The details of the expert:

Dr Merchant has a Pharmacy degree (BPharm) with a Masters in Pharmaceutics (MPharm) from University of Karachi and a PhD in Pharmaceutical Formulations from the University College London (UCL). He also have a PGD in Quality Management from NED and a PGCert in Higher Education from Huddersfield.

Dr Merchant has a particular interest in drug delivery research at the interface of gastroenterology and publishes in various aspects of oral delivery.

Unanswered Questions during Q&A session:

1. Chlorhexidine causes brown staining for teeth surface and needs scaling to remove. From Samir Haj Bloukh

Yes, this is a common side effect but product is still widely used and a popular choice in dental practices across UK. If you are using this in CoViD-19 setting, staining can be potentially prevented by brushing/cleaning the teeth after rinsing mouth/throat with chlorhexidine solution. There can be alternatives to chlorhexidine, such as antiseptics mouth rinses containing povidone iodine solution.

2. Political role of WHO, CDC FDA is also questionable nowadays, pls comment. From Saima Mahmood Malhi

It is true that the statements in the press and politicians have played a significant role in public understanding and perception of CoViD-19, particularly misinformation over the social media and misinterpretation of scientific studies by the press has been a major concern.

3. Is acetyl cysteine is useful in this condition? From Aisha Sana

Acetylcysteine is the N-acetyl derivative of the amino acid L-cysteine and is considered effective to help with liver toxicity following paracetamol overdose or fatty-liver disease. It also helps loosen the thick mucus in patients with cystic fibrosis or COPD. Refer https://doi.org/10.1038/s41598-018-26033-z and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270338/ on hepatotoxicity/liver function. There is a hypothesis that it may also prevent COVID-19-associated cytokine storm and the acute respiratory distress syndrome observed in severe ill CoViD19 patients, please refer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195028/ There are some ongoing clinical trials to confirm its effectiveness in CoViD19 that should provide a conclusive answer soon, for instance this one, https://clinicaltrials.gov/ct2/show/NCT04374461

4. Is there any evidence of essential oils inhibiting cytokine storm? From Naseem Akhter

Some components of essential oils have been reported to possess anti-inflammatory properties, however, evidence is not very strong to suggest that they would be able to prevent cytokine release syndrome. However, their antiviral/antimicrobial properties along with heat attenuation from steam can help reducing the viral load in nasal and oropharyngeal region in combination with an antiseptic mouth/throat rinse and lozenges. The throat rinse with anti-inflammatory drugs such as aspirin or benzydamine solution can help with the inflammation and potentially prevent the development of a more severe inflammatory disorder.

5. What do you think about Hydroxychloroquine? From Adil Hakeem Khan

The evidence is still not very strong and there are issues concerning the safety and toxicity if permitted for mass use by the public. Due to lack of evidence around CQ/HCQ in preventing the CoViD-19, its potential risk of fatal cardiac arrhythmia, and greater risk of self-use and harm in the developing world, it is recommended that the use of CQ/HCQ should only be initiated by specialist clinician dealing with CoViD-19 outbreak to treat CoViD-19 associated pneumonia under close cardiac monitoring, unless proven otherwise by an RCT. Please refer https://doi.org/10.5920/bjpharm.745 for further details.

6. What is your comment on COVID19 shifting from respiratory to vasculotropic disease? From Naseem Akhter

Yes, it has been a cause of concern and coagulopathy has been one of the main reason for CoViD-19 associated mortality. Clinicians in UK have suggested to use low dose aspirin as soon as patients get CoViD-19 to prevent any severe form of coagulation disorder, please refer: https://www.bmj.com/content/369/bmj.m2035/rr-1 for details. It may be that a throat rinse with aspirin or benzydamine solution could proivde a more targetted localised effect in the throat in the early disease, please refer: https://www.bmj.com/content/369/bmj.m2035/rr-2

7. What do you think about immune based vaccine? From Adil Hakeem Khan

Vaccines are a type of immunotherapy – not sure if I have understood your question.

8. May I ask your opinion about the heparin use? From Ferdinando Mannello

Heparin has been in-use across hospitals to prevent thrombus formation in severely ill hospitalised patients with CoViD-19 as this has been one of the main reasons for CoViD-19 associated mortality. However, if a low dose aspirin is started as an early intervention in CoViD-19 patients, we could potentially prevent a coagulation disorder. please refer: https://www.bmj.com/content/369/bmj.m2035/rr-1 and https://www.bmj.com/content/369/bmj.m2035/rr-2 for further details.