Can we prevent large viral loads of COVID-19, influenza, and other viruses that cause the common colds and bronchitis?

I personally think one can. 

This is very controversial as the below is not approved by the CDC. But Dr. Naito wrote in the NYT, back in March, a balanced article on how to decrease viral loads.

This is worth the read. He notes it is unfortunate most governments do not promote this to their population (in the responses below the article). 
https://www.nytimes.com/2020/03/29/well/live/gargle-gargling-coronavirus-infections-bacteria-virus.html

Of note, Japan has been recommending salt water gargles and even neti pots filled with salt water for years. A friend from India recently noted this is common practice in her country to prevent colds and considered part of personal hygiene. It is such low risk it makes total sense to use this at home and in schools.

Here is a new randomized study using hypertonic saline for COVID: https://clinicaltrials.gov/ct2/show/NCT04465604

Hypertonic Saline usually mean about 1 teaspoon of salt for 1/2 cup water or 6 gram NaCl to 100 ml of water: (It is a little more than 1teaspoon per 1/2 cup water). 

I and my family will be using more hypertonic saline but I do have diluted betadine available just in case.

Sandra Lora Cremers, MD, FACS 

———

Here is my personal protocol: parts of which I have used for years  https://youtu.be/U5O8YruicL4

The below part seems to be safe for most adults. I have used some of the below for some of my children at first sign of a cold in the past with good results. But that is not a randomized, controlled, prospective, double blinded study. 


Preventative Measure to Potentially Decrease Viral Loads of COVID-19, Influenza, Colds:


Every parent would like to keep their children and family safe and free from COVID-19 and keep the schools open for in-person learning for their child. In the absence of a suitable vaccine, all doctors and families are searching for safe and effective treatments and ways to better prevent and decrease viral loads which can be used with little risk and expense to children and their families. 

The below recommendations may potentially prevent a COVID spike. 

These recommendations have not been tested in randomized, controlled, prospective studies in adults or children, but have been used by some US doctors for their family and children with good success and minimal risk. We recommend you discuss these recommendations with your pediatrician or medical doctor as it to relates to your individual family members’s medical issues and past medical history. 


Each suggestion has minimal risks as long as no allergy is present to the treatment. For povidone iodine, for instance, we recommend doing a patch test (see below) if there is any concern of an iodine allergy.

 

1. Social distancing, using masks, avoiding touching one’s face (ie, no nose picking) without first cleaning hands (ie, 60-70% alcohol/hand sanitizers and/or soap and water for 20 second; some doctor moms recommend kids rubbing hands with alcohol sanitizer first for 3-5 seconds and then washing alcohol off before eating food) as currently recommended is key. Particularly if someone in the family begins to have COVID symptoms, a designated private room/area and bathroom are key to contain the virus at school and home.

2. Teach children to recognize when they are starting to get sick or not feel well (sore throat, headache, runny nose, early fever). 

3. Start below possible preventative options as soon as symptoms start.  

 

If someone starts to feel sick with any new symptoms (particularly if they do not suffer from allergies where runny nose, sneezing are frequent), such as cough, runny nose, loss of smell, headache, or early fever, we recommend consultation with your pediatrician/doctor. In the event that concerning symptoms begin to appear, many MDs follow some or all of these home remedies for themselves and their children: 

  1. Suck on sugar-free Cold Eeze or zinc lozenges if you start to feel sick. Follow package directions exactly. Avoid calcium, magnesium pill intake 30 min before and after use. Choking hazard for little kids. One doctor mom I know holds the Cold Eeze so a young child can lick it multiple times at first symptoms of a cold or flu. (Be aware of choking hazard). Consider liquid, quick melt or oral spray form of Cold Eeze for the younger age patient. 

  2. Use one of the below options:

    1. Gargle diluted (5%) povidone iodine (ie, Betadine) for 30 seconds 2-4 times per day. Insert soaked Q-tips into the nose and get to the back of the throat if possible. If this makes one sneeze, that is good and do this in a safe location that can be isolated from family, such as a private bathroom that can be cleaned with Lysol/alcohol wipes prior to general use. 

    2. 70% ethyl alcohol (ie rubbing alcohol): gargle for 30 seconds 2x per day and use soaked Q-tips to clean out nasal mucus membranes. Children can use 70% alcohol pads to clean out their nose at school in bathroom stalls privately if concerned of COVID safety. 

    3. Listerine: gargle for 30 seconds 2x per day and use soaked Q-tips to clean out nasal mucus membranes when exposed or getting sick.  The Listerine website says it does  NOT kill COVID but a recent paper (Reference 1, 2) notes that it does kill COVID-19 in-vitro. There are no randomized, controlled, prospective studies in children or adults for COVID prevention. Chronic Listerine use may have potential risks. 

    4. Hypertonic Saline/saltwater gargles/nasal washes: https://drcremers.com/2020/08/covid-prevention-salt-water-or.html

  3. Take a hot shower to raise body temperature potentially slightly to kill any microbe brewing. Keep fevers below 101-102F in kids and 103F in adults by keeping warm clothes off and using cool compresses. Avoid ibuprofen if possible, but this med may be needed if fever control not achieved by Acetaminophen (ie, Tylenol) alone.  Tylenol can be used to help control pain/fever. Fevers are part of the body’s immune response to fight off the virus. Consult your pediatrician or MD on all medications and fever issues. 

  4. Get to bed at reasonable times and sleep as much as possible. Some doctor moms will massage children’s legs, feet, back, and shoulders, particularly the trapezius (shoulder/back) muscles if headache starts.  Massage may potentially help with immune-boosting during a viral illness.

  5. “Starve a fever, feed a cold:” Give the sick person plenty of water and electrolyte fluids. Avoid food if fever is present. Bone broth with fresh, organic bones may help when ready to eat and in patients with colds. 

 

Risks of Options:

  1. Risk of ethyl alcohol:

    1. It is flammable, so students need to be aware of this. 

    2. Avoid ingestion of solution/hand-sanitizer: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use

  2. Risk of Povidone Iodine: 

    1. Be careful that no allergy is present. Do a patch test if there are concerns of allergy. Seek medical attention if a severe allergy is present. 

    2. Excessive povidone-iodine can rarely increase iodine blood levels and can be rarely associated with side effects. Avoid ingestion of povidone-iodine regardless. If you are pregnant or nursing, speak to your MD before using. 

 

  1. Risk of Listerine: 

    1. Listerine has 20% alcohol, so it should NOT be used as hand sanitizer or for cleaning. It also has saccharine so there is a concern that long term 2-3/day could increase risk of throat cancer (Ref 3, 4), diabetes (Ref 5, 6), hypertension (due to changing mouth/gut flora: Ref 7, 8, 8a). Short term use in cases of COVID exposure or early symptoms is likely safe as oral flora returns to normal after 1 week without use. 

  2. Risk of Hypertonic Saline/salt water gargles/nasal washes

  1. Low risk.

  2. Avoid ingestion. 

 

In general, many doctors recommend the following: Discuss with your physician for any specifics regarding your own unique medical situation.

  1. Getting some sun exposure safely to naturally increase Vitamin D levels without getting a sunburn or taking Vitamin D supplements is recommended. In the winter, Vitamin D levels often decrease. Some doctors and researchers recommend the following: 2000 IU/day for kids, 5000 IU/day for adults if healthy and not sick. [For some children and adults, MDs  may recommend 50,000 IU once per week of Vitamin D3 for 8 weeks]. Check with your doctor, who may order a lab test to check your vitamin D level. 

  2. Eat a low inflammatory diet with daily servings of green leafy vegetables: low/no gluten; low/no sugar. If green leafy vegetables intake is not possible/ or are unavailable, some MDs recommend supplements of Vitamin A Palmitate 1000 IU for kids, 10,000 IU for adults daily [for immunocompromised: 400,000 IU recommended]

  3. Quercetin and Vitamin C: Vitamin C 500 mg BID (2x per day) and Quercetin 250-500 mg BID (2x per day) (Ref 11,12). 

  4. Iodine/iodide: recommended by Shiva Ayyadurai, PhD. 3 drops in drink per day for kids; 6 drops per day in drink for adults. Lugol’s brand recommend though application of povidone iodine on skin can increase iodine levels as well. (Ref 13,14). 

  5. Consider intermittent fasting for adults to strengthen the immune system: don’t eat until after noon stop eating before 6-7pm. 

  6. Exercise: get your 10,000 steps in at least per day for adults if possible and encourage exercise in kids. Limit electronic screen time as much as possible, ideally less than 4 hrs per day and ideally not within 3hrs of sleep time. 

  7. Pray/meditate. Get good sleep. Avoid cell phones and electronics in bedrooms. 

  8. Again: Eat green leafy vegetables every day: get your natural antioxidants daily: https://drcremers.com/2019/07/low-inflammatory-diet-anti-cancer-diet.html

 

References:

  1. https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa471/5878067

2. https://www.listerine.com/covid-19-update#does-rinsing-with-listerine-antiseptic-mouthwash-kill-the-covid-19-virus

3. 

https://www.nhs.uk/news/cancer/is-frequent-mouthwash-use-linked-to-oral-cancer/

4. 

https://www.listerine.com.au/does-listerine-cause-oral-cancer

5.

https://www.sciencedirect.com/science/article/abs/pii/S1089860317301532?via%3Dihub



6.

https://www.google.com/amp/s/www.forbes.com/sites/robertglatter/2017/11/26/regular-use-of-mouthwash-may-increase-risk-for-diabetes/amp/



7. https://www.frontiersin.org/articles/10.3389/fcimb.2019.00039/full


8. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960472/


8a. 

https://www.sciencedirect.com/science/article/pii/S0891584912018229


https://www.sciencedirect.com/science/article/abs/pii/S1089860317301532?via%3Dihub



9. 

https://pubmed.ncbi.nlm.nih.gov/2133450/


10.

https://clinicaltrials.gov/ct2/show/NCT04377789

11. 

https://www.frontiersin.org/articles/10.3389/fimmu.2020.01451/full


12.

https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf


Prophylaxis: to prevent COVID-19. 

While there is very limited data (and none specific for COVID-19), the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease.  Doses have not been verified for children. Please consult with your child’s health care provider for age/weight specifics. 

■ Vitamin C 500 mg BID and Quercetin 250-500 mg BID

■ Zinc 75-100 mg/day

■Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 2 mg at night

■ Vitamin D3 1000-4000 u/day

■ Optional: Famotidine 20-40mg/day


Mildly Symptomatic patients (at home):

■ Vitamin C 500mg BID and Quercetin 250-500 mg BID

Zinc 75-100 mg/day

■ Melatonin 6-12 mg at night (the optimal dose is unknown)

■ Vitamin D3 2000-4000 u/day


13.

https://shiva4senate.com/immune-and-economic-health-for-america-coronavirus/

14. 

 https://www.optimox.com/iodine-study-20

skin application of iodine is an effective, if not efficient and practical, way for supplementation of iodine with an expected bioavailability of 6-12% of the total iodine applied to the skin




Others notes:


13. Listerine does NOT have chlorhexidine. Avoid mouthwashes with chlorhexidine: https://www.nature.com/articles/s41598-020-61912-4



14. Listerine may lose its antibacterial effect if used over period of time: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645771/

——


More references:

Origin of Mouthwash: https://prezi.com/bn3vvv1fndym/mouthwash/?frame=38e0387f88097a2b2bb8820819e19c10035b8a9e

History

The first known references to mouth rinsing is in Ayurveda and Chinese medicine, about 2700 BC, for treatment of gingivitis.[citation needed] Later, in the Greek and Roman periods, mouth rinsing following mechanical cleansing became common among the upper classes, and Hippocrates recommended a mixture of salt, alum, and vinegar.[58] The Jewish Talmud, dating back about 1800 years, suggests a cure for gum ailments containing “dough water” and olive oil. Before Europeans came to the Americas, Native North American and Mesoamerican cultures used mouthwashes, often made from plants such as Coptis trifolia.[60] Indeed Aztec dentistry was more advanced than European dentistry of the age.[60] Peoples of the Americas used salt water mouthwashes for sore throats, and other mouthwashes for problems such as teething and mouth ulcers. Anton van Leeuwenhoek, the famous 17th century microscopist, discovered living organisms (living, because they were motile) in deposits on the teeth (what we now call dental plaque). He also found organisms in water from the canal next to his home in Delft. He experimented with samples by adding vinegar or brandy and found that this resulted in the immediate immobilization or killing of the organisms suspended in water. Next he tried rinsing the mouth of himself and somebody else with a mouthwash containing vinegar or brandy and found that living organisms remained in the dental plaque. He concluded—correctly—that the mouthwash either did not reach, or was not present long enough, to kill the plaque organisms.

From Shiva A, PhD : 

http://www.jogh.org/documents/issue202001/jogh-10-010332.htm


Sandra Lora Cremers, MD, FACS

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