The logic of surviving the Coronavirus pandemic

In this arti­cle, we sug­gest what we con­sid­er, in large part poten­tial­ly instead of dras­tic quar­an­tine for basi­cal­ly every­one, to be the most log­i­cal and most promis­ing approach to sur­viv­ing the Coronavirus pan­dem­ic, both on an indi­vid­ual and on a sys­temic lev­el. We draw con­clu­sions from infor­ma­tion uncov­ered and dis­cussed by the med­ical sci­en­tif­ic com­mu­ni­ty and by med­ical prac­ti­tion­ers, and give prac­ti­cal instruc­tions on what to do.

We will start with the core points and leave con­tex­tu­al elab­o­ra­tion of our views to the lat­ter part of this as well as to sub­se­quent articles.

The one question that really matters

It is wide­ly esti­mat­ed that around 70 % of the respec­tive pop­u­la­tion will even­tu­al­ly be infect­ed by the Coronavirus. While the major­i­ty of infec­tions appears to result benign, a large num­ber of those infect­ed require hos­pi­tal­iza­tion, close to 10 per­cent can cur­rent­ly be esti­mat­ed to require inten­sive care, and between 1 and 3 per­cent to die. It has by now become appar­ent that not just old­er peo­ple with seri­ous comor­bid­i­ty are at risk of seri­ous health prob­lems or even death from a Coronavirus infec­tion, and we per­son­al­ly are aware of the case of a 40 year old healthy man very quick­ly need­ing inten­sive care after catch­ing the virus (he like­ly became infect­ed in the hos­pi­tal where he had work assign­ments as a crafts­man, and con­tin­ued to work there while already hav­ing fever; he has since died in the hospital’s ICU). Measures against the spread of the virus as dras­tic as those pur­port­ed­ly employed in the People’s Republic of China, though pur­port­ed­ly suc­cess­ful, can not be expect­ed to be employed in the exact same way in the rest of the world. The one and only ques­tion that mat­ters, there­fore, for both the indi­vid­ual and the entire health care sys­tem which risks to become over­whelmed by a steady inflow of new patients, is not so much how to avoid an infec­tion but how to rad­i­cal­ly min­i­mize its diverse con­se­quences. The one ques­tion that mat­ters is how to avoid need­ing hos­pi­tal­iza­tion and par­tic­u­lar­ly inten­sive care, and ulti­mate­ly how to avoid to die of Coronavirus-induced pneumonia.

The logical answer

Diverse hints help­ful at attempt­ing to craft a con­fi­dent answer to this ques­tion have been men­tioned, often in pass­ing, in media appear­ances as well as in media and sci­en­tif­ic pub­li­ca­tions by mem­bers of the med­ical sci­en­tif­ic com­mu­ni­ty, and we will seek to put them into their sys­tem­at­ic con­text while elab­o­rat­ing more deeply on the core point.

The two cru­cial dots need­ing to be con­nect­ed were pro­vid­ed by Professors Dr. Christian Drosten, Charité Berlin, and Dr. Clemens Martin Wendtner, Ludwig-Maximilians-Universität München, as well as by the pul­mo­nolo­gist Bruce L. Davidson MD, MPH, Seattle, respectively.

Professors Drosten and Wendtner, for their part, observed that for the first 5 days after the occur­rence of symp­toms the virus repli­cates mas­sive­ly in the throat, much unlike the SARS virus of 2003 was observed to be doing, and that this mas­sive repli­ca­tion was already declin­ing when mea­sure­ments began (imply­ing that from a cer­tain point onwards, in line with Professor Drosten’s obser­va­tions, pha­ryn­geal swabs will often result in false neg­a­tive test­ing results). They also found a new­ly mutat­ed vari­ant of the virus which was first only detect­ed in the throat and a few days lat­er also mas­sive­ly repli­cat­ing in the lung. Symptom onset, in case an infect­ed per­son does not remain asymp­to­matic, has since been esti­mat­ed to occur around 5 days into the course of an infec­tion, around the time the viral pop­u­la­tion in the throat peaks. Around this time, an infec­tion often starts affect­ing the lungs. If lung involve­ment remains mild, it will start to reverse after a few days; if it results in pneu­mo­nia, the lat­ter will either heal up with­in one to two weeks or progress rapid­ly to severe disease.

Dr. Davidson, for his part, remind­ed of a sci­en­tif­ic study that had shown that even com­plete­ly healthy peo­ple do aspi­rate flu­id from the nose or throat to the lungs dur­ing sleep.

Combined, these find­ings sig­ni­fy that, in the case of a Coronavirus infec­tion, peo­ple can be expect­ed to even­tu­al­ly aspi­rate flu­ids with large viral loads from their throats into their lungs, even­tu­al­ly over­whelm­ing the body’s pro­tec­tive mech­a­nisms. Importantly, this can hap­pen, accord­ing to the data pro­vid­ed by Professors Drosten and Wendtner, even before the infect­ed expe­ri­ence sig­nif­i­cant rec­og­niz­able symptoms.

Adding to this the immuno­log­i­cal com­mon­place that a suc­cess­ful immune response to a path­o­gen­ic attack is in large part a ques­tion of quan­ti­ty – sim­ply put: how many pathogens col­lide with how many immune cells – the log­i­cal con­clu­sion to be drawn is that in order to avoid falling seri­ous­ly ill from a Coronavirus infec­tion, if not to avoid what can be called an infec­tion at all (pathogens are present in the throat at all times, but nor­mal­ly in man­age­able quan­ti­ties), the (poten­tial) viral pop­u­la­tion in the throat must be active­ly min­i­mized by all suit­able means at our dis­pos­al. This means pre­vent­ing the virus from pop­u­lat­ing the throat in sig­nif­i­cant quan­ti­ties in the first place, and rad­i­cal­ly sup­press­ing any virus pop­u­la­tion that may have devel­oped in the throat by reg­u­lar­ly employ­ing dis­in­fec­tants with known sig­nif­i­cant antivi­ral capa­bil­i­ties against the nov­el Coronavirus, and which are safe to use in the throat. This should, in most cas­es, ensure that we can safe­ly bridge the time span the immune sys­tem requires to ulti­mate­ly gain the upper hand against the virus and pro­vide us with long term immunity.

While this appears to pri­mar­i­ly help the indi­vid­ual to win his per­son­al bat­tle against the Coronavirus, it at once helps win­ning the war in gen­er­al. Since evi­dence at least indi­rect­ly sug­gests that infec­tions pre­dom­i­nant­ly occur via micro­scop­ic flu­id drops trans­mit­ted from an infect­ed per­son over the air, through speak­ing and cough­ing, a dras­ti­cal­ly sup­pressed viral load in the throats of infect­ed peo­ple, whether they show symp­toms or not, reduces the risk of virus trans­mis­sion, slow­ing and even­tu­al­ly even halt­ing its spread.

In this arti­cle, we will address the issue in these quan­ti­ta­tive and prac­ti­cal aspects. In a fol­low-up arti­cle we plan to address the ques­tion of who is espe­cial­ly vul­ner­a­ble and should there­fore observe (in part poten­tial­ly with help from oth­ers) the pre­cau­tion­ary mea­sures of con­tact avoid­ance as well as min­i­miza­tion of the viral load in the throat with extreme rig­or, and who is rather unlike­ly to devel­op severe disease.

What to do

Of course: avoid expo­sure, espe­cial­ly via inhala­tion, and wash your hands. But, as men­tioned, you can and should seri­ous­ly con­sid­er to do more:

Gargle with hydro­gen per­ox­ide at a con­cen­tra­tion of 1 % for 60 sec­onds (in case this seems long to do in one go, con­sid­er that you can do 4 times 15 sec­onds or 6 times 10 sec­onds). Do not swal­low the solu­tion, but spit it out after gargling.

How often?

One to a max­i­mum of four times a day. The most impor­tant – and nor­mal­ly only – time to do it is before going to sleep to min­i­mize the viral load that may be aspi­rat­ed into the lungs dur­ing sleep. 

When? In what circumstances?

  1. Once a day before going to bed as a pre­ven­tive mea­sure, even if you do not expect to have been infect­ed yet.
  2. Since you may be infect­ed even with­out expe­ri­enc­ing symp­toms, you should do it before an unavoid­able inter­ac­tion with vul­ner­a­ble per­sons, before vis­it­ing a doctor’s office or pos­si­bly to pre­vent trans­mis­sion gen­er­al­ly if you have to go out, but not more than 4 times a day and not in case your mucosa in the mouth feels irri­tat­ed or burn­ing. DO NOT DISREGARD THE SOCIAL DISTANCING MEASURES WHILE THEY ARE STILL IN FORCE. What we sug­gest here is an addi­tion­al safe­ty mea­sure in and after sit­u­a­tions where you can­not avoid con­tact with oth­ers, pri­mar­i­ly the espe­cial­ly vulnerable.
  3. Of course, in order to dimin­ish the risk of get­ting infect­ed your­self, you should equal­ly do it as soon as pos­si­ble after com­ing in con­tact with many dif­fer­ent peo­ple or with peo­ple who are infect­ed or show any signs of pos­si­bly being infected.
  4. If you have symp­toms or are test­ed pos­i­tive­ly, do it to min­i­mize viral load, but not more often than four times a day.

Who?

Generally every­one, but not chil­dren, even if you sup­pose they could be excep­tion­al­ly vul­ner­a­ble (which typ­i­cal­ly they are the least to be), and not if you can­not coor­di­nate gar­gling with­out swal­low­ing the mouth­wash.

Be care­ful and always use the right con­cen­tra­tion. Probably you will find the hydro­gen per­ox­ide in a 3 % or 6 % con­cen­tra­tion. Dilute it with water to arrive at 1% (case 3% com­bine one part hydro­gen per­ox­ide with two parts water, case 6% com­bine one part with 5 parts water). If the mucosa does feel sig­nif­i­cant­ly irri­tat­ed, you could fur­ther dilute it to 0.5 % (com­bine 1 part 1 % solu­tion and 1 part water). In case you choose to use anoth­er sub­stance, fol­low the respec­tive instruc­tions, nev­er sup­pose that more works bet­ter! The Chinese lady who pur­port­ed­ly ate 1.5 kg of gar­lic seri­ous­ly dam­aged her body.

In addi­tion:

  1. Dr. Davidson advis­es to “wash your hands and face well with soap and warm water, includ­ing — on a fin­ger — a quar­ter-inch into each nos­tril. Then gen­tly blow your nose. DON’T use those irri­gat­ing devices, like neti pots, that might force virus fur­ther inside! Brush your teeth and tongue, swish and spit, and gar­gle once or twice with an anti­sep­tic mouth­wash. Limit seda­tion before sleep dur­ing an epi­dem­ic [alco­hol, sleep­ing pills].” (The “don’t use irri­gat­ing devices” sup­pos­es that you have just caught the virus and it is still in your nos­tril and you don’t want to do any­thing to bring the virus from there to the place where it best can repli­cate, the deep throat; apply this thought to your own situation.)
  2. Regarding the mouth­wash, which Dr. Davidson does not spec­i­fy (this could mean that in his view an OTC drug store mouth­wash labelled “anti­sep­tic” is suf­fi­cient if you clean the mouth as he pro­pos­es), mea­sure a small mouth­ful of the dilut­ed solu­tion (ca. 10-20 ml), take it into your mouth and tilt your head back. Gargle and swish the mix­ture around in your mouth for 60 seconds.
  3. Spit the solu­tion out after gargling.
  4. If used appro­pri­ate­ly in the pro­posed con­cen­tra­tion, major side effects are rare, even when swal­lowed, but red­ness and irri­ta­tion of the gums can hap­pen yet should go away after a few hours. Do not use it again on irri­tat­ed mucosa. In the improb­a­ble case that this becomes a major prob­lem, lim­it it main­ly to the throat or switch to anoth­er substance.

To facil­i­tate a some­what deep­er con­tex­tu­al under­stand­ing of what we sug­gest, in the remain­ing part of this arti­cle we will pro­vide some addi­tion­al as well as more detailed infor­ma­tion on

  • why wash­ing and dis­in­fect­ing the mouth can pre­vent pneu­mo­nia and why to do it espe­cial­ly before going to bed,
  • which oth­er mouth­wash options exist and what viral reduc­tions you can expect,
  • what else you could do to min­i­mize viral load in the throat.

Why washing and disinfecting the mouth can prevent pneumonia and why to do it especially before going to bed

Dr. Davidson points to a find­ing that prob­a­bly all nor­mal peo­ple will have aspi­rat­ed throat con­tent by the end of a giv­en week and that this is the way pneu­mo­nia usu­al­ly devel­ops. (There are many stud­ies demon­strat­ing suc­cess­ful pre­ven­tion of pneu­mo­nia by using mouth­wash in the ICU setting.)

Chances of aspi­ra­tion of big­ger amounts are even high­er if the sleep is deep­er, such as after tak­ing a sleep­ing pill or a cou­ple of beers or shots, or in old­er peo­ple who have swal­low­ing coor­di­na­tion prob­lems, or in the case of lung dam­age due to smoking.

All of which is why, in addi­tion to thor­ough­ly wash­ing one’s hands, face and nos­trils with warm water and soap, brush­ing one’s teeth and tongue, swish­ing and spit­ting, Dr. Davidson rec­om­mends to gar­gle once or twice with an anti­sep­tic mouthwash.

What other mouthwash options are there and what viral reductions can you expect

But what mouth­wash? Any mouth­wash with the label ‘anti­sep­tic’?

We are obvi­ous­ly look­ing for an anti­sep­tic mouth­wash that is known or at least log­i­cal­ly like­ly to be effec­tive against the nov­el Coronavirus, and that, impor­tant­ly, is not known to do any harm.

What mouthwash is effective against the Coronavirus?

Of the sub­stances that Kampf et al. report to be effec­tive against the nov­el Coronavirus, the fol­low­ing except ethanol are used dur­ing den­tal pro­ce­dures or to pre­vent pneu­mo­nia dur­ing a stay at the inten­sive care unit, they have been used for many decades also at home, are read­i­ly avail­able and seem suf­fi­cient­ly safe:

Hydrogen per­ox­ide, min. 60 % ethanol and povi­done iodine are very effective,

Chlorhexidine is report­ed to be less effec­tive, but for the respec­tive study a much small­er dose was used than the usu­al one which had already been shown to be effec­tive against coat­ed virus­es such as the Coronavirus.

Are the pro­posed anti­sep­tics able to pre­vent the Coronavirus from pop­u­lat­ing the throat in sig­nif­i­cant quantities?

Hydrogen per­ox­ide 0,5 %, min. 60 % ethanol and povi­done iodine can all reduce a Coronavirus strain after 1 minute by more than 4 orders of mag­ni­tude (Kampf et al.). 

This means that the aver­age virus RNA load per swab mea­sured by Professors Drosten and Wendtner dur­ing the first 5 days of 6.76×10^5 (max­i­mum: 7.11X10^8 copies/swab) would be reduced to 70 copies (resp. 70000 max­i­mum). Interestingly, they found that virus iso­la­tion suc­cess also depend­ed on viral load: sam­ples con­tain­ing <10^6 copies/ml nev­er yield­ed a “liv­ing” infec­tious virus.

This means that after a mouthrinse/gargle, viral trans­mis­sion as well as aspi­ra­tion of infec­tious mate­r­i­al to one’s own lungs can be expect­ed to be dras­ti­cal­ly minimized.

  1. Hydrogen per­ox­ide. The effec­tive con­cen­tra­tion of 0,5 % is rel­a­tive­ly small, 1 % is com­mon for a med­ical gar­gle solu­tion to be used up to 3 times a day. Generally, it does not pose any longterm risk, but of course it can be harm­ful if not used appro­pri­ate­ly, in order to not harm good oral bac­te­ria avoid using it more than once a day for a longer duration.
  2. Povidone iodine is regard­ed as a good option but can be harm­ful if one has thy­roid prob­lems or an aller­gy against it.
  3. 60 % ethanol is not used in clin­i­cal settings/trials as a mouth­wash, one would prob­a­bly have to mix it by com­bin­ing alco­hol in high con­cen­tra­tion with pure (96%) ethanol. I tried it myself so see how it feels (burn­ing!), after a friend of mine, a doc­tor and depart­ment head in a German hos­pi­tal, told me that she had told her par­ents, liv­ing in an east­ern European coun­try where anti­sep­tics were soon out of sup­ply, to use their self-burnt vod­ka hav­ing a 60 % con­cen­tra­tion for hand dis­in­fec­tion and tak­ing a good swal­low of it in the mouth when unsure about poten­tial infec­tious con­tacts, espe­cial­ly when hav­ing to leave their home. Interestingly, the idea of mouth dis­in­fec­tion was per­fect­ly nat­ur­al to her just from her clin­i­cal under­stand­ing of a viral pneu­mo­nia and the Coronavirus, just as every sin­gle oth­er med­ical prac­ti­tion­er I have so far spo­ken to said that this was a good idea. Interestingly, also, my friend, hav­ing advised her par­ents on mouth dis­in­fec­tion, did not apply it to her­self, telling me: “I would not know how often to do it dur­ing the day as I am exposed to infect­ed patients all the time; I just have to some­how get through it.” It is, of course, bet­ter to do it four times a day than not at all, and it should not be nec­es­sary at all to to it after every sin­gle patient contact.
  4. Another sub­stance used as a gar­gle dur­ing den­tal pro­ce­dures and to pre­vent pneu­mo­nia in a hos­pi­tal set­ting is chlorhex­i­dine in a con­cen­tra­tion of 0,12 per­cent. In this con­cen­tra­tion it seems to gen­er­al­ly have a good killing activ­i­ty against coat­ed virus­es but was only test­ed against coro­na virus­es in a con­cen­tra­tion of 0.02 per­cent and in this con­cen­tra­tion found to be less  effective.
  5. There is also evi­dence that the Listerine anti­sep­tic, a com­mon mouth­wash, prob­a­bly has antivi­ral activ­i­ty against coat­ed RNA virus­es (such as the nov­el Coronavirus which was not test­ed specif­i­cal­ly). So before doing noth­ing, this may be an alter­na­tive (and pos­si­bly con­gru­ent to Dr. Davidson’s unspe­cif­ic protocol).

In sum­ma­ry, we sug­gest to use 1 % hydro­gen per­ox­ide. Interestingly, such a rinse is a recent “com­mon sense rec­om­men­da­tion” by a den­tists’ asso­ci­a­tion to request of patients before each appoint­ment in order to pre­vent Coronavirus trans­mis­sion (if you fol­low the link above, under “Coronavirus Frequently Asked Questions” click on “Questions regard­ing coro­n­avirus, the virus which caus­es COVID-19”; the rec­om­men­da­tion we cite is the sec­ond to last and has since been updat­ed to read “1,5 %” instead of “1 %”).

What we do additionally

We per­son­al­ly do take small nuggets of very dark choco­late (90 % cocoa) in our mouths, place them between our teeth and our cheeks and just let them melt there, with­out active­ly swal­low­ing the melt­ed choco­late, to let it cov­er the mucosa, help­ing to counter the con­tin­u­ous viral attacks orig­i­nat­ing from our small chil­dren. This was dis­cussed by med­ical doc­tors (who had tried it on them­selves) in a pro­fes­sion­al online dis­cus­sion board as being suc­cess­ful in com­bat­ing a run­ning nose and cough­ing. According to our expe­ri­ence, it helps best (and prob­a­bly only) at the onset of the very first symp­toms of a throat infec­tion (sore throat).

Conclusion

Based on new sci­en­tif­ic data (the virus repli­cates mas­sive­ly in the throat before and dur­ing the first 5 days after symp­toms appear; there is viral leak from the throat into the lung) as well as the long-estab­lished under­stand­ing of how pneu­mo­nia, the severe COVID 19 com­pli­ca­tion, ini­ti­ates (via aspi­ra­tion), in order to both indi­vid­u­al­ly as well as sys­tem­i­cal­ly min­i­mize the Coronavirus impact, we pro­pose ded­i­cat­ed throat dis­in­fec­tion as described in this arti­cle as a pre­ven­ta­tive as well as a treat­ment mea­sure. Prevention of pneu­mo­nia and pre­ven­tion of viral dis­ease trans­mis­sion by dis­in­fec­tion of the mouth with anti­sep­tic solu­tions are com­mon prac­tice and regard­ed by med­ical prac­ti­tion­ers as a “com­mon sense rec­om­men­da­tion” (again, if you fol­low the link, under “Coronavirus Frequently Asked Questions” click on “Questions regard­ing coro­n­avirus, the virus which caus­es COVID-19”; the rec­om­men­da­tion we cite is the sec­ond to last and has since been updat­ed to read “1,5 %” instead of “1 %”).

Update:

Van Doremalen et al. con­clude in a paper pub­lished today, March 17, 2020, in the NEJM (Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1), DOI: 10.1056/NEJMc2004973:

“We found that the sta­bil­i­ty of SARS-CoV-2 was sim­i­lar to that of SARS-CoV-1 under the exper­i­men­tal cir­cum­stances test­ed. This indi­cates that dif­fer­ences in the epi­demi­o­log­ic char­ac­ter­is­tics [high­er trans­mis­sion of SARS-CoV-2] of these virus­es prob­a­bly arise from oth­er fac­tors, includ­ing high viral loads in the upper res­pi­ra­to­ry tract and the poten­tial for per­sons infect­ed with SARS-CoV-2 to shed and trans­mit the virus while asymptomatic.”

This con­firms that it appears high­ly advis­able that every­one seek to sub­stan­tial­ly reduce the (poten­tial or actu­al) high viral load in his throat on a reg­u­lar basis in the way described above.

Update 2:

Xi He et al. report on an exten­sive study con­duct­ed in Hong Kong, post­ed to doi.org on March 18, 2020 and since updat­ed (“Temporal dynam­ics in viral shed­ding and trans­mis­si­bil­i­ty of COVID-19”), doi: https://doi.org/10.1101/2020.03.15.20036707:

“We report tem­po­ral pat­terns of viral shed­ding in 94 lab­o­ra­to­ry-con­firmed COVID-19 patients and mod­elled COVID-19 infec­tious­ness pro­file from a sep­a­rate sam­ple of 77 infec­tor-infectee trans­mis­sion pairs. We observed the high­est viral load in throat swabs at the time of symp­tom onset, and inferred that infec­tious­ness peaked on or before symp­tom onset. We esti­mat­ed that 44% of trans­mis­sion could occur before first symp­toms of the index.”

This fur­ther con­firms that the ini­tial and there­fore pri­ma­ry bat­tle­field in the case of COVID-19, unlike with SARS 2003, is the throat, with the infec­tion mov­ing fur­ther down into the lung – even­tu­al­ly caus­ing pul­monary inflam­ma­tion – only at a lat­er stage.

So again, pre­ven­tive­ly dis­in­fect­ing the throat in the way we describe above should most­ly resolve the prob­lem as it (1.) slows the devel­op­ment of a pos­si­ble infec­tion, if not sup­press­ing it out­right, to the point where the immune sys­tem is giv­en the nec­es­sary time to devel­op a sus­tained response; and (2.) dras­ti­cal­ly reduces infectiousness.

Update 3:

It has come to our atten­tion that one clin­i­cal tri­al pre­sum­ably test­ing what we have pro­posed in our arti­cle is report­ed to have been reg­is­tered with the World Health Organization. The “Type of med­i­cine” is spec­i­fied as “Hydrogen per­ox­ide”, and the hypoth­e­sized “mech­a­nism of action” is spec­i­fied as “Non-spe­cif­ic sup­posed antivi­ral action in the throat”.

Update 4:

We have now estab­lished that the tri­al referred to in Update 3 is being con­duct­ed in Guangdong, People’s Republic of China.

The tri­al design appears to pro­vide that only patients who have already devel­oped pneu­mo­nia are includ­ed in the study. Instead of focus­ing on com­bat­ing COVID-19 induced pneu­mo­nia, how­ev­er, the study’s stat­ed intent is only “to deter­mine whether the nov­el coro­n­avirus exists in the oral envi­ron­ment, and dis­cuss the trans­mis­sion route of the virus and the influ­ence of oral gar­gle on the virus, to pro­vide ref­er­ence for the ear­ly diag­no­sis of COVID-19 and the pre­ven­tion and con­trol of infec­tion dur­ing the clin­i­cal diag­no­sis and treat­ment of oral cavity.”

We insist that deci­sive empha­sis should be put on employ­ing gar­gling with a solu­tion of hydro­gen per­ox­ide as a pre­ven­tive mea­sure, or at least as ear­ly as pos­si­ble in the course of an infec­tion. Once pneu­mo­nia has devel­oped in the absence of such pre­ven­tion, a reg­u­lar gar­gle in the way we have described in detail in this arti­cle should still help pre­vent the soil­ing of addi­tion­al lung regions or rein­fec­tion, alle­vi­at­ing dis­ease and win­ning poten­tial­ly deci­sive time for the immune sys­tem to devel­op its response.

Update 5:

The con­clu­sion that the authors of the study con­duct­ed in Hong Kong (see update 2) have drawn from their find­ings regard­ing prob­a­ble presymp­to­matic trans­mis­sion of the virus have been fur­ther cor­rob­o­rat­ed by a study done in Singapore.

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Logic is all about relating individual pieces of information in a consistent way. “Consistent” means non-contradictory. An apparent tendency of two pieces of information to appear inconsistent calls for express differentiating clarification, with the logically required depth of differentiating discussion depending on the extent to which both pieces of information appear similar.
We had expressed ourselves confident to be able to predict the outcome of the 2020 US presidential election with a high degree of confidence based on financial market behavior. What we figured out – with the highest degree of confidence – was that we were maximally uncertain about the outcome (keeping us in silent consternation). Which in hindsight would appear exactly as the correct assessment to have been made.

This Post Has 13 Comments

  1. Elaine M

    Please clar­i­fy the use of the word “aspire” ear­ly in the article.

    1. loico

      Thank you very much for your com­ment, as it leads toward an inter­est­ing lit­tle piece of insight into how the human brain func­tions, and how and why it can malfunction:

      1. 1. One has active­ly used the German word “aspiri­eren” maybe a thou­sand times in the hos­pi­tal set­ting, espe­cial­ly the inten­sive care unit, and heard it utter by oth­ers about as or even more often.
      2. 2. One has read the English word “aspi­rate” (inhale) in the spe­cial­ist and sci­en­tif­ic lit­er­a­ture only maybe dozens of times.
      3. 3. The use of “aspire” occurs much more fre­quent­ly in the English lan­guage than the use of “aspi­rate”.

      Now it appears that the greater sim­i­lar­i­ty of “aspiri­eren” to “aspire” ver­sus to “aspi­rate” “over­rules” said read­ing expe­ri­ence, equal­ly stored in the cor­tex, upon infor­ma­tion retrieval, at least when at a severe lack of sleep while work­ing on an extreme­ly urgent mat­ter such as the Coronavirus pandemic.

      Error cor­rect­ed, thank you again!

  2. Luke

    Greetings!

    Thank you for your insight.

    I have 3 questions:

    1. Forgive me if I have mis­un­der­stood this but cur­rent­ly from what I’ve been able to gath­er from your text is that while the the­o­ret­i­cal foun­da­tion has been laid down by the 2 pro­fes­sors you men­tion, the ”log­i­cal con­clu­sion” extrap­o­lat­ed from this foun­da­tion you talk about was made entire­ly by you, ergo the 2 pro­fes­sors nev­er talked or writ­ten about gar­gling per­ox­ide etc? Can you please clar­i­fy this?

    2. Wouldn’t this rig­or­ous dis­in­fec­tion of the throat harm and weak­en the throat’s mucosa (and the good bac­te­ria for that mat­ter) mak­ing the virus’s path into the low­er res­pi­ra­to­ry tract prac­ti­cal­ly unopposed?

    3. You men­tion that hydro­gen per­ox­ide 1% should not be used more than once a day for a longer dura­tion in order to not harm good oral bac­te­ria. So for how long do you esti­mate can we use it for up to 4 times a days before we have to low­er the fre­quen­cy down to only once per day?

    Don’t want to under­mine you, I would like your (or professor’s the­o­ry 😉 ) to be suc­cess­ful just as the next guy but before I actu­al­ly start doing this and advise oth­ers to do, I need answers on the above questions 🙂

    Thank you.

    Regards,
    L

    1. loico

      Thank you for your questions!

      1. The log­i­cal con­clu­sion is ours. Dr. Davidson, whose CNN arti­cle we cite exten­sive­ly, being a pul­mo­nolo­gist and high­ly respect­ed expert author in his field, advis­es some­thing very sim­i­lar, based on his under­stand­ing of the mat­ter. We are in pri­vate com­mu­ni­ca­tion with him, which may lead to an update of our arti­cle to the effect that the use­ful range of appli­ca­tion of what we have sug­gest­ed is even more broad than pre­vi­ous­ly seen. – The pro­fes­sors whose find­ings we cite are virol­o­gists, and Prof. Drosten has pub­licly stat­ed that his clin­i­cal expe­ri­ence is “lim­it­ed” and that he feels “uncom­fort­able” hav­ing been pushed into the spot­light in this emer­gency the way he has been. Experimental results and sta­tis­ti­cal eval­u­a­tion, rep­re­sent­ing the “hard” facts (con­sid­er that the “p” in “p-val­ue” does, “in fact” as it were, not stand for “fact” but for “prob­a­bil­i­ty”), are all ground­ed in log­i­cal delib­er­a­tion (on how to design an exper­i­ment aso.); inter­pre­ta­tion of exper­i­men­tal results as well as the act of mean­ing­ful­ly relat­ing them to oth­er such results rely on log­ic only, so log­ic is, indeed, the supreme arbiter in all of sci­ence; “in fact”, log­ic is real­ly all we have. And we may still get it wrong, which is why we have stat­ed in our “Welcome” text that “the biggest favor loico can ask of its read­ers and view­ers is … to doubt and dissent.”

      2. We have stat­ed in our arti­cle that this should typ­i­cal­ly not be the case, giv­en avail­able evi­dence and decades of clin­i­cal expe­ri­ence in ICUs, at least not when done once a day as a pre­ven­tive mea­sure. Specifically for this arti­cle, we have ana­lyzed a com­plex body of evi­dence that, tak­en togeth­er, indi­cates that oral flo­ra and par­tic­u­lar­ly nitrate pro­duc­ing bac­te­ria can not be expect­ed to be com­pro­mised by a once-a-day dis­in­fec­tion in any sig­nif­i­cant way. – If the good bac­te­ria were by them­selves suf­fi­cient­ly pow­er­ful to con­trol this kind of infec­tion, as it could seem you imply, we would all be going about our nor­mal busi­ness now instead of hav­ing to deal with the COVID-19 pan­dem­ic. Consider, also, that it is always also a ques­tion of quan­ti­ty. Nothing against the good bac­te­ria; loico is, when it comes to per­son­al health, all about min­i­miz­ing out­side inter­ven­tions into the unbe­liev­ably well-orga­nized human body. But there are sit­u­a­tions where out­side assis­tance is need­ed to help our organ­ism regain full autonomous control.

      3. As stat­ed, we con­sid­er it advis­able to do it once a day before going to sleep for self-pro­tec­tion, more often only as an excep­tion. Our clin­i­cal under­stand­ing is that even doing it more than once a day just for the lim­it­ed dura­tion of the pan­dem­ic should typ­i­cal­ly not cause any prob­lems worth men­tion­ing. “Typically” does not guar­an­tee, of course, that none will occur. As always in chaot­ic sys­tems such as the human organ­ism, all we have is prob­a­bil­i­ty to always try and obtain the best pos­si­ble risk/reward ratio (unlike­ly yet pos­si­bly irri­tat­ed mucosa ver­sus pos­si­ble devel­op­ment of severe pneu­mo­nia pos­si­bly lead­ing to death).

  3. Luke

    Thank you for exten­sive clar­i­fi­ca­tion 🙂 Keep up the good job!

  4. Luke

    Just one more ques­tion – I was googling and found noth­ing of use, per­haps you know some­thing or can use one of your pri­vate con­nec­tions to per­haps get the infor­ma­tion, I would be very grateful 🙂

    Is hydro­gen per­ox­ide 1% gar­gle once per day allowed in 2nd/3rd trimester pregnancy?

    Thanks,
    Luke

    1. loico

      Hydrogen per­ox­ide is com­plete­ly harm­less for preg­nant women and does not harm the baby at all. Hydrogen per­ox­ide is a nat­ur­al sub­stance that the body pro­duces itself to defend itself against virus­es and bac­te­ria, and which decom­pos­es into oxy­gen and water. The oxy­gen oxi­dizes and thus destroys the pro­tein shell of the virus­es and also irri­tates the mucous mem­brane local­ly, which how­ev­er can regen­er­ate well, the dam­ag­ing effect on the oral flo­ra / bac­te­ria is min­i­mal and only to be expect­ed with sev­er­al times dai­ly and long-term use.

  5. Kathy LeCompte

    Gargling with a solu­tion of hydro­gen per­ox­ide sounds easy enough to do, but as soon as any CDC offi­cial or any oth­er health pro­fes­sion­al sug­gests this over the air waves, sure­ly some peo­ple, ( espe­cial­ly hoard­ers ) and oth­er pan­ic-prone indi­vid­u­als will flock to their near­est drug store or super­mar­ket and clean the shelves off leav­ing none for any­one else.

    1. loico

      For the moment at least, it seems that a very well known online retail­er, which we will obvi­ous­ly not name, still has hydro­gen per­ox­ide in stock. And then there is still the alco­hol option, as well as the oth­er options we have mentioned.

  6. Ralph Raschen

    Hello every­body,

    Is any­body of you aware of this: http://www.drwlc.com/blog/2020/03/21/hydrogen-peroxide-nebulizer-to-treat-covid-19-infection/

    SAME thing, only by use of a neb­u­liz­er, so that it gets direct­ly into the lungs (and also dis­in­fects the nose and mouth (and the blood and what not…), as it seems…

    Please read it!

    Random quote:

    “The treat­ment is known as neb­u­lized hydro­gen per­ox­ide, and Dr. Shallenberger began using the tech­nique some years ago when he had a patient who was tak­ing asth­ma med­ica­tion that her doc­tor had been admin­is­ter­ing in a neb­u­liz­er. For those who are unfa­mil­iar, a neb­u­liz­er is a device that is able to con­vert a liq­uid into tiny, micro­scop­ic bub­bles. As a result, these extreme­ly small bub­bles, which appear as smoke escap­ing from the neb­u­liz­er, can be inhaled into the deep­est regions of the lungs with­out any dis­com­fort or irri­ta­tion. Such a device has long been uti­lized for asth­mat­ics to get med­ica­tion to open their lungs, but Shallenberger fur­ther noticed that neb­u­liz­ers have a sys­temic effect, which is deliv­ery far beyond the lungs only. According to one of Dr. Shallenberger’s patients, the inhala­tion of her pre­scribed drug in the neb­u­liz­er was ‘unbe­liev­ably strong,’ and ‘affect­ed her entire body.'”

    I have been tweet­ing about this (as well as on the method described on this site) at @bendettocom, but there has not been much res­o­nance, so far…

    1. loico

      Thank you for your com­ment Bendetto ( and a warm wel­come to loico where we appre­ci­ate such spir­it­ed play­ing with names 😉 ), you make us aware of the prob­lem that peo­ple might think “that’s the same thing” just because we pro­pose the use of hydro­gen per­ox­ide as one pos­si­ble potent antivi­ral agent able to inac­ti­vate Coronaviruses in a con­cen­tra­tion of 0.5% (used by Kampf et al., we said 1 %) to 4 orders of magnitude.
      It is indeed some­thing very dif­fer­ent to expose the whole sur­face of the lung (size of a ten­nis court) or the whole body by iv injec­tion to a poten­tial­ly irri­tat­ing sub­stance or only the local mucosa of the throat.
      So called “alter­na­tive ther­a­py” of iv injec­tion of hydro­gen per­ox­yde has lead to sev­er­al deaths:

      • Hirschtick RE, Dyrda SE, Peterson LC. Death from an uncon­ven­tion­al ther­a­py for AIDS. Ann Intern Med 1994; 120: 694
      • Leikin J, Sing K, Woods K. Fatality from intra­venous use of hydro­gen per­ox­ide for home ‘super­ox­y­gena­tion ther­a­py’. Vet Hum Toxicol 1993; 35: 342
      • Jordan KS, Mackey D, Garvey E. A 39-year-old man with acute hemolyt­ic cri­sis sec­ondary to intra­venous injec­tion of hydro­gen per­ox­ide. J Emerg Nurs 1991; 17: 8–10

      We do explain why it is ben­e­fi­cial to min­i­mize viral load specif­i­cal­ly in the throat in case of an infec­tion where the virus repli­cates ini­tial­ly mas­sive­ly in the throat before the dis­ease pro­gress­es in a minor­i­ty of cas­es to pneu­mo­nia (mean­ing mas­sive viral repli­ca­tion in the lung and sub­se­quent local and sys­temic inflam­ma­tion with microthrom­bi in lung microblood­ves­sels, even­tu­al­ly lung dys­func­tion). We explain why dis­in­fect­ing the throat espe­cial­ly before going to bed is ben­e­fi­cial. Maybe we should addi­tion­al­ly make clear that inhala­tion into the lungs is some­thing very dif­fer­ent than gar­gling or desin­fect­ing by com­mer­cial­ly avail­able anti­sep­tic mouth­sprays or swab­bing the throat as done in inten­sive care units or nurs­ing homes.
      Inhalation of the same sub­stance as pro­mot­ed with a lot of false argu­ments by the web­site you cite is not a solu­tion but can lead to severe tox­ic lung dys­func­tion, even death, in peo­ple who fol­lowed this advice by web­sites full of adver­tise­ments and sim­ple solu­tions to com­plex prob­lems with no sci­en­tif­ic back­ground, just names of doc­tors and sto­ries (Here an exam­ple that sounds pecu­liar­ly close to the one you cite of how doing what this web­site pro­pos­es can in fact go very bad­ly wrong: https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2015.191.1_MeetingAbstracts.A1537). A search in the sci­en­tif­ic data­base pubmed reveals that work­ers in the pack­ag­ing indus­try who inhale hydro­gen per­ox­ide (https://pubmed.ncbi.nlm.nih.gov/3195819/, https://onlinelibrary.wiley.com/doi/abs/10.1539/joh.44.433 ) or ani­mals who inhale it when dis­in­fec­tion is done in their pres­ence (https://www.st-va.ncbi.nlm.nih.gov/pmc/articles/PMC4549891/) can become very sick prob­a­bly because the cil­i­at­ed epithe­lial cells of the bronchi and low­er air­way cells have become severe­ly inflamed by the oxy­gen rad­i­cals. Of course this is con­cen­tra­tion depen­dent with very low con­cen­tra­tions being regard­ed as safe for work­ers (https://www.sciencedirect.com/science/article/abs/pii/S0378427412011502).
      Inhalation is dif­fer­ent to gar­gling and may lead to severe inflam­ma­tion, the oppo­site of what is intended.
      Gargling and mouth­wash or spray­ing or swab­bing the throat with dis­in­fect­ing solu­tions is safe and the local mucosa can regen­er­ate from the pos­si­ble irri­ta­tion, even if a bit of the solu­tion is aci­den­tial­ly swal­lowed severe effects are not expect­ed (https://pubmed.ncbi.nlm.nih.gov/8667471/?dopt=Abstract).

  7. Ralph Raschen

    Thank you very much for mak­ing me aware that things might not be as sim­ple as I tend­ed to think – and even dangerous.

    I am not a doc­tor, I don’t think that I will have much time to dig much deep­er into this top­ic in the near future, so all that remains for me for now is to stress that in any case it’s not me who is oper­at­ing “with a lot of false argu­ments”, at least not on this page. 😉

    1. loico

      Thank you for point­ing to this ref­er­en­tial ambi­gu­i­ty, isn’t lan­guage amazing:

      “… as pro­mot­ed by the web­site [you cite] with a lot of false arguments …”

      ‘f course we didn’t mean you how would we 😉

      Reshuffled the sen­tence, hope this elim­i­nates any ambiguity.

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Logic is all about relating individual pieces of information in a consistent way. “Consistent” means non-contradictory. An apparent tendency of two pieces of information to appear inconsistent calls for express differentiating clarification, with the logically required depth of differentiating discussion depending on the extent to which both pieces of information appear similar.
We had expressed ourselves confident to be able to predict the outcome of the 2020 US presidential election with a high degree of confidence based on financial market behavior. What we figured out – with the highest degree of confidence – was that we were maximally uncertain about the outcome (keeping us in silent consternation). Which in hindsight would appear exactly as the correct assessment to have been made.
An Egyptian man takes a hostage at knifepoint in the Milan cathedral, threatening to slit his victim’s throat. A once reputable Italian paper tells its readers that police “convinced him to lay down his weapon and release the hostage”, when in fact, for everyone to see on video, police had to forcefully overwhelm him. The full and unredacted video, in turn, explodes on social media.