By Lambert Strether of Corrente.
“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” —Will Durant (attributed to Aristotle)
Policy on Covid in the West is being locked down around a few bullet points, as you can see from what was discussed at the recent meeting of the FDA Advisory Panel on Covid Vaccines, and what was not discussed (see additional material in today’s links). These bullet points (here numbered for reference) form a program:
(1) Mass infection without mitigation
(2) Intramuscular injection of vaccines
(3) Hospitalization and death as only metrics that matter
And a corollary:
(4) PMC who support this program are hegemonic, hence amplified; the exceptional others are at best ignored and at worst ostracized or attacked. (This applies to the media, academe, medical professionals, the political class, and agencies like CDC; NIH; HHS, etc.)
“The Ultimate Lockdown,” we might call this program. (Or perhaps “The Big Cheese Model”, as opposed to the “Swiss Cheese” model.) This program is serves the interests of many powerful actors, all of whom make bank on mass infection.
The Ultimate Lockdown is, of course, eugenic in character, and not merely stochastically. Continous mass infection by Covid is a recipe for falling life expectancy, already achieved in the United States, whether the cases are “mild” or not. As with deaths of despair, eugenics is what our rulers “repeatedly do.” It is what they are “excellent” at.
The Ultimate Lockdown is therefore opposed — implicitly, and sometimes even consciously — by many scattered forces. The most important force should be not unscattered but ubiquitous: hundreds of millions of those who are conscious that their lives — and the lives of their families, friends, and co-workers — will most likely be sicker and shorter (albeit marked by rental extraction even more intense than today’s). Perhaps that will happen. However, if you sort by the bullet points above, you will see other pockets of opposition, and those not without force. For example, people opposing the Ultimate Lockdown are:
(1) Developing or supporting vaccines that do not require muscular injection;
(2) Fighting (sorry; I don’t mean “‘fighting’”) on behalf of those suffering from Long Covid, or from the neurological or vascular damage that comes even from mild cases (in other words, for metrics other than death or hospitalization);
(3) Pursuing mitigation strategies (for example, masks and Corsi Boxes);
(4) Incorporating non-vax prophylaxis and treatments into their Covid prevention protocols, and sharing their protocols with others (as we shall see);
(5) Overturning outdated paradigms of Covid transmission (where would we be without the efforts of those exceptional aerosol scientists? Still washing our hands behind Plexiglass barriers);
(6) Amplifying the above five points and correcting or rebuking the hegemonic PMC.
In this post, I will focus on (1) vaccines that do not require intramuscular injection (briefly), and then on (4) non-vax prophylaxis and treatments. By so doing, I will be (6) amplifying the good guys. But first, I will briefly review — from the previous post, “The Latest Anti-Covid Nasal Spray Vaccine Science,” which was an assault on point (2) of the Ultimate Lockdown — how Covid enters the body, because understanding this mechanism undergirds every other measure we could take (that is, (1) – (5)).
SARS-CoV-2’s First Hours in the Body
As my companion piece explains, SARS-CoV-2 enters the body through the nose, and initially multiplies there. During this period, SARS-CoV-2 is asymptomatic, but can still spread, as the infected individual breathes shared air in and out. (Asymptomatic spread is one characteristic that makes SARS-CoV-2 so hard to stop.) Later, SARS-CoV-2 infects other parts of the body, including the mouth (see below). Therefore, if we really want to stop SARS-CoV-2 — remember, our current ruling elites are in favor of transmission — we have to stop it in this early period, while it is still multiplying in the nose. It follows that any sterilizing vaccine — the unfortunate term for a vaccine that prevents community transmission — must activate mucosal immunity — the nose has its own separate immune system (!) — which intra-muscular injections do not do. It also follows that non-vax treatments, that also may kill SARS-CoV-2 in its initial phase, can be very, very useful. From The Mail in the UK:
T-cells and B-cells in the mucosal layer can prompt a lightning-fast attack ‘pretty much the instant the virus comes in’, attacking it before it has a chance to infect cells, [Muhammad Munir, a professor in virology and viral zoonoses at Lancaster University] says. ‘These nasal immune cells get to work in a couple of minutes — whereas the immune cells made by intramuscular vaccines get to work six to eight hours after entry of the virus.’
This time difference, he says, is vital. ‘If just one virus particle successfully sticks to one cell it takes over that cell and replicates to produce a million more viruses in an eight-hour cycle,’ says Professor Munir, who has been leading the research into Lancaster University’s nasal vaccine.
‘That’s why the nasal vaccine will have the advantage — the immune cells it produces in the nasopharyngeal region can act immediately. It’s a bit like having the police sitting and waiting for a crime to be committed.
‘With the intramuscular vaccine approach, the police only come once the problem is there, and by that time damage could be done.’
I want to underline that non-vax nasal prophylactics leverage the time difference as well. If a nasal vaccine is the cops, perhaps non-vax nasal prophylactics are the neighborhood watch. Let me now quickly turn to Bharat’s just-introduced nasal vaccine, after which I will move on to prophylactics.
Bharat’s Nasal Vaccine
Hilda Bastian tracks nasal vaccines; her latest update was back in September, and presumably there will be an update coming soon. As she shows, nasal vaccines have already been introduced in Iran, Russia, and China. However, Bharat’s release is — or should be — really big news; it’s an enormous vaccine company that does a lot of contract work for other brands. From the Economic Times of India, “Bharat Biotech’s nasal Covid vaccine iNCOVACC launched“:
The shot will be on the Covid-19 list of vaccines and be accessible in private institutions. According to Bharat Biotech, the intranasal vaccine will cost Rs 325 per injection for government purchases and Rs 800 per shot for private immunisation facilities.
A primary 2-dose regimen for people aged 18 and older in an emergency situation had previously been authorised under limited use. Phase III trials of the vaccine were conducted on 3,100 participants at 14 trial sites across India to evaluate immunogenicity and safety. Hyderabad-based companies also intend to export iNCOVACC overseas once it gets licensed.
Bharat Biotech is currently in discussions with overseas “potential partners”, who have contacted the company about producing and distributing the intranasal vaccine internationally, according to corporate sources. The vaccine was partnered with Washington University in St. Louis, who created the recombinant adenoviral vectored construct and tested its efficacy in pre-clinical investigations.
(Perhaps some kind reader familiar with Indian sources can supply a link to the 3,100 participant-study.) From the BBC:
Dr Krishna Ella, chairman of Bharat Biotech, told ANI news agency that the vaccine was “easy to deliver” as it didn’t need a syringe or needle, and that it produced a broader immune response as compared to injectable Covid vaccines.
No cold chain. No medical personnel, trained in injection, needed. No hospital setting. Ideal for a country like India, and entirely opposed to The Ultimate Lockdown. (In theory at least. One sour note: The Indian government may not be procuring it; private hospitals may. Perhaps the views of India’s elites are much like our own?)
We now turn to what every really wants to read about.
Nasal Prophylactics
This is not an exhaustive list. There are too many products! However, I hope users will share their own experiences in comments.
Let me underline that prophylactic advocacy should be based firmly on a mechanism — exactly in the way that we assess a room to see if the ventilation is in order. That’s why understanding SARS-CoV-2’s first hours in the body is so important (ditto mucus transport). Modulo a “miracle cure” that really does cure, if one of these methods turns out to be unsupported by a mechanism, it does no good to cling to it as part of our protocol; we should either find the mechanism, or replace it with something that has a reason to work (if only to prevent others from imitating us).
Let me also underline that we can’t be waiting around for the RCTs (which are always in danger of being gamed by those who can fund them in any case). The Don’t Believe the Hype blog writes of prophylaxis:
Whilst I generally like to end blogs saying ‘don’t believe the hype,’ in this case it is unknown whether this is hype or not. As above, ; it is at worst a harmless intervention, and at best something that could reduce COVID severity (and therefore, potentially COVID complications).
Finally, let underline that I view all this as a form of “citizen science.” Hence, my concern for a mechanism. If something works for you personally, that’s great, but it’s even better if we know why it works, so others have reason to adopt the protocol you have adopted. With that, I’ll take a look at four products; then I’ll look at a product ingredient (carrageenan), and a method (nasal irrigation). In no particular order:
Vaill CoviTRAP. Sadly available (so far) only in Thailand (and Cambodia)– though the Hong Kong-based Watson’s pharmacy chain may end up carrying it — CoviTRAP is a true “morning after” nasal spray. From a medRvix preprint, “A randomized, placebo-controlled trial of a nasal spray solution containing broadly potent neutralizing antibodies against SARS-CoV-2 variants in healthy volunteers“:
Successful COVID-19 prevention requires additional measures beyond vaccination, social distancing, and masking. A nasal spray solution containing human IgG1 antibodies against SARS-CoV-2 (COVITRAP™) was developed to strengthen other COVID-19 preventive arsenals…. Collectively, COVITRAP™ can safely and effectively support mucosal immunity at thepoint of entry of the virus, making it an essential and complementary tool in our preexistingCOVID-19 prevention arsenals. Nevertheless, a large-scale efficacy trial measuring COVID-19incidence will be required to demonstrate the efficacy of COVID-19 prevention by COVITRAP™.
I like the non-vax use case: After possible exposure, a spritz of antibodies (clearly useful in a tourist-heavy economy like Thailand’s). Yes, a large-scale trial would be great, but personal risk assessment: the cost is low, the risk and low, and the benefits are huge. So I wish this product had a commercial rival in the West!
Enovid Sanotize/Virx (two brands, same formulation). A Nitric Oxide technology, described in “Clinical efficacy of nitric oxide nasal spray (NONS) for the treatment of mild COVID-19 infection“:
Treatment with NONS in this trial was found to be effective and safe in reducing the viral load in patients with mild, symptomatic COVID-19 infection. … Accelerated SARS-CoV-2 clearance with NONS may reduce symptom duration, decrease infectivity period, reduce hospital admissions, and lower disease severity. Consequently, this study could be used as supporting evidence for emergency use of NONS for patients with mild COVID-19 infection.
Same risk assessment as above. A traveller’s review:
I won’t pretend that it’s very pleasant using the product, as there’s a slight stinging sensation when using as directed (slightly inhaling when spraying each nostril). The stinging is temporary, just for a few seconds. Our son doesn’t like it, although he tolerates it.
While it could be luck, we’ve remained negative for Covid while using the product, even while in Denmark, where we did have some meals indoors and were in relatively crowded areas such as Tivoli. No one in Denmark, apart from a few foreigners, was wearing face masks during our visit. We were especially focused on not becoming infected with Covid because our son had to test negative before attending a summer camp, which he did. We can’t prove it, but we suspect our family’s use of Enovid helped his odds.
I use the product regularly, and pleasant is not the word. Not too bad though! Not even “this may sting a little”-level.
Algovir. From “Recommendation of the German Society of Hospital Hygiene (DGKH): Prevention of COVID-19 by virucidal gargling and virucidal nasal spray – updated version April 2022“:
In the absence of a PVP-iodine based nasal spray, use a Carragelose®-based nasal spray (e.g. Algovir® cold spray) in the morning and evening; probably more effective is 0.23% PVP-iodine solution (self-production see above).
(More on Carragelose below.)
There is also the old standby, Betadine Povidone (iodine for throat, carrageenan for nose). See NC here and here.
Now to the ingredient: Carrageenan. From “Efficacy of a Nasal Spray Containing Iota-Carrageenan in the Postexposure Prophylaxis of COVID-19 in Hospital Personnel Dedicated to Patients Care with COVID-19 Disease“:
A total of 394 individuals were randomly assigned to receive I-C or placebo. Both treatment groups had similar baseline characteristics. The incidence of COVID-19 differs significantly between subjects receiving the nasal spray with I-C (2 of 196 [1.0%]) and those receiving placebo (10 of 198 [5.0%]). Relative risk reduction: 79.8% (95% CI 5.3 to 95.4; p=0.03). Absolute risk reduction: 4% (95% CI 0.6 to 7.4).
In this pilot study a nasal spray with I-C showed significant efficacy in preventing COVID-19 in health care workers managing patients with COVID-19 disease.
So check the label! Finally, nasal irrigation. From “Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients: a randomized clinical trial compared to a national dataset observational arm.” n=79:
SARS-CoV-2 enters the nasopharynx to replicate; nasal irrigation soon after diagnosis could reduce viral load and inhibit furin cleavage necessary for cell entry, thereby reducing morbidity and mortality…. A consecutive sample of 79 high-risk adults (mean age 64, BMI 30.3) were randomized toinitiate one of two nasal irrigation protocols within 24 hours of a positive COVID-19 test. Compared to aCDC COVID-19 National Dataset observational arm, 1.27% of participants initiating twice daily nasalirrigation were hospitalized or died, compared to 11%, a significant difference.
And from Augusta University:
Starting twice daily flushing of the mucus-lined nasal cavity with a mild saline solution soon after testing positive for COVID-19 can significantly reduce hospitalization and death, investigators report.
They say the technique that can be used at home by mixing a half teaspoon each of salt and baking soda in a cup of boiled or distilled water then putting it into a sinus rinse bottle is a safe, effective and inexpensive way to reduce the risk of severe illness and death from coronavirus infection that could have a vital public health impact.
“What we say in the emergency room and surgery is the solution to pollution is dilution,” says Dr. Amy Baxter, emergency medicine physician at the Medical College of Georgia at Augusta University and corresponding author of the study in Ear, Nose & Throat Journal.
“By giving extra hydration to your sinuses, it makes them function better. If you have a contaminant, the more you flush it out, the better you are able to get rid of dirt, viruses and anything else,” says Baxter.
“We found an 8.5-fold reduction in hospitalizations and no fatalities compared to our controls,” says senior author Dr. Richard Schwartz, chair of the MCG Department of Emergency Medicine. “Both of those are pretty significant endpoints.”
Mouthwashes
Now let’s turn to the next line of defense after the nose: The mouth. (Note that I don’t know whether mouthwashes leverage the time difference between infection and viral shedding, the way nasal sprays and vaccines can. Still, it seems like a good idea to kill the virus where found.) From BDJ Team (the online adjunct to British Dental Journal), “How a radiologist became an evangelist for dental hygienists“:
Dr Lloyd-Jones says: ‘It’s a simple concept – in those with poor oral health the mouth is like an open wound. The absorption pathway for pathogens passing across damaged oral mucosa is the same as for the skin – pathogens can pass into the blood but do not pass through the liver, as is the case for absorption via the gut. Oral pathogens have direct access to the systemic circulation, which explains why they end up all over the body and are directly implicated in the development of multiple important systemic diseases’.
He rang up two of his friends, one a dentist and the other an oral surgeon, asking whether damaged mucosa of the gums could be the anatomical pathway to the lungs via the blood. They both confirmed his ideas made sense, explaining that the gingival epithelium is easily breached by bacteria in plaque biofilm, so why not a virus? The missing link between the blood and the lungs, they agreed, could well be gum disease. Dr Lloyd-Jones set to work, developing a scientific hypothesis, first published on his own educational website in February 2021
(In my view, this is exactly how exceptional PMC should behave.) Here is a guide to mouth care from Lloyd-Jone’s hospital. And a preprint from medRxiv, “Brief Report: The Virucidal Efficacy of Oral Rinse Components Against SARS-CoV-2 In Vitro“:
The ability of widely-available mouthwashes to inactivate SARS-CoV-2 in vitro was tested using aprotocol capable of detecting a 5-log10 reduction in infectivity, under conditions mimicking thenaso/oropharynx. During a 30 second exposure, two rinses containing cetylpyridinium chloride and a third with ethanol/ethyl lauroyl arginate eliminated live virus to EN14476 standards (>4-log10reduction), while others with ethanol/essential oils and povidone-iodine (PVP-I) eliminated virus by 2-3-log10. Chlorhexidine or ethanol alone had little or no ability to inactivate virus in this assay. Studiesare warranted to determine whether these formulations can inactivate virus in the human oropharynxin vivo, and whether this might impact transmission.
So “cetylpyridinium chloride” and “ethanol/ethyl lauroyl” are the ingredients to look for on the label. Perhaps readers can suggest from brands?
Conclusion
I should have a peroration, but I feel like I’ve said what I’ve had to say. Let’s all contest The Ultimate Lockdown, especially by, as citizen scientists, developing protocols and sharing them. We can save some lives! Let us become excellent by saving lives, repeatedly.