Artemisia annua (wormwood) has antiviral activity against COVID virus

There is a long and strange history of antimalarial drugs and pandemics. Could the antimalarial herb wormwood add to that history during the COVID pandemic?

One of the early blogs we wrote at the beginning of the COVID pandemic mentioned the antimalarial herb Artemisia annua, which is a species of wormwood. It came up because, at the time, there was still a controversy over whether the drug hydroxychloroquine was useful for COVID. Hydroxychloroquine is an antimalarial drug.

But hydroxychloroquine was not the first antimalarial to be prescribed during times of pandemic. During the misleadingly labeled 1918 Spanish Flu, quinine, an earlier antimalarial, was recommended to patients. In 1921, The Domestic Health Society’s book, A Thorough and Concise Knowledge of the Prevention, Causes, and Treatments of Disease, Simplified for Home Use, published in New York, recommended “two to four doses of quinine of 5 grains each, one hour apart.” It also suggested hot mustard foot baths, plenty of hot lemonade or milk and keeping the bowels functioning.

The seemingly random inclusion of lemonade is also intriguing—but probably meaningless—because, lime juice has been shown to significantly shorten the time needed to improve malaria when it is added to drugs in children with malaria (Phytother Res 2011;25(10):1547-50).

And quinine and chloroquine are not the only antimalarials to come up. One of the many herbs that may be active against coronaviruses in vitro is Artemisia annua, a species of wormwood. The potential of Artemisia annua seen, not in people, but in test tubes, is leading to further study of this herb in Germany and Denmark. The researchers chose Artemisia annua because early studies in China identified an alcohol extract of the herb to be the second most powerful herb against the closely related SARS virus.

Though not yet proven, the appearance of Artemsia anua is intriguing because, like quinine and chloroquine, it is an antimalarial.

And now, a new study has suggested the early possibility that Artemisa annua could have antiviral activity against the SARS-CoV-2 virus that causes COVID-19. Caution is required because the research is very preliminary, since it is just a test tube study and not a study in people.

But the study found that hot water extracts of Artemisia annua had antiviral activity against SARS-CoV-2 and that it prevents replication of the virus in vitro. Surprisingly, the active ingredient may be something other than wormwood’s usual antimalarial active ingredient, artemisinin. The herb may not stop the virus from entering but seems to be active against the virus after entry.

Importantly, the Artemisa annua was similarly effective against the UK and South African variants.

The researchers report that a small study on humans found that a combination of artemisinin, an active ingredient in Artemisia annua, combined with the antiparasitic drug piperaquine was twice as effective as a placebo in completely eliminating the COVID virus 21 days after a week of treatment in people with confirmed mild to moderate COVID (Int J Antimicrob Agents 2021 Jan;57(1):106216). It would be interesting to see what using the whole plant extract in combination with piperaquine would do, since the Artemisia annua hot water extract has now been seen to be more effective than artemisinin alone.

In this study, the Artemisia annua was extracted in hot water for ten minutes. The researchers say that the concentration of the extract was at a level that can be achieved by drinking the tea.

J Ethnopharmacol 2021 March 12;274:114016

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