COVID: UV Light and Disinfectants
This blog is a reprint from Covid-19 Compendium For Clinicians , and written by jon pincus. I would just add that i think Trump might consider 2 actions:
- drinking lysol, just to show how safe it is (though, i should note that there has been a significant uptick in calls to poison control centers for ingestions of bleach and lysol (see https://www.nbcnewyork.com/news/local/nyc-poison-control-calls-for-bleach-lysol-double-after-trump-disinfectant-comment/2389593/ ). though that should not deter Trump, since science does not really matter (and his decidedly anti-science proclivities perhaps should encourage him to try it)
- using his immense power, through the Defense Production Act, to force tanning salons to redesign themselves to have ultraviolet probes to insert in all accessible body cavities (and ?create new ones)
geoff
Summary: a random perusal of the literature (PubMed search – Lysol, Household Cleaners) shows several reports of harm and no reports of benefit. Admittedly the quality of the literature on this topic is poor (my impression, no formal analysis) with no RCTs found and a suspected publication bias towards publication of “interesting” cases of harm. I hear this is something that might be studied.
UV Irradiation for treatment of infections – a treatment that had been used prior to the invention of antibiotics and antivirals with limited data in the past 50 years but a good summary below. One device was FDA approved in 2017 for treatment of T Cell Lymphoma. One site claims that intranasal therapy is as effective as intravenous but this was based on secondary markers and the only studies I could find on intranasal therapy are for rhinitis. Uh, not much more to say now but again, I hear this is something some people might want to look at.
A controlled clinical trial of ultraviolet blood irradiation (UVBI) for hepatitis C infection 2018 9 patients, 5 treatments – 56% decrease in HCV RNA
Ultraviolet Irradiation of Blood: “The Cure That Time Forgot”? Michael R. Hamblin Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA Adv Exp Med Biol. 2017
In 1904, the Danish physician Niels Finsen was awarded the Nobel Prize in Physiology or Medicine for his work on UV treatment of various skin conditions. He had a success rate of 98% in thousands of cases, mostly the form of cutaneous tuberculosis known as lupus vulgaris [5]. Walter H Ude reported a series of 100 cases of erysipelas (a cutaneous infection caused by Streptococcus pyogenes) in the 1920s, with high cure rates using irradiation of the skin with UV light [6].
Emmett K Knott (Fig. 25.1) in Seattle, WA reasoned that the beneficial effects of UV irradiation to the skin obtained by Ude, might (at least partly) be explained by the irradiation of blood circulating in the superficial capillaries of the skin. With his collaborator Edblom, an irradiation chamber was constructed to allow direct exposure of the blood to UV. The irradiation chamber was circular and contained a labyrinthine set of channels that connected the inlet and outlet ports. All these channels were covered with a quartz window that formed the top of the chamber. The irradiation chamber was so designed as to provide maximum turbulence of the blood flowing through (see Fig. 25.2). This was done in order to: (a) prevent the formation of a thin film of blood on the chamber window that would absorb and filter out much of the UV light; (b) insure that all the blood passing through the chamber was equally exposed to UV [7].
Knott and co-workers then carried out a series of experiments using UV irradiation of blood extracted from dogs that had been intravenously infected with Staphylococcus aureus bacteria and hemolytic Streptococcus species, and then the treated blood was reinfused into the dogs. They found that it was unnecessary to deliver a sufficient exposure of UV light to the blood to directory kill all the bacteria in the circulation. It was also found unnecessary to expose the total blood volume in the dogs. The optimum amount of blood to be irradiated was determined to be only 5–7% of the estimated blood volume or approximately 3.5 mL per kg of body weight. Exceeding these limits led to loss of the benefits of the therapy. All the dogs that were treated with the optimized dose of UV to the blood, recovered from an overwhelming infection (while many dogs in the control group died). None of the dogs that were treated and survived, showed any long-term ill effects after 4 months of observation [7].
The first treatment on a human took place in 1928 when a patient was determined to be in a moribund state after a septic abortion complicated by hemolytic streptococcus septicemia. UBI therapy was commenced as a last resort, and the patient responded well to the treatment and made a full recovery [7]. She proceeded to give birth to two children.
Hancock and Knott [8] had similar success in another patient suffering from advanced hemolytic streptococcal septicemia. These workers noted that in the majority of cases, a marked cyanosis (blue tinge to the skin caused by a lack of oxygenated blood flow) was present at the time of initiation of UBI. It was noted that during (or immediately following) the treatment a rapid relief of the cyanosis occurred, with improvement in respiration accompanied by a noticeable flushing of the skin, with a distinct loss of pallor.
These observations led to application of UBI in patients suffering from pneumonia. In a series of 75 cases in which the diagnoses of pneumonia were confirmed by X-rays, all patients responded well to UBI showing a rapid decrease in temperature, disappearance of cyanosis (often within 3–5 min), cessation of delirium if present, a marked reduction in pulse rate and a rapid resolution of pulmonary consolidation. A shortening of the time of hospitalizations and accelerated convalescence was regularly observed.
The knowledge gained in these successful studies led to the redesign of the irradiation chamber to allow a more thoroughly uniform exposure of the circulating blood, and led to the development of the “Knott Technic of Ultraviolet Blood Irradiation.” A number of irradiation units were manufactured and placed in the hands of physicians interested in the procedure, so that more extensive clinical data could be accumulated [7]. The Knott technique involved removing approximately 3.5 mL/kg venous blood, citrating it as an anticoagulant, and passing it through the radiation chamber. The exposure time per given unit of blood was approximately 10 s, at a peak wavelength of 253.7 nm (ultraviolet C) provided by a mercury quartz burner, and the blood was immediately re-perfused [7].
George P Miley at the Hahnemann Hospital, Philadelphia, PA published a series of articles on the use of the procedure in the treatment of thrombophlebitis, staphylococcal septicemia, peritonitis, botulism, poliomyelitis, non-healing wounds, and asthma [9–22].
Henry A Barrett at the Willard Parker Hospital in New York City in 1940 reported on 110 cases including a number of different infections. Twenty-nine different conditions were described as being responsive, including the following: infectious arthritis, septic abortion, osteoarthritis, tuberculosis glands, chronic blepharitis, mastoiditis, uveitis, furunculosis, chronic paranasal sinusitis, acne vulgaris, and secondary anemia [23, 24].
EV Rebbeck at the Shadyside Hospital in Pittsburgh, PA, reported the use of UBI in Escherichia colisepticemia, post-abortion sepsis, puerperal sepsis, peritonitis, and typhoid fever [25–29] and Robert C Olney at the Providence Hospital, Lincoln, NE, treated biliary disease, pelvic cellulitis and viral hepatitis [30–32].
In this chapter, we will discuss the mechanisms and the potential of UBI as an alternative approach to infections and as a new method to modulate the immune system. Our goal is to remind people to continue to do more research and explore more clinical uses. The topics include the efficacy of UBI for infections (both bacterial and viral), to cure autoimmune disease, disease, and the similarities and differences between UBI, and intravenous ozone therapy, and extracorporeal psoralen-mediated photochemotherapy (photophoresis).
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