Pluralism Medical Treatment, Prevention, and Control of COVID-19 Infection and Its Long-Sufferings among the Older Adults in the Northeast of Thailand from 2019 to 2022

Abstract

COVID-19 in 2019 has brought both changes and challenges to the world. This global pandemic has an impact on people of all age levels, especially older adults. In Thailand, older persons are at high risk of COVID-19 infection. They are included in the so-called 608 groups. The objective of this review article was to synthesize and present medical pluralism, the development of drugs from herbs, and projects conducted to treat, prevent, and control the infection and long sufferings of COVID-19. The review covers 10 studies, three projects produced at Mahasarakham University, Chaiyaphum Rajabhat University, and Khon Kaen University that were reviewed, synthesized, and analyzed. The results of the synthesis indicate that modern and Thai traditional medicine can help reduce the severity of the infection and long sufferings of COVID-19. The medical pluralism between modern and Thai traditional medicine is needed to remedy COVID-19 cases among the older adults in the Northeast of Thailand.

1. Introduction

The global pandemic of COVID-19 has an impact on people of all age levels [1]. Similar to other countries, older adults are more likely to have a chronic illness [1]. Over the world reported that 66% of people aged 70 and over have at least one underlying condition that increased the risk of the severe impact of COVID-19 infection and its long sufferings [1].

The Ministry of Public Health (MOPH), the leader of the Department of Disease Control, nongovernmental organizations, and local organizations have an active role and follow the World Health Organization’s (WHO’s) eight pillars of COVID-19 response, which are a good guide for strengthening surveillance, case investigation, and the laboratory system, institutionalizing, the mechanism of coordination, and strengthening communication between stakeholders [1]. Medical pluralism (MP) is used for the treatment, prevention, and control of the COVID-19 pandemic in Thailand since 2019 [2, 3, 4, 5].

The World Health Organization (WHO) acknowledges that Thailand shows significant progress on overall population health indicators, as seen in the relatively low COVID-19 cases number (less than one death per million population) and improving capacity for pandemic response [1]. WHO has recognized Thai Village Health Volunteers (VHVs) as “unsung heroes” who have made a great effort to fight COVID-19 [6]. The VHVs formulated “Socio-politics networks” or can be seen as a “Pluralistic network” based on a “collaborative system” between numerous agents/stakeholders in the community, including VHV groups, villagers, families/households level politicians’ officials, and private sector actors [6, 7].

In the Northeast of Thailand, research and project produced by the staff of Mahasarakham University (MSU), Chaiyaphum Rajabhat University (CPRU), and Khon Kaen University (KKU) presented medical pluralism, development of herb medicine, health-seeking behaviors of older adults for treatment, prevention, and control of COVID-19 infection and its long sufferings [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22].

This study aimed to synthesize knowledge about successful cases of pluralism medical treatment, prevention, and control of COVID-19 infection and its long sufferings among older adults.

2. Objective

The objective of this study was to synthesize knowledge about the successful pluralism of medical treatment, prevention, and control of COVID-19 infection and its long sufferings among the older population in the Northeast of Thailand from 2019 to 2022.

3. Methodologies

The study reviewed the results of the author’s research and project in four steps as follows:

1. Step 1: Synthesize contents from the staff of Mahasarakham University (MSU), Chaiyaphum Rajabhat University (CPRU), and Khon Kaen University (KKU)‘s research studies and projects from 1987 to 2022.

2. Step 2: Reported herbal medicine in pluralism medical treatment, prevention, and control of COVID-19 infection and its long COVID-19 sufferings.

3. Step 3: Reported cases of success in treatment, prevention, and control of COVID-19 infected.

4. Step 4: Summarized the organization chart related to the pluralism medical treatment in the Northeast of Thailand.

The research review was approved by the Ethics Committee for Human Research at Mahasarakham University (MSU), Chaiyaphum Rajabhat University (CPRU), and Khon Kaen University (KKU) (HE591125).

Most of the research studies were based on secondary data. Those who volunteered had signed the consent form.

4. Results

There are four steps to this research result as follows:

In step 1: We reviewed research results of pluralism medical treatment, prevention, and control of COVID-19 Infection and its long sufferings among the older adults. This study was analyzed and found that since 1987 the staff of Mahasarakham University (MSU), Chaiyaphum Rajabhat University (CPRU), and Khon Kaen University (KKU)‘s research studies and projects about the elderly, promotion of herbal medicine gave knowledge of working with COVID-19 outbreaks since 2019 to health personnel by academic conference [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22], as summarized in Tables 1 and 2.

Study No.	Title	Ref.	Study design	Age group (Years old)	Sample size (sex) (Data from)	Findings	Year of pubn.
1. [N]	The causes of unpopularity of the traditional medicine	[8]	Descriptive study Document Analysis In-depth-interview Participant observation of traditional medicine treatment	Most of them were older adults	30 patients 30 Thai Traditional Medicine Doctors 4 Experts persons.	Five factors affecting unpopularity of the Traditional medicine are as follows: Socio-economic status of TTMD Poor curative efficiency Teaching and education system of TTMD Law of government health service system New Technology of modern biomedicine	1987
2. [N]	The promotion of herbal planting for medical use and increasing household income to the villagers	[9]	Action research study Planting of 300 kg of Curcuma longa lion by 2 villagers and 4 households	Most of them were older populations	20 community leaders and health volunteers (VHVs) 20 Villagers 4 Households at Mooban Bausimma Tambon Non-udom Amphur Chumpae Khon Kaen province	Coucuna Longa Linn planting in 4.96 square meters Sell 633 kg to Phon Hospital Villagers received 4431 Baths or 651 Baths/household/9 months The villagers in Mooban Bausimma and others 5 nearby gain knowledge and experience of herbal planting for medical use	1992
3. [N]	The promotion of health care and health environment of target populations women, children, and aging people) at Mooban sum, Amphur Mahachanachai, Yasothorn	[10]	Action Research by Using Health Education Health training Health Check	Woman Children Aging	51 Woman 40 Children 34 Aging 40 Caregivers of the Children 30 Caregivers of the older adults	After 1 month, 3 months, and 1-year follow-up found that the target populations, increase of; The effectiveness of self-care Best experiences of caring for children and aging peoples Better health status than before Need health team to evaluate sustainable development after 5 year	1992
4. [N]	The factors affecting an acceptance of herbal treatment	[11]	Survey of knowledge, opinion, and experiment on 5 herbs in Thai Traditional Medicine (TTM) Aloe Snake plant Candle bush Curcuma longs Linn Andrographis paniculate Utilized TTM in Phon Hospital	18-85 years old; mean age 51; 74 Males; 127 Females	OPD cases at Phon hospital 112 used modern Medicine and 89 cases used Thai Traditional Medicine (TTM)	77.1% present TTM equal to modern biomedicine; 12.9% herbs better than modern biomedicine 76.6% herbs cheaper than modern drugs, factors affecting are as follows: beliefs in herbal curative efficiency receiving advice from the health personals receiving advice from the relative’s neighbor receiving advice from mass media physician-prescribed herbs for the patients	1995
5. [N]	The problems of seeking continuous medical care of patients with paralysis in Nonmuang Village, T. Sila, A. muang, Khon Kaen Province.	[12]	Descriptive study	All of them were older adults	11 cases living in Nonmuang village, Khon Kaen; 5 Males; 6 Females; With hemiplegia caused by stroke, and had spinal cord disease	6 cases get better; 2 cases stable; 3 cases worsened; Three cases believe that they will remain stable Four cases believe that they will get worse One has no idea Srinagarind Hospital and Nonmuang primary care unit has responsibility for continuous medical care	2005
6. [N]	Proportion of outpatient’s perception in Srinagarind hospital about drugs after receiving from central dispensary	[13]	Descriptive study Using time allocation Interviewed cases	18-84 years old median (45.6, IQR 18); 39.9% were educated as Bachelor’s degree	143 cases at our outpatients at Srinagarind Hospital; 44 Males; 99 Females	Half of them had the right drug perception Factors that decreased drug perception were receiving new drugs and more amount of drugs	2016
7. [I]	Effect of institution-based management for elderly health promotion programs in Northeastern Thailand	[14]	Interviewed Clinical, diagnostic management Examine IBM-EHP program	Older adults 60 years old and over	60 cases; 55 controls	Cases demonstrated improvements in perceived self-efficacy, received social support, health promotion behavior, and HDL-C level (p < 0.05) than control	2016
8. [N]	Health promotion behaviors of elderly living in an urban community of Khon Kaen Province	[15]	Descriptive study	60-79 years old	545 older adults; 218 Males; 327 Females	Factors related to health promotion behaviors were as follows: Caregiver at home Home visit by a health care professional Health promotion training Health promotion education Community broadcasting tower Television and radio as p < 0.05	2018
9. [N]	Frailty and associated factors of elderly Buddhist monks in Chiang Mai Province, Thailand	[16]	Cross-sectional descriptive study Interviewed Physical examination	Age 60 and over	135 older Buddhist monks	80.0% pre-frailty 7.4% frailty Barthel ADL. Score 12 85.2% low grip strength 17.8% Self-reported exhaustion 17.0% Slow walking speed 4.4% Low level of physical activity 3.0% unintentional weight loss	2019
10. [I]	Health problems and health care outcomes of older patients admitted to intensive care units in the low and middle-income counties: A systematic and review meta-analysis	[17]	Systematic and review meta-analysis published from 2010 to 2019	Older patients admitted to ICUs in the LMICS Age 60 years old and over	10 out of 1486 observational studies from 4915 from 6 general and 13 specialty ICUs in the 7 LMICS	Over one-fourth of older patients had severe conditions and loss of functional independence on ICU admission. Infection-related problems were evidenced during ICU stays	2020

Table 1.

Summary of medical pluralism (MP) from MSU, CPRU, and KKU staffs’ publications and presentations from 1987 to 2022.

I: index journal; and N: non-index journal.

Study No.	Title	Ref.	Study Design	Age group (years old)	Sample size (sex) (Data from)	Findings	Year of pubn.
1 [P]	Poster presentation: “Maelong volunteer for long-term care”	[18]	Trained the health volunteers (VHVs) Evaluated their knowledge, attitudes, and practices (KAP)	Most of them are adults and aging who work as VHVs at Maelong village	28 VHVs 1 Male 27 Females	Increase awareness of long-term care Gain more knowledge of caring for aging Need repeat training every year	2018
2(AC)	The 1st Academic Conference “COVID-19 Situation Nursing Challenge”, during 1-2 June 2021 at Faculty of Nursing, Chaiyaphum Rajabhat University, Chaiyaphum Province	[19]	Zoom Conference	Participants were 25 years old and over 60 years old	300 participants were Registered nurses who work in Thailand and abroad.	Most of them get more knowledge about the prevention and control of people and people infected with COVID-19 in terms of policy and practice	During 1-2 June 2021
3(AC)	The 2nd Academic Conference “COVID-19 Situation Leadership: Nursing Challenge”, during 7-9 April 2022 at Faculty of Nursing, Chaiyaphum Rajabhat University, Chaiyaphum Province	[20]	Zoom Conference	Participants were 25 years old and over 60 years old	250 participants were Registered nurses who work in Thailand and abroad.	Most of them developed nursing leadership potential in the situation of COVID-19, covering services, administration, research, and nursing education.	During 7-9 April 2022

Table 2.

Summary of project related to the older populations and Medical Pluralism (MP) from MSU, CPRU, and KKU staffs’ presentation during 2018-2022.

P: poster presentation; and AC: academic conference.

For older adults, these three universities had worked with this problem to prepare health personnel to face aging as advancement in medical technology has resulted in the Thai population having a longer life expectancy, leading Thailand to the “Aging Society”. Such changes affect the quality of life of the elderly and the working-age population who are direct caregivers. Ministry of Public Health prepares to step into a quality elderly society. The policy to promote the health of the elderly in the issue of “Long-term care for the elderly” to create understanding and ability to implement the policy appropriately.

The health promotion policy “Long-term care for the elderly” uses an analysis through cultural sensitivity aspects. The formulation process was divided into the five stages of policy formation, namely: (1) Policy Agenda Setting, (2) Policy Formulation, (3) Policy Implementation, (4) Evaluation Stage Policy, and (5) Policy Implementation.

The results of the analysis revealed that: (1) the policy arose from two major currents, namely the mainstream and the policy stream; (2) it was the government’s policy with cultural sensitivity due to the policy transformation, taking into account the classification of the elderly into three groups (the home group, the social group, and the bed group). The policy implementation strategy is open to each sub-district to be able to develop an innovative long-term care system that takes into account the local context, community potential, and social costs [21]. Besides this, Chaiyaphum Rajabhat University (CPRU)‘s staff has the arrangement of teaching nursing student’s computer-assisted instruction (CAI).

The computer-assisted instruction (CAI) was selected for gerontological nursing lessons on Depression, Dementia, Parkinson’s, and Geriatric assessment. Thirty third-year nursing students of the Faculty of Nursing at Chaiyaphum Rajabhat University were attending the gerontological nursing course. The lessons on Depression, Dementia, Parkinson, and Geriatric assessment were taught via Tutorial Instruction Pattern. The constructed CAI efficiency was 87/84 with an E.I. value of 0.7, higher than the expected criteria. It was found that the mean score of the students’ knowledge at post-test (x = 9.00) was higher than those at pre-test (x = 6.00), with a significant level of p < 0.001. Moreover, the score of satisfaction toward the CAI was high on every item. The computer-assisted instruction results in the student’s acquiring knowledge on nursing care of gerontological nursing [22].

For giving knowledge of COVID-19 infected during the pandemic in 2019–2022, Chaiyaphum Rajabhat University (CPRU) had organized two academic conferences to educate professional nurses about the prevention and control of people and people infected with COVID-19 in terms of both policy and practice. Those professional nurses were provided with knowledge and understanding of situations and trends for the COVID-19 management. At the conference, the Director-General of the Department of Medical Sciences gave a talk on treating and caring for COVID-19 patients by medical professionals, effects and infection control in Asian countries including Japan and Indonesia, management for nurses in hospitals, roles of professional nurses in hospitals and communities, and application of nursing theories and processes. The conference was continually organized as the second meeting to develop nursing leadership potential in the situation of COVID-19. This second conference covered services, administration, research, and nursing education. The conference was paid an honor by the Dean of the Faculty of Nursing at UCLA and was attended by scholars from all the regions of Thailand and professional nurses who work in Thailand and abroad (Table 2).

In step 2: Reported herbal medicine in pluralism medical treatment, prevention, and control of COVID-19 infection and its long sufferings of Thai people in the Northeast of Thailand.

To promote herbal medicine, the staff of Khon Kaen University (KKU), Mahasarakham University (MSU), and Phon Hospital gave knowledge and practice to the villagers in Khon Kaen province. The results showed that the Community leaders, Health Volunteers (VHVs), and the villagers gain more knowledge and experience of herbal planting for medical use and increase household income (Table 1).

The medical practice guidelines, diagnosis, treatment, and prevention of infection in the hospital in case of Coronavirus infection in 2019 (COVID-19) from the Department of Thai Traditional and Alternative Medicine, Ministry of Public Health, the treatment of COVID-19 are as below:

Probable case person with test results positive for Rapid Antigen Test or Antigen Test Kit (ATK per SAR-CoV-2), and total confirmed cases, both those who have symptoms and asymptomatic person separate group according to the severity of the disease and risk factors can be in four cases as follows:

1. Asymptomatic COVID-19

   • Out-patients with self-isolation, home isolation, or state locations are provided as appropriate

   • Provide symptomatic care

   • Do not give antiviral drugs such as Favipiravir due to most of the patients’ s symptoms decreasing on their own.

   • Consider giving Andrographis paniculate for treatment

   • Do not give Andrographis paniculate with an antiviral drug, because there may be side effects from the medicine.

2. Symptomatic COVID-19 without pneumonia, and no risk factors for severe disease.

   • May consider giving Favipiravir by starting the drug as soon as possible.

   • If the infection is detected when the patient has symptoms for more than 5 days and the patient is asymptomatic, or the patient had few symptoms, may not need to give the antiviral drug, because the patient may heal by themselves without the complications.

3. COVID-19 with mild symptoms, but has risk factors for severe disease or having comorbidity or mild pneumonia, any of the risk factors are as follows:

   • Older than 60 years

   • Chronic Obstructive Pulmonary Disease (COPD), includes another Chronic Lung Disease

   • Chronic Kidney Disease (CKD)

   • Cardiovascular disease, including congenital heart disease

   • Cerebrovascular disease

   • Uncontrollable Diabetes

   • Obesity (weight more than 90 Kg, or BMI > 30 Kg/Square meter)

   • Liver Cirrhosis

   • Low immunity, and lymphocytes less than 1000 cells/cubic millimeter, or

   • Patients without risk factors, but tends to the severity of the disease increased

     It is recommended to use only one antiviral drug as below, considering congenital disease; contraindications to the drug against each other of antivirus drug, and original medicine (drug-drug interaction), bed management, ease of drug administration, and reserve dose of drugs.

   1. Nirmatrelvir/ritonavir for 5 days (Medication is not recommended, if systems last more than 5 days), or.

   2. Molnupiravir for 5 days (This medication is not recommended for use if symptoms persist for more than 7 days).

   3. Remdesivir for 3 days (This medication is not recommended for use if symptoms persist for more than 7 days).

   4. Favipiravir for 5–10 days (This medication is not recommended for use if symptoms persist for more than 4 days).

4. Confirmed patients with pneumonia, who have hypoxia (resting oxygen saturation <94%), or have hypoxia (SPO2 > 3%) of measured value while exercising (exercise-induced hypoxemia) or chest radiograph has the progression of pulmonary infiltrates.

   • Recommend Remdesivir for 5–10 days, in the patients who require oxygen, depending on the clinical symptom, the patients should closely follow-up for the symptoms.

   • First choice, in the case of mild pneumonia at SpO2 during 94-96%, or no oxygen receives, may consider giving Molnupiravir for 5 days, which should start using the drug within 5 days, after symptoms or Remdesivir, which gives within 7 days after symptoms.

   • Consider giving Remdesivir for 5–10 days as follows:

     • Patients with mild symptoms but their risk factors for the severe disease, or have major comorbidities or patients with pneumonia, also do not need oxygen.

     • Patients with severe pneumonia no later than 10 days after symptoms, and receive cannula >1 liter/min, and level of SpO2 < 95%, or receive HFNC/NIVHFNC or use a ventilator (if wear a breathing apparatus may benefit from this drug is not fully).

     • Pregnant woman with pneumonia (has more details on the topic of treatment COVID-19 in pregnant women).

     • There are contraindications to the administration of the drug by mouth or absorption problems.

   • Choose to use antiviral drugs, kind to eat or Remdesivir, either not shared due to medicine active in the same position when giving Remdesivir until the recommended date.

   • No recommend Corticosteroid in case of mild symptoms (No additional oxygen is required), or asymptomatic pneumonia.

The Department of Thai Traditional and Alternative Medicine presented the restored health after COVID-19 infection with herbal medicine as shown in Table 3.

Herbal medicine name	Properties
Andrographis panicolata	Reduce fever, anti-inflammatory
Benjalokwichian Medicine	Cure a fever, make poison out of the body
Prasacanthr Daeng Medicine (Dracaena loureiroi Gagnep)	Reduce fever, hot fix, cure thirst
Reduce Fever Medicine namely Junleera	Relieve symptoms of fever, seasonal Fever
Aromatic Medicine namely Na Wa Kot	Cure wind dizziness, Squeamish, vomit, fix the wind, late fever
Triphala	Cough relief, expectorant, Elemental balance
Cough Medicine namely Makhampom	Expectorant, cough relief
Ginger pill	Relieve flatulence, and indigestion, expel cure heartburn
Cannabidial (CBD oil)	Cure insomnia, headache, and appetizing
Muscle Relaxants	Joint pain relief, muscle pain chest pain, stomach ache
Ya SUK SAI YAI	Cure insomnia, for mode changes, alleviate exhaustion

Table 3.

Restore health after COVID-19 Infection with herbal medicine (Available from: https://web.facebook.com/informationcovid19/posts/498540561764273?_rdc=1&_rdr).

Source: Department of Thai Traditional and Alternative Medicine, 2022.

In step 3: We reported case success in treatment prevention and control of COVID-19 infected.

Since 2019, the elderly who get COVID-19 received treatment in the hospital and home isolation. The older adults who used medical pluralism (MP) during treatment were our case studies.

We followed the treatment of Coronavirus with the phone who was admitted to the University Hospital of KKU and MSU. Those cases who did not use MP and died from their complication did not report in this study.

We could only review report the number of cases with COVID-19 on May 31, 2022 at the Area Health District, which includes seven provinces in the Northeast of Thailand such as Udon Thani, Sakon Nakhon, Nakhon Phanom. Loei, Nong Khai, Nong Bua Lamphu, and Bueng Kan reported cases of COVID-19 as +264 new cases; 123,760 cumulative patients, 21,956 hospitalized, and 120,195 healed [23].

Our cases reported from 2019 to 2022 are divided into four groups as follows:

1. Case of unable to COVID vaccination

2. Case of COVID-19 infected

3. Case of COVID-19 infection and its long-sufferings

4. Case of the older adults’ health-seeking behavior in the Northeast of Thailand during COVID-19 Outbreaks

4.1 Case of unable to COVID vaccination

One Thai male, age 64 years old who cannot vaccinate COVID vaccine since 2019, because he has health problems of chronic illness and heart diseases. He needs to insert three catheters entering the heart and used much medicine to protect against embolism. His life is very difficult during the COVID-19 pandemic in Thailand.

He changes his lifestyle by quitting smoking, taking medicine and food as prescribed by the doctor, taking some supplements and herbs, exercising according to the doctor’s orders, living in a well-ventilated environment, getting enough rest, and following Thai policies to prevent COVID-19 infection. He insisted that pluralism of medical treatment prevention and control of COVID-19 infection was very good for him.

4.2 Case of COVID-19 infected

One Thai female, age 70 years old who had controllable diabetes mellitus, got COVID-19 infected with test results positive for Rapid Antigen Test. She was asymptomatic COVID-19 and received Andrographis Paniculate for treatment and home isolation. She takes this medicine and food as prescribed by the doctor, exercises according to the doctor’s order, lives in a well-ventilated environment, and gets enough rest.

Nowadays, she takes some supplements and herbs, also has health practices as above, and follows Thai policies to prevent long Covid-19 suffering.

4.3 Case of COVID-19 infection and its long sufferings

One Thai female, age 59 years old, got COVID-19 infected in 2021 with symptomatic COVID-19 without pneumonia and no risk factors for severe disease. Her doctor gave Favipiravir by starting the drug as soon as possible. But she needs to work hard and not get enough rest.

At present, she still has a persistent cough. She uses cough medicine, namely Makhampom for cough relief, takes some supplement and herbs, and follows Thai policies to prevent COVID-19 infected to other people nearby.

4.4 Case of the older adults’ health-seeking behavior in the Northeast of Thailand during COVID-19 Outbreaks

One Thai female, age 60 years old, she fell in the bathroom and ruptured blood vessels in the brain that paralyzed her. Her husband is famous for Thai traditional treatment, but her daughter believes in treatment with modern medicine because she works in one private hospital in Khon Kaen province. During the COVID-19 outbreak in Thailand, patients have difficulty going to the hospital.

Her family members always quarreled about treatment. One female health volunteer in this village recommended her family and other patients to the treatment of Thai traditional medicine and modern medicine. After that, this older adult with hemiplegia gradually got better, and her family is happy.

In step 4: We summarized the organization chart related to pluralism medical treatment in Northeastern, Thailand, since 2019.

Medical pluralism (MP) plays a role in many people’s lives over the world. Older people in the Northeast of Thailand are familiar with the herb, Thai government policies have implemented pluralism medicine for treatment, prevention, and control of COVID-19 infected Thai people as summarized by the organization as present in Figure 1.

Figure 1.

Summarized the organization chart related to pluralism medical treatment in Northeastern, Thailand, since 2019.

5. Discussions

Medical pluralism (MP) is used in many countries over the world during the COVID-19 outbreak. Our review articles found that pluralism in medical treatment, prevention, and control of COVID-19 infection and its long sufferings was found in most older adults worldwide, it presented that most countries have medical pluralism (MP) for care sickness of the populations [24].

The government of Thailand focuses on the older adults and classified them as a risk group, by giving it the name 608 groups (groups of people who need to get vaccinated with the most COVID are older people aged 60 years and over and those with underlying disease, including chronic respiratory disease, cardiovascular disease, chronic renal disease, cerebrovascular disease, obesity, cancer, and diabetes) that will be vaccinated in the first priority group. Similar to other countries, which are the aging society, they also focus on the older populations, they arranged at least three vaccinations of COVID-19 vaccine for those older adults [25].

Most Thai older adults are familiar with herbs because it’s grown for food and medicine [9, 11]. During the COVID-19 outbreak in 2019, Thai older people in rural communities used herbs, such as Andrographis paniculate to build immunity for preventing COVID-19 infection [26]. Similar to other studies presented, herbal medicine is a class of natural substances and is also used as adjuvant therapy for COVID-19. These herbal medicines are psoralidine, silverstrol, quwrrectin, myricellin, flavonoids, and polyphenols [27, 28, 29].

Health interventions have been implemented, reducing the rate of the COVID-19 infection, including a face mask, hand hygiene, COVID vaccination, home isolation, and social distancing, similar to the prior studies [30, 31].

Our review of research, and projects produced at Mahasarakham University (MSU), Chaiyaphum Rajabhat University (CPRU), and Khon Kaen University (KKU) presented that Modern Biomedicine and Thai Traditional Medicine can help reduce the severity of the infection and long sufferings of the COVID-19 during 2019–2022, among the older adults in the Northeast of Thailand.

6. Conclusion

The medical pluralism (MP) between modern biomedicine and Thai traditional medicine is needed to remedy COVID-19 cases among the older adults because most of them are familiar with herbs used in their household for food and medicine.

The promotion of herbal planting for medical use, which is increasing household income for the villagers in the Northeast of Thailand, should be widely developed and safe for all people in Thailand.

Acknowledgments

The authors thank (a) all the respondents for their valuable contribution to this study, (b) The Faculty of Medicine of Mahasarakham University and Khon Kaen University for data and financial support, (c) The Faculty of Nursing of Chaiyaphum Rajabhat University for data and financial support, and (d) Dr. Thawalsak Ratanasiri, Dr. Bangonsri Jindawong, Dr. Chanchanok Aramrat, and Mrs. Sompong Chantakram for help search.

Conflict of interest

All authors declare that they have no conflicts of interest.