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\begin{document}

\title{Is active individual prevention against Covid-19 possible?}



\author[1]{Sergio Messini}%
\affil[1]{Woman Health Center}%


\vspace{-1em}



  
  \date{May 07, 2024}


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\textbf{Introduction}

The Covid-19 pandemic is posing a major worldwide problem, although at
various levels in the different States.~ ~Although Covid-19 in most
cases develops benevolently and fearfully or asymptomatically, however
it can present different percentages of serious complications,
especially in elderly, defed or chronically ill subjects, with need of
hospitalization and intensive care. Since Sars-CoV-2 is characterized by
marked infectivity and a high percentage of serious complications (on
average 3.6\%), there has been a rapid spread, with logarithmic growth
also of cases with serious complications, so that the Healthcare Systems
have been subjected to high pressure, not always well sustainable.
Therefore, in an attempt to contain the exponential growth of the
virosis, various degrees of isolation and/or social distancing measures
have been implemented in almost all States, with the closure of
educational, economic, commercial and social activities (\emph{lockdown}
), albeit with different timing and different intensity and
duration.This has, however, led to a particularly remarkable, almost
deflagrating social and economic impact.For example in Italy from
20.02.2020 in about a month the following were detected:~ - stock market
losses of 30\%;~- drop in the price of the barrel of crude oil by about
50\%;~- 6\% decrease in GDP and subsequent reduction of 0.75\% for each
week of additive lock-down;~- loss of about 2 million jobs, with
unemployment rising to 11\% of the potentially active
population.\textsuperscript{1~ ~~}Considering that similar, albeit
different, data are found in all the other affected States and that they
depend on the~\emph{lockdown}strategies applied, it is understandable,
that this viral spread containment strategy, although useful in an
initial initial phase, cannot be sustained for too
long.\textsuperscript{1~ ~}Therefore, it follows the need to propose
infection containment strategies, which are reconcilable with a
reduction of the\emph{lockdown} , pending the development of a decisive
vaccination campaign.~In this perspective, we must be open to new
perspectives in the preventive field, just as new perspectives are being
evaluated in the therapeutic field.

\textbf{Sustainable individual prevention}

The evolution of Sars-CoV-2 virosis, like all the other aerial viroses,
passes biologically, substantially through the following steps:~

\emph{step 1} : interhuman contamination by droplets (''\selectlanguage{ngerman}\emph{Függe
droplets} '')~

\emph{step 2} : local multiplication at the contamination site

\emph{step 3} : active infection

\emph{step 4} : inflammatory response

\emph{step 5} : symptoms and clinical evolution

\emph{step 6} : complications.

The management of the Covid-19 pandemic can be summarized in the
following stages

\emph{phase 0} : the local spread of the virus has not yet occurred and
so occurs only observation of the events, that have developed in other
countries.

\emph{phase 1} : beginning of the infection with rapid growth of cases;
therefore application of social isolation measures (\emph{lockdown} )
for the prevention of \emph{step 1} (interhuman contamination) and, at
the same time, commitment to increase the treatment possibilities
of\emph{step 6} (serious complications)

\emph{phase 2} : flattening/descent of the virosis diffusion curve and
reduction of cases of serious complication; therefore interruption of
the and resumption of interhuman activities. In this phase specific
therapy methods are developed to interact on \emph{steps 4} and\emph{5}
. However remains the need for social distancing methods, associated
with the recovery of interhuman contacts, to continue controlling
\emph{step 1} (interhuman contamination).

In practice, these are the following passive contamination prevention
methods:~ - personalized social isolation, aimed at subjects with
Sars-CoV-2, also if asymptomatic, with electronic monitoring, through
personalized geolocation methods;~ - maintenance of a minimum
interpersonal distance, variously determined in distances between 1 and
3 meters;~ - use of protective face masks;~ - use of disposable gloves;~
- avoid touching mouth, nose or eyes

- frequent hand washing. \textsuperscript{2,3}

\emph{phase 3} : development of adequate vaccination and implementation
of a vaccination campaign and therefore stop of the effects of the
pandemic on populations.

In this evolutionary context, thinking of the \emph{phase 2} scenario,
with the resumption of normal socio-economic activities, it makes sense
to consider appropriate, to be able to add additional active prevention
actions, pertaining to the second step of the infectious process
(\emph{step 2} ), that is, the passing from contamination alone to
clinically obvious infection, through local viral multiplication. Each
virus exchanged contaminates the first arrival sites and will tend to
multiply here. Only following consistent viral multiplication, does an
infection take place, with all its pathophysiological consequences,
linked to the inflammatory reaction. An important role is therefore
represented by the size of the infectious load: if this is reduced, the
clinical manifestations are equally reduced.\textsuperscript{4,5~}In the
presence of a favoring pathophysiological pabulum (co-pathologies), the
infection can sometimes evolve, even in a serious and sometimes lethal
way, instead of passing benignly and going out, following the
inflammatory and immune response.\textsuperscript{5~}Therefore,
intervening at the level of contamination, we can think of reducing or
preventing the passage to infection, reducing the possibility of viral
multiplication and, therefore, the infectious load, and, with this, all
further potentially related events. Personal prevention could,
therefore, be pursued not only in a passive way, with the reduction of
the risk of exchange of contaminating droplets (facial masks, glasses,
gloves, prevention of interpersonal distancing, disinfection, hand
washing, etc.), but also in an active way, with the prevention of the
passage from contamination to active infection, intervening in reducing
the multiplication of the contaminating viral particles. In this
scenario, three active personal prevention practice methods could be
applicable by each one individually:

- probiotic prevention, by using Streptococcus salivarius k12

- phytotherapeutic prevention, through phyto-extracts of the root
of~Echinacea angustifolia

- thermal prevention, using the Messini thermo-prevention method.

All these methods, if applied regularly, result in a direct and/or in an
interferon-mediated antiviral effect. So they can act as limiters of the
viral contaminant share and, with this, participate in reducing viral
multiplication (\emph{step 2} ) and preventing infectious
development\emph{(steps 3-4-5} ).

\textbf{Prevention by oral probiosis (Streptococcus salivarius k12)}

When evaluating a viral infection, we must not make the mistake of
thinking that the pathogen arrives in a healthy territory, as it is free
from microorganisms. In reality, it is necessary to think in terms of
the relationships between microbial (bacterial, mycotic and / or viral)
consortia.\textsuperscript{6~~}In fact, if we evaluate the genome of
each human subject, the specifically human eukaryotic one represents
only 3.6\%; the bacterial one is 9.5\%; the viral one represents
67.7\%.\textsuperscript{6~~}Each of us, therefore, is, in reality, an
integrated multi-being association, in which bacteria and viruses are
present and essential to healthy human life. An infection, therefore, is
not to be considered simply the afference of a pathogen and that's it,
but it must be seen, as the interaction of a new microbe on the balance
of the pre-existing resident bacterial and viral consortium. Therefore
the new microbial agent can more easily spread to the contamination
site, if the microbial consortium residing therein is already per se
altered or anomalous. This may be one of the explanations, why
Sars-CoV-2 in many cases does not give symptoms, in others only mild
symptoms and in some, instead, serious symptoms and complications. The
eubiotic oral microbiota, as resulting from the Human Oral Microbiome
Database/HOMD (\emph{\href{http://www.homd.org}{www.homd.org}} ) is a
complex consortium, which includes 619 taxa in 13 phyla, namely:
Actinobacteria, Bacteroidetes, Chlamydiae, Chloroflexi, Euryarchaeota,
Firmicutes, Fusobacteria, Proteobacteria, Spirochaetes, Synergistetes,
Tenericutes.\textsuperscript{7,8~ ~}It is however characterized by a
preponderant presence of Firmicutes of the genus Streptococcus, with the
dominant species S. salivarius. The most documented Streptococcus
salivarius in the world is the k12 strain. Through the release of
bacteriocins (A2 and B), it antagonizes and counteracts the presence of
a ''pathogenic'' oral bacterial consortium, characterized by the
presence of species such as S. Pyogenes and Pneumococcus and by genera
such as Moraxella and Haemophilus.\textsuperscript{9~~}The~ oral
microbiota in which the S. salivarius k12 strain is present is also
characterized by the salivary presence of IFN\selectlanguage{greek}γ \selectlanguage{english}higher than the average
of the controls. This element strongly correlates with the ability of
the k12 strain to reduce pharyngo-tonsillary recurrences and other viral
respiratory diseases.\textsuperscript{9~ ~}The lung microbiota both in
healthy subjects and in pathology\textsuperscript{5,9,10,11} is borrowed
from the oral one. The stable and dominant presence of Streptococcus
salivarius in the lung is an indication of
eubiosis.\textsuperscript{9,10}~ The stable presence of S. Salivarius
k12 in the oral consortium would suggest its presence also in the lung
and the creation, therefore, in the respiratory district of an eubiosis,
potentially anti-pathogens and so also
anti-viral.\textsuperscript{9,10~~}Therefore the probiosis with
Streptococcus salivarius strain k12 can be proposed as a useful means to
support an oral and consequently optimal lung microbiota, which
collaborates to prevent the engraftment and multiplication of exogenous
virosis, especially through the increase of the presence of salivary
\selectlanguage{greek}γ-\selectlanguage{english}interferon (IFN\selectlanguage{greek}γ\selectlanguage{english}).

\textbf{Prevention by phyto-extracts of the root of Echinacea
angustifolia}

There are 9 species belonging to the genus Echinacea, but the most
studied are three: Echinacea angustifolia, Echinacea purpurea and
Echinacea pallida, all different from a botanical point of view, in
composition and pharmacological activity, although similar in their
clinical use. Echinacea has been better known to Europeans since the
eighteenth century, while Native Americans have used it for much longer,
for example, to heal wounds; in particular, the Cheyenne but also the
Pawnee and Lakotah-Siux used it for sore throat, cough or as an
analgesic.\textsuperscript{13~~}Echinacea has several properties
confirmed by research and these derive from the extremely eclectic
composition of this family of plants in whose roots, but also in the
aerial parts, there are several active ingredients that confer an
immunostimulating, anti-inflammatory, antioxidant,
antiviral\textsuperscript{14} and antibacterial action .~ Echinacea
purpurea root extracts are found to have immunomodulatory effects in
experimental mouse models.\textsuperscript{15~~}Specifically, the
immunomostimulating action is determined by the polysaccharide fraction
(\emph{echinacein} , \emph{echinacoside} ), which leads to an increase
in leukocytes, macrophages with their ability to engulf pathogens, and
NK (\emph{Natural Killer} ) lymphocytes, capable of recognizing and
destroying, for example, virus infected cells.\textsuperscript{14~~}In
particular, echinacein determines an anti-inflammatory action, while
polyphenols and chicory acid an indirect free radicals activity, which
protects the collagen, the main constituent of the human connective
tissue.\textsuperscript{16~~}The antiviral activity, on the other hand,
is attributable to the generic ability of this plant to interact with
the macrophage metabolic pathways of production of interferon \selectlanguage{greek}α \selectlanguage{english}and \selectlanguage{greek}β,
\selectlanguage{english}capable of inhibiting the replication of viruses inside the infected
cells and specifically to the chicoric acid and caffeic acid, as well as
its derivative, echinacoside, substances that tend to hinder the
aggression of viruses.\textsuperscript{17~~}In fact, in virus infected
cells, all Echinacea extracts increased the inducible amount of nitric
oxide synthase (iNOS) and this effect varied, according to the type of
extraction preparation. The results suggest that any potential antiviral
activity of Echinacea spp. extracts are probably not mediated by direct
induction of type I interferon, but rather involve
iNOS.\textsuperscript{18~~}Oral preparations containing hydro-alcoholic
extracts of Echinaceae purpureae and Echinaceae pallidae root,
administered 6 days before exposure to the influenza-A virus, expresses
immunomodulatory activity and is a potent inhibitor of the pathology of
the virus in vivo.\textsuperscript{19~~}The documented antiviral
immunomodulatory action of Echinacea extracts, could also be correlated
with its prebiotic action on the human microbiota due to the presence in
the Echinacea root extracts of inulin-type fructans (\emph{ITFs}
).\textsuperscript{20~~}Therefore, the antiviral activity of Echinacea
extracts is overall documented. Consequently, the administration of
Echinacea angustifolia preparations can be proposed as a preventive
antiviral aid.

\textbf{The Messini thermo-prevention}

The SARS-CoV2, even if it is most aggressive, is still a Coronavirus,
with capsid structure and lipid envelope.\textsuperscript{6,12,21~~}Like
other coronaviruses, SARS-CoV-2 has four structural proteins, known as:
protein S (spike), E (envelope envelope), M (membrane) and N (nucleus);
protein N contains the RNA genome while proteins S, E and M together
create the viral envelope.\textsuperscript{12~~}Coronaviruses, together
with Rhinoviruses and Orthomyxoviruses, are often implicated in
respiratory diseases of common cold, which, more often, appear mainly in
cold seasons, or in periods of sudden thermal decrease. They mainly
affect the upper respiratory tract, and, first of all, initially, the
mucous membrane of the nasal and paranasal cavities in particular and/or
of the larynx.~Alphacoronavirus and betacoronavirus are distinguished;
some cause mild diseases of the upper respiratory tract, including the
common cold (229E, NL63, OC43, HKU1); others underlie far more serious
respiratory diseases (Sars-CoV, Mers-CoV, Sars-Cov-2). Almost all these
viruses, can be defined as ''cryophilic'' (\emph{cold loving} ), that
is, they prefer and survive better at temperatures of around 33-35\selectlanguage{ngerman}°C or
lower; therefore they prefer the mucous membranes of the ''colder'' or
''more easily cooled'' bodily territories, that is, whose average
temperature is lower than the average basal endocorporeal human standard
(37°C). Coronavirus dried on smooth surfaces retains its vitality for
over 5 days at temperatures of 22-25°C and relative humidity of 40-50\%,
that is the typical typology of air-conditioned
rooms.\textsuperscript{25~~}Conversely, the viability of the virus is
rapidly lost (\textgreater{} 3 log10) at higher temperatures and higher
relative humidity (for example: 38°C and relative humidity\textgreater{}
95\%). The improved stability of the Sars-CoV at low temperature and low
humidity environment can facilitate its transmission even in communities
in the subtropical area (such as Hong Kong) in air-conditioned
environments.\textsuperscript{27~~}Moreover, innate immune defenses,
however, have a temperature-dependent efficacy in limiting the
replication of common cold viruses: it increases with hot
temperature.\textsuperscript{27~~}In fact, it is documented that
hyperthermia induces endogenous production of \selectlanguage{greek}γ-\selectlanguage{english}interferon (IFN\selectlanguage{greek}γ\selectlanguage{english}), with
a consequent antiviral effect.\textsuperscript{29,30,31~~}Yamaya M.'s
2019 work on the effects of high temperatures on the replication of
seasonal or pandemic human influenza virus\textsuperscript{32} is
particularly interesting, but, above all, the very recent February 2020
work published by Wang, reports, that the diffusion difference of the
new coronavirus Sars-CoV-2 in different Chinese cities, correlate with
its temperature. As a result, the minimum temperature increase of 1\selectlanguage{ngerman}°C
correlates with the reduction in the cumulative number of cases by a
factor of 0.86 and at a temperature of 38°C the virus quickly loses its
activity.\textsuperscript{33~~}Even if the spread of viral pathologies
of the airways, and in particular of the more serious ones, such as the
recent pandemic from coronavirus Sars-CoV-2, cannot be influenced only
by the ambient temperature, however the correlations existing between
the spread of the virosis and environmental temperatures are
documented.\textsuperscript{34~~}These epidemiological evaluations are
consistent with the potential of the use of hyperthermic treatment, not
so much as therapy of acute pathologies already in place, but for
prophylactic/preventive purposes.~ The Messini thermo-prevention method
has been proposed for the prevention of seasonal common cold
diseases,\textsuperscript{35} but, considering the common structural
bases with the other coronaviruses, it can be sensibly considered, to be
also suitable for an active auxiliary personal prevention against
Sars-Cov-2.~The thermo-prevention, therefore, consists of individually
heating the upper respiratory tract several times daily, so as to reduce
the viral contaminating share, reducing or preventing its
multiplication. This favors the interruption of the evolution from
contamination to infection. This can be simply achieved by heating the
nose, jaws, ear cavities and throat by means of a flow of hot air,
generate, for example, by a simple hairdryer with at least 600 watts of
power. The 70-80°C hot air-flow produced by hair dryers easily allows
increasing the temperature of the affected areas to over 40-43°C. Such
applications, repeated daily and regularly for two minutes, at least 4
times a day, allow effective active prophylaxis. The Messini method
\textsuperscript{35} suggests, therefore, the heating of the territories
of the nasal cavities, of the areas of the frontal and maxillary
sinuses, followed by the jaws with open mouth, subsequently of right and
left ear, finally the right and left lateral cervical region with hot
air flow at about 70-80°C, so that in these areas a temperature higher
than 40-43°C is obtained. So is it possible to contrast the ''vital''
and replicative biological capacities of the ''cryophilic'' viruses,
both directly, interfering with the viral capsidic
structure,\textsuperscript{22,23,24,26} and indirectly by increasing the
local production of IFN\selectlanguage{greek}γ
\selectlanguage{english}(\selectlanguage{greek}γ-\selectlanguage{english}Interferon).\textsuperscript{28,29,30,31~~}Obviously the result can
only be obtained with a regular use of the method and, therefore, it is
intrinsically subjective and dependent on individual diligence.

\textbf{Conclusions}

In the context of a~\emph{phase 2} of loosening the~\emph{lockdown} for
the Covid-19 pandemic, it is reasonable to propose, to add to the
expected strategy of social distancing, which seeks to reduce the
inhuman spread of the virus (\emph{step 1} ), also active personal
preventive strategies, which seek individually and daily to reduce the
contaminating viral load, reducing the risk of passing from
contamination to active infection (\emph{step2} ).~This additional
active individual prevention takes the form of three proposals:
probiotic prevention, by means of Streptococcus salivarius k12;
phytotherapeutic prevention, through phyto-extracts of the root of
Echinacea angustifolia; thermal prevention, using the Messini
thermo-prevention method.

\textbf{Conflict of interest}

The author declares no conflicts of interest

\par\null

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new and simple form of individual prevention

Authorea 20 04 2020 DOI: 10.22541/au.158740089.97393591

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