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Ether Therapy in SARS-Cov-2: Prophylactic, Therapeutic and Mass Elimination

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Review Article http://doi.org/10.18231/j.ijirm.2020.022 Ether therapy in SARS-CoV-2: Prophylactic, therapeutic and mass elimination S. S. Jha Director and Head, Dept. of Orthopaedics & Joint Replacement Surgery, Mahavir Vaatsalya Aspatal, Patna, Bihar, India *Corresponding Author: S. S. Jha Email: [email protected] Abstract No specific therapeutic drug has been found. In the absence of any specific therapy and non-availability of vaccine, anaesthetic ether (diethyl ether) is recommended to be used as a prophylactic and therapeutic intervention in the management of COVID-19 disease. Strong evidence based property of ether as lipid solvent has provided the impetus for this approach. The lipid content of the outer envelope of the virus is the weak-link to get dissolved ether and thus leading to disintegration of the single-stranded RNA. The viruses present inside the blood stream are bound to be killed by the presence of ether in the blood circulation. Keywords: Lipid bilayer, Lipid solvent, Oxygenation, Recreational, Halothane, Ether. Coronaviruses are RNA virus and some of the viruses dropping directly over an anaesthesia mask) or by a close (RNA / DNA) are enveloped whereas some of them are circuit (on an anaesthesia workstation). naked viruses. The envelopes of these viruses have a fat The COVID-19 outbreak causes pneumonia, failure membrane. This fat membrane is a self assembled nano of multiple organs and systems, and death. The World particle with lipid bilayer, which is the weakest link. Health Organization has indicated that COVID-19 Compared to non-enveloped (naked) viruses, the fat viruses can be killed by ether solvent. One can ask membrane enveloped viruses are more sensitive to whether ether can be used to treat patients with COVID- neutralizing agents like chemical antiseptics and changes 19, especially in the case in the light of the fact that no in pH / temperature. specific therapeutic intervention is available against this There is extensive proof that on exposure of the virus virus, it is definitely plausible that ether can be used to to soap, the semi-rigid envelope of the corona virus prevent and treat patients with COVID-19. opens up at the lipid weak-link and the virus gets The usefulness of Ether in management of COVID annihilated. All coronaviruses including SARS-CoV-2 patient is strongly recommended. This is in conformity possess this fat layer as a component of the viral with previous evidence based concept of the virus fat envelope. envelope dissolving in ether and this has been further Anaesthetic ether vapour works as a lipid solvent and testified in the recent article in BMJ (19 February, 2020) ether has a traditional heritage of having the lipid by Deng (February 2020) clearly mentions “ether, 75% dissolving quality and is extensively used in labs for this ethanol, chlorine disinfectant, peracetic acid, and purpose. Liquid alcohol is used similarly to dissolve the chloroform can effectively inactivate the virus, but not fat content. This anaesthetic ether vapour will dissolve chlorhexidine”.7 Cascella (April 2020) similarly the lipid bilayer in the viral envelope and subsequently emphatically mentions “These viruses can be effectively the viral RNA gets disintegrated. inactivated by lipid solvents including ether (75%), The outer surface of the virus has an overcoat / ethanol, chlorine-containing disinfectant, peroxyacetic envelope of lipid with protein. The presence of lipid acid and chloroform except for chlorhexidine”.5 makes it vulnerable to fat solvents like Ether, Ethanol Fortunately, the progress in research has helped to prove and Chloroform, of which Ether is most easily available this path-breaking invention. During this pandemic and cheap and can be safely administered through oral period, unfortunately attention has not been drawn inhalation as vapour on a sugar crystal vehicle in small towards the use of Ether in prevention and management dose (few drops) otherwise it can be administered as an protocol. inhalation anaesthetic agent either by open method (by Covid-19 Special Issue, April, 2020;1(2):28-31 28 S. S. Jha Ether therapy in SARS-CoV-2: Prophylactic, therapeutic and mass elimination Deng (February 2020) and Cascella (April 2020) Apart from this, all the viruses circulating in the blood have separately written along with their colleagues and gets disintegrated-most unique feature of Ether. have reconfirmed the sensitivity of COVID virus to With use of volatile anaesthetic, diethyl ether for Ether. In spite of this fat dissolving property, Ether has general anaesthesia, blood concentration is 24% or never been considered for being included in the higher. These concentrations could be higher enough to management protocol of SARS-COVID-2 at various kill COVID-19 viruses. In clinical practice volatile stages. This is strongly being recommended for anesthetics in current use are isoflurane, sevoflurane and consideration by ICMR, Union Ministry of Health and desflurane. These newer volatile anesthetics reach a Prime Minister Office for permitting to implement the much lower blood concentrations during general use of Ether in prevention and management of SARS- anesthesia. Volatile anesthetics can induce vascular COVID disease. dilation and improve ventilation. Those lung segments Anaesthetic Ether can be used in three phases in the capable of ventilation, will contain inhaled volatile following ways:- anesthetics to dilate their vasculature. These agents including ether may improve oxygenation of patients First Phase Prophylactic and Therapeutic use with pneumonia. Thus, these agents could have role in Ether should never be consumed as such, rather it should treating patients with COVID-19. In this regard, diethyl be used as vapour after sucking ten drops of Ether, ether or its like could be very useful for its potential of soaked on to a lump of sugar and put over the tongue and “viral killing effects”. A watch is to be kept on liver inhale the fumes. The residual saliva-sugar mixture is enzymes. It also increases oxidative stress and may then allowed to be sucked down the throat. It kills the modulate immune functions. corona virus lodged in the throat. This is noteworthy, that Apart from hepatic functions, patients should be this virus is lodged in throat for initial four days after carefully monitored for blood gas changes, acidosis and getting infected from other corona patients. If this hemodynamics. The use of diethyl ether should be used procedure is conducted in similar way as “mass via a closed circuit system. It may be ideal to combine its immunization by polio drops”, REVOLUTIONARY use and immunoglobulin or other immune function success to prevent the pandemic of corona can be modulators to maintain or enhance the immune functions achieved. These viruses, still present in upper respiratory of the patients. tract of the patient, brought in contact with the vaporized Ether, will get eliminated. It should preferably be Third Phase administered once on a single day to each family member The continuation of corona pandemic beyond few of the hotspot affected areas. The oral administration of months, there is a possibility of spread of the disease into Ether should be initiated in similar way as “Two Drops the frontline health workers including doctors. Despite of Pulse Polio” programme to eradicate corona virus. The the negative test for corona in all routine or emergency family members of marked households of positive operations, it should be assumed that they can be corona patients in the hotspot areas, should be administered oral positive in subsequent few days. The government is ether daily for continuous five days. The quarantined requested to recommend the use of Ether as an anesthetic people should also be administered with immediate agent for patient undergoing surgery wherever indicated. effect. It should also used for prevention in frontline By doing this, the corona viruses will disintegrate in the warriors. system following ether inhalation anaesthesia. Second Phase of Critical Management Diethyl Ether Elimination of Virus - It is recommended to administer History of anaesthetic ether ether inhalation in small quantity through anaesthesia The compound may have been synthesised by either Jābir machine to the patients suffering from inflammation of ibn Hayyān in the 8th century8 or Ramon Llull in 1275.4, lungs by corona viruses. It is also indicated for the 20 It was synthesized in 1540 by Valerius Cordus, who patients waiting for intubation for undergoing ventilatory called it "sweet oil of vitriol" (oleum dulce vitrioli)—the support. Ether expands the vessels of alveoli which are name reflects the fact that it is obtained by distilling a inflamed providing more blood and better oxygenation. mixture of ethanol and sulfuric acid (then known as oil of Covid-19 Special Issue, April, 2020;1(2):28-31 29 S. S. Jha Ether therapy in SARS-CoV-2: Prophylactic, therapeutic and mass elimination vitriol)—and noted some of its medicinal properties.8 At climates, help with cold starting an engine at sub-zero about the same time, Paracelsus discovered the analgesic temperatures. properties of the molecule in dogs.8 The name ether was 3. Laboratory uses given to the substance in 1729 by August Sigmund Diethyl ether is a common laboratory aprotic solvent. It Frobenius.20 is ideal for use as the non-polar solvent in liquid-liquid William T. G. Morton participated in a public extraction. When used with an aqueous solution, the demonstration of ether anesthesia on October 16, 1846 at diethyl ether layer is on top as it has a lower density than the Ether Dome in Boston, Massachusetts. British doctors the water. Due to its application in the manufacturing of were aware of the anesthetic properties of ether as early illicit substances, it is listed in the Table II precursor as 1840 where it was widely prescribed in conjunction under the United Nations Convention Against Illicit with opium.3 Diethyl ether largely supplanted the use of Traffic in Narcotic Drugs and Psychotropic Substances.17 chloroform as a general anesthetic due to ether's more 4.
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