An Engineering Perspective to Managing COVID-19 While Waiting for Safe, Effective Vaccines*
Op-Ed • Dr. Nansen G. Saleri • 09/18/2020
The stubbornly disturbing question for the country remains – what happens if the vaccines under development offer partial protection only and/or are delayed well into 2021 and beyond? Are the current modus operandi sustainable for the country? Quarantines forever? Absolutely not. We can do better, America. A hardcore engineering and risk management approach is a must (remember Apollo and Manhattan Projects). The good news is that an ensemble of simple, safe, and readily available treatment and prevention options hold high odds of substantially reducing the pandemic’s relentless grip on America and unlocking its economy.
Speaking as a person with a science background, I believe an engineering perspective can vastly illuminate the path forward. Admittedly, I am not a medical doctor; however, it would be disingenuous to claim that principles involving laws of thermodynamics, physics, chemistry, and risk assessment fail to apply to seeking solutions to the COVID-19 pandemic. At our engineering firm, in formulating strategies to tackle complex problems – many with social, economic, and political facets as well – we use a highly specialized form of SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) – a gold standard across a broad spectrum of industries. What SWOT tells us about the current COVID-19 game plan can be summed up in three questions: 1) Are we attacking COVID-19 virus’s weaknesses, 2) Are there ready-to-go solutions that can be accelerated, and 3) What are we missing in the prevailing US strategy against COVID-19?
Are there COVID-19 weaknesses that are not being exploited? Any gaps in current strategy? The short answer is yes to both. Did you know that as with MERS, SARS, and the influenza virus, COVID-19 has an Achilles heel – an oily/lipid outer shell that is susceptible to heat, soap, and commonly known, safe disinfectants including warm steam and saline water. Many lipids typically have melting points ranging from 20° to 40°C – hence the likely explanation why local hyperthermia (such as steam or hot water as tolerable) could also be beneficial against the virus.
COVID-19 virus enters the body mainly through the nose and throat. These entry points have long been recognized by allergy sufferers and scientists alike. Recently, investigators at European and American Research Institutions identified two cell types in the nose that have surface receptor sites specific to this virus (Nature, May 2020). These cells appear to be “the doorway” to the disease. They allow initial viral attachment, infection, replication, and the spread of the virus. A targeted attack at these key access and exit portals can add a powerful protection to our presently adopted protocols of hand washing, masks, and safe distancing. Criticality of nasal hygiene is well known in medical circles but not by the public.
While there is an abundance of public safety pronouncements on masks and handwashing, there is virtually none for nasal and oral hygiene. Remedying this conspicuous omission in public education will save lives at an infinitesimal fraction of the costs that are resulting from this pandemic. It should also be a priority as part of the national drive to safely operating schools and colleges.
Are there ready-to-go solutions? Yes, with some risks. Did you know that Low Dose Radiation (LDR) was the treatment of choice during the first half of the 20th century for viral pneumonia with success efficacies in excess of 75%? Preliminary results from Emory University in June among elderly patients (median age 90) with advanced-stage COVID-19 produced remarkably positive and fast outcomes. Given the universal availability of x-ray machines and their current sophistication, LDR represents a prime example of a treatment option, with acknowledged risks, that can be fast-tracked. Currently there are nearly a dozen clinical trials in progress both in the States and abroad.
Did you know that in a recent editorial (June 30, 2020) Gallo (a prominent scientist whose contributions to HIV research are well known) and Arbess highlighted the potential benefits of the Sabin Oral Polio Vaccine (OPV) as a preliminary defense against COVID-19? “Stimulating the innate immune system with OPV looks like a free and safe option while we wait for an effective COVID-19 vaccine” is how the authors described the concept. Measles and TB also offer similar immune-bolstering opportunities according to many scientists including NIH’s Anthony Fauci. The question then is, “Why is this not a high priority action item?” Redundancy in safety designs is a standard engineering tenet in building airplanes, bridges, etc. It should also be the way forward in preference to a singular silver-bullet solution (perfect vaccine) in fighting the pandemic.
What are we missing? The complex web of issues around COVID-19 boils down to risk/reward tradeoffs. The potential downside consequences of prevailing COVID-19 strategies for America are predictable – daily fatalities fluctuating, a multi-trillion dollar budget deficit, a chronically shackled economy, and growing social disharmony. Extraordinary circumstances require extraordinary solutions. Insisting on legacy strategies reliant on double-blind vetting and paramount safety-first paradigms unwittingly results in more harm, absent an intelligent risk-reward assessment, hence the need to urgently reassess current approval protocols for new treatments and common sense extra protections of oral and nasal hygiene. What is the downside of taking hot showers and gargling with commercially abundant and safe mouthwash products?
My engineering-thinking-based Plan B consists of three complementary actions: 1) Initiate a vigorous public information campaign for oral and nasal hygiene, 2) Accelerate approval of new treatments and vaccines tasking oversight agencies to provide timely associated risk/benefit analysis, and 3) Allow patients and/or their advocates to opt for experimental new treatments or vaccines. Individual freedom of choice must remain an uncompromised principle of any strategy.
We can substantially marginalize the COVID-19 threat with simple, practical, and currently available weapons. As French statesman Georges Clemenceau once remarked, “War is too important to be left to the generals.” Hope is much needed but cannot be our sole strategy. Why wait? Action via a combination of complementary solutions will gain time and can possibly save tens of thousands of lives. When the cavalry shows up with a truly effective vaccine, we can still celebrate, and hopefully do so without masks.
Note from the Author: My main goal for this opinion-editorial is to bring about more public awareness to the fact that we as Americans and global citizens are not helpless against COVID-19. If you like the op-ed, please feel free to disseminate liberally via all channels available to you.
Chairman and CEO, Quantum Reservoir Impact (QRI), Houston, www.qrigroup.com;
President and Cofounder, Kristin Saleri Art Foundation (KSAF), Houston, www.kristinsaleri.com