Containing the spread of COVID-19

All over the world various populations are more susceptible to COVID-19 because of poverty, over crowed housing and the disabled or elderly ill in medical or long-term care facilities. Living or working in any of these social conditions leads to increased risk of becoming infected and then spread COVID-19 to others in their homes and communities. COVID-19 is a novel respiratory virus that primarily infects the epithelial cells in the respiratory tract. The virus is transmitted by droplets or aerosols lodging in the  nasal and oral passages. The only known method to decrease the spread of a respiratory virus is quarantine, social distancing and personnel protective equipment for staff. A new novel method calls for the use of hypochlorous acid, a non-toxic antiseptic, in low concentration nasal/oral spays decreasing viral load and the spread of this disease to our families, friends and the community. 

Problem:

For COVID-19 the highest viral load increasing the risk of spread to others occurs when a person is asymptomatic or with mild symptom that are identified clinical symptoms or testing. The theses presumed or test positive patients are required to quarantine, usually at home, with the risk of spreading the disease with those living in the home or nearby primarily by droplet and aerosol of virus. This spread is more likely to occur in dense housing with limited air flow. This type of housing is also seen blighted areas affected by poverty and war in shantytowns and refugee camps all over the world. Containing this disease in these setting is extremely challenging.

Innovation: 

Our program would incorporate low concentration of hypochlorous acid (HOCL) spay to the nose/mouth lowering the viral load and thereby decrease further spread of COVID-19. This method has been used in studies for chronic infections of the sinuses and mouth and shown to be safe and effective against respiratory viruses. Our HOCL spray has a lower concentration of free chlorine than chlorinated water and HOCL is widely available for purchase or onsite manufacture. Using HOCL will decrease the spread of COVID-19 particularly in dense housing structures.  

 COVID-19 infection is primarily infects the mouth and nose, and if not killed by the innate immune system the virus invade these cells and begins to replicate and spread to the rest of the body. Since there is no known treatment for this viral infection we are dependent on our immune system to fight and kill the virus. HOCL occurs natural in our white blood cells (neutrophils) and kills viruses and bacteria. Studies have shown COVID-19 be easily spread by loud talking, sneezing or coughing. Our solution incorporates HOCL that is use in our immune system to decrease the viral load of COVID-19 in our mouth and nose.  Using HOCL spray along with quarantine and social distancing will help limit the spread of the pandemic virus. The HOCL used twice a day and as needed will decrease the COVID-19 viral load and decrease the chance of spreading the disease with no side effects.

COVID-19 pandemic is spreading world-wide in every continent. All people exposed to the virus are at risk for infection and some groups are at greater risk for serious infection and death. Many peoples are more susceptible to COVID-19 because of poverty, over crowed housing and the disabled or elderly ill in medical or long-term care facilities. 

HOCL is low cost can be diluted by trained personnel and widely distributed. This would be an interim measure before the development of safe and effective vaccines.

Both of our proposed trials include undeserved areas in the US and the world community. By controlling the spread of COVID-19 we would save many lives allowing these undeserved peoples to live their lives and hopefully to a better social and economic status.

The healthcare workers in both setting would in the future be able to use HOCL spray to lessen the chance of spreading COVID to their families, co-workers and  community.

There will be other out breaks of different respiratory viruses in the future  this novel prophylactic treatment could used to decrease the spread. 

All over the world various populations are more susceptible to COVID-19 because of poverty, over crowed housing and the disabled or elderly ill in medical or long-term care facilities. Living or working in any of these social conditions leads to increased risk of becoming infected and then spread COVID-19 or others in their homes and communities. 

COVID-19 pandemic is spreading world-wide in every continent. All people exposed to the virus are at risk for infection and some groups are at greater risk for serious infection and death. The use of disinfectants in the mouth creates a new dimension in controlling the spread of COVID. It may also will be applicable to other novel respiratory virus vincluding influenza. 

Other clinicians/researchers have proposed the antisepsis model to decrease the asymptomatic spread of COVID-19 and reviewed the use of low concentrations of HOCL, povidone iodine (POP-I) and NaOCL have been studied in oral and nasal sprays/rinse for chronic bacterial and viral infections.  HOCL have been used safely in similar previous studies and this would be the safest disinfectant for our proposed protocol-trial.

The use of disinfectants in the mouth has been report in studies on periodontal biofilm-plaque comparing sodium hypochlorite (NaOCL), hypochlorous acid (HOCL) and chlorhexidine. One study used low concentration HOCL (3.5 ppm) in nasal sprays significantly reduced the viral titers human rhinovirus (HRV). In another study oral low concentration of HOCL (3.5 ppm) was used and effective against bacteria and the influenza virus7. HOCL is an effective disinfectant on surface areas and is safe to use on food and other areas without human toxicity. HOCL has not been specifically test against SAR-COV-2 in vivo but has been shown in clinical trials to be viricidal in non-enveloped HRV and influenza virus and therefore should also decrease viral load in the mouth and nose of infected patients with SAR-COV-2. Low concentrations of povidone iodine (POP-I) as a nasal/oral rinse to decrease viral load has been recommended as a protocol for COVID-19. All of these disinfectants have some limitations. POP-I has the possibility of increasing increases serum iodine levels and is not recommended for those with thyroid disease. NaOCL is a safe disinfectant that has been used for over one hundred years but has only been used in one trial as a nasal irrigation. HOCL is used in wound and skin antiseptics and oral rinses for gingivitis. All three products have an after-taste and POP-I and NaOCL may temporarily stain the teeth. All three would require dilutions and individualized delivery method. Since POP-1 has the potential of excluding patients/staff with thyroid disease.

References

1.        Lukassen S, Chua RL, Trefzer T, et al.  SARS ‐CoV‐2 receptor ACE 2 and TMPRSS 2 are primarily expressed in bronchial transient secretory cells . EMBO J. 2020:1-15. 

2.        Xu R, Cui B, Duan X. Saliva : potential diagnostic value and transmission of 2019- nCoV. Int J Oral Sci. 2020;(March). 

3.        Wolfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Marcel A. Virological assessment of hospitalized patients with COVID - 2019. 2020:1-14.

4.        Galván M, Gonzalez S, Cohen CL, et al. Periodontal effects of 0.25% sodium hypochlorite twice-weekly oral rinse. A pilot study. J Periodontal Res. 2014;49(6):696-702. 

5.        Wu S, Lin J, Jiang R. Antibacterial Effect of Hypochlorous Acid Solution on Nasal Discharge from Patients with Chronic Rhinosinusitis. 2018;2018.

6.        Yu MS, Park HW, Kwon HJ, Jang YJ. The effect of a low concentration of hypochlorous acid on rhinovirus infection of nasal epithelial cells. Am J Rhinol Allergy. 2011;25(1):40-44. 

7.        Kim BJ, Kim YH, Jang TY. The Safety of Low Concentration Hypochlorous Acid as an Oral Gargle Solution and Its Anti-Microbial Effects. Korean J Otorhinolaryngol Neck Surg. 2011;54(6):403. 

8.        EPA. Hypochlorous acid 7681-52-9 Code of Federal Regulations Tolerance exemptions for active and inert ingredients for use in antimicrobial formulations . Presented at the:

9.       Raza T, Elsherif HS, Zulianello L, Plouin-Gaudon I, Landis BN, Lacroix JS. Nasal lavage with sodium hypochlorite solution in Staphylococcus aureus persistent rhinosinusitis. Rhinology. 2008;46(1):15-22.

One theory on how the HOCL solution works that it adds free chlorine to the local tissues enabling neutrophils to be activated and kills foreign invades such as COVID-19. It also can directly kill bacteria and virus on inanimate surfaces.

This is a new project and we are not using it at this time.

We have a one year goal to implement this new solution as quickly as possible because live may depend on it use. COVID-19 could have a second or third recurrence until we have vaccine for the world. In the next five years this could become a new standard to use in novel respiratory viral outbreaks 

We would need to carry out a clinical trial comparing HOCL ans normal saline trial in the US. We will also have complete supply chair to make the HOCL spray as needed.

We are hoping to get funding to implement this trial. We also hope the applying for the MIT Challenge will help publicize the need for the rapid development of this new therapy .

Three part time staff presently work on this project.

We are developing the infrastructure to set this project forward.

We are developing partnerships with the Syrian American Medical Society WHO, NIAID, CDC and US Military.

Since we are not for profit we would establish partnership with manufactures and other support companies to implement this project.

After establishing the effectiveness of the HOCL intervention we will seek other funding and grants to continue our work in Pandemic Nursing care models and treatments.