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COVID Crisis Post 18: Chemical PPE. Badass.


My COVID-19 results came back. And the result?

Negative.

A bummer and relief at the same time. There are lots of false negatives, but I've also been totally asymptomatic. I guess I just do a really good job protecting myself. Or maybe I am inherently protected because I'm a sexy Indian man. Who knows.

The struggle is real ๐Ÿ˜…๐Ÿ˜ฌ๐Ÿ™ƒ.

One of the coolest things about medicine is how a new discovery could change the world at any given moment.

And those discoveries are typically driven by the ingenuity and brilliance of individuals who have a desire to create lasting change.

I am blessed to have gone to medical school with one of those brilliant individuals. Not shocking when you're an alumnus of the University of Michigan.

The Leaders and Best, baby ๐Ÿ’™๐Ÿ’›๐Ÿ’™๐Ÿ’›๐Ÿ’™๐Ÿ’›.

My brilliant, beautiful, and hysterical (like super legit) friend Alexandra Kejner, who is trying to do her part to change the world, has formulated a study which could potentially protect those on the front-lines eg ME AND MY COLLEAGUES.

To start, her credentials: Dr. Alexandra Kejner, MD FACS, is an Assistant Professor of Head and Neck Surgical Oncology and Microvascular Reconstruction within the Department of Otolaryngology at the University of Kentucky.

She's legit.

Alex is almost done detailing her study for submission to her IRB. Her study looks at the virucidal efficacy of betadine (active ingredient povidone-iodine (PVP-I)) and whether it could play a protective role for healthcare providers against COVID-19.

And the in vitro studies suggest it just may.

Back when SARS and MERS were a major thing, this solution, even in low concentrations, was shown to be extremely effective against these viruses based on in vitro studies. Australia as well is looking to study the same thing: https://link.springer.com/article/10.1007/s40121-018-0200-7 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3563092

This is super cool.

If you want to understand the details of where the inspiration for her study came from, please click on the links above.

The basic gist: COVID-19 tends to collect in high concentrations in the nasopharynx (nostrils down to our soft palate) and in saliva within our oropharynx (the back of the throat). As a result, those two areas harbor the largest amounts of the virus, and spread from those areas are the biggest reasons individuals are at high-risk of contracting the virus.

For example, during intubations. Again, meaning me and my colleagues.

Betadine has been shown to be 99.99% bacterical AND virucidal even in very low concentrations against a number of pathogens, including SARS and MERS (both coronaviruses). Chlorhexidine is NOT virucidal against SARS and MERS on its own, but when 70% isopropyl alcohol is added (ie Chloraprep), it IS effective.

The evidence based on in vitro studies of SARS and MERS shows that intranasal betadine and a betadine oral swish and gargle mixture could be very effective in reducing the risk of transmission of COVID-19 from positive individuals AND reduce the chance of infection in those individuals taking care of them. It also prevents the virus from sticking in the first place.

In other words: chemical PPE. Badass.

And this has been rarely mentioned in the media. I guess it's not that sexy.

But I don't care if protecting myself looks sexy.

Yes, these are test-tube studies. There is absolutely ZERO evidence that this could work. But you know what?

WHO CARES.

In MY opinion (I don't speak for any person OR institution), there is absolutely ZERO downside to doing this. We know so little about what works against this virus, so any advantage we may be able to garner against it or to protect ourselves is essential. And compared to Plaquenil, betadine's safety profile is MUCH better.

The intranasal betadine (5%) swabs are the same used intraoperatively when swabbing patients to protect against staph aureus infections (MSSA/MRSA). Insert into both nostrils until you can taste the betadine. You also could use on awake or intubated patients too prior to doing any type of airway procedure. The effect likely lasts ~12 hours.

The gargle is a 1:30 dilution of 10% PVP-I (0.33%), which at that concentration has been shown to be effective in vitro, does not permanently stain teeth, and runs a very low risk of causing any olfactory or thyroid issues. You could also use this on patients who are awake prior to intubation if able to tolerate or as a swab if intubated. This also likely lasts ~12 hours. She suggests doing a swab and gargle before AND after your 12 hour shift but for no more than 5 days in a row with a subsequent 5 days off if so.

And those with thyroid disorders, iodine sensitivity, or who are pregnant/breastfeeding should probably avoid this regimen for safety reasons or check with their physicians first.

Overall though, it seems pretty damn safe. And again I ask: why not? It may not taste the best and it may not work but the potential benefit seems worth it ๐Ÿคท๐Ÿฝโ€โ™‚๏ธ.

When I asked her if I could share her idea with everyone, this is what she texted back to me:

"Oh thatโ€™d be great thank you ๐Ÿ˜"

"If I can help one person Iโ€™m down"

She is an amazing human being.

A leader. And best. Go Blue.

#covid19 #nyc

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