The Effect of Pomegranate Tea on the Clinical Outcomes and Symptom Alleviation in COVID-19 Patients: A Double-Blind Randomized Clinical Trial.

The short version

This double-blind, randomized trial of 66 hospitalized COVID-19 pneumonia patients in Shahrekord, Iran, tested whether pomegranate tea added to standard hospital care improves recovery. Pomegranate (Punica granatum) is rich in plant polyphenols such as punicalagin and anthocyanins, compounds that antioxidant and antiviral lab studies suggest could dampen inflammation and block the virus's spike protein from binding to its human receptor, ACE2. Lab results do not always carry over to patients, so the researchers tested the idea in a placebo-controlled clinical trial. Patients aged 18 or older with a positive SARS-CoV-2 test, low blood oxygen (SpO2 of 93% or less) and pneumonia on imaging were randomly assigned, balanced by how much oxygen support they needed. Half received a freeze-dried pomegranate fruit extract syrup (110 mg per 10 cc), dissolved in warm water as a tea, four times a day; the rest received a matching coloured placebo syrup. Treatment continued through the hospital stay and after discharge until symptoms eased. The team tracked recovery, hospital days, deterioration, death, symptom severity on a four-point scale, blood tests and side effects. The results were flat. By day 14, 84.8% of the tea group and 83.3% of the placebo group had improved (p = 1.0, meaning no difference). Median time to improvement was 6 versus 5 days (p = 0.83), and hospital stay 6 versus 5 days (p = 0.87). Deterioration occurred in 18.2% versus 20.0% (p = 1.0). Death at 28 days was 18.2% versus 6.7%, a gap that was not statistically significant (p = 0.26) in groups this small. Cough, fever, fatigue, breathlessness and other symptom scores did not differ, and day-14 blood markers such as CRP, ferritin and ESR were similar between groups. Some serious events such as ARDS (15.2% versus 3.3%) and liver dysfunction (15.2% versus 6.7%) were numerically more common with pomegranate but not significantly different, and no allergic reactions were reported. The authors conclude that pomegranate tea did not help in COVID-19. The small trial had unevenly matched groups at baseline, including time since symptom onset, and used an extract that was not chemically standardized. They recommend standardized extracts and adaptive trial designs, noting that laboratory activity does not guarantee clinical benefit. Nearly all patients in both groups also received antivirals (93.9% and 93.3%), and only 63 completed follow-up, so larger trials would be needed to detect modest effects or rare harms.

Key findings

• In this double-blind trial of 66 hospitalized COVID-19 pneumonia patients, pomegranate tea added to standard care did not improve outcomes: 84.8% of the tea group and 83.3% of the placebo group improved within 14 days (p = 1.0, meaning no difference).
• Hospital stay (median 6 versus 5 days, p = 0.87), time to improvement (6 versus 5 days, p = 0.83) and deterioration (18.2% versus 20.0%, p = 1.0) were also similar between groups.
• Death within 28 days was 18.2% with pomegranate versus 6.7% with placebo, which was not statistically significant (p = 0.26) in groups of this size.
• Adverse events did not differ significantly and no allergic reactions occurred, although ARDS (a severe lung injury), liver dysfunction and hypertension were numerically more frequent in the pomegranate group.
• The groups were unevenly matched at baseline (for example in time since symptom onset) and the extract was not chemically standardized, so the authors recommend standardized extracts in future trials.

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