Objective To explore the impact of the COVID-19 pandemic on mental health of Obstetricians and Gynaecologists Study Design We performed a survey-based study from doctors working in the field of Obstetrics and Gynaecology across all Hospitals in United Kingdom. Surveyed information included demographics, past history of mental health conditions, screening for current symptoms of depression and anxiety, the significance of contributory factors and the effects of mental health on workplace behaviour. Results 207 doctors completed the survey. Of the respondents, 22.2% (n=46) had previously received treatment for a mental health condition. During the COVID-19 pandemic, O&G doctors as compared to UK-wide population estimate, reported significantly higher rates of both Major Depressive Disorder (15.94% versus 3.3%, p=0.023) and Generalised Anxiety Disorder (24.64% versus 5.9%, p=0.044). Sub-group analysis showed that anxiety was more common amongst female doctors as compared to males (27.5% versus 12.50%, p=0.047). Respondents felt that the most significant factors for work-related changes to mental health was keeping up to date with frequently changing guidelines and protocols related to COVID-19. Only 38.65% of respondents agreed that they felt able to talk to colleagues about their mental health. Conclusions This is the first reported study that assesses the impact of COVID-19 on mental health amongst Obstetricians and Gynaecologists. Further research should focus on assessing if changes in the way rapidly changing guidelines and protocols are disseminated reduces the impact on mental health. Ongoing efforts are also needed to improve support networks and encourage normality around discussing mental health amongst doctors

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a serious health problem worldwide. In the pediatric population, currently available epidemiological data seem reassuring as the incidence of coronavirus disease 2019 (COVID-19) is much lower than in adults, with less critical cases and very few deaths. At present, there are no evidence-based studies on chest imaging in pediatric COVID-19. Chest X-rays showed non-specific findings and chest computed tomography (CT) exhibited similar, but fairly less severe CT changes compared to adult. Moreover, in approximately 50% of pediatric patients no correlation was found between chest CT imaging results and clinical characteristics. Lung ultrasound is rarely used, despite its unquestionable benefits as it can be performed at bed-side with a portable device, which minimizes virus transmission, is cheap and can be easily repeated. In conclusion, the chest imaging use in children, who are typically spared from severe infection, deserve recommendations different than adults also considering the increased risk of radiations exposure. In view of this, pediatric comparative studies among different chest imaging techniques, either less or more invasive, are urgently needed possibly after standardization of interpretation criteria of lung ultrasound.

SARS-CoV-2 not only causes viral pneumonia but has major implications for the cardiovascular system. Nevertheless, we assisted to a drastic reduction in the number of ACS during this period. Telemedicine and telecardiology, intended as integration to the traditional management appear precious tools especially in Covid-19 era. Given the decrease in new Covid-19 cases worldwide20, now we are approaching the so-called “Phase 2” challenge of a gradual return to pre-Covid-19 life. The epidemiological and clinical situation is rapidly evolving and practice patterns with policies depend on institutions and local availability.

The complement system is an ancient part of innate immunity sensing highly pathogenic coronaviruses by Mannan-binding lectin resulting in lectin pathway-activation and subsequent generation of the anaphylatoxins (AT) C3a and C5a as important effector molecules. Complement deposition in endothelial cells and high blood C5a serum levels have been reported in COVID-19 patients with severe illness, suggesting vigorous complement activation leading to systemic thrombotic microangiopathy (TMA). Strikingly, SARS-CoV-2-infected African Americans suffer from high mortality. Complement regulator gene variants prevalent in African Americans have been associated with a higher risk for severe TMA and multi-organ injury. These findings allow us to apply our knowledge from other complement-mediated diseases to COVID-19 infection to better understand severe disease pathogenesis. Here we will discuss the multiple aspects of complement activation, regulation, crosstalk with other parts of the immune system and the options to target complement in COVID-19 patients to halt disease progression and death.

Coronavirus disease 2019 (COVID-19), an infectious disease caused by the novel coronavirus SARS-CoV-2, represent an ongoing global health emergency. Common symptoms are mild including fever, cough, myalgia and difficulty breathing. In patients most severely affected, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS). The management of ARDS mainly focuses on the provision of supportive care, e.g., oxygenation, ventilation, and fluid management. Polyethylene glycol (PEG) is a water soluble non-toxic polymer approved by FDA and widely used in food, cosmetics and pharmaceutics. PEG has interesting properties that makes it suitable for use as an adjuvant treatment in COVID-19 patient with ARDS: (1) PEG could create a physical barrier that inhibits virus entry and invasion; (2) PEG reduces inactivation and enhances the surface activity of pulmonary surfactant; (3) PEG decrease cytokine release and (4) PEG preserve lung endothelial cells integrity.

Introduction COVID 19 in particular affects the lungs causing an ARDS type picture resulting in an atypical form of ARDS whereby there is disproportionately poor oxygenation despite reasonably preserved lung compliance in the early stages 1. Experience from Italy and China suggests that nursing the patient in a prone position is potentially beneficial and can improve outcomes when carried out in the early stages of the disease1,2. This has resulted in its inclusion in several international guidelines and adoption around the world as a valid intervention for COVID 19 patients3Proning is not a new phenomenon and has been used as a treatment option for ARDS for over 20 years. It is not without complications and as well as the displacement of tubes and lines, the exacerbation of existing traumas or dehiscence of surgical wounds there are also reports of pressure necrosis secondary to prone positioning particularly of the face and nose4A cochrane review in 2015 concluded that prone ventilation was directly responsible for an increased risk of pressure sores5There is some suggestion that the pressure damage caused by proning occurs regardless of preventative measures put in place (such as foam supports and measures to relieve pressure)4But it also seems that this pressure damage is often mild and self resolving6. Regular repositioning of the head may also reduce pressure damage accordingly7Given that larger numbers of patients are likely to be proned and that proning is directly linked to pressure damage to the face and nose it would seem logical that this would represent an increase in referrals to ENT to assess this. Anecdotally this is the case in our department where we have received several such calls having never previously encountered this complication in routine practice. Although patients should be proned with the head turned to one side to avoid such pressure damage8 due to the highly unstable nature of COVID 19 patients and in some cases limited cervical spine rotation inevitably some patients will end up in positions where there nose is at risk. We present our approach to the management of these injuries borrowing from theory and practice used to manage patients having undergone rhinological procedures.

• Patients with obstructive sleep apnea (OSA) and lung disease have more prominent nocturnal hypoxemia. • Nocturnal hypoxemia in patients with impaired lung function with co-morbid OSA can enhance the possible mechanisms through which presence of OSA has been associated with adverse outcomes • Hypoxemia-, sympathetic over-activation-, increased oxidative stress-, and systemic inflammation-related to OSA may exaggerate symptoms associated with COVID-19. • It can be suggested that presence of OSA may plays a role in the severity of symptoms associated with COVID-19. • Further investigation in COVID-19 patients with previous diagnosis of OSA is warranted.

Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) emerged from Wuhan, China at the end of December and spread rapidly around the globe with a higher degree of lethality reported than the endemic coronaviruses. Angiotensin convertase enzyme 2 (ACE2) host cell receptors mediate viral entry by binding to spike S protein of SARS-CoV2. ACE2 binding in viral pathogenesis has opened newer avenues for COVID-19 treatment with ACE2 at the center stage. Recombinant human ACE2 (rhACE2) protein has already shown therapeutic potential for vast array of therapeutic indications. In SARS-CoV2, the competitive binding of viral S protein with circulating ACE2 causing virus neutralization and sparing host ACE2 receptors is being proposed as the potential therapeutic mechanism in COVID-19. Though rhACE2 has moved into clinical trials in SARS-CoV2 patients, there are still some research gaps including lack of sufficient data about the proven efficacy of rhACE2 from in vitro and in vivo studies.

The pharmacological profile of benzodiazepines includes respiratory depression, and theoretically benzodiazepines might contribute to respiratory dysfunction. There are currently no data that indicate that benzodiazepines are problematic in COVID-19, and the risk is expected to be limited. Benzodiazepines are effective and frequently used, and if there is a clear indication in patients with COVID-19 there is insufficient reason to avoid benzodiazepines based on respiratory depression as side effect.

The use of renin-angiotensin system (RAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), is alleged to cause a more severe course of novel coronavirus disease 2019 (COVID-19). We systematically reviewed the available studies to assess the association of RAS inhibitors with mortality as well as disease severity in COVID-19 patients. A systematic literature search was performed to retrieve relevant original studies investigating mortality and severity (critical disease) in COVID-19 patients with and without exposure to ACEIs/ARBs. A total of 13 original studies were included; 11 studies reporting on mortality and 10 studies reporting on disease severity in ACEI/ARB exposed and unexposed groups. Among hypertensive COVID-19 patients, the use of ACEI/ARB was associated with a significant reduction in the risk of mortality exhibiting a pooled relative risk of 0.73 (95% confidence interval: 0.63-0.86). Moreover, there was no significant difference in the risk of developing severe/critical COVID-19 disease between ACEI/ARB and non-ACEI/ARB groups showing relative risk of 0.72 (95% confidence interval: 0.46-1.12). The data indicate that the use of ACEI/ARB was associated with reduced risk of mortality in COVID-19 patients taking these medications to manage their hypertension.

As COVID-19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions and themselves.  The difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients and healthcare staff, amid a scarcity of data on which to base informed choices. This paper explores the risks of COVID-19 incurred while striving to uphold the standard of care in head and neck oncology.  The ethical problems are assessed from the perspective of the cancer patient, healthcare provider, and other patients within the healthcare system.  While no single management algorithm for head and neck cancer can be universally implemented, a detailed examination of these issues is necessary to formulate ethically sound treatment strategies.

IntroductionThe COVID-19 pandemic has resulted in an unprecedented need for critical care intervention. Prolonged intubation and mechanical ventilation has resulted in the need for tracheostomy in some patients. The purpose of this international survey was to assess optimal timing, technique and outcome for this intervention.MethodsAn online survey was generated. Otorhinolaryngologists from both the United Kingdom and Abroad were polled with regards to their experience of tracheostomy in COVID-19 positive ventilated patients.ResultsThe survey was completed by 50 respondents from 16 nations. The number of ventilated patients totalled 3403, on average 9.7% required a tracheostomy. This was on average performed on day 14 following intubation. The majority of patients were successfully weaned (mean 7.4 days following tracheostomy).ConclusionThe results of this brief survey suggest that tracheostomy is of benefit in selected patients. There was insufficient data to suggest improved outcomes with either percutaneous versus an open surgical technique.

Background: An increasing number of COVID-19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID-19. We explored the safe and effective management of tracheostomy in COVID-19 patients, to benefit patients and protect healthcare workers at the same time.Methods: We retrospectively analyzed 11 hospitalized COVID-19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications and nosocomial infection of the healthcare workers associated with the tracheostomy were analyzed.Results: All the tracheostomy of 11 cases (100%) were performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no healthcare workers associated with the tracheostomy are confirmed to be infected by SARS-CoV-2. Conclusion: Comprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID-19 patients.

Background: Guidelines for ultrasonic devices use are imperative because infectious aerosols arising from airway procedures were a key etiologic factor in prior coronavirus outbreaks. This manuscript aims to summarize the available recommendations and the most relevant concepts about the use of ultrasonic scalpel during the SARS-CoV-2 pandemic. Methods: Literature review of manuscripts with patients, animal models or in vitro studies where the ultrasonic scalpel was used and the plume produced was analyzed in a quantitative and/ or qualitative way. Discussion: Activated devices with tissue produces a biphasic bioaerosol composed (size 68.3 - 994 nm) of tissue particles, blood, intact and no viable cells, and carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene). Conclusion: It is imperative to use an active smoke evacuator, to avoid ultrasonic scalpel use in COVID-19 positive patients and in upper airway surgery, as well as to follow the protection recommendations of the guidelines for management this type of patients.

A document by Sukanta Chowdhury, written on Authorea.

Objective: To assess the knowledge and attitude toward coronavirus disease-2019 (COVID-19) among Syrian community pharmacists. Methods: A cross-sectional study was performed between March 17th and April 10th, 2020 among practicing community pharmacists in Syria. Systematic random sampling strategy was used, and data was collected through an online questionnaire covering pharmacists’ knowledge and attitude towards COVID-19. Descriptive analysis was used to describe participants’ demographics, knowledge and attitude mean score. For inferential statistics, t-test, ANOVA and Spearman’s correlation were used to evaluate the relationship between study variables. Results: Of the 1236 randomly selected practicing community pharmacists, 427 completed the questionnaire (35%). Our participants primary sources of knowledge were social media and foreign health authorities’ websites. They achieved a mean good score of knowledge and attitude, of 7.17±1.3 and 1.84±0.5, respectively. Around two-thirds of the participants were able to identify all symptoms associated with COVID-19, while over 90% knew the different ways of disease transmission. Our participants had mixed answers about the times that COVID-19 can stay on different surfaces and the distance required to achieve physical distancing. Over 80% of our participants expressed positive attitude towards the emerging pandemic. A negative correlation between knowledge and attitude scores (r=-0.21, p<0.001) was noted. Conclusions: Syrian pharmacists expressed good knowledge and positive attitude towards COVID-19. This can provide a good support to the challenged Syrian healthcare system. The study showed a need to provide reliable and updated resource for knowledge for pharmacists that is administered by Syrian health authorities.

The incidence of thrombotic complications among critically ill patients with COVID-19 is high despite thromboprophylaxis. We describe a case of a young, otherwise healthy patient admitted to our intensive care unit with COVID-19-associatred acute respiratory distress syndrome (ARDS). Despite an initial uncomplicated course, he suffered cardiopulmonary arrest with a right ventricular clot in transit (CIT) identified on point-of-care ultrasound (POCUS) and redemonstrated on transesophageal echocardiography (TEE). We highlight the association between COVID-19 and thrombosis as well as the utility of TEE during cardiac arrest for both diagnostic and therapeutic purposes.

Coronavirus is a new virus that takes control over the immune system making it lose its ability to differentiate between the healthy and infected cells. After enervating its host’s capacity to fight, the virus now replicates and transmits to look for other susceptible hosts. Due to this hollowing out of the immune system there are noticeable effects in the health of the people. Mass transmission of this virus leads the disease caused by it, called COVID-19, to take the form of a pandemic. In this study, we aim to underline the importance of carrying out the studies of other diseases with similar symptoms, of different animals carrying the virus and medications used in preceding pandemics. Certain species have been observed to be immune to the disease. The steroid, Hydroxychloroquine (C18H26ClN3O.H2SO4) which is an anti-parasitic drug that has been showing promising results in COVID-19, creates an intriguing fact wherein an antidote for Malaria is proving promising against a Coronavirus. Here, we intend to reflect on the importance of an interdisciplinary study across biochemistry, medical sciences and molecular sciences so that we can stay prepared beforehand for an epidemic.

SARS-CoV-2 infection is characterized by a protean clinical picture that can range from asymptomatic patients to life threatening conditions. Severe COVID-19 patients often display a severe pulmonary involvement and develop neutrophilia, lymphopenia, and strikingly elevated levels of IL-6. There is an over-exuberant cytokine release with hyperferritinemia leading to the idea that COVID-19 is part of the hyperferritinemic syndromes spectrum. Indeed, very high levels of ferritin can occur in other diseases including hemophagocytic lymphohistiocytosis, macrophage activation syndrome, adult onset Still's disease, catastrophic antiphospholipid syndrome and septic shock. Numerous studies have demonstrated the immunomodulatory effects of ferritin and its association with mortality and sustained inflammatory process. High levels of free iron are harmful in tissues, especially through the redox damage that can lead to fibrosis. Iron chelation represents a pillar in the treatment of iron overload. In addition, it was proven to have an anti-viral and anti-fibrotic activity. Herein, we analyse the pathogenic role of ferritin and iron during SARS-CoV-2 infection and propose iron depletion therapy as a novel therapeutic approach in COVID-19 pandemic.

Despite the current presumption that SARS-CoV-2 is transmitted by droplets, the reported evidence of the presence of the virus in air suggests that droplets dry fast producing clusters of virus, which are most penetrative through commonly available fabric filters to the public.   We consider droplets corresponding to a typical bimodal distribution of droplets of sneeze and calculate the time taken for them to evaporate to their ultimate size for two virus loadings.  The dry virus clusters resulting from fine droplets of the first mode have a size distribution comparable to cigarette smoke. There are currently no masks available to the public which can filter these aerosols efficiently, and even FFP grade masks have low filtration efficiency for these particle sizes.The implications are that safe distance is considerably greater than the generally-recommended two metres, as the virus remains fully suspended in the air.  Secondly, mask filters available to the public are inefficient in preventing SARS-CoV-2 spreading, as it could penetrate through them. The rapid spread of the virus is indicative of the ease with which it spreads through the air, and apart from wearing a high efficiency mask, the only safe prevention is to self-isolate at home.

Since the outbreak of SARS-CoV-2 virus more than 2 800 000 cases have been reported worldwide. Patients suffering from diabetes and other comorbidities are particularly susceptible to severe forms of the COVID-19, which might result in chronic complications following recovery. Dipeptidyl peptidase-4 inhibitors exert beneficial effects in the prevention/treatment of pulmonary fibrosis, heart, and kidney injury, and since they may be a long-term consequence caused by COVID-19, it is reasonable to expect that DPP-4 inhibitors might be beneficial in alleviating long-term consequences of COVID-19. With that in mind, we would like to voice our concerns over chronic implications following recovery from COVID-19 especially in diabetic, but also in non-diabetic patients, and to indicate that some preventive measures could be undertaken by application of DPP-4 inhibitors.

Angiotensin-Converting Enzyme 2 (ACE2) is cell surface receptor responsible for SARS-CoV-2 entry highly expressed in maternal-fetal interface including placenta cells e.g. stromal cells, prevascular cells of deciduas, cytotrophoblast, syncytotrophoblast. Several studies reported lack of transplacental transmission of SARS-CoV-2 from a COVID-19 positive mother to fetus suggests that the SARS-CoV-2 may not be transmitted from mother to her child due to some placenta barriers but may be replicating inside the placenta. Our earlier studies demonstrated that human placenta organ culture supports the replication of Japanese Encephalitis(JE) virus indicating their susceptibility and possibility to support propagation of other viruses. Based on our previous experience and present work, we propose that human Placental organ culture will be an ideal in vitro model for propagation of COVID-19 as it has the requisite receptors and tissue architecture needed for virus replication and vaccine development.

For centuries it has been humankind’s instinct to cover the mouth and nose when coughing or sneezing. Common sense would dictate this instinctively reduces the dispersion of aerosol and droplets and thus the spread of contact and airborne infections.Aerosol generating procedures (AGPs) have become a new byword for procedures that put clinicians at increased risk of contracting COVID-19. Whilst the title suggests the risk is simply in aerosols, the science is much more interesting. Droplets and aerosols are different, with the distinction between them based on size. Whilst experts disagree on the absolute size when an aerosol becomes a droplet, the general acceptance is that anything bigger than 50 microns (0.05mm) is a droplet and those smaller are aerosols.In most contagious respiratory infections, the principal transmission agents are droplets (1). This is due to the relatively high viral load in a droplet, purely due to its large size, and also the fact that large droplets have weight, and so gravity pulls them down onto surfaces that others can touch – so passing it on. This is why washing hands is so effective against droplet spread.Aerosol transmission is thought to be a much less frequent cause of transmission, mainly due to the very small viral load (given the aerosol itself is by definition very small). However, it is clearly more concerning as these very small, and therefore very light particles, can travel large distances on air currents and can be directly inhaled. That said, it is thought to only play a minor role in transmission compared to droplet spread.During the COVID-19 pandemic PHE (Public Health England) updated guidance on what it considers (AGPs) Aerosol Generating Procedures. Included within this list were examinations of the upper aerodigestive tract in ENT. Any procedure enacting air over a fluid mucosal surface therefore poses a risk of viral dispersion within both droplets and aerosol. Healthcare workers were recommended to reduce endoscopy of the nose and throat. Any essential examination had to be performed using high level PPE including an respirator (N95 or FFP3)(2).Anfinrud et al (3) graphically represented a visual reduction in aerosol production by creating light sheet from a 532-nm green LASER. Comparisons were made between a person talking with and without a cover for the mouth, in their instance, a slightly dampened wash cloth. Light flashes were recorded to evaluate the number of droplets ranging between 5-200 microns. They showed that by covering the mouth, virtually no light flashes were seen. This observation supports the well-known concept that covering the mouth does indeed reduce droplet production.On impact with smooth surfaces droplets disperse to smaller sizes and can aerosolise. Similarly impact onto soft surfaces absorbs droplets reducing their projection as well as the tendency to aerosolise (3).As the pandemic plateaus in countries across the world various strategies are to be considered to return to a new normal. This would facilitate the resumption of diagnostic services whilst maintaining the protection to healthcare workers. One suggestion is the use of facemasks to help reduce the risk of inadvertent droplet dispersion (2). Despite the ‘soft surface’ barrier masks create, in the ENT setting, facemasks obscure access to the nasal cavity thus preventing nasoendoscopy.The ‘SNAP’ (Safe Nasoendoscopic Airway Procedure) developed by endoscope-i Ltd (West Midlands, UK) is a single-use, valved endoscopic port, retrofitted to any surgical mask (Figure 1), permitting entry of a 4mm flexible and rigid endoscope to examine the naso and pharyngolarynx. The valve, a 10.9 mm cylindrical tube truncated by two opposing 45 degree inclined membranes 700 microns thick, approaches a point but terminates in a 700 micron thick and 500 micron wide plateau, creating a ‘duck bill’ formation The valves are formed using a FFF (fused filament fabrication) 3D printing technique with a Flashforge Creator Pro 3D printer. The plateau atop the valve serves to provide a reference for introducing a slit using a hardened steel razor blade that is 400 microns thin. The blade is mounted in a jig to ensure angle, penetration depth and position are controlled as it is driven through the membrane. These measures ensure that the valve opening is observably consistent and less than 50 microns. Once the SNAP is fitted to a surgical mask, any cough or sneeze generated during the procedure is caught within the mask. The valve is configured such that pressure from the patient side will serve to collapse the walls of the valve membrane thereby further sealing the slit in the valve. This seal has been in vitro tested with aerosolised fluorescein(figure 2). The 45-degree angle of the valve walls from the non-patient side similarly allows the blunt tip of the nasoendoscope to deform the valve walls with ease. The cylindrical form of the walls encourages the valve membranes to return to their original flat shape following withdrawal of the endoscope.During the COVID-19 pandemic our tertiary head and neck cancer referral centre managed 120 urgent 2ww cases. Using the Tikka et al calculator (4) 40% of referrals were redirected back to the GP. The remaining 60% either went direct for imaging or underwent endoscopy. In total 40 cases were endoscoped, 9 of which using the SNAP. All 9 cases scoped with the SNAP were completed without any adverse effect. No cough or sneeze was elicited during any of the examinations and observations between the two groups were identical. Subsequently one consultant lead FEES examination was performed under controlled conditions. Again, the procedure was completed without any complications. The patient self-remarked on the comfort of the endoscopy as a result of the stability provided by the SNAP device in the alar region the prevented inadvertent movement during the chin tuck and head turn exercises.Our observations demonstrate the SNAP device is a practical and safe tool to aid reduction in droplet dispersion whilst performing nasoendoscopy. We hope to see the inclusion of such a device in recovery guidelines by national bodies in order to facilitate the return of safe nasoendoscopy in the post COVID Pandemic era.

Acute respiratory distress syndrome (ARDS) is the key cause for the morbidity and mortality due to COVID-19 infections. Recent clinical evidences suggest chronic release of pro-inflammatory cytokines as a prominent etiological factor. Adult stem cells are known to secrete potent immunomodulatory and bioactive compounds. We propose a nebulizer assisted treatment of Mesenchymal Stem Cells (MSCs) Secretome as a therapy which will counterbalance the COVID-19 induced cytokine storm as well as promote the regeneration of alveolar tissue attributed to the intrinsic cytokines and growth factor present in the Secretome. Intranasal administration of Secretome will not only protect against the COVID-19 associated complications but also bring down the necessity of the ventilator reducing the burden on health care infrastructure.