The rationale of ethanol inhalation for disinfection of the respiratory tract in SARS-CoV-2-positive asymptomatic subjects

Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic is a major health concern and is affecting the socio-economic lives. As other highly contagious diseases, it is of outmost importance to early identify and treat the healthy carriers or positive asymptomatic subjects (PAS). SARS-CoV-2 entry points are mainly in the respiratory tract. No specific virucidal treatments against SARS-CoV-2 are currently available. Monoclonal antibodies are under evaluation, but high cost and possible ineffectiveness against virus variants could limit its use. Resorting nonspecific drugs is an alternative approach. Among them, ethanol (EtOH) is known to be a powerful, cost-effective and abundant virucidal agent, now advised for surgical hand and surfaces disinfection. The paper aims to determine the potential role of inhaled ethanol to disinfect SARS-CoV-2 PAS, taking into account the dimension of the problem, ethanol efficiency and other beneficial effects on the respiratory tract, ethanol local and general toxicity and ethanol therapeutic window; consequently, to propose a study in order to verify this hypothesis. Together with the consolidated knowledge, an extensive review of the medical literature has been carried out looking for sound data able to support (or discard) the rationale on which a study could be built up. Evident data supporting the inhaled ethanol potential role on SARS-CoV-2 PAS disinfection have been found and discussed. A clinical trial to test the hypothesis that inhaled ethanol could be rapidly efficient in lowering or eradicating SARS-CoV-2 from the respiratory tract in PAS is advisable. Individual and public health benefits are stressed, together with socio-economic positive fallouts.

Construction of a Large Size Human Immunoglobulin Heavy Chain Variable (VH) Domain Library, Isolation and Characterization of Novel Human Antibody VH Domains Targeting PD-L1 and CD22

“…Human antibody VH domains offer distinct advantages: (1) no need for further time-consuming humanization; (2) flexible administration such as lung delivery via inhalation for rapid deployment in response to SARS-CoV-2 ( 9 , 45 ). Rapid progress has been made over the past few decades toward the development of therapeutic proteins ( 30 ).…”

Efficacy and Safety of Inhalation of Nebulized Ethanol in COVID-19 Treatment: A Randomized Clinical Trial

“…In this clinical trial, patients with positive RT-PCR test, moderate clinical symptoms, and suitable for remdesivir and dexamethasone treatment (according to the Iran Ministry of Health protocol) were included and the effect of adding nebulized inhalation was studied. The rationale for using EtOH in COVID-19 has been extensively treated [ 20 ].…”

“…This idea was first suggested and published one month after Iran's COVID-19 pandemic (February 2020) [ 18 , 19 ]. Later, a study dealing with the rationale for ethanol use in this field was presented [ 20 ]. A randomized clinical trial (RCT) evaluating the combined administration of dimethyl sulfoxide and ethanol recently showed considerable COVID-19 prevention in healthcare providers [ 21 ].…”

Efficacy and Safety of Inhaled Ethanol in Early-Stage SARS-CoV-2 Infection in Older Adults: A Phase II Randomized Clinical Trial

“…There is a large amount of evidence demonstrating the antiviral effects of ethanol with a graduation between 62–71° [ 10 , 11 ], possibly due to solvent action on lipids and protein denaturation [ 12 , 13 , 14 , 15 , 16 ]. In early stages of the disease, viral replication occurs in the epithelial layer of the upper respiratory tract [ 17 ].…”