Seven immediate, low-cost management strategies for Covid. Exploiting viral Thermolabity: Possible, immediate solutions

Seven strategies are proposed - and are under evaluation - to control the disrupting effects of COVID on our medical and social structures:


Introduction
A 'war' consensus document has been produced by a group of clinical research physician on the pandemics with special suggestions usable in a short term for patients at risk or affected by the Wuhan virus: 7 strategies may be used -at present -against the Wuhan virus (in association with what can be defined the standard management) to reduce its impact, morbidity and mortality. Each of these strategies is now in evaluation and more specific data will be available in days and analysed as separate observations or globally.
However, there is no time. War is now. They may be used according to the patients' best interest if the situation is adequate and if it is technically possible. Often the patient at risk is a physician.
We do not have a magic bullet for this new virus (vaccination or a specific antiviral) we may suggest different strategies to reduce its impact: one will decrease morbidity, for instance, of a factor of 20%; another may reduce viral replication of some 20%; one will reduce the inflammatory, respiratory response of some 25%; one strategy may avoid the side effects produced by drugs by 30-60% by local, direct administration into the bronchial tree. Anticoagulants (particularly LMWH, defibrotide), may reduce the occurrence of most thrombotic events in most of these patients both in the early phases and more during the hospitalization. All subjects with pneumonia should receive antithrombotic prophylaxis as indicated by several (consensus) documents now became a normal procedure.
All these apparently 'minor' steps may induce a decrease in morbidity and mortality with a great impact on costs, on the community and decreasing hospital load. Most patients should be managed (not abandoned) at home or in specific institutions to avoid viral spreading. One of the major problems of our health care system was the focus on hospitals, neglecting home care and GPmanaged defences. Hospitals are now castling without a moat but also without a wall. No sentinels of course (a soldier or guard whose job is to stand and keep watch; like the WHO). No defenders too. In November there was a significant cluster in Wuhan with some 57 deaths (data difficult to find and verify) in days and linked to the wet market ( Figure 1). It is possible that in this occasion several drugs were used without completely killing the virus but selecting more resistant and infective strains with a mechanism comparable to the creation of MRSA (methicillin resistant Staphylococcus aureus). MRSA infection is caused by a super-selected type of staph bacteria that has become resistant to many of the antibiotics used to treat staph infections. The over-selection of a resistant strain may have produced the COVID 19 virus. Most MRSA infections occur in patients who've been in hospitals or other health care settings (nursing homes, dialysis centres).  into Wuhan and into the rest of the world in a few weeks. The Virus 1 strain may have separately found its way into Europe causing a great number of atypical (inexplicable) pneumonia cases (however not very deadly) before the arrival of the super selected COVID virus. There is some limited evidence that subjects who had these atypical pneumonia episodes did not get the COVID.
Seven, low-cost, available strategies can be applied even in places where the healthcare system does not have many resources.
A study with Predictive Analytics is in progress to evaluate the relative impact of each strategy of morbidity and mortality.

B.
Pre-Intensive Care

Whv, Warm-Humid Vaporization
Bronchial-tracheal surface cells work at a specific temperature.
At their ideal range (37-38 °C) their response to viruses and bacteria tend to be optimal and mucus tends to have the specific grade of fluidity to contrast infections [1,2]. With a decrease of 3-4 °C or more, these cell layers may be less protected, less active and and mucin-reconstituting action, a warm-humid atmosphere may produce lower spread and limited symptoms. The graph in Figure   4 shows that daily hot-humid vaporization (WHV) can stop most of the winter respiratory viral infections (associated to fever) in a 3-month follow-up (the graph was obtained during the previous winter).

Figure 2:
COVID evolution. The syndrome shows long periods -before the respiratory insufficiency phase (RIP) -usable for management. So far most management methods have been focused on assisted respiration in ICUs. It is not possible to manage a disease, possibly involving millions of subjects, with ICUs. We may to focus on medical preventive methods (not only lockdown) particularly in higher-risk subjects and we need management methods of early symptoms, out of hospitals. improve the mucin layers may use antivirals may use anti-inflammatory agents. This disease should be considered, at least the in early phases, a local respiratory disease that requires a local, low-dose, lowcost management, with minimal occurrence of side effects.  [3,4] has also shown a significant potential in preventing winter-related viral respiratory infections. Its role needs alarger investigation particularly in high-risk subjects. A. Pre-Intensive Care: two management methods ( Figure  5) must be refined or considered and will be discussed in a different more detailed article with our initial experiences.

Prostaglandin E1 (PGE1)
Infusion (around 1 microgram/kg in 100 ml in 20 minutes) increases bronchial perfusion. The increase in bronchial blood flow makes O2 and CO2 exchanges more dynamic, faster and may greatly improve the function of the residual bronchial surface. PGE1 has no significant side effects, does not require monitoring and may greatly improve respiratory function. Also, PGE1 relieves distal vasoconstriction and avoids peripheral necrosis (also seen in some COVID patients) in hypo perfused area.

The Optimization of Anticoagulants
Needs to be evaluated in a more specific article. There a significant value in defining the right protocol for the different

A. Post-Intensive, Long-Term Follow-Up the Evolution of PCPF (POST-COVID PULMONARY FIBROSIS).
The last two long-term strategies involve post-COVID patients and are aimed at:

I.
Preventing pulmonary fibrosis in ICU survivors.

Protocols
These studies are now in progress. ICU survivors may have to deal with significant lung problems for the rest of their life.
Specific drugs and products are being tested to avoid post COVID pulmonary fibrosis (PCPF). A long period of morphological and functional observation appears to be needed (5-10 years or more).
Lung ultrasound is being specifically developed at this time to monitor these patients as CT scans and MRI would not be used (for costs and/or side effects) all the time for monitoring after COVID.
In conclusions the molability [10][11]   : no single antiviral is definitely effective; it is possible to suggest a management lasting 4 weeks based on 4 separate chemotherapic agents in sequence, each one, possibly active on a different aspect of viral replication. The cyclic use of the agents may limit side effects. The preventive dosage should be lower (50%) of the used therapeutic dose. Hydroxychloroquine, baicalein, colchicine, Lariam (mefloquine hydrochloride) can be used in this sequence. Other candidates (and the sequence) may be evaluated but the present availability of antivirals is very limited. All these products have been used for coronavirus. Baicalein has been extensively used in China even during the present Wuhan epidemy. This sequence seems to have no side effects, but large studies may be needed. However, there is no time and studies can be only organized for the next epidemy.
Most GPs use their own prophylaxis when they can, as the NHS often did (and does) not provide most physicians with essential tools. In Italy more than 120 physicians have been killed (so far) by COVID in less than 2 months. This circular, sequential management requires refinement but at the moment it is what it is possible and available out of hospitals. Another important aspect to consider is that all countries able to fight back with efficacy have a very efficient wireless and internet system used to communicate fast to almost all the entire population. In Italy, internet connection is relatively poor, it does not cover all places; often, even phone lines are not usable in most of the territories outside the main centres.
Most older people just have an ordinary phone for simple dialling and have no access to smartphones or sophisticated connections.
Thinking of using Apps in Italy may leave out more than 50% of the 'weaker' population; they could be cut out. The same goes for home schooling, only possible if the connection is good and free and if there are instruments available.
In case of emergency all phone and web connection services should be made immediately available and free to all population.
These studies are in progress and results should be available in days.

Comment
The santization of most oriental societies and nations (particularly China but excluding Japan that retains strong concepts of individuality) it is a time-bomb from an epidemiological point of view [13][14]. Simple, usable strategies may be useful during the war, now.