Effects of Ginger on clinical manifestations and paraclinical features of patients with Severe Acute Respiratory Syndrome due to COVID-19: A structured summary of a study protocol for a randomized controlled trial
Authors: Safa Omid , Hassaniazad Mehdi , Farashahinejad Mehdi , Davoodian Parivash , Dadvand Habib , Hassanipour Soheil , Fathalipour Mohammad 
Published: October 2020

Abstract
Objectives
We investigate the effects of Ginger, compared to the usual therapeutic regimen on clinical manifestations and paraclinical features in patients with confirmed COVID-19 that are moderately ill.

Trial design
This is a single center, randomized, double-blind, placebo-controlled clinical trial with parallel group design.

Participants
Inclusion criteria:
1. Patients admitted to Severe Acute Respiratory Syndrome (SARS) Departments at Shahid Mohammadi Hospital, Bandar Abbas, Iran
2. Age ≥18 years (weight ≥35 kg)
3. Hospitalized ≤48 hours
4. Confirmed SARS-CoV-2 diagnosis (Positive polymerase chain reaction (PCR))
5. Moderate pneumonia and lung involvement in imaging
6. Signing informed consent and willingness of study participant to accept randomization to any assigned treatment arm
Exclusion criteria:
1. Underlying diseases, including heart disease, chronic hypertension, severe renal failure, severe liver failure, and thyroid disorders
2. Use of warfarin, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), diuretics, corticosteroids, and antiarrhythmic drugs
3. Severe and critical pneumonia
4. History of known allergy to Ginger
5. Pregnancy and breastfeeding

Intervention and comparator
Intervention group: The standard treatment regimen for COVID-19 along with Ginger-based herbal tablets (Vomigone ®, Dineh Pharmaceutical Company, Iran) at a dose of 1000 mg three times a day for a period of seven days.
Control group: The standard treatment for COVID-19 based on the Iranian Ministry of Health and Medical Education's protocol, along with Vomigone-like placebo tablets (Dineh Pharmaceutical Company, Iran) at a dose of two tablets three times a day for a period of seven days.

Main outcomes
The primary outcome is recovery rate of clinical symptoms, including fever, dry cough, tiredness, and GI symptoms as well as paraclinical features, including thrombocytopenia, lymphocytopenia, and C-reactive protein within seven days of randomization.
Time to improvement of clinical and paraclinical features along with the incidence of serious adverse events are the secondary outcomes within seven days of randomization.

Randomization
An interactive web-based system will be used to allocate eligible participants, based on the inclusion and exclusion criteria, to one of the two study arms (in a 1:1 ratio) using block randomization.

Blinding (masking)
All study participants, research coordinators, clinicians, nurses, and investigators will be blinded to the group assignment.

Numbers to be randomized (sample size)
A total of 84 participants will be randomized into two groups of 42 patients.

Trial Status
The protocol is Version 1.0, May 23, 2020. Recruitment began July 21, 2020, and is anticipated to be completed by October 30, 2020.

Trial registration
This clinical trial has been registered in the Iranian Registry of Clinical Trials (IRCT). The registration number is “IRCT20200506047323N1”. Registration date is 23 May 2020.

Full protocol
The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.