"J Liu","year":"2020","journal-title":"Cell Discov"},{"issue":"4","key":"pone.0276773.ref021","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.joim.2020.04.001","article-title":"Diagnosis and treatment of novel coronavirus pneumonia based on the theory of traditional Chinese medicine.","volume":"18","author":"S. Wang","year":"2020","journal-title":"J Integr Med"},{"issue":"10238","key":"pone.0276773.ref022","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/S0140-6736(20)31143-0","article-title":"Use of herbal drugs to treat COVID-19 should be with caution","volume":"395","author":"Y. Yang","year":"2020","journal-title":"Lancet"},{"issue":"5","key":"pone.0276773.ref023","doi-asserted-by":"crossref","first-page":"694","DOI":"10.3390\/foods11050694","article-title":"In Vitro Determination of Inhibitory Effects of Humic Substances Complexing Zn and Se on SARS-CoV-2 Virus Replication.","volume":"11","author":"P Hajdrik","year":"2022","journal-title":"Foods"},{"key":"pone.0276773.ref024","volume-title":"Charaka Samhitha by Agnivesa, Commentary, Vimana sthana, Adhyaya 3, Edited by Vaidya Yadavji Trikamji Acharya","author":"Vimana Sthana","year":"2017"},{"key":"pone.0276773.ref025","article-title":"Ayurvedic treatment of COVID-19\/SARS-CoV-2: A case report.","author":"PLT Girija","year":"2020","journal-title":"J Ayurveda Integr Med."},{"key":"pone.0276773.ref026","unstructured":"Ministry of AYUSH Ayurveda\u2019s immunity boosting measures for self-care during COVID 19 crisis. 2020. Available from: https:\/\/www.ayush.gov.in\/docs\/123.pdf."},{"issue":"4","key":"pone.0276773.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12291-020-00918-1","article-title":"Snapshot of COVID-19 Related Clinical Trials in India.","volume":"35","author":"J Charan","year":"2020","journal-title":"Indian J Clin Biochem"},{"key":"pone.0276773.ref028","first-page":"2","article-title":"In-vitro Antiviral Activity of ZingiVir-H, a Novel Herbomineral Drug against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).","volume":"11","author":"HJ Nair","year":"2022","journal-title":"Virol Antivir Res."},{"key":"pone.0276773.ref029","first-page":"144","article-title":"A pilot clinical study to evaluate the safety and efficacy of ZingiVir-H, herbo-mineral drug in patients with viral fever","volume":"5","author":"HJ Nair","year":"2021","journal-title":"Curr Res Complement Altern Med"},{"key":"pone.0276773.ref030","first-page":"191","article-title":"In-vitro Cytotoxicity Assessment of ZingiVir-H Tablets, a Novel Herbo-Mineral Antiviral Drug along with Purified Mercuric Sulphide and Arsenic Trisulphide used for its Preparation, and its Corresponding Empirical Data to Reinforce the Evaluation.","volume":"10","author":"HJ Nair","year":"2021","journal-title":"Drug Design."},{"key":"pone.0276773.ref031","first-page":"3","article-title":"Subacute Oral Toxicity Studies of ZingiVir-H: A Herbomineral Antiviral Drug in Wistar Rats.","volume":"7","author":"HJ Nair","year":"2021","journal-title":"Toxicology: Open Access."},{"issue":"4","key":"pone.0276773.ref032","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.29294\/IJASE.6.4.2020.1482-1489","article-title":"Phytochemical 6-Gingerol\u2013A promising drug of choice for COVID-19.","volume":"6","author":"T Rathinavel","year":"2020","journal-title":"Int J Advan Sci Eng"},{"key":"pone.0276773.ref033","first-page":"6","article-title":"\u201cQuercetin as an antiviral agent inhibits influenza A virus (IAV) entry.","volume":"8","author":"Wenjiao Richan Li Wu","year":"2016","journal-title":"Viruses"},{"issue":"1","key":"pone.0276773.ref034","first-page":"47","article-title":"Clove: A champion spice.","volume":"2","author":"P Milind","year":"2011","journal-title":"Int J Res Ayu Pharm"},{"key":"pone.0276773.ref035","author":"D. Xinkan","year":"2009","journal-title":"The use of mercurid in formulating antiviral medicine"},{"key":"pone.0276773.ref036","unstructured":"Park K. Park\u2019s Textbook of Preventive and Social Medicine; M\/s Banarasidas Bhanot, Jabalpur, Ed.19, Chapter.3, p.75-79; 2005."},{"key":"pone.0276773.ref037","unstructured":"Clinical Trials on Traditional systems of medicine\u2014National Ethical guidelines for Biomedical and Health Research involving Human participants, ICMR, Chapter. 7, p. 83; 2017."},{"issue":"10","key":"pone.0276773.ref038","doi-asserted-by":"crossref","first-page":"e425","DOI":"10.1371\/journal.pmed.0030425","article-title":"Methods of blinding in reports of randomized controlled trials assessing pharmacologic treatments: a systematic review.","volume":"3","author":"I Boutron","year":"2006","journal-title":"PLoS Med."},{"key":"pone.0276773.ref039","unstructured":"WHO R&D Blueprint Novel Coronavirus COVID-19 Therapeutic Trial Synopsis. 2020. Available from: https:\/\/www.who.int\/blueprint\/priority-diseases\/key-action\/COVID-19_Treatment_Trial_Design_Master_Protocol_synopsis_Final_18022020.pdf."},{"key":"pone.0276773.ref040","unstructured":"Clinical Management Protocol: COVID-19, Government of India Ministry of Health and Family Welfare Directorate General of Health Services (EMR Division), Version 5, p12; 2020. Available from: https:\/\/www.mohfw.gov.in\/pdf\/ClinicalManagementProtocolforCOVID19dated27062020.pdf."},{"key":"pone.0276773.ref041","unstructured":"Diagnostic testing for SARS-CoV2: Interim guidance, World Health Organization 2020. Available from: https:\/\/www.who.int\/publications\/i\/item\/diagnostic-testing-for-sars-cov-2."},{"key":"pone.0276773.ref042","volume-title":"Handbook of Toxicologic Pathology","author":"WM Haschek","year":"2013"},{"key":"pone.0276773.ref043","volume-title":"Biostatistics for medical and biomedical practitioners","author":"JI Hoffman","year":"2015"},{"key":"pone.0276773.ref044","doi-asserted-by":"crossref","DOI":"10.1201\/9780429258589","volume-title":"Practical statistics for medical research","author":"DG Altman","year":"1990"},{"issue":"5","key":"pone.0276773.ref045","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1016\/j.dsx.2020.07.004","article-title":"COVID-19 pandemic and its recovery time of patients in India: A pilot study","volume":"14","author":"MP Barman","year":"2020","journal-title":"Diabetes Metab Syndr"},{"issue":"3","key":"pone.0276773.ref046","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/s41422-020-0282-0","article-title":"Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.","volume":"30","author":"M Wang","year":"2020","journal-title":"Cell Res"},{"issue":"1","key":"pone.0276773.ref047","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1186\/s13054-020-03045-8","article-title":"Body temperature correlates with mortality in COVID-19 patients.","volume":"24","author":"S Tharakan","year":"2020","journal-title":"Crit Care"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276773","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T18:41:41Z","timestamp":1670352101000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276773"}},"subtitle":[],"editor":[{"given":"Parasuraman","family":"Padmanabhan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,12,6]]},"references-count":47,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,6]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0276773","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,6]]}}}