Medicinal Plants used Traditionally in Sudan to Treat Viral Infections Related to the Signs and Symptoms of COVID-19: A Systematic Review

Background: The rapid global spread of the COVID-19 pandemic urged scientists to search for effective and safe anti-coronavirus drugs from natural resources. Through centuries, traditional medicinal plants have been providing cure for diseases and general health care worldwide. Objective(s): The main aim of this review was to explore and summarize the research works on the different plants used traditionally in Sudan to treat signs and symptoms of COVID-19 and respiratory diseases, characterizing their antiviral activities and exploring the different phytochemicals present in these plants. Method(s): The current review was carried out in line with the recommendations of the PRISMA 2020 statement. Information on plants traditionally used in Sudan to treat the signs and symptoms of COVID-19 and respiratory diseases was obtained from traditional medicine books and published articles, as well as the daily practice by ordinary people. Result(s): This article illustrated the use of 27 plant species belonging to 15 families in Sudanese traditional medicine to treat signs and symptoms of COVID-19 and respiratory diseases. Legumi-nosae/Fabaceae was found to be the most represented family (7 species), followed by Combretaceae (3 species) and Capparidaceae and Malvaceae (2 species each). From these plants, about 11 plant species were studied for their antiviral activity against at least one virus, and 5 plants, namely Adan-sonia digitata, Boscia senegalensis, Hibiscus sabdariffa, Nigella sativa, and Mangifera indica, were tested for their antiviral activity against influenza viruses. The phytoconstituents of the listed plants were summarized, and the antiviral activity of their isolated bioactive compounds was highlighted. Conclusion(s): The review could provide an in-depth theoretical basis and valuable data for designing future studies.Copyright © 2023 Bentham Science Publishers.

Self-medication Practices for COVID-19 Prevention: A Study among Medical Students in Yogyakarta, Indonesia

The corona virus disease 2019 (COVID-19) pandemic has increased the interest in self-care strategies, including self-medication. Medical students, as future health practitioners, learn more about medications than other students. This study aimed to describe self-medication practices for preventing COVID-19 among medical students at Universitas Islam Indonesia. This observational study used a cross-sectional design and was undertaken in November- December 2020. The study sample included 336 undergraduate medical students determined using a consecutive sampling technique based on inclusion and exclusion criteria. Data were collected using an online questionnaire about self-medication practices in the preceding 3 months. Among a total of 336 students, 137 (41%) reported using self-medication intending to prevent COVID-19, and 126 (92%) of these 137 took preventive supplements, mainly vitamins C, D, and E, and omega-3. Seven students reported the use of zinc, mainly in combination with other vitamins. Students who practiced self-medication lived closer to people confirmed with COVID-19, washed their hands more often, and desinfected their belongings more frequently than their counterparts (p<0.05). The mean duration for consuming vitamins was 11-16 days. Forty students (29%) used herbal medicine to prevent COVID-19;ginger, turmeric, honey, black seed, cutcherry, and Curcuma were the most often consumed herbal remedies. Fourteen students (10%) reported taking over-the-counter medications to relieve symptoms related to COVID-19, including antipyretic, analgesic, antiseptic, antihistamine, decongestant, antitussive, and expectorant medications. Most respondents (82%) purchased their medications at pharmacies, and 11 (9%) obtained them from online shops. These findings show the high rate of self-medication using vitamins and herbal remedies for COVID-19 prevention among university medical students. Further studies are needed to explore students' knowledge about the risks of self-medication including the use of herbal medicines.Copyright © 2022 Marmara University Press.

Black cumin (nigella sativa l.) and its effects on the nervous system.

Nigella sativa is an annual herb of the buttercup family, native to Western Asia and North Africa. Its seeds are used as a spice, especially in india and the Middle east, but also for medicinal purposes. Nigella sativa seeds contain a large number of bioactive substances, which have a number of pharmacological effects. It is a forgotten medicine and has been used in various systems of traditional medicine for thousands of years, but studies of modern medicine in recent years show that its therapeutic use can be much wider. it is likely that it could also find use in the treatment of mental disorders such as anxiety, depression and some neurodegenerative diseases. Its potential use in COVID-19 therapy is not without interest.Copyright © 2022 TIGIS Spol. s.r.o.. All rights reserved.

Discovery of Potential Inhibitors of SARS-CoV-2 (COVID-19) Main Protease (Mpro) from Nigella Sativa (Black Seed) by Molecular Docking Study

Purpose: A new human coronavirus (SARS-CoV-2), triggering pneumonia, is termed as Coronavirus Disease-19 (COVID-19). There is an alarming situation now as this new virus is spreading around the world. At present, there are no specific treatments for COVID-19. Nigella sativa is known as Prophetic Medicine as its use has been mentioned in Prophetic Hadith, as a natural remedy for all the diseases except death. Seeds and oils of N. sativa have a long history of folklore usage in various systems of medicine such as Unani and Tibb, Ayurveda and Siddha in the treatment of different diseases and ailments. The aim of this research is to provide a potential inhibitor of SARS-CoV-2 Mpro. Method(s): The Molecular docking tool was used to optimize the binding affinities of chemical constituents of N. sativa with SARS-CoV-2 Mpro. Result(s): Many constituents from N. Sativa have shown better binding affinity than reported drugs with SARS-CoV-2 Mpro i.e., the alpha-hederin, Stigmasterol glucoside, Nigellidine-4-O-sulfite, Nigellidine, Sterol-3-beta-D-glucoside, Dithymoquinone, beta-sitosterol have binding affinities (kcal/mol) of-9,-8.1,-8,-7.7,-7.7,-7.4,-7.4, and-6.9 and number of hydrogen bonds formed are 06, 04, 03, 03, 03, 00, and 01, respectively. Conclusion(s): There is rationale and pre-clinical evidence of the effectiveness of N. Sativa that it may be helpful for the treatment of COVID-19 and can serve as a potential natural candidate. However, more studies should be conducted to collect high-quality data and scientific evidence of N. Sativa to use it against COVID-19 clinically.Copyright © 2021 Bentham Science Publishers.

Indian medicinal plants are effective in the treatment and management of COVID-19

Indian medicinal plants are referred to as the "nectar of life" owing to their phytochemicals and bioactive complexes that are beneficial in treating diseases. Coronavirus disease 2019 (COVID-19) is a global health issue without any proper medication. The indigenous plants of India can be exploited to control the precise signs of SARS-CoV-2. The Ministry of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) has advised routine usage of medicinal plants for COVID-19. Medicinal plants like Zingiber officinalis, Azadirachta indica, Ocimum sanctum, Nigella sativa, Withania somnifera, Curcuma longa, Piper nigrum, Allium sativum, Tinospora cordifolia, etc. have immunity-boosting, antiviral, antibacterial, antioxidant and anti-inflammatory actions that can suppress and treat symptoms of COVID-19. In vitro, in vivo as well as in silico validation, these phytochemicals can help us to manage and treat COVID-19 disease. This integration of traditional knowledge in the prophylaxis of corona infection and current skills validating it for the development of precise and powerful therapeutic approaches will more efficiently resolve different clinical aspects of COVID-19. The review focuses on both traditional and emergent methods to prevent and treat COVID-19 with various Indian medicinal plants along with their phytochemicals.Copyright © 2023 Authors. All rights reserved.

Nutritional Intervention for the Treatment and Prevention Against Novel Coronavirus-19

Introduction: The ongoing pandemic of Severe Acute Respiratory Syndrome coronavirus-2 (SARS COV-2) has jeopardized people's health and the global economy. The infection caused by these viruses inflicts immunosuppression and an unprecedented range of symptoms leading to mortality. At this stage, there are no countermeasures or medicines to overcome rapid disease proliferation and aberrant immunological response. Objective(s): The study aims to determine different immunomodulatory therapeutics that could be potential agents to alleviate viral and other lethal infections and possibly rejuvenate immunological and tissue repair response against this disease. Method(s): A review of the literature was performed by screening different scientific databases to procure various immunomodulatory therapies for the treatment of SAR COV-2. Result(s): A comprehensive literature review indicated that different foods rich in vitamins (A-D), selenium and iron can enhance immunological response against various deleterious infections, whereas different nutritious drinks that include hydrogen-enriched water and green tea alleviate inflammation and elicit wound healing properties. Black cumin seeds and Garlic have a myriad of biological activities due to abundant bioactive phytochemicals that play an important role in the elimination of various bacterial and viral infections. Conclusion(s): These foods/supplements are relatively safe to consume and possess high toxicity profile and could be a potential nutritional intervention in order to create adequate immunity within a population to fight against this prevailing infection.Copyright © 2021 Bentham Science Publishers.

Nigella Sativa: An Immunity Booster as Pandemic Treatment Solution Against SARS-CoV-2

Nigella sativa (Family Ranunculaceae) is a common medicinal plant all across the world. It is quite popular in different traditional medicinal systems such as Unani, Ayurveda, Tibb, and Siddha. Oil and Seeds have a long tradition of folk medicine utilized in different medicinal systems and food. The seeds of N. Sativa have indeed been widely applied in the treatment of many diseases, ailments, and also as an immune booster. Our research goal was to primarily concentrate on the therapeutic efficacy of Nigella sativa in combating the COVID-19 pandemic.Copyright © 2021 Bentham Science Publishers.

Honey and Nigella sativa against COVID-19 in Pakistan (HNS-COVID-PK): A multicenter placebo-controlled randomized clinical trial.

Until now, no specific and effective treatment exists for coronavirus disease 2019 (COVID-19). Since honey and Nigella sativa (HNS) have established antiviral, antibacterial, antiinflammatory, antioxidant, and immunomodulatory properties, we tested their efficacy for this disease in a multicenter, placebo-controlled, and randomized clinical trial at four medical care facilities in Pakistan. RT-PCR confirmed COVID-19 adults showing moderate or severe disease were enrolled in the trial. Patients were randomly assigned in a 1:1 ratio to receive either honey (1 g kg-1 day-1 ) and Nigella sativa seeds (80 mg kg-1 day-1 ) or a placebo for up to 13 days along with standard care. The outcomes included symptoms' alleviation, viral clearance, and 30-day mortality in the intention-to-treat population. Three hundred and thirteen patients, 210 with moderate and 103 with severe disease, underwent randomization from April 30 to July 29, 2020. Among the moderate cases, 107 were assigned to HNS, whereas 103 were assigned to the placebo group. Among the severe cases, 50 were given HNS, and 53 were given the placebo. HNS resulted in ~50% reduction in time taken to alleviate symptoms as compared to placebo (moderate cases: 4 vs. 7 days, Hazard Ratio [HR]: 6.11; 95% Confidence Interval [CI]: 4.23-8.84, p < 0.0001 and for severe cases: 6 vs. 13 days, HR: 4.04; 95% CI: 2.46-6.64; p < 0.0001). HNS also cleared the virus earlier than placebo in both moderate cases (6 vs. 10 days, HR: 5.53; 95% CI: 3.76-8.14, p < 0.0001) and severe cases (8.5 vs. 12 days, HR: 4.32; 95% CI: 2.62-7.13, p < 0.0001). HNS further led to a better clinical score on day 6 with normal activity resumption in 63.6% vs. 10.9% among moderate cases (OR: 0.07; 95% CI: 0.03-0.13, p < 0.0001) and hospital discharge in 50% versus 2.8% in severe cases (OR: 0.03; 95% CI: 0.01-0.09, p < 0.0001). In severe cases, the mortality rate was less than 1/4th in the HNS group than in placebo (4% vs. 18.87%, OR: 0.18; 95% CI: 0.02-0.92, p = 0.029). No HNS-related adverse effects were observed. HNS, compared with placebo, significantly improved symptoms, expedited viral load clearance, and reduced mortality in COVID-19 patients. This trial was registered on April 15, 2020 with ClinicalTrials.gov Identifier: NCT04347382.

Therapeutic Potentials of Black Seeds (Nigella sativa) in the Management of COVID-19-A Review of Clinical and In-silico Studies

Background: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and patients with COVID-19 are managed mainly using repurposed conventional drugs, which target the viral entry and viral replication of SARS CoV-2 along with standard care and supportive therapy. Objective(s): This review article focuses on the potential benefits of black seeds (Nigella sativa) observed in clinical and in silico molecular docking studies of COVID-19. Method(s): The literature was searched using databases such as LitCOVID, Web of Science, Google Scholar, bioRxiv, medRxiv, Science Direct, EBSCO, Scopus, EMBASE, and reference lists to identify published manuscripts or preprints related to the prevention or treatment of COVID-19 with black seeds (N. sativa) or their phytoconstituents. Result(s): Various clinical studies and in silico molecular docking studies determined that black seeds (N. sativa) and their bioactive phytoconstituents have potential activity against SARS CoV-2 infection. Conclusion(s): Patients with COVID-19 could be managed using black seeds (N. sativa) along with supportive care, which would speed up the recovery and decrease the mortality rate. More randomized controlled clinical trials would further establish the safety and efficacy of N. sativa in COVID-19 patients. Copyright © 2023 Bentham Science Publishers.

Cross-sectional Study on Using Herbal Products and Medications During the COVID-19 Pandemic

The aim was to describe medication use during the COVID-19 pandemic in Saudi Arabia. This observational study was a multi-city cross-sectional study that involved an online survey and included people of all ages and educational levels living in Saudi Arabia. The survey was filled out by 403 respondents. Most of the respondents used at least one medicine (93.55%) and 31.02% of them used herbal products during the corona epidemic. Ginger was the most used (32.80%), followed by lemon (25.60%), honey (19.20%), and Nigella sativa (14.40%). The most frequently used medication was paracetamol (90.72%), followed by ibuprofen (11.67%), azithromycin (6.63%), penicillin antibiotics (5.04%), and vitamin C (4.24%). About 50% of the respondents said that the medication relieves only some symptoms and only 19.36% of them said that the medication relieves all of the symptoms. The present study showed that several medications and herbal products were used commonly during the corona epidemic although there was no clinical evidence of using most of these products. Most of the public misinformation is gained from social media so it is important to increase the awareness of the public about the use of medications and herbal products during the corona epidemic. Copyright © 2022, Colegio de Farmaceuticos de la Provincia de Buenos Aires. All rights reserved.

Phytochemicals in the Prevention and Treatment of SARS-CoV-2-Clinical Evidence.

The first case of SARS-CoV-2 infection was reported in December 2019. Due to the rapid spread of the disease and the lack of adequate therapy, the use of plants that have a long history in the treatment of viral infections has often been considered. The aim of this paper is to provide a brief review of the literature on the use of phytochemicals during the new pandemic. An extensive search of published works was performed through platforms Google Scholar, PubMed, Science Direct, Web of Science and Clinicaltrials.gov. Numerous preclinical studies on the use of phytochemicals (quercetin, curcumin, baicalin, kaempferol, resveratrol, glycyrrhizin, lycorine, colchicine) against SARS-CoV-2 have shown that these components can be effective in the prevention and treatment of this infection. Clinical research has proven that the use of black cumin and green propolis as well as quercetin has positive effects. As for other phytochemicals, in addition to preclinical testing which has already been carried out, it would be necessary to conduct clinical tests in order to assert their effectiveness. For those phytochemicals whose clinical efficacy has been proven, it would be necessary to conduct research on a larger number of patients, so that the conclusions are more representative.

Nigella sativa (Black Seed) as a natural remedy against viruses

The currently available antiviral agents are associated with serious adverse effects, coupled with the increasing rate of viral resistance to the existing antiviral drugs. Hence, the search for alternative natural remedies is gaining momentum across the globe. Nigella sativa Linnen, also called black seed, is a medicinal plant that is gaining worldwide recognition and has been extensively investigated. The present work is aimed to review the existing literature on the antiviral efficacy of Nigella sativa extracts (oil and bioactive compounds). The findings reveal that numerous articles have been published on Nigella sativa and its beneficial effects against different kinds of diseases. However, the antiviral efficacy of Nigella sativa is yet to be given the proper research attention it deserves.

16th INASH AbstractT Book

The proceedings contain 45 papers. The topics discussed include: neuropeptide levels effect on blood pressure in chronic kidney disease patients with hypertension;dry weight gain and incidence of intradialytic hypertension: a cross-sectional study in rural hospital;why they don't take the pill: a qualitative study of antihypertensive medication nonadherence in East Borneo primary health care;antihypertensive effect of nigella sativa (Habbatus Sauda) supplementation in population with cardiometabolic risk factors: a systematic review and meta-analysis of randomized controlled trials;risk factors of peripheral artery disease in the hypertensive chronic kidney disease patients on hemodialysis;impact of day-to-day blood pressure variability to in-hospital mortality in patients with COVID-19 and efficacy of antihypertensive agents;and systolic blood pressure as risk factor associated with persisting proteinuria after delivery in women with preeclampsia.

A meta-analysis of Nigella sativa in respiratory disorders

Plants have always been used as a remedy for various illnesses and their widespread use is because they are safe, effective, and affordable when compared to allopathic medications. Nigella sativa is considered as a miracle herb and is accepted as a panacea in Middle East and South Asian countries. Numerous therapeutic benefits of the plant extract against diabetes, hypertension, pediatric seizures, opioid dependence, anxiety, arthritis, various infectious diseases, infertility, dyspepsia, asthma, allergic rhinitis were demonstrated by clinical studies. The bronchodilating property of few constituents of the seeds contributes its potency against different illnesses of the respiratory system, including asthma, dyspnea, nasal dryness, and rhinitis. According to the World Health Organization (WHO), respiratory diseases are second to cardiovascular disease and make up to five of the 30 most common causes of deaths worldwide. Currently, there is no cure to the chronic respiratory diseases, but various forms of treatments may help to ameliorate the quality of life of people suffering with the condition. An increasing number of people are approaching toward natural remedy to improve their respiratory symptoms, this review is planned to summarize all the therapeutic benefits of N. sativa against different respiratory illnesses which were characterized by experimental and clinical studies. © 2022 Elsevier Inc. All rights reserved.

Knowledge, Attitudes, Practices, and Use of Herbal Supplements as Effective Constituents Against COVID-19 Among Undergraduate Pharmacy Students of Najran University: A College Based-Cross Sectional Study in Saudi Arabia

COVID-19 pandemic has infected more than 208 million people and accounted for more than 4.5 million deaths worldwide. In our present study, Najran university (NU) students’ knowledge, attitude and practice (KAP) towards COVID-19 was assessed using twenty, ten and eight-item scale questions respec-tively. Similarly, use of herbal and nutritional supplements to protect and cure against COVID-19 infections was measured including type, source of information and factors enforcing the use of such supplements. Addi-tionally, students shared their beliefs about immune enhancing potential of various nutritional components. SPSS package was used to perform statistical analyses. A total of 94 (67%) responses were obtained from male undergraduate pharmacy students. The students with good knowledge, positive attitude and proper practice towards COVID-19 were 29.6%, 85.2%, and 72.8%. respectively. Almost half of students used some herbal and nutritional supplements as protective measure against the COVID-19 infection. As forecasted, honey (34.6%), ginger (33.3%), and vitamin C (32.1%) were the most commonly used supplements. More than half students believe that using garlic (60.5%), black seeds (53.5%), citrus fruits (53.1%), and ginger tea (50.6%) will boost the immunity. Considering the fact that in-campus teaching has resumed in Saudi Arabian universities, amalgamate with peers would be common, hence adequate level of KAP towards COVID-19 is essential. Perhaps, getting COVID-19 vaccine shots are mandatory to attend in-campus classes in Saudi Arabia, still following precautionary measure are obligatory.

Natural Products and Their Promise Against COVID 19: Review

Background: Since the beginning of medical history, plants have been exemplary sources of a variety of pharmacological compounds that are still used in modern medication. Respiratory infections are a serious and persistent global health problem, most acute and chronic respiratory infections are caused by viruses, whose ability to mutate rapidly may result in epidemics and pandemics, as seen recently with MERS-COV (2012) and SARS-COV-2 (2019), the latter causing coronavirus disease 2019 (COVID-19). Methods: This study aims to highlight the tremendous benefits of plants that have been widely used as dietary supplements or traditional treatment for various respiratory infections, with a focus on the most effective constituents and studies that revealed their activities against COVID-19. Results: Several traditional plants and their phytoconstituents have shown activity against respiratory viruses, including SARS-COV-2. The presented plants are Nigella sativa, Punica granatum, Panax ginseng, Withania somnifera, Glycyrrhiza glabra, Curcuma longa, Zingiber officinale, Camellia sinensis, Echinacea purpurea, Strobilanthes cusia, Stephania tetrandra, and genus Sambucus. Conclusion: The data discussed in this review can encourage carrying out in-vivo studies that may help in the discovery of herbal leads that can be feasibly used to alleviate, prevent or treat COVID-19 infection.

Nigella Sativa Supplementation Accelerates Recovery from Mild COVID-19: First Randomized Controlled Trial

Introduction: Effective treatment for patients with the novel Coronavirus Disease (COVID-19) is desperately needed and is under rigorous research. Nigella sativa oil (NSO), a herbal medicine, that has a documented wide antiviral and immunomodulatory activities offering a therapeutic potential for COVID-19. Methods: Adult symptomatic patients with mild COVID-19 were recruited between May and August 2020 from King Abdulaziz University Hospital in Jeddah, Saudi Arabia. They were randomly assigned to receive supplementation with oral capsules of NSO (MARNYS' Cuminmar 500 mg twice daily for 10 days) plus standard of care or standard of care medications alone. The primary endpoint was the proportion of patients recovered (free of symptoms for 3 days) within 14 days after randomization. This trial was registered with clinicaltrials.gov, NCT04401202. Results: A total of 120 patients were enrolled. Their mean age was 35 (SD=11) years old and 57% of them were male. There were 60 patients in the treatment group (NSO) and 60 patients in the control group. The proportion of patients recovered in the treatment group was significantly higher than the control group, 42 (70%) versus 27 (45%) (p=0.006). Additionally, there was a significant difference in the average recovery time among both groups, 9.9 (SD=3.3) versus 11.6 (SD=3.4) days (p=0.006). Furthermore, 3 patients from the control group required hospitalization within the study period versus one in the treatment group. Adverse events were reported in 3 patients of NSO recipients as gastrointestinal symptoms. Conclusion: In this RCT of adult patients with mild COVID-19, NSO was associated with a significant increase in the likelihood of recovery and a decrease in the likelihood of hospitalization. To our knowledge, this is the first RCT that shows potential therapeutic benefits of NSO in patients with COVID-19 which requires further confirmation with larger double-blinded RCTs. Keywords: Black seed, Nigella sativa, COVID-19, SARS-CoV-2;randomized controlled trial

Prevalence of Complementary and Integrative Health Use in Patients Afflicted with COVID-19

Introduction: Complementary and Integrative Medicine (CIH) has been a popular medical approach. This study aimed to investigate CIH use in patients afflicted with COVID-19. Methods: In this telephone- based cross-sectional study, the data of CIH usage were collected from confirmed COVID-19 patients from February till June 2020in Fars province, Iran. Besides, we asked the patients' attitudes towards using these treatments. Results: Out of 453 patients diagnosed with COVID-19, 400 (88.30%) enrolled into the study and answered our question and. In this regard, 276 (69%) patients reported using CIH to treat COVID-19. The most frequently used herbal medicine among COVID-19 patients was ginger (98.9%), thyme (95.3%), and black cumin (74.3%). Most of these patients were recommended to use herbal medicine by their families and friends (34.8%). Overall, 86.2% reported high and very high levels of satisfaction using these medications. Residents of urban areas (p=0.005), employees (p<0.001), patients with an academic education (p<0.001), as well as outpatients(p<0.001) used more CIH in comparison with the others. Ultimately, only 9 (3.3%) patients consulted with their doctors regarding using these medications. Conclusion: The results of this study showed that many patients with COVID-19used CIH, but few of them consulted with their physician consultation. Physicians should ask their patients about CIH usage and patients should also report their use of CIH therapies during their medical visits. Keywords: COVID-19, complementary and alternative medicine, medicinal plant, traditional medicine, alternative medicine, Prevalence, use

Physical Activity and Natural Products and Minerals in the SARS-CoV-2 Pandemic: An Update.

Coronavirus-disease 19 (COVID-19) has rapidly become a global public health issue, and there is a desperate need for strategies of prevention, reduction, and treatment to halt the epidemic. The coronavirus affects the immune system, and individuals with a compromised immune system, such as those with diabetes, hypertension, obesity, are more susceptible to this virus. Lifestyle-related variables such as physical activity and nutritional supplements can decrease inflammatory markers, increase anti-inflammatory and antioxidant status, and improve the immune system. Lifesty-lerelated variables play preventive roles against various infectious diseases including COVID-19. This review highlights the effects of physical activity and nutrients supplements on the immune system and their possible benefits in combating the harms caused by infection with the COVID-19 virus.