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Introduction

Chlorine dioxide: A safe and potentially effective solution to overcome Covid-19

1. INTRODUCTION

1.1. Background

1.2. A brief overview of chlorine dioxide 

1.3. Key Points for consideration 

1.4.What is Chlorine Dioxide Solution (CDS) and what are the differences with Miracle Mineral Solution (MMS)? 

The unnecessary controversy and its consequences

2. EFFECTIVENESS, SAFETY AND TOXICITY OF CHLORINE DIOXIDE 

2.1. Action against viruses 

2.2. Pre-clinical studies 

2.3. Clinical studies 

2.4. Toxicity 

3. RECOMMENDATIONS, PRECAUTIONS AND CONTRAINDICATIONS FOLLOWING MEDICAL EXPERIENCES 

4. LEGAL FACTS AND INTERNATIONAL HUMAN RIGHTS 

5. FINAL CONSIDERATIONS 

6.REFERENCES 

7.ANNEXES Experience report: the case of Bolivia

AEMEMI

Ecuadorian Association of Expert Physicians in Integrative Medicine

CDS

Chlorine dioxide solution

Cl

Chlorine

Clo2

Chlorine dioxide

COMUSAV

Global Health and Life Coalition

COVID-19

From the English, Corona virus disease .

SHE

Amyotrophic Lateral Sclerosis

FDA

From the English, Food and DPlease Aadministration

H2O

Water

HCl

Hydrochloric acid

mL

milliliter

MMS

Of English: Mineral Miracle Substance

NaCl

Sodium chloride (common salt)

NaClO

Sodium hypochlorite (bleach)

NaClO2

Sodium chlorite

NaClO3

Sodium chlorate

NaClO4

Sodium perchlorate

NaOH

Sodium hydroxide

O2

Oxygen

WTO

World Trade Organization

PAHO / WHO / WHO

From Spanish, Oorganization Mundial da Savalanche.

From Spanish, Oorganization Pan-American of the Savalanche.

From the English, World Health Organization

pH

Hydrogen potential

ppm

Part per million

RNARibonucleic acid

COVID-2

Acute respiratory syndrome coronavirus type 2

TCLI

Free and Informed Consent Term

HIV

HIV

1. Introduction

1.1 Background

The recent Covid-19 pandemic shocked the world and has claimed thousands of lives, and as one of the equally complicated consequences, the global economy was compromised. Undoubtedly, this is a problem that requires an urgent solution and the commitment of everyone, especially the health personnel, to find a prompt solution.  

In order to identify a solution to this problem and also based on the scientific evidence already published and clinical experiences of the use of chlorine dioxide (ClO2) by Doctors and Researchers, we made an assessment of the main information to support our proposal for the use of chlorine dioxide solution (CDS), following the standardized protocol by Andreas Ludwig Kalcker as a safe and effective alternative to combat SARS infection -COV2.

From January to July 2020, a review survey was carried out on the use of chlorine dioxide in the indexed international literature and as an example, if we only analyze the PubMed website (National Library of Medicine 2020), 

We observe that only using the descriptor "chlorine dioxide", we have available a total of 1.372 documents dating from 1933 to the research date, 2020 (Figure 1).

Figure 1 - Number of documents found with the descriptor "chlorine dioxide" in the PubMed scientific database. The first red arrow indicates the descriptor used for the search and the second the number of published documents.

Source: https://pubmed.ncbi.nlm.nih.gov/?term=chlorine+dioxide&sort=pubdate.

Access date: 24/07/2020.

Another important source was the PubChem database (Figure 2), in which it is also possible to identify biochemical and toxicological information, among others, and registered patents (which can also be found in Google Patents), among which the following stand out:

1) The patent on the disinfection of blood bags (Kross & Scheer, 1991);

2) The patent on HIV (Kuhne 1993);

3) The patent for the treatment of neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), Alzheimer's disease and multiple sclerosis (McGrath MS 2011);

4) the Taiko Pharmaceutical patent (2008) for human coronavirus;

5) the patent on a method and composition “for treating cancerous tumors” to treat cancerous tumors (Alliger 2018);

6) the patent for a pharmaceutical composition for the treatment of internal inflammation. (Kalcker LA, 2017);

7) the patent on the pharmaceutical composition for the treatment of acute poisoning (Kalcker LA, 2017) and;

8) the patent of a pharmaceutical compound for the treatment of infectious diseases (Kalcker LA, 2017);

9) the patent on the use of CDS for coronavirus type 2 (Kalcker LA, 2020 - still pending publication: /11136-CH_Antrag_auf_Patenterteilung.pdf).

Figure 2 - Number of documents found with the descriptor "chlorine dioxide" in the PubChem scientific database. The first red arrow indicates the descriptor used for the search and the second the number of published documents.

Source: https://pubchem.ncbi.nlm.nih.gov/#query=chlorine%20dioxide

Access date: 24/07/2020.

Therefore, only with these initial data, we find that the research on ClO2 It is not a novelty, it is a chemical molecule that has been known for more than 200 years and has been marketed for 70 years with various uses, namely: the treatment of water for human consumption, the treatment of contaminated water, for biofilm control in cooling towers and in food and vegetable disinfection processing. In addition, there are preclinical and clinical studies carried out, as well as studies that allow us to understand its toxicological and safety characteristics, especially for use by humans (Lubbers et al 1984, Ma et al 2017).

1.2. A brief overview of chlorine dioxide

The chemical formula for chlorine dioxide is ClO2 and according to registry in Chemical Abstracts Services (CAS) from Chemical American Society its CAS number is 10049-04-4. In this formula, it is clear that there is one chlorine atom (Cl) and two oxygen atoms (O2) in a molecule of chlorine dioxide. These 3 atoms are held together by electrons to form the ClO molecule2. It can be used as a saturated gas in distilled water and therefore can be drunk or applied directly to the skin and mucosa, with the appropriate dilutions. Andreas Ludwig Kalcker, Biophysicist and Researcher, standardized a gas saturation in distilled water called chlorine dioxide solution or CDS (for its acronym in English, CDS: chlorine dioxide solution) (National Library of Medicine 2020).

The discovery of the ClO molecule2 in 1814, it is attributed to scientist Sir Humphrey Davy. The ClO2 It is different from the element chlorine (Cl), both in its chemical and molecular structure and in its behavior. The ClO2As has already been widely reported, it can have toxic effects if the necessary care for its various uses is not observed and the appropriate recommendations for human consumption are respected. It is more than known that ClO gas2 it is toxic to humans if inhaled neat and / or ingested in amounts greater than those recommended (Lenntech 2020, IFA 2020).

The ClO2 it is one of the most effective biocides against pathogens, such as bacteria, fungi, viruses, biofilms and other species of microorganisms that can cause disease. It works by interrupting the synthesis of the pathogen's cell wall proteins. As it is a selective oxidant, its mode of action is very similar to phagocytosis, in which a mild oxidation process is used to eliminate all types of pathogens (Noszticzius et al 2013, Lenntech 2020). It is worth saying that the ClO2, generated by sodium chlorite (NaClO2), is approved by the Environmental Protection Agency in the United States (EPA 2002) and by the World Health Organization for use in water suitable for human consumption, since it does not leave toxic residues (EPA 2000, WHO 2002) .

When applied in the appropriate concentrations, ClO2 does not form any halogenated product and its by-products ClO2 Residuals are normally within the limits recommended by the EPA (2000, 2004) and WHO (2000, 2002). Unlike chlorine gas, it does not hydrolyze easily, remaining in water as a dissolved gas. Also in contrast to chlorine, ClO2 it remains in molecular form in the pH ranges commonly found in natural waters (EPA 2000, WHO 2002). WHO and EPA include ClO2 in Group D (substances not classifiable in terms of human carcinogenesis) (IARC 2001, EPA 2009). According to the United States Department of Health and Human Services 2004, the FDA recommends that the use of ClO2 is allowed as a permitted additive in food and as an antimicrobial agent (disinfectant).

Many continue to confuse ClO2 with sodium hypochlorite (NaClO - Bleach) and the latter with sodium chlorite (NaClO2), in addition to other chemical compounds, causing frequent inappropriate comments both in the media and among professionals due to a lack of knowledge of elemental chemistry. NaClO (bleach), for example, is a powerful corrosive agent and the danger due to chronic and massive NaClO exposure is well known. It is believed that asthma symptoms developed by professionals who work in contact with this substance may be due to continuous exposure to bleach and other irritants. 

In contact with fats, sodium hydroxide (NaOH) breaks down fatty acids in glycerol and soaps (fatty acid salts), which reduces the surface tension of the remaining fat-solution interface. NaClO is responsible for dissolving organic tissue. Thus, it is observed that the main toxicity of the substances generated from the chemical reactions of sodium hypochlorite is the appearance of a hydroxyl NAOH radical, in the various reactions with secretions and the chemical structure of human tissues (Daniel et al 1990, Racioppi et al 1994; Estrela et al 2002, Medina-Ramon et al 2005, Fukuzaki 2006, Mohammadi 2008, Peck B et al 2011).

Based on this brief review of what chlorine dioxide is and its biocidal capacity, the results obtained by the doctors of the Ecuadorian Association of Integral Medicine Specialists (AEMEMI) are not surprising: who affirm the administration of the CDS in dilutions appropriate and safe is an effective and low-cost alternative that can rapidly contribute to the restoration of the health of the individual infected by human coronavirus type 2, and it is assumed that it can promote the reduction of morbidity and mortality, hospitalizations due to COVID -19 mostly, up to 4 days (AEMEMI 2020).

Through the evidence of available scientific publications demonstrating the efficacy of ClO2 to eliminate different pathogens (Kullai-Kály et al 2020), including SARS-CoV (Tables 1, 2, 3 and 4; Taiko Pharmaceutical patent 2008), as well as work confirming the safety of the use of chlorine dioxide for water purification and, more recently, the aforementioned work of the AEMEMI, we evaluate positively and with great biocidal potential the use of the aqueous solution of ClO2 (CDS) to combat coronaviruses (AEMEMI 2020, EPA 2000, WHO 2005, WHO 2002).

In this context, we are surprised that the mentions that official bodies such as the Ministries of Health, PAHO / WHO, and regulatory agencies and / or health entities do not recommend the use of ClO2 and all, instead of recommending, call attention to its toxicity and danger, but, in their speeches, they do not clearly indicate in what form and by which route of administration ClO2 it is really toxic. However, everything leads us to understand that they refer to the pure and concentrated form of this gas and not to the standardized formula by Kalcker: the aqueous solution of chlorine dioxide (CDS), at 3.000 ppm.

In this way, to help clarify the concepts, we invite all official bodies to learn about Andreas Kalcker's work with the aqueous solution containing chlorine dioxide gas (CDS). Certainly, after having this knowledge, we believe that definitely, these Organisms, who appreciate health, will naturally understand the potential of this solution for human use and from then on, they will be able to review their documents that may be in disagreement with published scientific reality and current medical experiences and perhaps they can offer this information more clearly and assertively in their articles published on official websites or even in their documents.

1.3. Key Points for consideration

Faced with the serious scenario to which the whole world is exposed with the coronavirus pandemic, we turn to the authorities and institutions responsible for human health that run the main institutions to ask them the following questions:

  • What can be the objective / impact of revealing a document with information that can be misinterpreted?
  • Is there a purpose to hide and / or translate scientific knowledge in a way that causes doubts or harm to the health of thousands of people, and prevent them from benefiting from something that can really save lives?
  • What's the purpose for not using the so-called "unconventional" but potentially promising options with clinician-proven clinical evidence on the front lines of COVID-19?

With the legally established purpose of saving lives, it is not logical, nor healthy, and even less humanitarian and compassionate action, in the face of a global public emergency situation, that misunderstandings in the translation of scientific knowledge occur for any purpose other than the preservation of life. We consider that these concepts that generate misunderstandings may be caused due to the lack of knowledge of the existing literature (even though it is open to public consultation). Remembering: in the PubMed database alone, there are more than 1.300 documents published using only the descriptor "chlorine dioxide".

Assuming the case that the team in charge of drafting the official documents, articles, and reports published on the websites of official organizations such as PAHO / WHO of the member countries, the Ministries of Health and the health regulatory bodies, did not have knowledge of the articles and patents (which does not exempt them from legal responsibility) where they prove the non-toxicity in these doses and the possible benefits of chlorine dioxide for human health and that, therefore, these teams in charge do not yet consider the ClO potential2 For the fight against type 2 coronavirus, as has been done by AEMEMI and the team of Doctors and Researchers who sign this dossier, we invite you to reflect on the following:

  • There are many scientific bases for public access, with many articles available for free, which contain the information necessary for the production of a document that supports a decision in public management, why were these bases not consulted or were they badly analyzed or simply not considered? For what reason? After all, it is an important decision to use or ban a substance for human health, in a context of a global public emergency to overcome COVID-19.

 

  • How is it possible that the legally responsible official health organizations made such an important decision without a thorough analysis of the effects that a ban on a substance would generate that could simply put an end to the pandemic quickly, safely and effectively?

 

  • The fact is that any neophyte in the matter who reads the different official publications coming from some health organizations about ClO2, will naturally be afraid of consuming this product because they think that it is toxic and harmful to health, and that it could endanger their lifetime. Likewise, a healthcare professional would also fear to use it in their therapeutic practice, since the ultimate goal of any healthcare professional is to preserve life and could not offer the patient something that would put life in danger.

Based on the dissonant and incoherent information when compared with what is really known about the CDS and its potential, it is that we, health professionals in the intention of respectfully giving our contribution so that the health governing institutions review their documentation and officially published guidelines to promote the clearest and most accurate information on the use, efficacy and safety of ClO2 for oral human consumption (CDS), as standardized by Kalcker (2020 - About evaluation: /11136-CH_Antrag_auf_Patenterteilung.pdf),

We share below a summary of key scientific facts and evidence that CDS is effective against several pathogens, including human coronavirus type 2, the etiologic agent of SARS-CoV2. Unfortunately, the way information about ClO is spread2 it generates doubts and above all it reveals to those who understand the subject under scientific aspects, that the misinformation generated is somewhat surprising.

1.4.What is Chlorine Dioxide Solution (CDS) and what are the differences with Miracle Mineral Solution (MMS)?

More than 13 years ago, Andreas Ludwig Kalcker started scientific investigations to study the applicability of ClO2 and its dilutions, so that it can be used safely for human consumption. On these studies, it has developed 4 patents, of which 3 are published and one is pending approval. These studies are based on the safe toxicity levels established by the German Gestis toxicology database (IFA 2020), and take into account other reference studies already developed, for example, by the WHO (2000, 2005) and the EPA (2000).

These studies confirm the non-toxicity of this gas in aqueous solution for human consumption and establish, for example, that the safe dose is 0,3 mg / L to be used for the potability of the water. The Kalcker studies and the clinical experiences of Physicians recommend using 10 mL of this concentrated solution, diluted in 1000 mL of water as one of the protocols to combat SARS-VOC 2. In this specific recommendation, it is allowed at the end, the consumption of 30 mg / day, divided into 10 doses of 100mL, which is safe and non-toxic based on recognized scientific references (Lubbers & Bianchine 1984; Ma et al 2017).

The unnecessary controversy and its consequences

Contextualizing the origin of the mistaken controversy that has arisen on the subject of "chlorine dioxide", it is important to clarify: 

Historically, a product called "miracle mineral solution" (MMS) has been the subject of much controversy in the media around the world because it is sold as "medicine."

We often see news on the Internet that confuse the "miracle mineral solution" (MMS = citric acid + sodium chlorite + water) with the "chlorine dioxide solution" (CDS = hydrochloric acid + sodium chlorite + water) and the latter with sodium hypochlorite (bleach). The main differences between the MMS and the CDS can be conferred in table 1:

General characteristics

MMS

CDS

ClO2 concentration (part per million - ppm)

Not known

3.000 ppm

Ph

Acid

Neutral (7)

Waste

Chlorates, chloride

Without residues

Table 1 - General characteristics that differentiate the miracle mineral solution (MMS) from the chlorine dioxide solution (CDS).

The consequences and impact of these failures in the translation of scientific knowledge are worrying at a time of global public health emergency, when the lives of many people are in danger. 

Therefore, it is urgent that all institutions are alert through the prior qualification of the information that is published so that there are no failures in the translation of scientific knowledge, thus generating room for doubts and misinterpretations through the media. communication, with serious consequences and negatively influencing the decision-making of managers.

If we used sodium hypochlorite (NaClO) with hydrochloric acid in the water, the solution would contain Cl2 + NaCl + H2O. The Cl2 It is a toxic gas that reacts with organic substances, mainly in aqueous media where it can form toxic acids.

Although we are clear about the very well established biochemical differences, many continue to confuse some chemicals with ClO2 (Table 2):

 

CHEMICAL COMPOUNDS

BIOCHEMICAL CHARACTERISTICS

Sodium perchlorate

Sodium chlorate

Chlorite

sodium

Hypochlorite

of sodium

Sodium chloride

Chlorine

Chlorine Dioxide

Structure

 Sodium perchlorate

 Sodium chlorate

 sodium chlorite

 sodium hypochlorite

 NaCl

 chlorine2

 chlorine dioxide

Chemical formula

NaClO4

NaClO3

NaClO2

NaClO

NaCl

Cl2

Clo2

Molecular weight

122.44 g / mol

106.44 g / mol

90.44 g / mol

74.44 g / mol

58.44 g / mol

70.9 g / mol

67.45 g / mol

2. Effectiveness, safety and toxicity of Chlorine Dioxide

2.1. Action against viruses

Most viruses behave similarly because, once they infect the cell, the nucleic acid of the virus takes over the synthesis of the cell's proteins. 

Certain segments of the nucleic acid of the virus are responsible for the replication of the genetic material of the capsid, a structure whose function is to protect the 

viral genome during its transfer from one cell to another and assist in its transfer between host cells.

When the ClO2 encounters an infected cell, a denaturation process occurs very similar to phagocytosis because it is a selective oxidant (Noszticzius et al 2013).

2.2. Pre-clinical studies

Pre-clinical studies exploring the toxicity of ClO2 They do not usually find adverse effects when animals are exposed to different concentrations of this biocide. We are going here to reference some of the most important ones. Ogata (2007) exposed 15 rats to 0,03 ppm of ClO2 gaseous for 21 days. 

Microscopic examination of histopathological samples from the lungs of these rats showed that their lungs were "completely normal". In another preclinical study, Ogata et al. (2008) exposed rats to 1 ppm of ClO2 soda for 5 hours a day, 5 days a week for a period of 10 weeks. No adverse effects were observed. They concluded that the "no observed adverse effect level" (NOAEL) for chlorine dioxide gas is 1 ppm, a level that is believed to be non-toxic to humans and exceeds the reported concentration of 0,03 ppm to protect against influenza virus infection.

In studies on rats, Haller and Northgraves (1955) found that long-term exposure (2 years) to 10 ppm of chlorine dioxide does not produce adverse effects. However, rats exposed to 100 ppm showed an increased mortality rate.

 

Musil et al (2004) reported that high doses (200-300 mg / kg) of sodium chlorite caused the oxidation of hemoglobin to methemoglobin. However, when the rats drank water for 40 days with varying levels of chlorine dioxide (ranging from 0,175 to 5 ppm), no changes in hematological parameters were observed. In another study, chickens and rats that drank chlorine dioxide in drinking water daily in concentrations as high as 1000 ppm for 2 months did not produce methemoglobin. Richardson (2004) reported that high doses of oral sodium chlorate (NaClO3) (which is not the same as sodium chlorite - NaClO2) produced methemoglobinemia and nephritis (US Department of health and human service, 2004).

Fridliand & Kagan (1971) reported that rats orally consumed 10 ppm of ClO solution2 for 6 months they had no adverse health effects. When the exposure was increased to 100 ppm, the only difference between the treatment group and the control group was a slower weight gain in the treatment group. In an effort to simulate the conventional human lifestyle, Akamatsu et al (2012) exposed rats to chlorine dioxide gas at a concentration of 0,05 - 0,1 ppm, 24 hours a day and 7 days. of the week for a period of 6 months. They concluded that whole-body exposure to chlorine dioxide gas of up to 0,1 ppm over a 6-month period is non-toxic for rats. 

Higher doses of ClO solution2 (for example, 50-1000 ppm) can produce hematological changes in animals, including decreased red blood cell count, methemoglobinemia, and hemolytic anemia. Reduced serum thyroxine levels were also observed in monkeys exposed to 100 ppm in drinking water and in rat pups exposed to concentrations up to 100 ppm through the gavage or indirectly through the drinking water of their prey (US Department of health and human service, 2004).

Moore & Calabrese (1982) studied the toxicological effects of ClO2 in rats and observed that when the rats were exposed to a maximum level of 100 ppm by drinking water and neither the A / J nor C57L / J rats showed any hematological change. It was also found that rats exposed to up to 100 ppm of sodium chlorite (NaCIO2) in their drinking water for up to 120 days could not demonstrate any histopathological change in the structure of the kidneys. 

Shi and Xie (1999) indicated that an acute oral LD50 value (expected to result in the death of 50% of the dosed animals) for stable chlorine dioxide was> 10.000 mg / kg in mice. In rats, the acute oral LD50 values ​​for sodium chlorite (NaClO2) ranged from 105 to 177 mg / kg (equivalent to 79-133 mg chlorite / kg) (Musil et al 1964, Seta et al 1991. No exposure-related deaths were observed in rats that received chlorine dioxide in water drinking for 90 days at concentrations that resulted in doses up to approximately 11,5 mg / kg / day in men and 14,9 mg / kg / day in women (Daniel et al 1990).

2.3. Clinical studies

According to the United States Environmental Protection Agency (EPA), the short-term toxicity of ClO2 it was evaluated in human studies by Lubbers et al (1981, 1982, 1984a and Lubbers & Bianchine 1984c). In the first study (Lubbers et al 1981, also published as Lubbers et al. 1982), a group of 10 healthy adult men drank 1.000 mL (divided into two 500 mL servings, 4 hours apart) of a solution of 0 or 24 mg / L chlorine dioxide (0,34 mg / kg, assuming a reference body weight of 70 kg). In the second study (Lubbers et al 1984a), groups of 10 adult men received 500 mL of distilled water containing 0 or 5 mg / L ClO2 (0,04 mg / kg day assuming a reference body weight of 70 kg) for 12 weeks. 

No study found physiologically relevant changes in general health (observations and physical examination), vital signs (blood pressure, pulse rate, respiratory rate, and body temperature), serum clinical chemical parameters (including glucose levels, urea nitrogen and phosphorus), alkaline phosphatase and aspartate and alanine aminotransferase), serum triiodothyronine (T3) and thyroxine (T4), nor hematological parameters (EPA, 2004).

Michael et al (1981), Tuthill et al (1982) and Kanitz et al (1996) examined the effects of drinking water disinfected with ClO2. Michael et al (1987) found no significant abnormalities in hematological parameters or serum chemistry. Tuthill and colleagues (1982) retrospectively compared data on morbidity and mortality of newborns in two communities: one using chlorine and one using ClO2 to purify the water. In reviewing this study, EPA found no differences between these communities (US Department of Health and Human Service, 2004). 

Kanitz et al (1996) studied births in two Italian hospitals where the water was purified with chlorine or ClO2. Although the authors concluded that babies born to mothers who consumed drinking water treated with ClO2 during pregnancy they were at increased risk of neonatal jaundice, a reduction in head circumference and body length, the EPA wrote that confusing variables prevented the possibility of drawing conclusions from this study (US Department of Health and Human Service, 2004 ).

Survival was not significantly decreased in groups of rats exposed to chlorite (such as sodium chlorite) in drinking water for two years at concentrations that resulted in estimated chlorite doses of up to 81 mg / kg / day. 

In another study, Kurokawa et al. (1986) found that survival was not adversely affected in rats receiving sodium chlorite in drinking water at concentrations that 

they resulted in estimated chlorite doses of up to 32,1 mg / kg / day in males and 40,9 mg / kg / day in females ”.

Exposure of rats to sodium chlorite for up to 85 weeks at concentrations resulting in estimated doses of chlorite up to 90 mg / kg / day has not affected survival (Kurokawa et al. 1986). 

According to Lubbers et al 1981, there were no signs of adverse liver effects (evaluated in serum chemistry tests) in adult men who consumed ClO2 in aqueous solution, resulting in a dose of approximately 0,34 mg / kg or in other men adults consuming approximately 0,04 mg / kg / day for 12 weeks. The same researchers administered chlorite to healthy adult men and found no evidence of adverse liver effects after each individual consumed a total of 1.000 mL of a solution containing 2,4 mg / L of chlorite (approximately 0,068 mg / kg) in two doses (4 hours apart), or in other normal or G6PD-deficient men who consumed approximately 0,04 mg / kg / day for 12 weeks (Lubbers et al 1984a, 1984b).

No signs of ClO-induced impairment of liver function were observed.2 or chlorite among rural village dwellers who were exposed for 12 weeks through ClO2 in drinking water at weekly concentrations measured from 0,25 to 1,11 mg / L (ClO2) or 3,19 to 6,96 mg / L (chlorite) (Michael et al 1981). In this epidemiological study, the levels of ClO2 in drinking water before and after the treatment period they were <0,05 mg / L. Chlorite level in drinking water was 0,32 mg / L before treatment with ClO2. One week and two weeks after stopping treatment, chlorite levels fell to 1,4 and 0,5 mg / L, respectively.

In its official document entitled "Laboratory biosafety manual" (page 93), WHO (2005) talks about ClO2:

 

"Chlorine dioxide (ClO2) is a powerful, fast-acting germicide, disinfectant, and oxidant that tends to be active in concentrations lower than those required for chlorine bleach. The gaseous form is unstable and decomposes into chlorine gas (Cl2) and oxygen gas (O2), producing heat. However, the ClO2 It is soluble in water and stable in aqueous solution.

It can be obtained in two ways:

1) By generation in situ, mixing two different components, hydrochloric acid (HCl) and sodium chlorite (NaClO2), Or

2) ordering the stabilized form, which is activated in the laboratory when necessary.

ClO2 is the most selective of the oxidizing biocides. Ozone and chlorine are much more reactive than ClO2 and they are consumed by most organic compounds. 

In contrast, ClO2 It only reacts with reduced sulfur compounds, secondary and tertiary amines, and other highly reduced and reactive organic compounds. 

Therefore, with the ClO2 a more stable residue can be obtained at much lower doses than when using chlorine or ozone. If generated correctly, the ClO2Due to its selectivity, it can be used more effectively than ozone or chlorine in cases of higher organic matter load ”.

Based on the WHO Strategy on Traditional Medicine 2014-2023 (WHO 2013), which recognizes practices related to traditional, complementary and integrative or "unconventional" medicine as an important part of health services, a In order to continuously integrate them with the various member countries that are signatories of this initiative, we put here the potential of the aqueous solution of ClO2 (Kalcker 2017) as a potent biocide and therefore a safe supplement alternative to combat SARS-CoV2. The ClO2 It can fight viruses through the selective oxidation process through denaturation of capsid proteins and subsequent oxidation of the virus's genetic material, rendering it inactive. As there is no possible adaptation of the virus to the oxidation process, it is impossible for it to develop resistance to ClO2, it becomes a promising treatment for any strain of virus.

There is scientific evidence that ClO2 It is effective against the SARS-CoV-2 coronavirus and others:

 

  • Wang et al. (2005) will study the persistence conditions of SARS-CoV-2 in different environments and its complete deactivation by the effect of oxidants such as ClO2;

 

  • The Department of Microbiology and Medicine at the University of New England investigated the inactivation of human and simian rotavirus (SA-11) by ClO2. The experiments were carried out at 4 ° C in a standard phosphate-carbonate buffer. Both viruses were rapidly inactivated in just 20 seconds under alkaline conditions, with concentrations of ClO2 ranging from 0,05 to 0,2 mg / L (Chen & Vaughn 1990);

 

  • The Japanese University of Tottori evaluated the antiviral activity of ClO2 in aqueous solution and sodium hypochlorite against human influenza virus, measles, canine dystemperosis virus, human herpesvirus, human adenovirus, canine adenovirus, feline calicivirus and canine parvovirus; 
  • The ClO2 At concentrations ranging from 1 to 100 ppm, it produced powerful antiviral activity, inactivating> or = 99,9% of the viruses in just 15 seconds of treatment. The antiviral activity of ClO2 it was approximately 10 times that of NaClO (Sanekata et al 2010). 
  • The Italian University of Parma has carried out studies on the deactivation of viruses resistant to oxidizing agents, such as Coxsackie virus, hepatitis A virus (HAV) and feline calicivirus: the data obtained from the studies shows the following: complete inactivation of HAV and Feline calicivirus, concentrations> or = 0.6 mg / L are required. Similar tests for Coxsackie B5 gave the same results. However, for feline calicivirus and HAV, at low concentrations of disinfectant, it takes approximately 20 minutes to obtain a 99,99% reduction in viral load (Zoni et al 2007); 
  • The Institute of Public Health and Environmental Medicine in Tainjin, China, conducted a study to elucidate the mechanisms of inactivation of the hepatitis A virus (HAV) through the use of ClO2, observing the complete destruction of antigenicity after 10 minutes of exposure with 7,5 mg of ClO2 per liter (Li et al 2004); 
  • The Department of Biology of the State University of New Mexico (USA) conducted a study on the inactivation of poliovirus with ClO2 and iodine. It concluded that the ClO2 inactivated poliovirus by reacting with viral RNA and affecting the ability of the viral genome to act as a model for RNA synthesis (Alvarez ME & O'Brien RT 1982)
  • Taiko Pharmaceutical Co., Ltd., Seikacho, Kyoto, Japan demonstrates in this study that ClO gas2 in extremely low concentrations, without any harmful effect on human health, it produces a strong deactivating effect on bacteria and viruses, significantly reducing the number of viable microbes in the air in a hospital surgical center (Taiko Pharmaceutical 2016).
2.4. Toxicity

The LD50 toxicity (acute toxicity index) established by the German GESTIS toxicology database for ClO2 is 292 mg per kilogram for 14 days, when the equivalent in a 50 kg adult would be 15.000 mg for 14 days (IFA 2020). According to the U.S. Department of Health and Human Services, the ClO2 it acts quickly when it enters the human body. The ClO2 it rapidly converts to chloride ions, which in turn decompose to chloride ions. The body uses these ions for many normal purposes. These chloride ions leave the body within hours to days, primarily through urine (EPA 1999).

 

The short-term toxicity of ClO2 It has been evaluated in human studies by the research groups of Lubbers et al:

In the first study (Lubbers et al 1981; also published as Lubbers et al 1982), a group of 10 healthy adult men drank 1.000 mL (divided into two 500 mL servings, 4 hours apart) of a solution of ClO2 24 mg / L (0,34 mg / kg, assuming a reference body weight of 70 kg). In the second study (Lubbers et al 1984a), groups of 10 adult men received 500 mL of distilled water containing 0 or 5 mg / kg-day of ClO2 (0,04 mg / kg-day assuming a reference body weight of 70 kg) for 12 weeks. No study found physiologically relevant changes in general health (observations and physical examination), vital signs (blood pressure, pulse rate, respiratory rate, and body temperature), serum clinical chemical parameters (including glucose levels, urea nitrogen and phosphorus), alkaline phosphatase and aspartate and alanine aminotransferase), serum triiodothyronine (T3) and thyroxine (T4), nor hematological parameters (EPA 2000).

Ma et al (2017) evaluated the efficacy and safety of an aqueous solution of ClO2 containing 2.000 ppm. Antimicrobial activity was 98,2% at concentrations between 5 and 20 ppm for fungal bacteria and H1N1 viruses. In an inhalation toxicity test, 20 ppm ClO2 During 24h, he did not show any mortality or abnormality in clinical symptoms and / or in the functioning of the lungs and other organs. A concentration of CLO2 up to 40 ppm in drinking water did not show any subchronic oral toxicity. 

Taylor and Pfohl, 1985; Toth et al. 1990), Orme et al. 1985; Taylor and Pfohl, 1985; Mobley et al., 1990) studied the toxicity of chlorine dioxide, in various organs of the body, at different stages of development of the animal specimens studied, and reported a Minimum Observed Adverse Effect Level (LOAEL) for these effects of 14 mg kg -1 day-1 of chlorine dioxide.

While Orme, et al. (1985) identified a No Observed Adverse Effect Level (NOAEL) of 3 mg kg-1 day-1. The clinical experience of Latin American physicians, during the last six months, suggests that the ingestion of 30 mg day-1 of chlorine dioxide dissolved in one liter of water and drunk during ten events throughout the day as a successful treatment for COVID-19, which is 6 times below the NOAEL dose.

Therefore, the literature review confirms that the use of chlorine dioxide ingested at a dose of 0,50 mg kg-1 day-1 does not represent a risk of toxicity to human health by ingestion and does represent a very effective treatment. plausible for COVID-19.

3. Recommendations, precautions and contraindications following medical experiences

Following medical experiences, we have made the following recommendations: 

  • It is recommended to generate chlorine dioxide the mixture between sodium chlorite (NaClO2) and an activator (hydrochloric acid) or in its electrolytic form (the ideal one). What is used to make CDS is saturated chlorine dioxide gas in water with neutral pH;
  • We do not recommend that anyone ingest sodium hypochlorite (NaClO) or any other chemical substance;
  • Do not inhale chlorine dioxide gas massively, for a long time, as it can cause throat irritation and breathing difficulties. In small amounts for a short time it is safe, as shown by the studies of Dr. Norio Ogata;
  • Preferably, do not mix CDS with: coffee, alcohol, bicarbonate, vitamin C, ascorbic acid, orange juice, preservatives or supplements (antioxidants). Although they do not usually interact, they can neutralize the effectiveness of chlorine dioxide;
  • We recommend taking care of food in content and quantity;
  • The first recommendation should be: Chlorine Dioxide (ClO2) must be administered by prescription and medical follow-up, self-treatment is not promoted.

4. International legal facts and human rights

Scientific advances and discoveries are constant, and in the field of health, prompt access to them by healthcare personnel and patients becomes essential and urgent, being logical and obligatory, out of a pure humanitarian sense and in accordance with scientific rigor, testing with substances such as Chlorine Dioxide (ClO2) for which there is proven evidence of its efficacy and usefulness. In the history of medicine, the supremacy of the criterion of the "compassionate appeal" has been constant over the criterion of the "perfectly contrasted appeal."

The articles 32 and 37 of the Declaration of Helsinki of 1964 thus allow it in the case of "Unproven Intervention»(INC),"When proven interventions do not exist in the care of a patient or other known interventions have been ineffective, the physician, after seeking expert advice, with the informed consent of the patient or an authorized legal representative, may be allowed to use unproven interventions , if, in his opinion, this gives some hope of saving life, restoring health or alleviating suffering ".

Doctors, in accordance with the 1948 Geneva Declaration, before patients whose health and life are in danger, have the obligation to use all the means and products at their disposal, which offer indications of effectiveness and, to a greater extent, in a medical emergency, Since in accordance with the duty of fraternity and humanitarian aid, the use of Chlorine Dioxide (ClO2) cannot be limited or denied, whose non-toxicity has been documented and whose efficacy and safety has been demonstrated in studies and practices carried out in different countries. .

To the same extent, States, Institutions and Organizations cannot restrict or prevent its use in the face of existing clinical evidence, otherwise they would fail to comply with the obligations assumed in international and national texts, incurring in the violation of fundamental rights such as the right to life and health as well as the patient's right to self-determination and professional autonomy and clinical independence.

In accordance with the above, the exercise of the medical profession implies a vocation of service to humanity, with the health and life of the patient being its greatest concern, having to ensure the benefit of the interests of citizens, making medical knowledge available to them. within the framework of professional autonomy and clinical independence. In the currently existing, fully applicable and enforceable legal framework, the medical profession must have professional freedom without interference in the care and treatment of patients, by having the privilege of using their professional judgment and discretion to make the necessary clinical and ethical decisions .

Physicians are legally conferred a high degree of professional autonomy and clinical independence, so they can make recommendations based on their knowledge and experience, clinical evidence, and holistic understanding of patients, including what is best for them without undue or inappropriate external influence , and take appropriate measures to ensure that effective systems are in place.

Every patient has the right to be cared for by a doctor who he knows is free to give a clinical and ethical opinion, without any outside interference. The patient has the right to self-determination and to make decisions freely in relation to his person. Patients in the free exercise of their right to autonomy have the right to dispose of their body, their decisions must be respected, being fully protected to prevent third parties from intervening in their body without their consent, and must be adequately informed about the purpose of the intervention, nature, its risks and consequences. 

The right to health requires that governments comply with the obligations they have assumed in the aforementioned agreements, so that health goods and services are available in sufficient quantity, with public access, and of good quality, in accordance with the provisions of the General Comment 14 of the Committee of the Covenant on Economic, Social and Cultural Rights.

All this covered in the provisions that are related and whose essential contents are extracted below;

  • Universal Declaration of Human Rights, of December 10, 1948.
  • American Declaration of the Rights and Duties of Man, Bogotá, 1948.
  • American Convention on Human Rights, San José (Costa Rica), from November 7 to 22, 1969.
  • International Covenant on Economic, Social and Cultural Rights of December 16, 1966.
  • The Convention for the Protection of Human Rights and Fundamental Freedoms Rome of November 4, 1950.
  • International Covenant on Civil and Political Rights of December 16, 1966.
  • Convention for the protection of human rights and the dignity of the human being with respect to the applications of Biology and Medicine of April 4, 1997, Oviedo Convention.
  • Nuremberg Code of Ethics of August 19, 1947.
  • Geneva Declaration of 1948.
  • International Code of Medical Ethics of October 1949.
  • Declaration of Helsinki adopted by the 18th World Medical Assembly, 1964.
  • Belmont Report of April 18, 1979.
  • 1981 WMA Declaration of Lisbon on the Rights of the Patient.
  • Declaration of the WMA on the Independence and Professional Freedom of the Physician of 1986.
  • Madrid Declaration of the AMM on Professional Autonomy and Self-Regulation of 1987.
  • WMA Seoul Declaration on Professional Autonomy and Clinical Independence 2008.
  • Madrid Declaration of the AMM on Professional Regulation of 2009.
  • WMA Declaration on the Relationship between Law and Ethics 2003.
  • UNESCO Universal Declaration on Bioethics and Human Rights of 2005.
  • International Health Regulations 2005.

The International Covenant on Economic, Social and Cultural Rights of December 16, 1966, signed by Ecuador on June 24, 9 and ratified on June 1968, 11, recognizes the right of everyone to the enjoyment of the highest possible level of health. physical and mental; artº2010 "1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest possible standard of physical and mental health. "and the duty to protect this right by the state through a global health care system, which is available to all, without discrimination and economically accessible, article 2:

1."Each of the States Parties to the present Covenant undertakes to adopt measures, both separately and through international assistance and cooperation, especially economic and technical, to the maximum of the resources available to it, to progressively achieve, by all the appropriate means, including in particular the adoption of legislative measures, the full realization of the rights recognized herein. "

The International Code of Medical Ethics of October 1949, so that articles 36 and 59 of the aforementioned text, among others, become effective;

Article 36 of Chapter VII regarding medical care at the end of life.

"1. The doctor has the duty to try to cure or improve the patient, whenever possible. When it is no longer so, the obligation to apply the appropriate measures to achieve their well-being remains, even when this may lead to a shortening of life.

2. The doctor must not undertake or continue diagnostic or therapeutic actions harmful to the patient, without hope of benefits, useless or obstinate. Should withdraw, adjust or not initiate treatment when the limited prognosis so advises. The diagnostic tests and the therapeutic and support measures must be adapted to the clinical situation of the patient. You must avoid futility, both quantitative and qualitative.

3. The doctor, after adequate information to the patient, must take into account his willingness to reject any procedure, including treatments aimed at prolonging life.

4. When the patient's condition does not allow him to make decisions, the doctor must take into consideration, in order of preference, the indications previously made by the patient, the previous instructions and the opinion of the patient in the voice of their representatives. It is the doctor's duty to collaborate with the people who have the mission of guaranteeing compliance with the patient's wishes "

- Article 59 of Chapter XIV relative to medical research;

"1.Medical research is necessary for the advancement of medicine, being a social good that must be fostered and encouraged. Research with human beings must be carried out when scientific progress is not possible by alternative means of comparable efficacy or in those phases of research in which it is essential.

2.-The investigating physician must adopt all possible precautions to preserve the physical and mental integrity of the research subjects. You must take special care in protecting individuals belonging to vulnerable groups. The good of the human being who participates in biomedical research must prevail over the interests of society and science.

3.- Respect for the research subject is the guiding principle of the same. Your explicit consent must always be obtained. The information must contain, at least: the nature and purpose of the research, the objectives, the methods, the expected benefits, as well as the potential risks and discomforts that its participation may cause. You must also be informed of your right not to participate

or to withdraw freely at any time during the investigation, without being harmed by it.

4.- The medical researcher has the duty to publish the results of his research through the normal channels of scientific dissemination, whether they are favorable or not. It is unethical to manipulate or conceal data, whether for personal or group gain, or for ideological reasons. "

La WMA Declaration of Lisbon on the Rights of the Patient de 1981,"Every patient has the right to be treated by a doctor who he knows is free to give a clinical and ethical opinion, without any outside interference. 

The patient has the right to self-determination and to make decisions freely in relation to his person. The doctor will inform the patient of the consequences of his decision.

The mentally competent adult patient has the right to give or deny consent for any examination, diagnosis, or therapy. The patient has the right to the information necessary to make his decisions. The patient must clearly understand what the purpose of any examination or treatment is and what are the consequences of not giving consent "

The Declaration of the AMM on the Independence and Professional Freedom of the Physician of 1986, according to which; "Doctors must enjoy a professional freedom that allows them to care for their patients without interference. 

The privilege of the physician to use his professional judgment and discretion to make the clinical and ethical decisions necessary for the care and treatment of his patients must be maintained and defended. By ensuring the independence and professional freedom for the physician to practice medicine, the community ensures the best medical care for its citizens, which in turn contributes to a strong and safe society. "

The 2009 WMA Madrid Declaration on Professional Regulation reaffirms the Seoul Declaration on the professional autonomy and clinical independence of physicians by providing"Physicians are given a high degree of professional autonomy and clinical independence, so they can make recommendations based on their knowledge and experience, clinical evidence and holistic understanding of patients, including what is best for them without undue or inappropriate external influence . "

The universal principles that permeate all regulations must comply with respect for humanitarian laws innate in the collective unconscious, as stated in the maxim of the Hippocratic Oath "MAINTAIN the greatest respect for human life from the beginning, even under threats, and do not use medical knowledge against the laws of humanity.

 

Ethical values ​​have primacy over limiting legal provisions, as is well recognized in the WMA Declaration on the relationship between law and ethics of 2003, which provides "When legislation and medical ethics are in conflict, physicians should try to change the legislation. If this conflict occurs, ethical responsibilities prevail over legal obligations."

When a patient in the face of a disease seeks relief or to save his life and requests to try a therapeutic option of which there are indications of usefulness, such as Chlorine Dioxide (ClO2), it is the doctor's duty to support the patient, acquire knowledge, do studies , and disseminate it in accordance with article 27 of the Universal Declaration of Human Rights of 1948, so that everyone benefits from scientific progress, information must be freely shared so that it is disseminated in all countries without restrictions, "Everyone has the right to freely take part in the cultural life of the community, to enjoy the arts and to participate in scientific progress and the benefits that result from it. "

5. Final considerations

In view of the historical moment that all humanity faces with the Coronavirus pandemic and the urgent need to save lives, the recent events related to the treatment of COVID-19 in both the medical and academic fields, and especially the object of this document, which is to provide authorities with correct information on chlorine dioxide for correct and safe human use, some fundamental questions related to human rights and medical practice are worth considering for reflection:

 

  • Adherence to any treatment depends on the agreement and tacit collaboration between the parties: the doctor and the patient (or their guardian when they are in special conditions that do not allow a conscious choice of medical intervention, for example, memory loss situations , induced or trauma unconsciousness, in boys / girls). This agreement is freely and spontaneously agreed upon;
  • Based on his clinical experience, the doctor is free to prescribe what he considers appropriate for the patient, always communicating the correct way to use a medicine, the possible benefits and risks of a therapeutic intervention. On the other hand, the patient, based on the explanations given, personal beliefs and complementary information, also has the freedom to accept or not any form of indicated treatment;
  • Medical practice should always be based, whenever possible, on scientific data that support the diagnostic and therapeutic behaviors used. However, in situations where scientific evidence is not available, or is not reliable, it is up to the Doctor to use his knowledge, previous experience, and common sense to conduct the clinical situation in the way that seems most appropriate. In this case, it is important that the doctor ask the patient to sign a Term of Free and Informed Consent (TCLI). For this conduct, the Doctor relies on the Declaration of Helsinki (Article 37) which tells us: "In the treatment of an individual patient, when it is established that there have been no interventions or other interventions known to have been ineffective, the physician, after seeking expert advice, with the informed consent of the patient or an authorized representative, may use an unproven intervention if, in the judgment of the clinician, it offers hope of saving lives, restoring health, or alleviating suffering. This intervention should be investigated to assess its safety and efficacy. In all cases, new information should register and, where appropriate, be made available to the public ”;
  • Respecting the aforementioned aspects, we cannot underestimate the fact that there is not enough evidence in the scientific literature that indicates the use of SCDs for the prophylaxis or etiological treatment of COVID-19 cases of any severity, when we observe, for example , the technical report of AEMEMI doctors on the 97% efficacy of the treatment of patients with COVID-19 in 4 days in Guayaquil / Ecuador (AEMEMI 2020). It is worth mentioning that so far the only research group in the world that intends to carry out an international multicenter epidemiological study is registered with the number NCT043742 in the United States National Library of Medicine / National Institute of Health, in Dr. Eduardo Insignares Carrione (Fundación Génesis) and entitled "Determination of the Efficacy of Oral Chlorine Dioxide in the Treatment of COVID-19" (https://clinicaltrials.gov/ct2/show/study/NCT04343742) and so far it cannot begin its work because the regulatory institutions are making this confusion in the translation of knowledge, thinking that chlorine dioxide is toxic;
  • In the specific case of ClO2, currently available information and clinical tests point to the efficacy of this substance against coronavirus (AEMEMI 2020).

In summary:

In view of the above, on the basis of the evidence presented here with evident experience on the part of Scientists and Health Professionals, as well as already well demonstrated in scientific articles already published, we recommend the use of chlorine dioxide solution (CDS ), according to the standardized by Andreas Ludwig Kalcker (2017), duly diluted and therefore, respecting the safe doses from what is already known from toxicity studies, which according to reports from doctors from several countries has proven to be safe for human consumption and also effective against COVID-19 when consumed correctly in internationally standardized protocols.

As an example of the conscious and compassionate use of chlorine dioxide (ClO2), we can cite the Plurinational State of Bolivia, after a prolonged process of debate and resolution within the framework of the exercise of Human Rights and within the framework of the Law of Participation and Social Control, the population has sued through its assembly representatives departmental and national law that allows the authorization of the production, distribution with quality control and compassionate use of Chlorine Dioxide.

To date (Sep. 13, 2020), 4 departmental laws and 1 national laws are in process; In La Paz, the government headquarters, the Law was promulgated on September 9, 2020.

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Special thanks:

 

Andreas Ludwig Kalcker and Helena Valladares from the Liechtenstein Association for Science and Health, Geneva / Switzerland for sharing the scientific technical data necessary to compose this dossier.

Physicians and researchers who contribute to the writing of this document.

7. Annexes: Experience report, the case of Bolivia

Background

The Epidemiological Surveillance activated in the country for COVID-19, determines the intervention of the health system in suspected and confirmed cases; The attitude of the population is generally to go to a health facility at a late stage with little chance of recovery, considering that we have a cycle of disease and transmissibility of around 14 days, it does it more or less 4 days after the appearance of symptoms; In addition to this responsibility, the lack of installed means of diagnosis and treatment for the initial phases of the disease, the lack of laboratory tests, added to the difficulties of geographical access have determined the few or null probabilities of primary, secondary and secondary preventive care. consistent treatment, with early detection and adequate containment.

This epidemiological antecedent has allowed a group of independent health professionals to become aware of and effectively contribute to attenuate the transmissibility of SARS-CoV2, adapting to the capacities of the context, and rescuing the experiences of medical professionals with the use of Chlorine Dioxide that go back more than 10 years throughout the country facing acute and chronic pathologies; These professionals are provided with the CDS solution and after informing about the properties and benefits, they have the informed consent of the affected persons so that they voluntarily agree to the administration of this alternative not contemplated in the baggage of medicines suggested by the Ministry of Health, whose same governing body refers, “....

The therapeutic indication must consider, at all times, the risk / benefit of the prescription of the aforementioned drugs. The possible pharmacological strategies proposed to date are based on studies with low level of evidence, where trust in him expected effect is limited, so the true effect may be far from expected, which generates a weak recommendation grade (expert recommendations). " (Page 52, MINISTRY OF HEALTH, PLURINATIONAL STATE OF BOLIVIA, GUIDE FOR THE MANAGEMENT OF COVID-19, MAY 2020). With this certainty, the administration of Chlorine Dioxide in suspected and confirmed COVID-19 patients begins legally. 

Two scenarios are contemplated for detection and containment in the Plurinational State of Bolivia: house-to-house raking to listen, inform and sensitize people about the importance of blocking the transmissibility of the disease in

the family and in the community, where there are no conditions for confirming care and diagnosis, and even less basic conditions to follow recommended actions of hand washing and use of a chinstrap / mask (real precariousness in remote places of the country), although the attitude of the population in complying with these coexistence regulations is evident.

The other scenario where it was possible to have the possibilities of documenting the treatment with Chlorine Dioxide had the support of services (Laboratory and TAC) for diagnosis and treatment. In both scenarios, the information and voluntary decision to sign the Informed Consent have been complied with. (ANNEX No. 37: INFORMED CONSENT FOR THE DRUG TREATMENT OF PATIENTS WITH COVID-19 (CORONAVIRUS), MINISTRY OF HEALTH, PLURINATIONAL STATE OF BOLIVIA, GUIDE FOR THE MANAGEMENT OF COVID-19, MAY 2020).

Key results

Given the premise of acting with the raking strategy, we have the number of cured cases and the testimonies NOT considered probably as SCIENTIFIC EVIDENCE, but yes like LIVING EVIDENCE, those affected, are cured and it contributes to the blocking of transmissibility at least at the family level and consequently for the community.

There are 30 cases that have been documented at the moment, in the hospitalization modality and around 35 in outpatient care, these cases are being documented, collected and systematized by the Bioethical requirements and Scientific Studies respecting the structures and procedures for the respective guarantee. As a country, we bet that these processes and procedures of an eminently administrative nature will adjust to the innovative requirements and demands for timely responses to the ruthless Pandemic. 

Of the 30 documented patients who were hospitalized, with an average age of 51 years (31-68); 22 men and 8 women; 100% have the PCR-RT and / or Elisa Laboratory exam, 

Clinical Laboratory, blood gas and others; Imaging studies, 22 patients have a Lung Tomography compatible with COVID-19, "ground glass pattern in both hemithorax"; Chlorine Dioxide has been administered orally and intravenously, according to established protocols. The mean hospital stay was a mean of 8 days (Range 1 - 31).

The origin of patients (3 men and 3 women), has foreseen the adequacy of the protocol in the dosage for intravenous administration (from 10 cc to 40 cc / 1l of Ringer Lactate to be administered in 12 hrs. These patients came from a center miner (Height 4.266 meters above sea level), population with a diverse degree of Pneumoconiosis due to the same with a decreased oxygen saturation among other aspects; There is a documented case directed to clinical discussion due to the importance of a slow recovery after being treated in The Intensive Care Unit, this together with a control case that they decided to take with conventional treatment, will be attached to the publication of the conclusions to share the experience.

Conclusions

The responsibility and powers assumed by each of the actors in the country have led to acting in the most effective way in the face of the pandemic, health personnel within the framework of Ethics and Medical Deontology, assume the responsibility of joining the care of the needs and demands of the population, in this particular case the population has demanded the use of Chlorine Dioxide as a preventive and curative treatment. 

Faced with a lack of control of the pandemic, the representatives of the population (Neighborhood Councils, Civics, grassroots organizations, associations, Central Obrera Boliviana,

Federation of Miners of Bolivia, Departmental and National Assemblies) the latter have directed to elaborate, treat and enact the Law of Production, Use and Distribution of Chlorine Dioxide.

Finally, we appeal to scientific societies, bioethics, academic training institutions to join this advance in the exercise of human rights before the decision of the population to choose autonomously and in justice, solutions to face the pandemic.

Legality

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