Special Alert on COVID-19 and Treatment Options
The world is focused and fixated on the fear of the Corona virus as everyone sits at home tuned in to media reports and news conferences. As a Physiologist and Biochemist, it shocks me that so many “medical experts” have apparently forgotten basic and fundamental laws of nature and how the human body works with their recommendations for treatment of COVID-19.
The solution to COVID-19 worldwide pandemic may well be nitric oxide. In fact, there are a number of clinical studies using inhaled nitric oxide in critically ill patients. There are a few problems with this approach many of the hospitals are using. Number 1, it may be too late to introduce nitric oxide in ventilated patients. We need nitric oxide prior to escalation of respiratory distress. Number 2, administration of too much nitric oxide or for too long can cause methemoglobinemia which will further compromise the oxygen carrying capacity of the blood. It is better to be pro-active instead of reactive. Furthermore, we need systemic increases in nitric oxide, not just in the airways and pulmonary circulation.
Chest X-ray of patient with acute respiratory distress syndrome on the left vs a normal healthy patient on the right. Lungs should be clear for optimal ventilation. Any therapy should clear up infection and match perfusion to ventilation in the lungs.
In any treatment regimen it is ALWAYS a balance of risk vs benefit. Do the potential benefits of taking a specific mediation outweigh the risks or the known side effects of the medication. The recommendation for using hydroxychloroquine makes no sense to me from a mechanism of action perspective. Hydroxyychloroquine is a drug approved by the U.S. FDA for prevention or treatment of malaria, a plasmodium infection spread by mosquitos. It is also used to treat certain auto-immune diseases. Two completely distinct uses that are completely different from prevention or treatment from viral infections. Perhaps it is preventing or disrupting the cytokine storm that occurs with any infections that can sometimes lead to increased symptoms of the disease. However, production of cytokines and inflammatory mediators are necessary for a proper immune response to eradicate the infection. So MAYBE, there might be some clinical utility for this drug. However, when I look at the known side effects, the risk assessment becomes clear. Nausea, vomiting, loss of appetite, diarrhea, dizziness, or headache may occur. Other side effects include slow heartbeat, symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), mental/moodchanges (such as anxiety, depression, rare thoughts of suicide, hallucinations), hearing changes (such as ringing in the ears, hearing loss), easy bruising/bleeding, signs of infection (such as sore throat that doesn’t go away, fever), signs of liver disease (such as severe stomach/abdominal pain, yellowing eyes/skin, dark urine), muscle weakness, unwanted/uncontrolled movements (including tongue/face twitching), hair loss, hair/skin color changes. This medication may cause low blood sugar (hypoglycemia). This drug itself causes symptoms similar to the COVID-19 infection and we certainly don’t need to compromise the body’s ability to defend itself which is what this drug does.
The major symptom and cause of death from COVID-19 is respiratory distress and respiratory failure. The lung is unique in that when there is decreased blood flow to certain regions of the lungs, the lungs shut down perfusion or blood supply to that part of the lungs so there can be better oxygen exchange between the lungs that have good blood flow to then carry oxygen throughout the body. This is referred to as hypoxic pulmonary vasoconstriction. All other organs and tissues vasodilate during hypoxia (low oxygen) in order to try to increase blood flow to the area starved of oxygen. You can then begin to see this vicious cycle. Low blood flow to the lungs, low oxygen exchange and delivery of oxygen to all other parts of the body. No oxygen, no life and this is what we are seeing clinically in COVID-19 patients and why many are dying. So how do you address this fundamental physiological response and mitigate the severity of disease? The only way to address this from an immunological, pulmonary and vascular viewpoint is through nitric oxide. Nitric oxide is what controls and regulates blood flow to all organs and tissues throughout the body. Without sufficient nitric oxide production, there is loss of regulation of blood flow throughout the body, including the lungs. We now know that people with underlying cardiovascular disorders, high blood pressure, diabetes, kidney dysfunction, smokers, African Americans, etc have worse symptoms, increased need for ventilation and ten times higher death. These are the exact symptoms and populations of people with insufficient nitric oxide production. So rather than recommend medications not even approved or mechanistically effective against viral infection or pulmonary function, let’s focus on the right solution. Furthermore, nitric oxide has actually been shown to inhibit Corona virus replication.
So in summary we know from epidemiology all the way down to cellular and molecular biology, that loss of nitric oxide is the problem and restoration of nitric oxide is the solution. It is that simple. Address underlying risk factors in at risk patients, restore nitric oxide and perhaps even prevent infection, but at the very least you decrease the severity of sickness, decrease the need for ventilation (of which there appears to be a shortage), and decrease death from respiratory failure from infection. AND even inhibit virus replication. These are fundamental truths that cannot be ignored or misinterpreted by political influence. Unfortunately, there appears to be political pressure in this scenario. Please share this with your local congressman/woman, physicians or any political figure that may be able to communicate these fundamental laws of nature and human physiology to the so-called medical experts.