Low doses of radiation may be effective for COVID-19 | Guest Opinion

A dozen or so medical institutions in five countries have begun human medical trials on severely ill COVID-19 patients using low-doses of radiation. The first results on a very small group at Emory University Hospital in Atlanta were quite extraordinary.

Dr. Mohammad Khan, Radiation Oncologist, treated five COVID-19 patients with severe pneumonia who were requiring supplemental oxygen and whose health was visibly deteriorating. Their median age was 90. These patients were given a single low-dose of radiation to both lungs, and were in and out of the Radiotherapy Department in 10 to 15 minutes. Doses were about fifty times less than those used to treat cancer.

Within 24 hours, four of the patients showed rapid improvement in oxygenation and mental status (more awake, alert and talkative) and were discharged from the hospital 12 days later. Testing confirmed that the radiation was safe and effective, and did not cause adverse effects — no acute skin, pulmonary, gastrointestinal or genitourinary toxicities.

This treatment is critical because severe COVID-19 cases cause cytokine release syndrome, also known as a cytokine storm. Such a storm is a deadly uncontrolled systemic inflammatory response of the body’s immune system resulting from the release of great amounts of pro-inflammatory cytokines, which act as a major factor in producing acute respiratory distress syndrome, which is what kills.

It’s why we need ventilators and ICU beds so badly, and why this pandemic threatens to overwhelm our hospital systems.

COVID-19 has increasing fatality rates with age — 8% for patients aged 70 to 79 and 14.8% for those aged 80 and over. Mortality rates are even higher if you get hospitalized and are in the ICU, over 50%. So showing this treatment is safe for these very elderly patients was vital.

It’s the anti-inflammatory effects of radiation, not any antiviral action, that helps with COVID-19. And we are already completely set up for these radiation treatments at almost every hospital and cancer center — no new preparation, additional equipment, or training is needed. Tri-Cities has many such facilities ready to go.

We could have been doing this since the pandemic began and saved tens of thousands of lives.

We kind of knew this would work because we did the same thing 70 to 80 years ago. X-ray therapy was used during the first half of the 20th century to successfully treat pneumonia, especially viral pneumonia like that caused by this coronavirus. Oppenheimer first started to use X-ray treatments in 1943 for pneumonia patients, and Powell even earlier in 1939. Since then, low-dose radiation has been used for many medical applications, anything from cancer treatments to rheumatoid arthritis and other chronic autoimmune inflammatory diseases that continue today.

Unfortunately, 70 years of irrational and unfounded fear of low doses of radiation, even those doses that occur naturally in the environment, have prevented testing of many of these treatments. Between the discovery of penicillin and the atomic bombs used in World War II, most interest in using radiation therapy against any disease other than cancer steadily waned.

The likely mechanisms by which low doses of radiation mitigate inflammation and facilitate healing is the polarization of macrophages to an anti-inflammatory or M2 phenotype. The M1 type tends to overstimulate the immune system which can lead to a cytokine storm, while the M2 type tends to suppress the overreaction of the immune system.

We still don’t have any established treatment for COVID-19. Remdesivir, an RNA polymerase inhibitor, has shown promise in human trials but only in shortening recovery times by a few days. But for COVID-19 patients who become severely ill, low-dose radiation would appear to be a relatively safe strategy that could be widely implemented immediately. As the other human radiation trials move forward, it will be exciting to see their results because we need an easy, quick and safe treatment for the most dangerous virus of our time. The longer we dawdle, the more people will die.

This story was originally published June 22, 2020 at 3:48 PM with the headline "Low doses of radiation may be effective for COVID-19 | Guest Opinion."