Intended for healthcare professionals

Rapid response to:


Preventing a covid-19 pandemic

BMJ 2020; 368 doi: (Published 28 February 2020) Cite this as: BMJ 2020;368:m810

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Rapid Response:

Preventing a covid-19 pandemic: Thinking outside the box.

Dear Editor,

Prevention of the spread of a new virus appears difficult but there appear to be some features that might enhance the community response.

Early data on hospitalised patients shows a large proportion with lower respiratory disease including consolidation (1.)

When my grandson died in 2011, an atypical chest infection threatened to prevent me from attending his funeral. Considering that the infection was likely to be interfering with pulmonary circulation, I used, a PDE-5 inhibitor on the basis that it would reduce pulmonary arterial pressure and so reduce any AV shunt created by alveolar vascular resistance caused by products of infection, thereby enhancing oxygenation of the blood in the pulmonary vein and peripheral circulation (2.). I was able to fly for an hour and to attend the funeral, even walking in the courtage with the family. Though unconventional, this simple inexpensive approach might be trialled on known COVID-19 patients with a view to reducing mortality. PDE-5 inhibitors (eg Sildenafil & Tadafil) are widely available oral medication that are considered so safe that they are sold over the counter.

Spread of the virus appears to be enhanced by air travel. Airliners are typically depressurised environments and therefore may result in decreased oxygenation. The use of simple pulse oximeters on passengers when a plane is at altitude may be a means of identifying cases (who might have low paO2) or/and airlines could pressurise their planes to sea level (though this would increase fuel consumption).

In the face of what appears to be a significant public health threat do we not need to be prepared to think outside our current bureaucratic box and rapidly trial some new approaches?

1. Xiao-Wei Xu et al. Clinical Findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2_ outside of Wuhan, China: retrospective case series. BMJ2020;368:m606

2. Ashworth, A. Enhanced recovery from respiratory infection following treatment with a PDE-5 inhibitor: a single case study. Prim Care Respirating J 21,17 (2012). https://doi .org/10.4104/pcrj.2012.00016

Competing interests: No competing interests

29 February 2020
Andrew J Ashworth
GP & Occupational Physician