International researchers pick up loico’s idea of throat disinfection to counter COVID-19

A group of researchers from the United Kingdom (Cardiff and Cambridge), the United States (Denver, Colorado), Spain (Barcelona), and Canada (Ottawa) has now picked up the idea we have put for­ward almost exact­ly two months ago1 for pre­ven­tive throat dis­in­fec­tion with viru­ci­dal agents that are known to be effec­tive against coro­n­avirus­es and safe to use in the throat.2

The authors begin their arti­cle acknowl­edg­ing that “[e]merging stud­ies increas­ing­ly demon­strate the impor­tance of the throat and sali­vary glands as sites of virus repli­ca­tion and trans­mis­sion in ear­ly COVID-19 dis­ease.”3 They con­tin­ue: “We review known mech­a­nisms of viral lipid mem­brane dis­rup­tion by wide­ly avail­able den­tal mouth­wash com­po­nents that include ethanol, chlorhex­i­dine, cetylpyri­dini­um chlo­ride, hydro­gen per­ox­ide and povi­done-iodine. We also assess exist­ing for­mu­la­tions for their poten­tial abil­i­ty to dis­rupt the SARS-CoV-2 lipid enve­lope, based on their con­cen­tra­tions of these agents, and con­clude that sev­er­al deserve clin­i­cal eval­u­a­tion. We high­light that already pub­lished research on oth­er enveloped virus­es, includ­ing coro­n­avirus­es, direct­ly sup­port the idea that oral rins­ing should be con­sid­ered as a poten­tial way to reduce trans­mis­sion of SARS-CoV-2.”

While it appears to us that the arti­cle slight­ly mis­in­ter­prets the avail­able evi­dence for tem­po­ral virus shed­ding pat­terns in COVID-19, the approach as such, the com­pre­hen­sive analy­sis of avail­able options as well as the detailed descrip­tion of struc­tur­al aspects of the viral infec­tion process can only be very much welcomed.

Close to the end of their arti­cle, the authors state that “giv­en the the­o­ret­i­cal plau­si­bil­i­ty and data we have reviewed plus the read­i­ly avail­able prod­ucts and urgent need to reduce SARS-CoV-2 infec­tion, mea­sures could be con­sid­ered and action tak­en to insti­gate clin­i­cal inves­ti­ga­tion in the pop­u­la­tion dur­ing the outbreak.”

While such clin­i­cal inves­ti­ga­tion should def­i­nite­ly be car­ried out (we have called for such in the past4), pri­or­i­ty should clear­ly be giv­en to advis­ing peo­ple to include our pro­pos­al in their per­son­al pro­tec­tive regime even before results of such research are avail­able, giv­en pre­cise­ly (1.) the “the­o­ret­i­cal plau­si­bil­i­ty” and (2.) what the authors say them­selves imme­di­ate­ly after­wards: “Mouthwashes [are] wide­ly uti­lized in dai­ly oral and den­tal hygiene for cos­met­ic and med­ical rea­sons and have demon­strat­ed accept­able tol­er­a­bil­i­ty when used mul­ti­ple times dai­ly for dura­tions of 6 months and longer.”

Little to no risk, high the­o­ret­i­cal plau­si­bil­i­ty of a pos­i­tive effect.

For any­one rely­ing on log­ic in urgent deci­sion mak­ing, in this case the appar­ent med­ical log­ic of the mat­ter, rather than on wait­ing for dis­as­ter to strike, our pro­pos­al was clear­ly the first choice for self-pro­tec­tion from the outset.

We would also like to men­tion anoth­er call to rea­son, pub­lished just two weeks after our own ini­tial arti­cle, in a let­ter to the edi­tors of the British Medical Journal by a Visiting Professor at Aston University, UK – point­ing to pri­or indi­ca­tions for effi­ca­cy of pre­ven­tive throat dis­in­fec­tion -,5 that went most­ly unheed­ed in a sim­i­lar way as did our ini­tial proposal.

It has become clear from pos­i­tive exam­ples in Italy that empha­sis must be put on tack­ling infec­tions as ear­ly as at all pos­si­ble in order to avoid lethal out­comes. In the exem­plary regime devel­oped in Piacenza, infect­ed peo­ple are advised on how to mon­i­tor and treat them­selves at home6 rather than being (lat­er) mon­i­tored and treat­ed in the hos­pi­tal (an opti­mal idea giv­en that hos­pi­tals are known for being “opti­mal” envi­ron­ments for acquir­ing infec­tions and super­in­fec­tions). One pro­ce­dure which is typ­i­cal­ly being car­ried out in a hos­pi­tal ICU is reg­u­lar oropha­ryn­geal dis­in­fec­tion in order to avoid devel­op­ment of pneu­mo­nia in patients. Hence our pro­pos­al might well, some­what flip­pant­ly, be con­sid­ered as “Piacenza on steroids”.

And we can­not resist to share the expe­ri­ence we made on the Facebook page of “Nature”, one of the world’s two lead­ing sci­en­tif­ic jour­nals. In the ear­ly days, hope­ful and con­fi­dent to be con­tribut­ing to sav­ing many lives and healthy lung func­tions, we post­ed a link to our arti­cle in the com­ment sec­tion. An edi­tor told us he had masked our link and asked us what we were doing, telling us he could not see on the Website of the WHO any rec­om­men­da­tion to do what we were propos­ing. Belief in author­i­ty: 100 %. Confidence in his own think­ing and sci­en­tif­ic log­ic: 0 %.

So, one might ask, why did we not pur­sue oth­er routes to make our pro­pos­al more wide­ly known? We did. Among oth­er things, we imme­di­ate­ly wrote to Professor Drosten of Charité Berlin, inven­tor of the first COVID-19 test and prin­ci­pal COVID-19 advi­sor to Mrs. Merkel. We received the same answer that high­ly reput­ed US pul­mo­nolo­gist Bruce L. Davidson MD, whom we had cit­ed exten­sive­ly in our arti­cle, per­son­al­ly told us he received from Professor Drosten: none.

The stark irony, bet­ter: illog­ic of the mat­ter is that Professor Drosten just very recent­ly admon­ished col­leagues, doc­tors and pro­fes­sors, in the med­ical com­mu­ni­ty for exceed­ing their area of com­pe­tence when weigh­ing in on COVID-19. While him­self acknowl­edg­ing that, being entire­ly focused on the virol­o­gy of coro­n­avirus­es, he has lim­it­ed to no clin­i­cal expe­ri­ence and, as we may con­fi­dent­ly hypoth­e­size, is there­fore not as accus­tomed to think­ing in the same sys­temic way about the human organ­ism as, for exam­ple, we are. And we ask our­selves where the log­ic resides when he, in his most recent pod­cast, goes to great lengths to dis­cuss eco­nom­ic impli­ca­tions of reopen­ing the econ­o­my rather soon­er or rather lat­er, with­out any appar­ent per­ti­nent expertise.

We can­not stress enough, on the oth­er hand, that with­out Professor Drosten’s pio­neer­ing work in his col­lab­o­ra­tive Munich study, we would not have arrived at for­mu­lat­ing our pro­pos­al, at least not this early.

Observing in our own local neigh­bor­hood, par­tic­u­lar­ly in our local super­mar­ket, how the offi­cial­ly pre­scribed mea­sures against COVID-19 are being observed, we must observe that these mea­sures can­not pos­si­bly be very effec­tive. Except for the own­er of the super­mar­ket (who, by the way, told us he is per­son­al­ly doing exact­ly what we have pro­posed), all employ­ees wear their face masks under their chins at all times (at least that we see them), appar­ent­ly because it is high­ly uncom­fort­able to car­ry and breathe through a mask dur­ing an entire shift.

The sim­ple and prac­ti­cal way to tack­le COVID-19 appears, thus, to still be the old-fash­ioned way that “sim­ply makes sense” (as a senior sci­en­tist with NASA has writ­ten to us privately).

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