Authoritative guidance if possible on prophylaxis and early treatment would help.
Shyam Ponappa | May 7, 2021
For people outside the medical community with limited knowledge of medicine, there is a need for informed advice on preventives for Covid-19, if our experts know of any. We know of the advice to wear masks, maintain distance, and sanitise our hands. Beyond that, with all the information and opinion swirling in the press and the media, what exactly is one to do? Apart from the vaccination initiative and behaviour protocols, we need advice on possible preventives, and early-stage treatment. While it is a difficult call, the consideration of including preventives, if any are known, may help strengthen safety protocols (masking, distancing, and hand sanitisation), as would advice on early-stage treatment.
As lay people, we encounter information about possible preventives. Compiled information from a single, informed source on potential prophylactics, and efforts to evaluate possibilities, would help. If there are compounds known to be safe that might help, perhaps authorities could consider dissemination, instead of waiting for proof positive. If trials are to be designed and coordinated, these could be facilitated to the extent possible.
This is not a time to add to or expect more from our burdened healthcare system. Yet, their ability to advise and to facilitate trials may have no substitute. If the hope is that the private sector will step in, reflection on the investment of time, effort, cost, and risk compared with the profit potential suggests that may take much longer.
Possible preventives
Preventives seem to be under the radar in our defences against the virus. One is left wondering about their efficacy, or whether it is the difficulty in validation through trials that explains the apparent lack of promotion of preventives or early-stage treatments, as described below. Two possible candidates are povidone-iodine, known commonly by the brand name “Betadine”, and Ivermectin.
( a) Povidone-iodine, one brand being Betadine, is a formulation of iodine with a water-soluble polymer (povidone) that enables slow iodine release, resulting in greater effectiveness as a germicide and virucide, with no stinging or staining. There are exceptions, however, for people with thyroid problems, pregnant women, and those undergoing radioiodine therapy.
The Betadine site in the USA disclaims its efficacy against Covid-19.1 However, several recent studies show that povidone-iodine is an effective virucidal in the nose and mouth, including against the SARS-CoV-2.2 The citations below report virucidal activity against SARS-CoV-2, and reduction in the severity of early-stage infection by limiting the viral load.
Established practice and several studies confirm that povidone-iodine is effective and safe, excluding certain categories. Could this not be promoted as a possible prophylactic? With evidence, as in the citations below, barring compelling reasons to the contrary, the authorities could decide on its inclusion in our protocol.
(b) Ivermectin is in the protocol of the Uttar Pradesh health department for healthcare professionals as a preventive, and along with doxycycline for early-stage treatment. This is despite WHO’s statements not supporting its use. Ivermectin has been used for years all over the world to treat children and adults for roundworm and intestinal parasites, as well as for skin diseases such as scabies. If one or both are effective and generally considered safe with certain exclusions, could experts evaluate including these in preventive protocols? This would be in addition to vaccination, masking, distancing, and hand-sanitisation. If validation is required, the authorities could consider possibly facilitating trials.
[Added May 12, 2021: Real time meta analysis - Ivermectin - 54 studies:
Early-stage treatment
Apart from Ivermectin (to be considered), the ayurvedic practice of coconut oil “pulling”, or swishing/lavaging in the mouth, has undergone trials in the Philippines and Indonesia. Second, trials are reportedly under consideration here for an inhaled recombinant interferon. Virgin coconut oil has been studied by the Philippines for medicinal purposes for decades. Reports on its use for treatment against Covid-19 were published from late 2020. The two citations indicate their findings for [added later: prophylaxis as well as] early-stage treatment.3
Bolstering Immunity — Interferon Beta-1a (SNG001): In 2003, faculty members from the University of Southampton started a company, Synairgen, for drug discovery and biotechnology in respiratory diseases. In 2009, they developed an inhaled form of recombinant interferon beta-1a, SNG001, patented in the USA as IFN-beta. This was for people with asthma and with chronic obstructive pulmonary disease, who are especially susceptible to seasonal colds and the flu caused by coronaviruses such as the Severe Acute Respiratory Syndrome-Coronavirus (SARS-CoV), and the Middle East Respiratory Syndrome (MERS). SNG001 works by providing localised concentrations of the immune protein to strengthen a user’s defences.
Interferon beta-1a in injectable form has been in use since the 1990s for the treatment of multiple sclerosis. Subsequently, it was found to be effective against SARS-CoV, MERS, and recently, SARS-CoV-2. For acceptance in treating Covid-19, it must clear successive trials as must any medication. These are expensive, difficult, and time consuming. The difficulties beyond high costs include the availability of suitable candidates, trained professionals, and time. Trials are also often delayed because of staffing shortages, space-material-and-funding constraints, and reluctant or unavailable patients. Sometimes, trials are called off for reasons such as insufficient enrolment. These factors have delayed SNG001’s deployment so far, despite a good safety record.
Encouraging Phase 2 results were announced in mid-2020,4 but it has taken a year to get Phase 3 trials going in about 20 countries, aiming for over 600 patients. In India, the Subject Expert Committee is reportedly evaluating a proposal for clinical trials. Could this product be considered for immediate use under medical supervision?
Government-sponsored trials
The Philippines government has championed trials such as of virgin coconut oil, Ivermectin, and Melatonin.3 Their example is inspiring, although the small sizes detract from the potential gains. Perhaps our experts could consider whether Ivermectin as a preventive and for early-stage treatment needs validation through trials here, or could be included in our protocols.
It would help to have a public advisory on Betadine gargles and nasal spray if they are effective, and likewise for Ivermectin. If possible, advice on the early-stage use of inhaled corticosteroids (Ciclesonide or Budesonide) to protect the lungs and airways would also be very helpful.
Shyam (no space) Ponappa at gmail dot com
1: https://betadine.com/covid-19/
2: https://journalotohns.biomedcentral.com/articles/10.1186/s40463-020-00474-x;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7341475/;
https://pubmed.ncbi.nlm.nih.gov/32608097https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2770785
https://cnnphilippines.com/news/2021/4/16/virgin-coconut-oil-COVID-19-patients.html
4: https://clinicaltrials.gov/ct2/show/study/NCT04385095
