Are Dietary Supplements “Essential” During a Pandemic?

As it makes its way around the globe, the fast-moving coronavirus is raising questions about the “essential” nature of countless goods and services––including natural health and wellness products.

Prior to the Coronavirus outbreak, millions of Americans relied on health foods and dietary supplements both for illness prevention and treatment. Given the absence of a proven therapy for COVID-19, many more people have flocked to health stores and online retailers to stock up on natural immune-boosting remedies ranging from vitamin and mineral supplements like zinc and Vitamin C, to elderberry, echinacea, and other healing botanicals.

According to a recent Nutrition Business Journal survey of 1,000 representative US consumers, 36% report that they are using more supplements now than they were prior to NBJ Supplement Use COVIDthe pandemic. And 39% indicated they expected their elevated usage to continue for several months, “signaling a potential halo effect for supplements beyond the immunity category.”

The coronavirus threat also appears to be bringing new consumers into the supplement market, with 20% of respondents who claimed to “never” use supplements reporting an expected increase in usage over the coming months.

Looming over the industry is the question of whether natural product purveyors can be considered “essential” businesses.

For the most part, the answer to that question is “Yes.”

Supplement manufacturers, health food stores and other health-related retailers have largely fallen under the “essential business” umbrella, as defined by the recent stay-at-home orders issued in most US states that have implemented them.

Defining “Essential”

In mid-March, the nonprofit Natural Products Association (NPA) issued a letter to the governors of all 50 US states, asking them to designate health food stores selling nutritional supplements as essential businesses. The trade association represents over 700 retailers, manufacturers, wholesalers, and distributors of natural foods, dietary supplements, homeopathic products, and health and beauty aids. 

“It is imperative that essential businesses such as health-food stores that provide nutritional supplements and other health and wellness products are allowed to remain open for business during this public health emergency,” said NPA President and CEO Daniel Fabricant, PhD, in a press announcement. “Local businesses are an essential resource for Americans in times like these, especially people at risk, who need access to neighborhood stores. Communities need these stores open.” 

On March 19, California’s Governor Gavin Newsom became the first in the US to declare a statewide shelter-in-place mandate in response to COVID-19. His executive order, like the many that have since followed, exempted essential workers and industries. “The supply chain must continue, and Californians must have access to such necessities as food, prescriptions, and health care,” the order stated.

Three days later, the state’s Public Health Officer listed “Essential Critical Infrastructure Workers” necessary for “ensuring continuity of functions critical to public health and safety.” This included “groceries, pharmacies, and other retail that sells food and beverage products,” as well as farmers’ markets, food banks, and farm and produce stands. Most states now have similar orders allowing for food and health care-related manufacturing and retail to continue, while much of the country shelters at home.

Viral Economics

NPA’s Dan Fabricant notes that holistic health products as a category represent a significant slice of the overall American economy. The natural products industry represents more than 380,000 direct jobs, over $16 billion in direct wages, and nearly $15 billion in taxes each year, NPA reports. “Three in every four Americans use at least one natural product.”

For retailers selling supplements and other health products, simply receiving an “essential business” designation does not necessarily mean business as usual––particularly for smaller shop owners. Local health food stores are among those hardest hit by the virus’s economic toll.

Over the past several weeks, some have shuttered completely. Those able to stay open are often dramatically changing the way they interact with and serve their customers.

Grocery stores around the country are scrambling to develop and implement new procedures to maintain staff and shopper safety. Larger chains like Whole Foods and Natural Grocers are adjusting their operating hours to provide extra time for cleaning and restocking. Customers are growing accustomed to following one-way arrows directing the flow of traffic through stores and seeing face-masked cashiers from behind plexiglass sheets.

Many how have special hours for elderly and vulnerable patrons, and most limit the number of shoppers allowed inside a facility at one time.

For smaller businesses, overhauls like these are physically or financially feasible. A host of mom-and-pop stores around the country are simply closing their doors, converting their operations into online or phone ordering services, and offering curbside pick-up or delivery only.

From Brick to Click

San Francisco’s Scarlet Sage Herb Co. is one natural health business that temporarily shuttered its storefront while transitioning to a virtual platform. The herbal apothecary supplies local shoppers with medicinal products including organic herbs, nutritional supplements, and essential oils.

Owner Laura Ash, a clinical herbalist, says she made the difficult decision in an attempt to protect not only the health of her workers, but also community members who shop in her small store. Many of her customers are patients with significant underlying health conditions.

Initially, Ash downsized her staff and kept the apothecary open in a limited capacity. “We set up a table in the front so [customers] could only come into a tenth of the store. We grabbed products for them so that we were protected as a staff, and we maintained six feet of space between us.” She also cut her usual 20-plus person workforce down to 3 or 4 employees in the shop at a time.

Despite the fact that San Francisco city officials formally confirmed the essential nature of her operation, Ash chose to close her brick-and-mortar shop completely for the duration of the outbreak. She continues to operate her business through an ecommerce store, personally fulfilling phone and online requests and shipping all orders via mail to her customers.

Top Sellers

In the days before she closed her physical storefront, Ash described a rush of business that felt “like holiday hours.”

“People were in here buying everything, shelves were empty, we were doing really well. It really helped buffer the remainder of the month, when we were doing very little business.”

Among the first products to sell out in Ash’s store were popular virus-fighting botanicals. Initially, “a lot of people just came in for the basic immunomodulating herbs,” like elderberry and echinacea. “Elderberry sold out everywhere.”

Medicinal mushroom products emerged as another top seller. “Those are completely sold out within days of getting a shipment,” she said.

Herbs to support the nervous system have also proved incredibly popular during this period of heightened stress and anxiety. “I haven’t seen as many sleep remedies sell, but I know that they should be,” Ash noted. Some customers came in seeking homeopathic preparations like Oscillococcinum, a common over-the-counter remedy for flu-like symptoms.

Also quick to sell were Vitamin C and zinc supplements. “We can’t keep enough of them––we can’t even get enough to sell it,” she said. “A lot of our vendors and suppliers have been running out very, very fast.”

Longtime customers were also “coming in filling three or four months of formulas that they get regularly.” That included patients with cancer and other chronic conditions whose planned medical procedures––including surgeries––were deemed “nonessential” and thus postponed in light of the virus. “They are the ones that are not getting the care they need right now,” Ash stressed.

She says that integrative health professionals like herbalists, naturopathic physicians, and nutritionists are helping to fill wide gaps in care for patients who are suddenly unable to access critical medical services. “They’re getting formulas, they’re getting medicine––they need to maintain their health while they’re waiting for larger surgeries or other procedures to happen.”

Squelching False Claims

Given the public concern about COVID, it was inevitable that some marketers would seek to cash in by promoting various vitamins, herbs, and homeopathics as “cures” for Coronavirus infection, despite the FDA’s clear and unwavering position that this is illegal.

Back in early February, a coalition of dietary supplement associations issued a stark warning to consumers and retailers regarding assertions that dietary supplements can heal or prevent COVID.

“While research supports the use of certain dietary supplements to maintain immune system health, we are not aware of clinical research that demonstrates using a dietary supplement specifically to prevent or to treat the Novel Coronavirus,” says the position statement issued by the UNPA, American Herbal Products Association, Consumer Healthcare Products Association and Council for Responsible Nutrition (CRN).

“Even if research is conducted and published on the topic, the law that regulates dietary supplements, the Dietary Supplement Health and Education Act of 1994 [DSHEA], prohibits marketers of dietary supplements in the United States from promoting any dietary supplement product that makes disease prevention or treatment claims.”

By the second week in March, the FDA had already issued warning letters to seven companies promoting an array of teas, essential oils, tinctures, and colloidal silver products as COVID treatments. The agency fired off a second wave of warning letters in April.

“The FDA considers the sale and promotion of fraudulent COVID-19 products to be a threat to the public health,” Commissioner Stephen Hahn, MD, said in a news release. “We understand consumers are concerned about the spread of COVID-19 and urge them to talk to their health care providers, as well as follow advice from other federal agencies about how to prevent the spread of this illness. We will continue to aggressively pursue those that place the public health at risk and hold bad actors accountable.”

From Trendy to Essential

The COVID pandemic has pushed the topic of immune system health and resilience to the forefront of public consciousness. This is amplified by the realization that chronic conditions like diabetes, heart disease, and obesity raise the risk for COVID.

Consequently, many more people now recognize that self-care is not a luxury––it is a necessity. In general, this has been good for the holistic healthcare movement, especially since the conventional medical toolbox has little to offer for protection against or treatment of COVID. Suddenly, many more people––including many physicians––are now willing to consider the possibility that things like Vitamin C, Vitamin D, and certain herbs and mushrooms might have a real role to play.

But will this positive trend continue once the threat of the virus subsides? Will we start to see a higher degree of integration of natural medicine within the allopathic world?

As with most other aspects of this virus, only time will tell.


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