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Wednesday, June 10, 2020

Indian Scientists and Doctors got therapy that can halt Corona Virus Transmission as well as save lives

Indian Scientists and Doctors has suggested Indian Council of Medical Research a therapy that not only halt prevent spread of SARS-COV-2 virus but can kill the novel corona virus which is infected in the human body, looking at the mode of action of these medicines these medicines appears to be promising and has potential to save world from the COVID19 pandemic the suggested medicines are already approved but yet to be approved from ICMR for SARS-COV-2 .

Following is the proposed line of treatment.

Proposed line of treatment to be adapted for treating suspected COVID19 as well as confirmed COVID19 positive patients with
1)Aspirin and Diethylcarbamazine and Doxycycline
2)Proposed use of povidone iodine cream by doctors to prevent infection from patients to doctors and healthcare providers.

Corona virus is highly contagious and keep on spreading from patients to other persons coming in contact with the patient as well as it is getting transmitted to people who come in contact with articles, cloths used by patients.

It is observed that healthcare professionals are at higher risk of getting infection even they use PPES, since PPES too have certain limitations, the N95 masks even do not assure that the air filtered through mask will filter out corona virus particles since the pore size of mask is 0.3 micron which very bigger than the corona virus particle size which is 120 nm (.12 μm) lesser than the pore size of N95 mask.

Therefore, use of N95 mask does not guarantee that a corona virus particle will not go through the filter medium and infect the doctors and healthcare professionals.

A methodology also required to be adapted to prevent novel corona virus infection in event of accidental damage or misplacement of nose masks and PPEs.

Therefore it is very important that a methodology is required to adapt to ensue that even after the novel corona virus particles come in contact with Doctors, healthcare professionals nurses, it should not make way to individuals buccal cavity and nostril openings and will not infect them.

Therefore, following methodology is required to be adapted by doctors and nurses and healthcare professionals.

· Occlusion of body part, lips, nostril opening by povidone Iodine a virucidal cream.

Rationale behind using povidone iodine cream

It contains 0.5 % w/w iodine complexed in polyvinyl pyrrolidone polymer which permeate out free Iodine, Iodine molecule when it come in contact with viral particle, it instantaneously reacts with viral proteins and enzymes, and ensure that novel corona virus 19 particle do not survive in contact with povidone iodine cream.

Strength: Povidone Iodine IP 5 % w/w available Iodine 0.5 % w/w

A) Guidelines for Doctors and healthcare professionals

How to use povidone iodine cream

Before entering the COVID patients ward.

1. Swab frontal and dorsal surface of palms and fingertips with cream, forming a thin layer of Povidone Iodine cream.

2. Apply aliquot of cream inside the nostril making it a thin layer over linings of nostril.

3. Apply over lips, so that cream layer permeates smaller amount inside the buccal cavity forming a protective layer, while working in a highly contagious environment.

Wear outer PPES one can work without fear of getting any infection from accidental damage of nose mask and PPES.

· Proposed First line of treatment for Suspected covid19 and COVID19 positive Patients


A) Buccal cavity, nostrils, throat, and bronchial track decontamination.

Use 1) Povidone Iodine Cream 0.5% available iodine. (Cipladine/ Betadine/Wokadine)

Following creams to be used on individuals who cannot tolerate Povidone Iodine Cream but preference to be given to Povidone Iodine.

2)Silver nitrate cream 0.2 % (Burnheal Cream)

3)Silver Sulphadizine Cream 1%

B) Gargles with Povidone Iodine Gargle solution/

Use Betadine Gargle/ Cipladine Gargle Four times in day, before going to sleep it is must.

C) Drug treatment for reducing fever, cytokine flare, and emboli formation and prevention of viral growth.

Aspirin 300 mg two times a day for first five days, in case of aged patients’ dose to be reduced to 150 mg twice a day. After five days dose to reduce 150 mg & 75 mg daily maintenance dose depending on patients age for 15 days.
(To counter acidity, systemic acting antacids drugs should not be used, only Aluminium hydroxide and Magnesium hydroxide antacids to be given.)

D) Antiviral drugs that acts as adjuvants to increase antibody response faster and acts as antiviral drug.

Diethylcarbamazine 100 mg (DEC) or 10 mg/kg body weight for 7 days. (One tablet daily) Brand available is Hetrazan.

A gap of 5 hours to be kept in between dose of aspirin and DEC

E) Maintenance of with antiviral RNA elongation Inhibitor drug.

Doxycycline 100 gm daily one tablet for 10 days.
Buccal Cavity and Nasal Cavity, Decontamination procedure:

In initial stage before the infection is making way towards lung tissue, a suspected COVID19 patient after his or her diagnostic samples are taken from his mouth and nostril should be subjected to topical antiviral decontamination treatment of Povidone Iodine IP 5 % w/w cream and Povidone Iodine gargles as follows.

1)Apply aliquot of cream inside the nostril making it a layer over linings of nostril.

2) Apply over lips, so that cream layer permeates smaller amount inside the buccal cavity forming a protective layer.

Patient should keep povidone iodine cream applied over his lips, and inside nostril for first three days.

Then after for two more days patient should apply cream over lips only.

Then application of cream can be discontinued after 7 days.

3) Gargle to be done with Povidone Iodine IP 5 % w/w gargle three times a day. And on 4th time before sleeping for 14 days.

Rational for use of Povidone Iodine IP 5 % w/w cream as buccal and nasal cavity decontaminating agent.

Currently there is no effective treatment available to clear or get rid of novel corona virus load in initial phase of infection when it is inside the nostrils and buccal cavity is making way towards bronchial and lungs tissue.

Povidone Iodine is very good antiviral agent, when applied in nostrils and over lips, a thin layer of cream melts down through lips and nostrils inside the buccal cavity and nostrils, and nasal root and Eustachian tube, and towards bronchial track

Initial stage of infection when patient is not exhibiting fever or any symptoms of covid, this method will help to clear viral load approaching lungs tissue.

Moreover, the patient is less likely to spread the infection to surrounding due to presence of iodine cream inside nostril and inside buccal cavity.

· First three days Iodine Ointment to be used as protective topical decontaminating agent.

· For 14 days Gargles for four times a day to be done with PVP Iodine gargle solutions.

Who should not use Povidone Iodine Cream?

1) Individual with Hyperthyroidism

2) High Blood Pressure.

3) Patient with congestive cardiac disease.

4) Ischemic heart disease

What is other option for these patients.

· Individuals who cannot tolerate Povidone Iodine Cream Should use Silver Nitrate cream 0.2% w/w or Silver Sulfadiazine 1% Cream.

· Povidone Iodine Gargle can be done by all.

· Instruct patients that gargles, or ointment should not be swallowed.

Rational for use of Aspirin in treatment of COVID19 positive patients and as prophylaxis for people coming in contact with COVID19 Positive patient

Aspirin is Acetylsalicylate, Aspirin as anti-inflammatory to protect cytokine flair:

1) Aspirin is good anti-inflammatory drug, that is it prevent prostaglandin synthesis by blocking enzyme cyclooxygenase, Prostaglandin is responsible for fever in covid19 patients so fever can also be managed with aspirin and paracetamol.

2) Aspirin has got antiplatelet aggregation activity, because of which it makes a very good blood thing and anti inflammatory as well as anti coagulant drug. This action of aspirin will provide protection to patients from rise in temperature, as well as it will act as anticoagulant and prevent formation of blood clots.

3) Aspirin is a pro-drug, it breakdown in to salicylic acid, it eventually reduces PH of body fluid and the presence of salicylic acid molecule in blood will not support corona virus reproduction.

Even the sputum and mucus accumulated in lungs will bet dissolve faster and provide protective effect.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155651/

Ongoing Clinical Trial : https://clinicaltrials.gov/ct2/show/study/NCT04365309

Rational for use of Diethylcarbamazine 100 mg OID dose in treatment of COVID positive patients and as prophylaxis in person coming in contact with COVID Positive patient

Diethylcarbamazine (DEC) once was studied for enhancing the antibody generation in patients infected with HIV, and it is found that it has good antiviral activity as well.

Its molecular structure is makes it potential competitive inhibitor for pyrimidine bases during transcription. Also, a negative feedback mechanism can increase the antibody well before the virus becomes harmful to the lungs tissue.

a dose of 10 mg / per kg/ day will be useful in treatment of Novel Corona Virus19 and management of covid19.



Reference: https://patents.google.com/patent/US4900548A/en

Kitchen Lynn W. M.d, Harvard University

Doxycycline 100 mg once a day dose for 7 days.

As maintenance dose of Antiviral RNA blocking drug

Doxycycline 100 mg once in a day it is a tetracycline group of antibiotic, it has property inhibit RNA synthesis, the inhibition of RNA synthesis is also expected for Corona Virus 19 as well.

Reference:

https://pubmed.ncbi.nlm.nih.gov/26459887/

https://www.mediterranee-infection.com/in-vitro-antiviral-activity-of-doxycycline-against-sars-cov-2/


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