Could we help people Covid-19 Coronavirus infections by inserting a flexible device emitting far Ultraviolet-C light in their mouth? A simple form of this device shines far-UVC into the oral cavity, throat, tonsils and upper trachea. A more complex form could be a Bronchoscope-like tube that light up bronchial passages in their lungs, as well as areas in their mouth, throat and trachea colonised by the viral infection. Killing viral particles, as well as cells infected by the virus, in the throat, tonsils and trachea would lower the viral load the immune system must fight. It would also help prevent pneumonia from secondary bacterial infections.
Continuous low doses of far Ultraviolet-C (far- UVC) light are safe to human tissue, but harmful to viruses. This light uses a wavelength of about 222 nanometers (nm), and is different from the more harmful UV-A and UV-B light. Far-UVC is proven to inactivate the H1N1 virus (see the first link below for more information).
This device could work in conjunction with ventilators. The virus does poorly in hot, humid, sunlit environments. Ventilator intake air is typically filtered, humidified, and heated. This device would add a sunlight-like sterilization feature to the ventilation process. Perhaps the brochoscope- like device can also use a gentle suction on exhalation to suction-out secretions which flood the lungs of Covid-19 patients.
To protect medical personnel, UV-C lamps would light areas where the brochoscope-like device enters the patient's body and overhead low-level far-UVC lamps would help sterilize the room.
To prevent Bronchospasm, a 'lite' version of this device can use a thin optic fiber, or bundles of fiber, lit by a far- UVC source outside the body. The fiber is inserted by mouth and emits far- UVC light from 'holes' along in its optic fiber coating. Or a simple flexible plastic tube containing a strip of LEDs.
There's evidence salt-water irrigation of nasal and throat passages combats coronaviruses (see links below to 'Nature' and 'Journal of Global Health' article; also link to '20 Billion Gargles Daily for Covid-19' Halfbakery idea). Based no this premise, the device could periodically emit a mist of warm salty air (maybe generated by an ultrasonic transducer vaporizing a hypertonic saline solution). In conjunction, the more invasive form of this device could use inflatable cuffs and gentle suction to briefly seal and suction up excess mucus generated by the mist.-- sonam, Mar 22 2020 Article on far ultraviolet C in hospital setting https://www.genengn...cteria-and-viruses/UV Light That Is Safe for Humans but Bad for Bacteria and Viruses [sonam, Mar 22 2020] Far-UVC optic fiber used to kill bacteria https://www.bioopti...ing-medical-devicesArticle on externally lit far-UVC optic fiber used to kill bacteria [sonam, Mar 22 2020] Detection of Covid-19 in clinical specimens https://jamanetwork...fullarticle/2762997Detection of Covid-19 in different types of clinical specimens, including lung wash and blood samples [sonam, Mar 22 2020] “They Are Essentially Drowning in Their Own Blood.” https://www.motherj...fluids-coronavirus/A chilling report from the frontlines why Coronavirus is so dangerous [sonam, Mar 23 2020] Bronchoalveolar lavage https://en.wikipedi...nchoalveolar_lavageSounds ... uncomfortable. [8th of 7, Mar 23 2020] "Whole lung lavage—technical details, challenges and management of complications" https://www.ncbi.nl...rticles/PMC5506114/This document describes whole lung lavage - a procedure to 'wash out' the whole lung, not just sample part of it. This document does not cover silicosis, but others do. [sonam, Mar 25 2020] Toll-Like Receptors and Viruses: Induction of Innate Antiviral Immune Responses https://www.ncbi.nl...rticles/PMC2593046/Recognition of viral RNA by immune system Toll-Like Receptors [sonam, Apr 03 2020] A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold https://www.nature....018-37703-3#ref-CR9Gargling and nasal irrigation with salt water combats the common cold virus (shorter illness, milder symptoms, reduced viral shedding, and 35% reduction in transmission to household contacts) [sonam, Apr 07 2020] Gargling and nasal irrigation procedure http://www.elvisstu...n-and-gargling.htmlThe nasal irrigation and gargling procedure described in the 2019 Nature study [sonam, Apr 07 2020] Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels https://www.nature..../s41598-018-31936-yThe mechanism how gargling and nasal-irrigation with salt solution works. Cell to use chloride ions from NaCl solution to generate hypochlorous acid (HOCl, the active ingredient in bleach) to suppress viral infection. [sonam, Apr 07 2020] How Grandmother’s Gargling Remedy Could Help Abate The Coronavirus https://thefederali...te-the-wuhan-virus/Media report: "Theoretically, the remedy your grandma gave you when you had a sore throat could be used as a proactive step to help kill Covid-19." [sonam, Apr 07 2020] Homemade saline solution that could help abate COVID-19 http://theheartatta...elp-abate-covid-19/Media report: "Saline sprayed in the nose and gargled in the throat can kill the common cold virus." [sonam, Apr 07 2020] Got a cold? Gargle salt water! Old wives tale really does work as scientists say it causes body to produce 'anti-viral BLEACH' https://www.dailyma...i-viral-BLEACH.htmlMedia report: "The common cold can be cured with salt water because the body uses it to produce anti-viral bleach, scientists say." [sonam, Apr 07 2020] Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19 http://www.jogh.org.../jogh-10-010332.htmReanalysis of 2019 gargling and nasal-irrigation study shows the procedure is also effective against coronaviruses. [sonam, Apr 07 2020] 20 Billion Gargles Daily for Covid-19 20_20Billion_20Garg...ly_20for_20Covid-19There's evidence salt-water irrigation of nasal and throat passages combats coronaviruses (see links to 'Nature' and 'Journal of Global Health' articles above). Hence this Halfbakery idea: if everyone who can, salt-gargles and nasal-irrigates daily to fight the COVID-19 pandemic [sonam, Apr 14 2020] Let there be light! https://en.wikipedi.../Two-photon_physics [Voice, Apr 24 2020] Operation -- Annihilate! https://memory-alph...nihilate!_(episode)A little light on the situation... [8th of 7, Apr 24 2020] The infection is systemic; it merely manifests itself in the lung tissue. Topical treatment of a specific area isn't going to help significantly, and you're obstructing an already compromised airway. There's no way any mechanical system can reach deep enough into the alveoli to do any good.-- 8th of 7, Mar 22 2020 Chairborne Hero -- Thanks. I added an explanation how reducing viral load on throat, tonsils and trachea surfaces can help lower the overall viral load the immune system must combat. Also, your 'Antiviral inhaler for influenza' link (the NEJM article) is subscription only - do you have a more open link?
8th of 7 -- See above. The idea is to reduce viral load. Only a small percentage (1%) of Covid cases indicate systemic infection (blood samples with positive PCR test results). But almost all lung wash samples, and most sputum samples, are positive. See latest link.-- sonam, Mar 22 2020 Valid points but not necessarily describing the problem. Reducing the viral load in the lung tissues will have a small effect, but more organisms will simply migrate in from untreated areas.
It's like trying to pump a swamp dry; unless you also re-engineer the water flow too, it will just trickle back in to fill the vacant space.
The answer is to attack and kill the virus everywhere - that means antibodies. The immune system will do that really efficiently if it has the time to do so and isn't already damaged or loaded. Hence the effect that coronavirus is really only a threat to the elderly and immune-compromised.
The system described will do a little good but not enough to significantly affect the prognosis; basic supportive care does that perfectly well without poking pipes into the bronchi ...
// 8th and I are in complete agreement. //
No need to worry about your medication, you're doing fine. Soon you will start to feel a strange, unaccountable compulsion to join us ... don't fight it, your instinct is correct.-- 8th of 7, Mar 22 2020 8th, Chairborne - Good points all, and I get all your analogies -- believe me. Yes, a properly choreographed immune response by your own (or donated) antibodies is the best weapon againt Covid. However, read the latest link -- several patients face a cytokine storm that fill their lungs with fluid despite being on ventilators. This idea is particularly applicable to vulnerable people on ventilators.
Chairborne - yes, antiviral delivered by an inhaler is a good idea. In fact, it could be delivered by the ventilator.
I'm aware far-UVC doesn't penetrate tissue much. It could be augmented with cycles of UVA and UVB. Yes, there's the risk of cancer, but given the alternative, it may be worth it.-- sonam, Mar 23 2020 The cytokine storm effect is what killed many of the victims of the 1918 H1N1 flu pandemic- young people with highly reactive immune systems experienced "over-triggering".
It's controllable if the medics catch it quickly.
UV is probably going to irritate and inflame lung tissue, as it is never normally exposed to light - that's going to be counterproductive. The epidermis gets bashed by UV a lot and has compensating and protective mechanisms, including melanin. Mucous membranes don't have that.-- 8th of 7, Mar 23 2020 sp. "epidermis", "Mucous".
Carry on ...-- pertinax, Mar 23 2020 Sp. fixed ...-- 8th of 7, Mar 23 2020 // lung wash //
TIL that's a thing. I wonder why it isn't used for coal miners and long-term smokers.-- notexactly, Mar 23 2020 Because euthanasia is illegal ?-- 8th of 7, Mar 23 2020 notexactly: "Whole lung lavage" (or washing out the lungs) is used to treat some conditions, including silicosis.-- sonam, Mar 23 2020 <link>-- 8th of 7, Mar 23 2020 Say, 8th of 7 -- How can doctors control a cytokine storm by catching it early? Was/is this not happening in Italy?
Added link on whole lung lavage procedure (not specific to silicosis).-- sonam, Mar 25 2020 Steroids - the correct ones, at the correct dosage - and immunosuppressants. The cytokine storm tends to hit after the original infection has already been killed by the immune system, which continues to run "full throttle" with no target to attack.
Some tricyclic antidepressants have a paradoxical effect which can help with the management, not for their psychological actions but for their physiological ones.-- 8th of 7, Mar 25 2020 8th of 7 - Based on tragic death toll worldwide, controlling a cytokine storm must be very hard in practice. I think we need to reduce the personal viral load. Since many (maybe all) of us will come into contact with Covid-19, and it's is a new pathogen to humanity, I think our immune systems will need to learn to handle it - individual by individual. But an immune system needs a "gentle introduction" -- a low viral counts so it has enough time to adapt and learn how to deal with it. So we'll all need to 'flatten the personal viral load curve' -- by handwashing, salt gargling, staying warm, chicken soup -- anything to reduce personal viral load and stop the virus setting up shop in our bodies. Essentially, we need to trade 'hygiene' effort for 'immune system training' time'.
So a simple form of this device that shines far-UVC into the oral cavity, throat, tonsils and upper trachea may be of more benefit. LEDs (or a strip of LEDs) in a plastic tube emitting far-UVC light.-- sonam, Apr 02 2020 // controlling a cytokine storm must be very hard in practice //
It is, but it only affects a very few susceptible individuals. Most mortality is among those with preexisting conditions.
// it's is a new pathogen to humanity //
No, it's not "new". It's a new variation on a virus type that's endemic. Every species is exposed to innumerable coronaviruses in their lifetime. Some are susceptible - they must be, otherwise it wouldn't survive.
Even with its tiny RNA genome, the number of possible mutations passeth all understanding. That's why there can never be a vaccine. By the time you create and distribute one, the virus has already mutated.
// I think our immune systems will need to learn to handle it - individual by individual. //
Kind of the definition of an immune response. Nothing you suggest will "slow the viral load" - either the immune system squashes it, or it doesn't. Some antivirals may help a little but they are notoriously difficult to design and target.
Infection can (but rarely does) arise from a single virus particle. The fact that it's so infectious shows it can propagate efficiently from relatively low exposure. There are mathematical models for spread in a body; the progression is usually geometric.
// by handwashing, //
May postpone infection, and slow the spread person-to-person, but all will be exposed eventually.
// salt gargling, //
Very low effectiveness - doesn't reach the nasal or optic mucous membranes.
// staying warm, chicken soup //
Mere palliatives once infected, no prophylactic benefit.
UV is more likely to promote long term cancer than actually do anything to kill viruses.-- 8th of 7, Apr 02 2020 // lung wash //
Bleach?-- whatrock, Apr 02 2020 Hypochlorite ?
Probably not. Trials with elemental Chlorine (c.f. Haber & Falkenhayn, KWI, Ypres, 1915) were not well tolerated by the test cohort.-- 8th of 7, Apr 02 2020 Details, details. Killing the disease is the prime objective anyway. Once that has been achieved the life* of the patient can be addressed.
*if any.-- whatrock, Apr 02 2020 Ruthless, brutal, utterly lacking in empathy, compassion or any shred of basic humanity.
We have a post available as Attending Physician to [doctorremulac3], a challenging yet rewarding case, with a superlative remuneration and benefits package, including unlimited use of a modified defibrilator and all the heavy-grade rubber hose you can swing. You're not even expected to effect any sort of a cure, as he's clearly a hopeless case - just concentrate on inventing some amusing "treatments".
Would you like us to send you the application "form"* ?
*Technically a Post-It™ Note with a hand-drawn square with "OK" scrawled next to it. Just make a mark in the box. Gravitational spatter tends to score high marks with the Selection Board.-- 8th of 7, Apr 02 2020 I am deeply honored to be considered for such an esteemed position, one that I feel uniquely qualified for as I have no medical experience whatsoever, a casual and detached bedside manner and a severe tendency to shake when handling pointy or edged weapo, er instruments when sober.-- whatrock, Apr 03 2020 Sober ? Oh, that will never do ...
<Dumps crate of alcoholic beverage on table/>
Off you go ... plenty more where that came from. Plenty.-- 8th of 7, Apr 03 2020 8th_of_7 :
>> // salt gargling, // > "Very low effectiveness"
Disagree and also disagree with your assertion that reducing viral load does nothing. See reason below.
> "either the immune system squashes it, or it doesn't"
No, because I'm sure the immune system needs all the leg up it can get. Mechanical removal of the virus (e.g., by salt-gargles) or destruction by UV light frees up white blood cells for use elsewhere. Regarding gargles not reaching the nasal system mucous membranes - true, but 'jal neti' can be used for this purpose.
In fact I won't be surprised if mechanical interventions such as salt gargling help the immune system -- not just directly, by reducing viral load, but indirectly too; by leaving viral RNA fragments exposed that help the immune system recognise and train itself better to fight this virus. <Link added>-- sonam, Apr 03 2020 Reducing viral load is useful, but a topical treatment will not affect total viral load, which is systemic. Leucocytes do not deal directly with virus particles - those particles need to be pre-marked by antigens bonded to their surface, inactivating them.
Silicosis is mechanical contamination, not systemic.
The immune system does not react to RNA fragments. It reacts to antigens expressed on the virus coat. Free-floating RNA strands are just so much harmless debris, and get cleaned up on a routine basis.
You seem to have a rather limited and distorted understanding of immunology and how the body deals with infection. There are some good online courses available that will give a reasonable grounding.-- 8th of 7, Apr 03 2020 8th: Regarding my education in immunology, your assertion is cheerfully and shamelessly accepted. But something cannot be both useful and useless at the same time. The assertion topical treatment and mechanical removal of viral particles cannot affect the course of a viral infection is a stretch (and disproven by those who've gargled away an infection at its very start). A leukocyte not recruited to fight a viral particle that's been removed is a leukocyte that lives to fight another day. Yes, Silicosis is mechanical contamination ("systemic" ???? ... that's not even wrong). From what I understand (though I am not certain), the immune system can sense cell- free RNA fragments.-- sonam, Apr 03 2020 It can, but disregards them, since they are meaningless and not a threat. The liver (and other waste-management functions) simply digest them and dispose of it.
Silicosis is not systemic. It is contamination of the surfaces of the bronchi and alveoli, and to some extent the digestive tract - but the digestion is adapted to deal with and eject all sorts of environmental rubbish. The lungs are not so good at expelling physical contaminants. Very little of the silica migrates beyond the immediate point of contact into the mass of tissue, hence it is not systemic.
The issue is not the quantity of available leucocytes, as the body is primed to manufacture huge quantities if a requirement is detected. The issue is having enough of the correct antigens to bind and inactivate viruses quickly enough to limit the infection.
// those who've gargled away an infection at its very start //
Have they ? Cite your data.
Patient senses inflammation. Patient gargles with salt solution. Symptoms recede.
What stopped the inflammatory response ? The gargling, or an immune response that was undetectable to the patient ?
Only blood tests can show which explanation is correct. Did the user also flush their eyes and nose with saline ?-- 8th of 7, Apr 03 2020 8th_of_7 : >> "the immune system can sense cell- free RNA fragments."...
> "It can, but disregards them"...
The immune system can sense viral genome using 'Toll-like receptors', present both on the cell membrane and intracellularly, and then launch an antiviral response (see link provided). I'm speculating salt gargling may expose more viral RNA fragments to the immune system, which can then recognise and fight the virus better. This mechanism may also apply to viral particles normally disguised from the immune system.
> Silicosis is not systemic.
I agree silicosis is not systemic.
> The issue is not the quantity of available leucocytes...
Metabolism is not free. By reducing viral load in important areas (throat and nose), we get a system better prepared to fight the virus overall.
>> [...] those who've gargled away an infection at its very start
> Have they ? Cite your data. [...] Did the user also flush their eyes and nose with saline ?
Yes. I've added a new link to a 2019 study published in the journal Nature: "A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold". Gargling and nasal irrigation with salt water helps combat the common cold virus (shorter illness, milder symptoms, reduced viral shedding, and 35% reduction in transmission to household contacts). Epithelial cells seem to use chloride ions from NaCl solution to generate hypochlorous acid (HOCl, the active ingredient in bleach) to suppress viral infection.
I'm adding links to the study, a how-to procedure, media reports, as well as a recent reanalysis of study data that shows gargling and nasal-irrigation is effective against coronaviruses too.
I intend adding a Half-bakery idea on gargling and nasal- irrigation for Covid-19 - if you agree, upvote it please.-- sonam, Apr 07 2020 Well played, [sonam].-- pertinax, Apr 07 2020 // sense viral genome using 'Toll-like receptors', present both on the cell membrane and intracellularly, and then launch an antiviral response (see link provided). //
If you read the abstract, it does not refer to free RNA fragments. By your own statement the mechanism operates " both on the cell membrane and intracellularly". This is emphatically not a free RNA fragment.
// hypertonic saline nasal irrigation and gargling for the common cold". //
Rhinoviruses and Coronavirises are completely different, therefore no useful parallel can be drawn.
If you can present a study showing significant clinical effectiveness against Coronaviruses then you can support your contention; however, your argument is essentially "Painting a wooden fence with creosote prevents rotting; therefore painting a metal fence with creosote will prevent rusting".
To be credible, you must provide peer-reviewed studies backed by large data sets. The last link is interesting but does not fulfill those criteria; it's a "Oh, let's try it, what harm can it do ?" Well, it can irritate the membranes and not only mask symptoms, but hypochlorous acid will also oxidse the very proteins and cells needed to fight the infection. It is indiscriminate.-- 8th of 7, Apr 07 2020 UVC and biology don't mix well. That's one of the reasons it is used.
//far-UVC doesn't penetrate tissue much//
Why? Because it interacts with everything. UVC interacts directly with proteins*, or more specifically some amino acids like tryptophan. These ionize, and from there lots of non specific chemistry takes place, reduction of adjacent disulfide bridges for example. Then there's all the small molecules, NADH,FAD+ and a host of other things like carotinoids/retinoids all absorb, ionize and destruct. So if you irradiate someone's respiratory tract with UVC, where almost all of the light will land on not-virus, quickly doing more harm than good.
//hypochlorous acid will also oxidse the very proteins and cells needed to fight the infection. It is indiscriminate.//
NaCl washes or whatever make minimal difference to the generation of HOCl, there's hundreds of millimolar Cl- hanging around in every relevant fluid. HOCl is generated by myeloperoxidase from H2O2, which is usually from superoxide, which is just O2 with an extra electron. That is mostly made by angry immune cells, and therein lies the problem.
You can die from acute respiratory distress syndrome as a complication of pancreatitis. This is strange, the patient presents as if they were infected with something, but the damage is just the pancreas digesting itself. Same with some muscle crush injuries, etc.
A popular theory, is that unregulated cell death, cells that just burst rather than neatly tidying up, release components of mitochondria. These molecules (unmethylated circular DNA, peptides starting with formylmethionine) look like virus/bacterial infection to the immune system. This surprises the immune system, which has to do something, so it gets very angry at everything and fires up it's bleach guns. This presents in the lungs because of the sheer availability of O2**.
This causes unregulated cell death, release of more mito DNA/peptides, immune system gets angrier, fires up more bleach guns and so on. The key will likely be found in giving the immune system something specific to focus on, a vaccine, or calming it the hell down for a bit.
In the meantime, an alternative method of oxygenating the blood might be advisable, a heart-lung machine.
*UV absorbance is a common analytical method for nucleic acid and proteins. **especially when the MDs start upping the percentage of O2-- bs0u0155, Apr 07 2020 Would a cyclosporin/cephalosporin mediate the cascade without unduly impacting the overall immune response ? That would appear to be a more targeted approach than systemic steroids.-- 8th of 7, Apr 07 2020 Did we just lose [Chairborne Hero]?-- pertinax, Apr 08 2020 So it would seem.-- 8th of 7, Apr 08 2020 //cyclosporin/cephalosporin//
I'm not sure where you're going with those, the two are unrelated. Cephalosporin is an old school antibiotic, cyclosporine is the calcineurin-binding immunomodulator with a side-gig inhibiting mitochondrial permeability transition. You would want neither of them. FK506/tacrolimus is a touch more specific. That has been used in autoimmune diseases where ARDS is a feature. Combined with steroids. Doctors like pushing steroids.-- bs0u0155, Apr 08 2020 The cephalosporin is a prophylactic, because the cyclosporin is damping the immune response; the combination is used in some cases of mild rejection after transplants. There may be more modern multidrug therapies but that's the one we've got best knowledge of.
There are better immnosupressants, but it's the balance between damping the response and opening vulnerabities to other opportunistic infections.
Steroids are cheap, and well-known; the downside is that they're very popular with medics, which suggests that they're good for making the patient go away, either temporarily (short term remission of symptoms) or permanently (death). The criteria for use seems to be that the patient is either bothersome, has a well known and uninteresting condition, or both.-- 8th of 7, Apr 08 2020 //popular with medics... criteria for use...//
Unlikely to do much immediate harm / get me in trouble / they're what we always use / not interested in the actual problem / feel good, go back to thinking about golf.-- bs0u0155, Apr 09 2020 Ah, you've met one ...-- 8th of 7, Apr 09 2020 // So it would seem. //
A shame. I would have thought our brilliant ideas and engaging discourse would have hooked him. The discourse anyway.-- whatrock, Apr 14 2020 If the light is sufficiently bright it will destroy the virus throughout the body.-- Voice, Apr 24 2020 "It's a million to one chance, but it might just work ! "
<link>-- 8th of 7, Apr 24 2020 <Corona-Wan Kenobe>
"If you strike me down, I will become more powerful than you can ever imagine ..."
<Raises Lightsabre />
</C-W C>
<later>
Why not try neat bleach ? After all, what could possibly go wrong ?-- 8th of 7, Apr 24 2020 random, halfbakery