Identification of unique and potent inhibitors of SARS-CoV-2 main protease from DNA-encoded chemical libraries (preprint)

In vitro screening of large libraries of compounds with automated High-throughput screening is expensive, time consuming and requires dedicated infrastructures. Conversely, the screening of DNA-encoded chemical libraries can be rapidly performed with basic equipment available in most laboratories. In this study we identified novel inhibitors of SARS-CoV-2 main protease (Mpro) through the affinity screening of the commercially available \'\'DELopen\'\' library, containing 4.2 billion compounds. The identified inhibitors were peptidomimetics compounds containing a C-terminal electrophilic group able to covalently bind to Mpro reactive Cys145 (confirmed by x-ray crystallography). Compound SLL11 had IC50 = 30nM and was found to be well optimized, proving that the rapid exploration of large chemical spaces, enabled by DECL technology, allows the direct identification of potent inhibitors avoiding several rounds of iterative medicinal chemistry. Compound MP6, a close analogue of SLL11, showed antiviral activity against SARS-CoV-2 in the low micromolar range when tested in Caco-2 and Calu-3 (EC50 = 2.3 M) cell lines. As peptidomimetics compounds can suffer from low cell permeability and metabolic stability, the cyclization of the compounds as well as the substitution of selected residues with D-enantiomers will be explored in the future to improve the antiviral activity of these novel compounds.

A Media Analysis of the COVID-19 Tobacco Sales Ban in South Africa (preprint)

The South African government introduced a nationwide lockdown in March 2020 to mitigate the spread of Covid-19. Among other restrictions, the government banned the sale of tobacco products, which lasted for nearly five months. We performed a Google search using the keywords smok*, puff*, lockdown, tobacco, and cigarette*, for articles published in English from 23 March 2020to 18 December 2020 and analysed 441 online media articles. We identified the main arguments made by proponents and opponents of the tobacco sales ban, which were categorised into themes. Three themes were prominent: medical, legal, and economic/financial. Legal aspects were covered in 48% of articles, followed by economic (34%), and medical aspects (18%). The media was generally ambivalent about the tobacco sales ban during the first five weeks of lockdown. Sentiment then turned against the ban. because the medical rationale was not well communicated by the government, there was limited empirical evidence of a link between smoking and contracting Covid-19, and the sales ban was ineffective, since most smokers still purchased cigarettes. Policy framing in the media plays an important role in how the public receives the policy. Any future tobacco control policy intervention should be well-considered and appropriate cessation support services offered.

COUNTERSAVIOR: AIoMT and IIoT-Enabled Adaptive Virus Outbreak Discovery Framework for Healthcare Informatics

In the current pandemic, global issues have caused health issues as well as economic downturns. At the beginning of every novel virus outbreak, lockdown is the best possible weapon to reduce the virus spread and save human life as the medical diagnosis followed by treatment and clinical approval takes significant time. The proposed COUNTERSAVIOR system aims at an Artificial Intelligence of Medical Things (AIoMT), and an edge line computing enabled and Big data analytics supported tracing and tracking approach that consumes global positioning system (GPS) spatiotemporal data. COUNTERSAVIOR will be a better scientific tool to handle any virus outbreak. The proposed research discovers the prospect of applying an individual's mobility to label mobility streams and forecast a virus such as COVID-19 pandemic transmission. The proposed system is the extension of the previously proposed COUNTERACT system. The proposed system can also identify the alternative saviour path concerning the confirmed subject's cross-path using GPS data to avoid the possibility of infections. In the undertaken study, dynamic meta direct and indirect transmission, meta behavior, and meta transmission saviour models are presented. In conducted experiments, the machine learning and deep learning methodologies have been used with the recorded historical location data for forecasting the behavior patterns of confirmed and suspected individuals and a robust comparative analysis is also presented. The proposed system produces a report specifying people that have been exposed to the virus and notifying users about available pandemic saviour paths. In the end, we have represented 3-D tracker movements of individuals, 3-D contact analysis of COVID-19 and suspected individuals for 24 h, forecasting and risk classification of COVID-19, suspected and safe individuals.

Impact of Type of Enteral Feeds on Early Postoperative Outcomes After Congenital Heart Surgery in Neonates and Young Infants: A Single Center Experience in a Limited Resource Environment.

Background: Breast milk is known to prevent infections and is recommended for enteral feeding of infants after congenital heart surgery (CHS). During the Covid-19 pandemic, expressed breast milk (EBM) was not always available; hence, feeding after CHS was maintained with EBM or infant formula (IF) or both; we evaluated the impact of enteral feed type on early postoperative outcomes after CHS. Methods: In a prospective observational study, consecutive neonates and infants <4 months undergoing CHS were divided into EBM, IF, or EBM+IF groups; incidences of postoperative infections, ventilation duration, intensive care unit (ICU) stay, and mortality were studied. Results: Among 270 patients; 90 (33.3%) received EBM, 89 (32.9%) received IF, and 91 (33.7%) received EBM+IF. IF group had more neonates (78.7%[IF] vs 42.2%[EBM] and 52.7%[EBM+IF], P < 0.001) and greater surgical complexity. Postoperative infections were 9 (10.0%) in EBM; 23 (25.8%) in IF; and 14 (15.4%) in EBM+IF (P = .016). IF group (OR 2.58 [1.05-6.38], P = .040), absence of preoperative feeding (OR 6.97 [1.06-45.97], P = .040), and increase in cardiopulmonary bypass time (OR 1.005 [1.001-1.010], P = .027) were associated with postoperative infection. Ventilation duration in hours was 26 (18-47.5) in EBM; 47 (28-54.5) in IF; and 40 (17.5-67) in EBM+IF (P = .004). ICU stay in days was 4 (3-7) in EBM; 6 (5-9) in IF; and 5 (3-9) in EBM+IF (P = .001). Mortality did not differ (P = .556). Conclusion: IF group had a greater proportion of neonates with higher surgical complexity. Patients who received EBM after CHS had fewer postoperative infections and better postoperative outcomes compared to those receiving IF or EBM+IF.

Natural Products as Potential Therapeutic Agents for SARS-CoV-2: A Medicinal Chemistry Perspective.

Coronavirus is a single-stranded RNA virus discovered by virologist David Tyrrell in 1960. Till now seven human corona viruses have been identified including HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1, SARS-CoV, MERS-CoV and SARS-CoV-2. In the present scenario, the SARS-CoV-2 outbreak causing SARS-CoV-2 pandemic, became the most serious public health emergency of the century worldwide. Natural products have long history and advantages for the drug discovery process. Almost 80% of drugs present in market are evolved from the natural resources. With the outbreak of SARS-CoV-2 pandemic, natural product chemists have made significant efforts for the identification of natural molecules which can be effective against the SARS-CoV-2. In current compilation we have discussed in vitro and in vivo anti-viral potential of natural product-based leads for the treatment of SARS-CoV-2. We have classified these leads in different classes of natural products such as alkaloids, terpenoids, flavonoids, polyphenols, quinones, cannabinoids, steroids, glucosinolates, diarylheptanoids, etc. and discussed the efficacy and mode of action of these natural molecules. The present review will surely opens new direction in future for the development of promising drug candidates particularly from the natural origin against coronaviruses and other viral diseases.

A comprehensive survey on the beliefs, perceptions, and clinical manifestations of pre and post Covid-19 vaccinations among physiotherapy students in the United Arab Emirates (preprint)

Background: The World Health Organization has defined Coronavirus Disease (COVID-19) as an infectious pandemic, caused by a newly discovered SARS-CoV-2 virus. Students relied heavily on the internet, social media, parents, and friends, in addition to medical advice for information on its presentation, complications, prevention, and management. It is evident from the literature that healthcare professionals including students who play an important role in the healthcare system may be lacking important information on COVID-19 vaccinations. Thus, the study aims to identify and compare the pre-post covid-19 vaccination-related essential information among Physical Therapy university students.Methods: A cross-sectional survey was conducted among physiotherapy university students in the United Arab Emirates using a self-administrated structured questionnaire. The questionnaire comprised three sections covering beliefs, perceptions, and clinical manifestations of the pre and post-COVID- 19 vaccination. The survey was shared with more than 300 students through email and social platforms during the time between January 2022 till December 2022.Results: The majority of the physiotherapy students believed the vaccines to be safe (71.3%) due to multiple reasons while others did not believe in the effectiveness of the vaccine (28.7%). Some students did report unusual symptoms (painful periods, hair loss, forgetfulness) after the vaccine (10%). Similar findings were reported for family members as well (14%). Students had a positive perception of the vaccine and reported willingness to take it even if not mandatory (68%).Conclusion: Some students did believe in the safety of the vaccine due to multiple reasons while some did not due to fear of long-term side effects and personal choices. The finding of the study could be useful to create confidence as well as awareness among physiotherapy students as they are often invited to aid during medical pandemics such as Covid 19. Also, higher rates of vaccination among healthcare professionals will impart higher acceptance in the medical organization due to safety guidelines. This could also help to counsel other students against fear and apprehension towards the vaccination of such kind in the future.

Radiotherapy in COVID-19: a review

The World Health Organization (WHO) stated the novel coronavirus (COVID-19) a global pandemic on 11th March 2020. The virus-infected patients suffered from a respiratory disease called Severe Acute Respiratory Syndrome Coronavirus 2 (SAR-CoV-2). A proteinaceous exudate, alveolar edema, and hyperplasia associated with monocytes and lymphocytes alveolar inflammatory infiltration was observed in the affected patient's lungs. Virus broadens a systemic inflammatory reaction with a cytokine release syndrome which is characterized with the aid of using unexpected growth in many pro-inflammatory cytokines especially IL-6, IL-1, and TNF-a through activated M1 macrophage phenotype. Virus block IL-6 with tocilizumab and the usage of respirator device appears to be very vital. Radioactivity is the process by which unstable atomic nucleus losses energy by radiation, mainly using alpha, beta, and gamma rays. SARS-CoV-2 affected lungs can be treated by a low dose of radiotherapy. It was found that minute dose chest radiation therapy can be able to wean patients off a ventilator as it can reduce inflammation inside the lungs of severely infected COVID-19 patients. Numerous such clinical trials are underway and researchers may work to cure the COVID-19 lung infections by radiotherapy.

In-silico strategies of some selected phytoconstituents from Mirabilis Jalapaas SARS CoV-2 main protease and spike protein (COVID-19) inhibitors

Mirabilis Jalapa(Lamiaceae) was used to treat multiple human afflictions. Literary works demonstrated that it has many biological activities. Today's research aims to recognise Mirabilis Jalapaphyto-derived anti-viral compounds against main protease and spike protein of COVID-19, to gain insight into the molecular interactions. In the current study, 12 molecules taken from Mirabilis Jalapawere analysed through docking, which is derived from the PubMed database. Docking experiments were conducted with Autodock tool. AdmetSAR and Data warrior servers were eventually used for drug-like prediction. Our research shows that three phytoconstituents from Melissa offi cinalis, namely, Luteolin-7-glucoside-3'-glucuronide, Melitric acid-A and Quadranoside-III have exhibited better binding affinity and stability with the targets of COVID-19 main protease and spike protein. The identified substances can be further extended for in vitro and in vivo studies to assess their effectiveness against COVID-19. Copyright © 2022, Anka Publishers. All rights reserved.

Response of vaccination on community transmission of COVID-19: a dynamical approach.

Due to the severity of COVID-19, vaccination campaigns have been or are underway in most parts of the world. In the current circumstances, it is obligatory to examine the response of vaccination on transmission of the SARS-CoV-2 virus when there are many vaccines available. Considering the importance of vaccination, a dynamic model has been proposed to provide an insight in the same direction. A mathematical model has been developed where six population compartments viz. susceptible, infected, vaccinated, home-isolated, hospitalized and recovered population are considered. Moreover, two novel parameters are included in the model to ascertain the effectiveness and speed of the vaccination campaign. Reproduction number and local stability of both the disease-free and endemic equilibrium points are studied to examine the nature of population dynamics. Graphical results for the community stage of COVID-19 infection are simulated and compared with real data to ascertain the validity of our model. The data is then studied to understand the impact of vaccination. These numerical results evidently demonstrate that home isolation and hospitalization should continue for the infected people until the transmission of the virus from person to person reduces sufficiently after completely vaccinating every nation. This model also recommends that all type of prevention measures should still be taken to avoid any type of critical situation due to infection and also reduce the death rate.

The second COVID-19 coronavirus wave and its implications for stress, anxiety, and depression among Indian adults

Purpose The purpose of this paper was to investigate the prevalence rates of stress, depression and anxiety and their sociodemographic factors linked with the Indian population following the second round of COVID-19 in India. Design/methodology/approach A cross-sectional study was carried out using an online questionnaire. In total, 505 individuals participated through convenience sampling. To measure anxiety, depression and stress, the Depression Anxiety Stress Scale (DASS-21), a 21-statement self-reported questionnaire, was used. Findings Multiple regression analyses were performed to evaluate the sociodemographic characteristics associated with depression, stress and anxiety. Results indicated salary/allowances reduction and alcohol consumption were associated with depression. Multiple regression also indicated that salary/allowances reduction, smoking status and alcohol consumption were associated with stress. In addition, this research also showed that chronic disease, salary/allowances reduction, smoking status and alcohol consumption were associated with anxiety. Research limitations/implications During the second COVID-19 wave in India, various individuals were affected. Anxiety, depression and stress were common among Indians after the second wave of COVID-19. Along with other actions to restrict the development of COVID-19, the Indian Government and mental health specialists must pay close attention to the inhabitants' mental health. More large-scale studies on various occupations should be conducted, and new mental health factors should be included. Originality/value This study provides empirical insights related the sociodemographic factors and stress, anxiety and depression.

Severe acute infection and chronic pulmonary disease are risk factors for developing post-COVID-19 conditions (preprint)

Post-COVID-19 conditions, also known as long COVID, has significantly impacted the lives of many individuals, but the risk factors for this condition are poorly understood. In this study, we performed a retrospective EHR analysis of 89,843 individuals at a multi-state health system in the United States with PCR-confirmed COVID-19, including 1,086 patients diagnosed with long COVID and 1,086 matched controls not diagnosed with long COVID. For these two cohorts, we evaluated a wide range of clinical covariates, including laboratory tests, medication orders, phenotypes recorded in the clinical notes, and outcomes. We found that chronic pulmonary disease (CPD) was significantly more common as a pre-existing condition for the long COVID cohort than the control cohort (odds ratio: 1.9, 95% CI: [1.5, 2.6]). Additionally, long-COVID patients were more likely to have a history of migraine (odds ratio: 2.2, 95% CI: [1.6, 3.1]) and fibromyalgia (odds ratio: 2.3, 95% CI: [1.3, 3.8]). During the acute infection phase, the following lab measurements were abnormal in the long COVID cohort: high triglycerides (meanlongCOVID: 278.5 mg/dL vs. meancontrol: 141.4 mg/dL), low HDL cholesterol levels (meanlongCOVID: 38.4 mg/dL vs. meancontrol: 52.5 mg/dL), and high neutrophil-lymphocyte ratio (meanlongCOVID: 10.7 vs. meancontrol: 7.2). The hospitalization rate during the acute infection phase was also higher in the long COVID cohort compared to the control cohort (ratelongCOVID: 5% vs. ratecontrol: 1%). Overall, this study suggests that the severity of acute infection and a history of CPD, migraine, CFS, or fibromyalgia may be risk factors for long COVID symptoms. Our findings motivate clinical studies to evaluate whether suppressing acute disease severity proactively, especially in patients at high risk, can reduce incidence of long COVID.

Effect of Ayurvedic Intervention as an adjunct therapy in Post COVID-19 Mucormycosis (PCM): A non-randomized parallel group study.

Background: The Ayurveda therapy is often used as an adjunct to conventional allopathic treatments for management of chronic disorders including life threatening infections such as post COVID-19 Mucormycosis (PCM). Aims/objectives: The aim of the current study is to evaluate the role of adjunct Ayurveda therapy (AAT + CAT) over conventional Allopathic therapy (CAT) in the prevention of progression of oral/orbital/neural extension of PCM. Material and methods: A non-randomised parallel group interventional study was on a sample of 92 cases of PCM, sorted into two groups i.e. group A (n = 46; AAT + CAT) and group B (n = 46; CAT/controls). The group A received AAT (lab-tested standardised regimen) while simultaneously receiving conventional antifungal measures (or CAT). The outcomes assessed were clinical symptomatic grading score, Nasal endoscopic examination for patency of sinuses, Progression or extension of disease from sinuses to maxilla, orbit and brain, need of additional surgical interventions and antifungal medication after study period, adverse drug reactions and mortality. Results: The group A (AAT + CAT)) had shown extension free PCM in 86.96% (n = 40) as opposed to 41.3% (n = 19) in group B (CAT), No surgical interventions were needed in 89.13% (n = 41) in group A vs. 60.87% (n = 28) in group B. Around 69.5% (n = 32) in group A vs. 4.37% (n = 2) in group B did not need antifungal medication. The safety of both arms of the therapy has been determined by liver function and renal profile which are with in normal range in both groups. Conclusion: Adjunct Ayurveda therapy (given along with routine medical therapy) for PCM showed a better cure and reduced disease progression after a trial period of 45 days and in the extended observational period of three months. AAT + CAT regimen is not only therapeutically effective, but also safe and economical option to consider for PCM.

Pakistan Flood of 2022: Assessment using suite of satellite sensors and hydrological modelling (preprint)

Floods are one of the most common natural disasters. In recent decades, climate change has increased the occurrence and severity of floods, which is exacerbated by population growth. Pakistan witnessed one of its most devastating floods during monsoon of 2022. In the present study, spatio-temporal characteristics of 2022 floods in the Indus river basin has been studied using an integrated framework of multi-satellite observations and hydrological modelling. Satellite sensors including Synthetic Aperture Radar (SAR), passive microwave radiometer, radar altimeters, optical sensors, gravity measurements etc. have been used to assess the extent of flood and retrieve various hydrological parameters. Multi-year river discharge simulation was performed using Weather Research and Forecasting (WRF)-Hydro model to analyse peak flood discharges in the Indus river system. Inter-comparison of hydrological variables viz. river and lake water levels, flood index & discharge obtained from remote sensing platforms and model simulation were performed. Passive microwave radiometer effectively captured the incidence, progression and persistence of flood owing to its high temporal resolution. Altimeters provided precise information on river and lake water levels in the Indus basin and high spatial-resolution SAR data (Sentinel-1A) provided information on areal flood extent, which was used to compute water depth and estimate water volume. Model simulated discharge of Indus River and its tributaries correlated well with the satellite-observed water level and mean flood index. This paper demonstrates the use of available satellite sensors for effective assessment and modelling of floods, which may prove useful for mitigating future flood events.

Determinants of stroke in patients with rhino cerebral mucormycosis seen during the second wave of COVID-19 pandemic: A prospective cohort study.

BACKGROUND: Rhino cerebral mucormycosis is an uncommon opportunistic infection of the nasal sinuses and brain, and a group of saprophytic fungi causes it. During the second wave of COVID-19, India witnessed an unprecedented number of patients with rhino cerebral mucormycosis. Invasion of the cavernous sinus and occlusion of the internal carotid artery in many cases resulted in a stroke. The study aimed to assess the clinical and neuroimaging predictors of stroke in patients with rhino cerebral mucormycosis. We also evaluated the predictors of death in these patients at 90 days. METHODS: A prospective study was performed at a tertiary care centre in India between July 2021 and September 2021. We enrolled consecutive microbiologically confirmed patients of rhino cerebral mucormycosis. All patients underwent neuroimaging of the brain. Treatment comprised of anti-fungal drugs and endoscopic nasal/sinus debridement. We followed the patients for 90 days and assessed the predictors of stroke and mortality RESULTS: Forty-four patients with rhino cerebral mucormycosis were enrolled. At inclusion, in 24 patients, the RT-PCR test for SARS-COV-2 was negative. Diabetes mellitus was the most frequent (72.7 %) underlying risk factor; in most, diabetes mellitus was recently discovered. At inclusion or subsequent follow-up, stroke was seen in 11 (25 %) patients. Only seven patients had hemiparesis. Imaging revealed internal carotid artery occlusion in 17 (38.6 %) patients. Hypertension, corticosteroid use, and cavernous sinus thrombosis were independent predictors of stroke. Nine (20.5 %) died during follow-up, and stroke was an independent predictor of death. CONCLUSION: Stroke indicated poor prognosis among rhino cerebral mucormycosis patients encountered during the second wave of the COVID-19 epidemic.

Response of vaccination on community transmission of COVID-19: a dynamical approach

Due to the severity of COVID-19, vaccination campaigns have been or are underway in most parts of the world. In the current circumstances, it is obligatory to examine the response of vaccination on transmission of the SARS-CoV-2 virus when there are many vaccines available. Considering the importance of vaccination, a dynamic model has been proposed to provide an insight in the same direction. A mathematical model has been developed where six population compartments viz. susceptible, infected, vaccinated, home-isolated, hospitalized and recovered population are considered. Moreover, two novel parameters are included in the model to ascertain the effectiveness and speed of the vaccination campaign. Reproduction number and local stability of both the disease-free and endemic equilibrium points are studied to examine the nature of population dynamics. Graphical results for the community stage of COVID-19 infection are simulated and compared with real data to ascertain the validity of our model. The data is then studied to understand the impact of vaccination. These numerical results evidently demonstrate that home isolation and hospitalization should continue for the infected people until the transmission of the virus from person to person reduces sufficiently after completely vaccinating every nation. This model also recommends that all type of prevention measures should still be taken to avoid any type of critical situation due to infection and also reduce the death rate.

Niacinamide enhances cathelicidin mediated SARS-CoV-2 membrane disruption (preprint)

The continual emergence of SARS-CoV-2 variants threatens to compromise the effectiveness of worldwide vaccination programs, and highlights the need for complementary strategies for a sustainable containment plan. An effective approach is to mobilize the body's own antimicrobial peptides (AMPs), to combat SARS-CoV-2 infection and propagation. We have found that human cathelicidin (LL37), an AMP found at epithelial barriers as well as in various bodily fluids, has the capacity to neutralise multiple strains of SARS-CoV-2. Biophysical and computational studies indicate that LL37's mechanism of action is through the disruption of the viral membrane. This antiviral activity of LL37 is enhanced by the hydrotropic action of niacinamide, which may increase the bioavailability of the AMP. Interestingly, we observed inverse correlation between LL37 levels and disease severity of COVID-19 positive patients, suggesting enhancement of AMP response as an interesting therapeutic avenue to mitigate disease severity. The combination of niacinamide and LL37 is a potent antiviral formulation that targets viral membranes of various variants and can potentially overcome vaccine escape.

Disruptions, restorations and adaptations to health and nutrition service delivery in multiple states across India over the course of the COVID-19 pandemic in 2020: An observational study.

BACKGROUND: Modeling studies estimated severe impacts of potential service delivery disruptions due to COVID-19 pandemic on maternal and child nutrition outcomes. Although anecdotal evidence exists on disruptions, little is known about the actual state of service delivery at scale. We studied disruptions and restorations, challenges and adaptations in health and nutrition service delivery by frontline workers (FLWs) in India during COVID-19 in 2020. METHODS: We conducted phone surveys with 5500 FLWs (among them 3118 Anganwadi Workers) in seven states between August-October 2020, asking about service delivery during April 2020 (T1) and in August-October (T2), and analyzed changes between T1 and T2. We also analyzed health systems administrative data from 704 districts on disruptions and restoration of services between pre-pandemic (December 2019, T0), T1 and T2. RESULTS: In April 2020 (T1), village centers, fixed day events, child growth monitoring, and immunization were provided by <50% of FLWs in several states. Food supplementation was least disrupted. In T2, center-based services were restored by over a third in most states. Administrative data highlights geographic variability in both disruptions and restorations. Most districts had restored service delivery for pregnant women and children by T2 but had not yet reached T0 levels. Adaptations included home delivery (60 to 96%), coordinating with other FLWs (7 to 49%), and use of phones for counseling (~2 to 65%). Personal fears, long distances, limited personal protective equipment, and antagonistic behavior of beneficiaries were reported challenges. CONCLUSIONS: Services to mothers and children were disrupted during stringent lockdown but restored thereafter, albeit not to pre-pandemic levels. Rapid policy guidance and adaptations by FLWs enabled restoration but little remains known about uptake by client populations. As COVID-19 continues to surge in India, focused attention to ensuring essential services is critical to mitigate these major indirect impacts of the pandemic.

A socio-ecological critique on India's local health traditions amidst rising incidence of global pandemics.

Introduction: The COVID-19 crisis has exposed inadequacy to deal with such health emergencies. The state of healthcare facilities in India is shambolic, which is further exacerbated by the exclusivity of modern health systems. The authors argue for vertical and horizontal expansion of the existing system to include traditional medicine systems, in favor of an urgently needed holistic and more inclusive healthcare system. Methods: Secondary data were collected from free online resources, including preprints, reprints and databases, J-gate Plus, PubMed and Web of Science, using keywords such as, "folk medicine", "folk medicine AND India", "traditional Indian medicines", "indigenous Indian medicines AND India", "Indian ethnomedicines", "Indian AND folk AND medicine", "indigenous Indian medicine". Results and conclusions: Insufficiently robust public healthcare infrastructure, lack of enough qualified health professionals, and poor use of its traditional medicinal systems, are limiting the access of basic healthcare facilities to a large section of the Indian population. Despite vehement opposition and criticism from modern health system practitioners, indigenous and local healing traditions do offer benefits and share a common global goal of health and healing. The objectives of Universal Health Coverage and Health for All as enshrined in the Sustainable Development Goals (SDGs) cannot be achieved without their involvement, especially in remote and economically disadvantaged regions of the country. Even a sub-optimal utilization of its biological and human resources and related traditional knowledge can not only profoundly change the health, but also the economic landscape of India. Here, we have nuanced the constrains posed by the emerging health challenges, status and prospects of the great and little traditions of the Indian System of Medicines in fulfilling the urgent healthcare needs of the country. The authors based their arguments on the available evidence, rather than emotive ideas or, as a fan of Indian traditional medicines, and suggest for the purposeful inclusion of traditional health systems and practitioners more actively in India's health care delivery systems. The country must not squander the opportunities offered by its traditional medicinal systems.