HYPOTHESIS:
The nebulization with aerosolized Trichloroisocyanuricacid in COVID-19 patients promotes early recovery and halts the
progression of the cytokine storm.
OVERVIEW
In 2019, novel beta coronavirus, also known as 1SARS CoV- 2i, emerged in Wuhan city of China.ii It is highly contagious and
can have profound implications, especially in people with pre-existing co-morbidities. In March 2020, 2COVID-19 pandemic
was declared, and it has affected millions of lives until now. SARS CoV-2 is an RNA virus which enters the human cells
through the Angiotensin-converting enzyme two receptorsiii (ACE 2-Receptor) and multiplies using the RNA dependent RNA
polymerase. The mean incubation period is 4-5 daysiv , and the ones who will become symptomatic will have symptoms by 12
days. However, the majority of patients remain asymptomatic or experience only mild forms of the disease. The infected person
starts shedding the virus one to three days before the onset of symptomsv, but the duration of the viral shedding remains unclear.
The patient presents with a high viral load in the nasopharyngeal swab just before and soon after the onset of symptoms, which
fall over the next week. The viral particles are released as droplets when an infected person coughs or sneezes, which spread up
to a few meters and remains viable on the inanimate objectsvi for variable periods. Therefore, maintaining a distance of at least 2
meters, frequent cleansing of the surfaces and hand sanitization significantly contains the spread of the virusvii. The detection of
viral RNA through the Polymerase Chain Reaction performed on the nasopharyngeal swab confirms the diagnosisviii. The
patient experiencing a mild form of the disease have a fever, sore throat, myalgias and malaise. They can also develop anorexia,
nausea, diarrhoea, ageusia and anosmiaix. Some patients report Shortness of breath 5 to 8 days after the symptom onset, which is
a predictor of worsening diseasex. The patients with age > 65, cardiovascular disease, lung disease, diabetes and obesity are at
more risk of developing complications. The other potential risk factors are immunodeficiency, infection with HIV, chronic
kidney disease and chronic liver diseasexi. The severity of clinical presentation outlines the management. Patients with mild
disease generally do not require additional evaluation as infection will spontaneously resolve with minimal supportive care and
isolation. However, some of these patients may deteriorate and develop dyspnea, tachypnea, hypoxemia and abnormal lung
findings and need hospitalization.
DISCUSSION
Chlorination has been the conventional method for water and surface disinfection since the 1800s as it is practical, accessible and
economical. Despite the use of Trichloroisocyanuricacid (TCCA) as a water disinfectant, there is no study in the literature showing
its efficacy against SARSCoV2 using nebulization. Our principal aim is to identify if the benefits of aerosolized TCCA
disinfectant can be extrapolated to eradicate the SARS CoV-2 virus from the respiratory tract and if it might help curb the
transmission of the virus to other people. We observed in a small group of symptomatic patients if they exhibit faster
recovery/resolution of symptoms and decrease in viral load as confirmed with RT-PCR on a nasopharyngeal swab, when
commenced on the aerosolized (TCCA) in addition to the recommended standard of care as outlined by 3WHO xiiand 4MOHFW,
Indiaxiii xiv. These patients were either RT-PCR5 positive for SARS CoV2 or had CT findings highly suggestive of coronavirus
disease. Since chlorine inhalation can be toxic at higher concentrations, we administered a minimal concentration of 1-2 ppm to
see if the disinfectant properties can be productive while avoiding airway injury. We hypothesize that the nebulization with
aerosolized Trichloroisocyanuricacid in COVID-19 patients promotes early resolution of symptoms and prevents or halts the
progression of an aggressive cytokine storm, which is the leading cause of complications in these patients. However, this
hypothesis needs corroboration with a more intense double-blinded randomized clinical trial.
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