Is low dose radiation therapy a potential treatment for COVID-19?

[neilparker62]

https://www.thegreenjournal.com/article/S0167-8140(20)30185-7/fulltext

What's the relevant science here ? Would just like to hear a bit more as to whether it holds out any meaningful prospects for treatment of Covid 19.

 

[jim mcnamara]

This is clinical observation. That means it has been documented as a treatment. Has it been verified by an RCT? No.

The model they suggest is that low level radiation (< 100cGy ) reduces Interleuken 1β, which, in turn reduces inflammatory response - which is what kills patients with pneumonia-induced ARDS.

https://en.wikipedia.org/wiki/Interleukin-1_family -learn about inflammation.

It worked well on pneumonia patients in the past. It would be completely up to the attending physician whether to use it or not.

Physicians are the ultimate pragmatists. Find some treatment modality: the physician finds that it does no harm, and it works to the patient's benefit, then that is great. All systems are go.

Example, with the point
'if it does no harm (especially when compared with no treatment) and works well, who cares if it looks or smells ridiculous?' :

You would think that fermented fish guts would be a ridiculous thing to use on a deep puncture would on the foot. Ichthyol is diluted shale residue that is high in organosulfates. It was rumored to be originally mixed with putrid fish parts in pharmacies in the 1900's. Hence the name. Nowadays it is a more genteel mixture - see the link. Podiatrists prescribe it as a drawing salve for foot wounds. Works very well. Still smells awful. Looks worse.

https://en.wikipedia.org/wiki/Ammonium_bituminosulfonate

 

[hutchphd]

That is an interesting idea. The dosage for a thoracic CAT scan is about 10% (maybe even 20%) of this low treatment level. Also the use of radiation on older people is less restricted, so that is a positive for the possible patients. If I start coughing, sign me up,.

 

[Vanadium 50]

It worked well on pneumonia patients in the past.

On not a huge number of studies, and not enough for this to be adopted as a standard treatment today, even by your ultimate pragmatists.

low dose

Not all that low. 1 Gy is maybe 20% of a fatal dose. LNT suggests this is an order of magnitude worse than the disease.

One could say, well, let's restrict it to 80+ patients, but I'd like to see studies showing that it works as well as it needs to in this cohort.

 

[jim mcnamara]

@Vanadium 50 - please read this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651829/
If you check the citations you'll see the longitudinal studies of post Pt therapy patients that show lots of problems. Sorting out:

post Pt induced problems
versus
population norms defining onset of disease

is not something I understand fully.

Then come back and consider your 20% of a fatal dose comment. Which is correct. BTW.

It appears physicians currently opt for survival with increased mortality and ugly side effects and reduced lifespan. So you cannot rule out a treatment solely on that basis. This assumes it "works". So how do we answer that question?

Maybe -
Currently in NYC, severe ARDS + Covid patients have >20% mortality rates. >24% for those on mechanical intubation:
https://www.cidrap.umn.edu/news-perspective/2020/04/new-data-highlight-deadly-covid-19-impact-nyc

Were physicians there to use a last ditch method like this on some failing patients in the NYC population, they would record results and report against their total ARDS population cohort. S.O.P.

... I think is a potential answer.

I do not believe the original we are discussing is any more than an informed comment for clinicians.

 

[Vanadium 50]

It appears physicians currently opt for survival with increased mortality and ugly side effects and reduced lifespan. So you cannot rule out a treatment solely on that basis. This assumes it "works". So how do we answer that question?

Well, I'm not a physician, but I would be disinclined to treat a patient with Covid in such a way that is likely to leave them immunocompromised.

Sure, if the patient were otherwise dying, try whatever the heck you want. But this wouldn't be my first choice. Not without testing it on geriatric mice first.

 

[hutchphd]

Then come back and consider your 20% of a fatal dose comment. Which is correct. BTW.

Yes 5 Gy is the median fatal dose but it is a misuse of the Linear No Threshold theory to assume that 1 Gy produces 29% death rate and each 0.1 Gy CAT scan produce 2% death rate. The estimated additional mortality for the CAT scan is nearly 100 times less than that. The mechanisms of prompt injury and low dose effects are quite different.. ( I did some research for personal reasons.! )

 

[neilparker62]

This is clinical observation. That means it has been documented as a treatment. Has it been verified by an RCT? No.

The model they suggest is that low level radiation (< 100cGy ) reduces Interleuken 1β, which, in turn reduces inflammatory response - which is what kills patients with pneumonia-induced ARDS.

https://en.wikipedia.org/wiki/Interleukin-1_family -learn about inflammation.

Thanks - had a look at your reference and have to confess I did not understand much. Also looked at the video recommended by Tom G.

https://www.physicsforums.com/threa...covid-19-spreads-infects-is-diagnosed.987180/

As I understand your post, the treatment described deals with secondary effects resulting from the Covid 19 infection so one assumes it buys time for the immune system to deal with the virus itself. What (if any) chance is there of 'nuking' the Covid 19 virus directly ? Does it cluster in 'colonies' that could somehow be recognised and targeted like cancer or is it so spread out in an infected person that that would be impossible without massive 'collateral' damage ?

 

[hutchphd]

What (if any) chance is there of 'nuking' the Covid 19 virus directly ? Does it cluster in 'colonies' that could somehow be recognised and targeted like cancer or is it so spread out in an infected person that that would be impossible without massive 'collateral' damage ?

I think this is a non-starter. Once the virus invades a cell it is controlling the cell for nefarious purposes. You might slow down the replication slightly but destroying lung tissue with radiation is not a good therapy. And the viruses themselves are diffusely in body fluids.

 

[neilparker62]

I think this is a non-starter. Once the virus invades a cell it is controlling the cell for nefarious purposes. You might slow down the replication slightly but destroying lung tissue with radiation is not a good therapy. And the viruses themselves are diffusely in body fluids.

Oh ok. If the virus doesn't clump anywhere but as you say is "diffusely in body fluids" , then no way to target it. Concerning destruction of tissue, this is an issue in medical sterilisation which seemingly can be addressed with correct dosage. Following extract from http://large.stanford.edu/courses/2018/ph241/goronzy2/

A key concern for tissue allografts is risk of disease transmission to the recipient. Hazardous microorganisms may be of donor origin or may have been introduced during tissue procurement, processing, storage and transfer. To reduce the possibility of bacterial, fungal or viral disease transmission, tissue samples must be sterilized before introduction into the recipient. Gamma irradiation allows for targeted reduction of microbials and viruses, often without drastic alterations of tissue properties.

But I can appreciate that an infected person's lungs are an altogether more difficult environment than external tissue grafts.

 

[Laroxe]

I think the effects of sever infection go beyond the effects of local inflammation in the lungs, patients often need multi-organ support showing evidence of kidney damage, liver damage and damage to the heart muscle which increases the risk of arrhythmia's. There is increasing evidence that a systemic vasculitis causing intravascular clotting is a significant factor in mortality.
We are also better at managing abnormal immune responses and several drugs that do this are used routinely.
I would expect that the possibility of increasing the local damage to the lungs in the immediate aftermath of the infection and the potential for serious longer term problems would make it an unlikely choice for clinicians. The fact that Covid 19 is really a systematic disease rather than just a pneumonia might also mean it would be far less useful than earlier experience might suggest.
In the UK the most advanced radiation sources tend to be concentrated in specialist centres, that also deal with patient groups already immune compromised, I imagine even trying to organise such treatments would be hugely complicated.

 

[neilparker62]

Not sure if this is a bit off topic in terms of the thread here but can I pose a more general question:

Apart from the obvious (and vital) efforts to develop a vaccine, are there any other emergent technologies which have something to offer in terms of dealing effectively with the Covid 19 crisis ? If we all want to resume 'normal living' as soon as possible, are there any potential 'game changers' in respect of trying to ensure that the virus transmission rate is reduced as much as possible ?

 

[mfb]

Everything that helps finding cases faster to isolate them. Tests contribute to that, encouraging people to isolate themselves if they show symptoms and to get tested helps as well.
And of course the usual actions to reduce spread. Keep some distance to others, wash your hands, don't sneeze/cough or at least limit the spread of droplets from it, mind what you touch, disinfect things that are touched frequently, ...

 

[neilparker62]

And of course the usual actions to reduce spread. Keep some distance to others, wash your hands, don't sneeze/cough or at least limit the spread of droplets from it, mind what you touch, disinfect things that are touched frequently, ...

As far as "touch contagion" is concerned regular hand washing and/or hand disinfecting are probably the most effective "technology" . But perhaps where technology could help us is in controlling the circulation of respiratory droplets. Could we use 3D design and printing to produce masks optimized to ensure droplets in exhaled breath fall as quickly as possible ? Would perspex masks be better than cloth or fabric ones ? What about full face visors ? Can ventilation systems in public places be better designed - eg extraction fans placed lower rather than higher ?

 

[Laroxe]

Its interesting that currently the most current information about vaccines and other potential treatments appear to be based on press releases rather than any published research papers. In fact the two recent reports about vaccine induced immunity in small numbers of monkeys didn't give any specific data that could help in interpretation. There seems to be a similar problem in drug evaluation and development with some extravagant claims being made without any actual data or context. I expect these things are a result of the money being made available for research but it will do even more damage to the public's confidence in the medical research community.
Having said that there does seem to be increasing evidence that convalescent plasma can modify the course of the disease but this is a limited resource. One company also claims to have produced a specific monoclonal antibody though without providing any detail, however these drugs are both complex to produce and expensive.
Its starting to look as if most of the drugs being tested, if they have an effect, its a minor one, there are no clear "stars" in the pack. The research seems to have shifted to try and look at when and with who any effect can be exploited, and this takes longer to establish.

 

[neilparker62]

Its interesting that currently the most current information about vaccines and other potential treatments appear to be based on press releases rather than any published research papers. In fact the two recent reports about vaccine induced immunity in small numbers of monkeys didn't give any specific data that could help in interpretation. There seems to be a similar problem in drug evaluation and development with some extravagant claims being made without any actual data or context. I expect these things are a result of the money being made available for research but it will do even more damage to the public's confidence in the medical research community.
Having said that there does seem to be increasing evidence that convalescent plasma can modify the course of the disease but this is a limited resource. One company also claims to have produced a specific monoclonal antibody though without providing any detail, however these drugs are both complex to produce and expensive.
Its starting to look as if most of the drugs being tested, if they have an effect, its a minor one, there are no clear "stars" in the pack. The research seems to have shifted to try and look at when and with who any effect can be exploited, and this takes longer to establish.

All the more reason perhaps to think about 'engineered' work and living spaces designed to cut transmission to a minimum. How expensive (for eg) are UV sterilizers , are they effective and can one obtain hand held models so you can 'zap' any surface before touching it ?

 

[BillTre]

You can't have people exposed to the UV light used for UV sterilization. This is not the same as black light of less energetic UV wavelengths. It can lead to problems like skin cancer.
UV can be used for sterilizing air or water flows where the air or water flow by a UV light in a contained space.
It can also be used for sterilizing the exposed surfaces of rooms and tissue culture hoods, when people are not present. It will not sterilize areas (in a room or whatever) that are not exposed to the UV.

Within these limits it might work, but wiping a surface down with an alcohol solution is probably easier.

On the higher tech path there are also vapor based ways (such as vaporized hydrogen peroxide or various vaporized bleach-like chemicals) to sterilize rooms (including surfaces not exposed to where light would go. These also would require people not be present and would probably require special engineering of a room to contain and resist the chemicals.

 

[256bits]

All the more reason perhaps to think about 'engineered' work and living spaces designed to cut transmission to a minimum. How expensive (for eg) are UV sterilizers , are they effective and can one obtain hand held models so you can 'zap' any surface before touching it ?

It would be more effective to take a look at ventilation systems and the role that has upon spread of a virus.
The study on the bathroom hand dryer electric dryer with its fan observed that the forced movement of air helped the virus "move around"within the confined space.

So HVAC systems for hospitals, restaurants, commercial establishments, and the like should be looked at more closely. There also is some hand wringing going on with regards to AC window units and the role those would play. ( As it seems fence sitting was the practice, and no decision was made until the issue is pushed ie the present heat wave and the onset of summer ).
The risk of dehydration ( and death ) vs the risk of acquiring the disease is the reason for the delayed choice, as they, the experts, do not know the numbers, any numbers, to put in an equation.

 

[Laroxe]

Actually there has been a lot of work done on the use of UV light in reducing cross infection, the sources are not really expensive and if built into ventilation systems they can certainly reduce the number of air-born organisms. There really shouldn't be any need to expose people to the light and as long as the systems are well planned they could help. Ventilation systems with a high rate of exchange with outside air would also reduce the possibility of a build up of pathogens but use a lot of energy for heating etc. What the effect of such systems would be on Covid 19 transmission is less certain, the latest research suggests that the role of surfaces in transmission may have been overstated. I doubt that anyone would suggest that trying to keep all surfaces sterile would be worth the effort but reducing the air born population of the virus in areas like schools - maybe.
In terms of other treatments it seems that Remdesivir, an antiviral drug has demonstrated a useful level of activity, it may be that when they work out the optimum time to begin treatment, this effect might be better still. While a great deal of government money was invested in developing this drug its still unclear how much it will cost and how quickly production can be stepped up.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789813/

 

[neilparker62]

Face visor design from MIT:

https://project-manus.mit.edu/fs-health

Well you might initially feel a little self conscious walking around with one of those on your head but if they can ramp up production for the mass market, I think I would definitely be ordering a few. And I would also wear a face mask underneath.

MIT's stated priority is for healthcare and emergency workers but it looks a simple enough design to be mass produced eventually.

If we're looking at cutting the Covid 19 transmission rate as much as possible, how effective would these be if mass produced and (I guess more importantly) "mass adopted" ?