While there has been a lot of good news for the country in recent weeks, with millions now vaccinated, with COVID rates plummeting, and with some states now opening now without the constantly foretold doom that should have befallen them, it's still a disease that should motivate us to be cautious. I say this as a relative just flew to Brazil to be there for his 44-year-old brother who is now hospitalized with serious case of COVID. He seemed so healthy a short while ago, and how he's in grave danger. 

We still need more science to follow. Not just science on the best vaccines or best way to deal with hospitalized patients, or the "political science" used to justify the endless whims of politicians, but science on how individuals can reduce their risk of having serious damage from the disease. Early last year I put in a tentative plug for nutrition and nutriceuticals as a possible safe way to reduce risks (see "Coping with the Corona Virus: A New Report on Glucosamine and Other Nutriceuticals, and an Update on Masks," April 7, 2020, and "Requesting Review from Medical Experts: Can Glucosamine Help Reduce COVID-19 Mortality?," Feb. 28, 2020). There I pointed to studies indicating that some materials commonly taken as nutritional supplements or nutriceuticals may be helpful in reducing death from pulmonary disease and thus might be wise to consider in our own preparations against COVID. Those suggestions included N-acetyl cysteine, glucosamine, zinc, and Vitamin D. I was chastised for thinking that nutriceuticals played a role in infectious disease and for offering advice that was not taken from WHO or the infallible Dr. Fauci, etc., all of which is fair. But at some point, I hope people can share hypotheses without being silenced or shamed. My hypotheses were based on multiple peer-reviewed studies that seemed that they ought to be considered. I believe that I even explained that these suggestions were hypotheses in search of further expert review.

Today I noticed a 2020 publication raising some related thoughts about N-acetyl cysteine that you may wish to consider: Stelios F. Assimakopoulos and Markos Marangos, "N-acetyl-cysteine may prevent COVID-19-associated cytokine storm and acute respiratory distress syndrome," Medical Hypotheses 140 (July 2020): 109778, doi: 10.1016/j.mehy.2020.109778. As with my posts, the authors are obviously only proposing a hypothesis, but it is based on logical inferences from significant peer-reviewed literature, and calling for more attention to be given to this generally safe nutriceutical. The proposed dose is simply what is normally consumed according to the label on this increasingly popular antioxidant. Before we shame these medical professionals for not keeping their mouths shut, I think there may be merit in their arguments that could be considered and pursued at low risk.

As disclaimer, I should first point out that I'm quite fond of this material, N-acetyl cysteine, found naturally in garlic and onions and a derivative of one of our essential amino acids,  even though I don't take it regularly. I'm fond of it because of its surprising role in my past and ongoing research work related to consumer products. In the fall of 2019, while on vacation in Malaysia aimed at going diving in Borneo, I became ill right as I got off the airplane in Kuala Lumpur. It wasn't the usual upper respiratory infection I used to get occasionally from a cold. It seemed pretty severe and I thought my only choice was to cancel the diving that was scheduled for 4 days later and head home to Shanghai. But the next morning I decided to not travel back to China and wreck the vacation for my wife, but to do what I could to cope, though it seemed clear I would not be diving that week. So the next morning, too ill to go to church in K.L. as we had planned, I went instead to a nearby Malaysian pharmacy to find something that might help. That was the first time I can recall seeing N-acetyl cysteine. It was in a little single dose packet that pretty much just had the name of the compound. Something about the name intrigued me. The package didn't say what it was for, but on a whim, I bought some. 

When I staggered back to my hotel room, I looked it up on the Web and found that it was used as a treatment for cystic fibrosis because of its ability in reducing the viscosity of mucous in the lungs. This made it effective in fighting the pulmonary biofilm in the lungs of cystic fibrosis patients. That got my interest up because I had recently developed a hypothesis that biofilm in clothing might be the cause for the persistent odor that athletic gear frequently develops over time, in which odor seems to persist or can quickly return after washing, unlike the original fresh clothing. How such biofilm could withstand repeated washing and drying in heated dryers seemed like a mystery at the time, but now that I had a natural, even edible material that was known for fighting biofilm in the lungs, I wondered if it could help reduce my hypothesized biofilm in clothing. 

My wife and I had some old athletic gear with us and were able to conduct some initial testing during our week in Malaysia with the help of some great gym equipment a few days later. I combined N-acetyl cysteine with some enzymatic laundry cleaning agents and after washing, tested the odor development after vigorous exercise. I found, to our surprise, that odor seemed to develop much less after an armpit had been treated with the N-acetyl cysteine plus a laundry cleaner versus the laundry cleaner alone. This lead to several patent applications (most recently United States Patent Application 20210032570, with another one to publish soon) and a variety of intriguing discoveries about N-acetyl cysteine, including an apparent discovery and new product opportunity in a cosmetic product trial I did this morning. I can't talk about how these may be used in the future, but it's been a surprisingly exciting journey since that dismal first day in Malaysia. By the way, four days after taking my first dose of N-acetyl cysteine, my congested lungs were clear and, to my surprise, I was able to go diving, though I was still nervous about it. But I survived and really enjoyed it. It was a wonderful trip overall, one of the best trips of my life. I came away loving Malaysia, loving K.L., loving Borneo and its diverse peoples, and would be happy to return. But I am especially grateful for the important conception of several inventions that occurred in Malaysia, thanks to the unexpected encounter with a compound I don't think I had ever seen before. 

So let's get back to the article from Assimakopoulos and Marangos. Here's what they say:

Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome associated with acute respiratory distress syndrome (ARDS), multiple organ failure and increased mortality. This syndrome is characterised by increased interleukin (IL)-2, IL-7, granulocyte colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor (TNF)-α ^[1].

N-Acetylcysteine (NAC), a well-known mucolytic agent used in respiratory infections, is a thiol-containing free-radical scavenger and a precursor of glutathione ^[2]. Reactive oxygen species and oxidative stress activate important redox-sensitive transcription factors like NF-κB and activator protein-1, which lead to the co-ordinate expression of proinflammatory genes of IL-6, IL-8, and TNF-α ^[3].

The beneficial action of 1200 mg/d of oral NAC in respiratory diseases has been previously demonstrated in prevention of chronic obstructive pulmonary disease exacerbations ^[2]. Moreover, a recent study including patients with community-acquired pneumonia, showed that the addition of this dose of NAC to conventional treatment improves oxidative stress and inflammatory response ^[4]. The positive effects of NAC in viral lower respiratory tract infections have been associated with inhibition of IL-8, IL-6, and TNF-α expression and release in alveolar type II cells infected with influenza virus A and B and respiratory syncytial virus ^[5].

The results of these studies offer reasonable basis for the addition of 1200 mg/d oral NAC on therapeutic schemes of patients with COVID-19, as a measure that could potentially prevent the development of the cytokine storm syndrome and ARDS. This hypothesis is worth clarifying in appropriately designed clinical studies.

That makes a lot of sense. Enough sense that I think it's also reasonable for people to consider having some of this edible antioxidant in their homes and using it in low, recommended doses after exposure to COVID has occurred or the infection has begun. I'd also recommend zinc, glucosamine (for glucoasamine, the proposed benefit may require being on it for a while before infection strikes, but I'm not sure), and Vitamin D3, all safe, natural materials that can be consumed in low, recommended amounts with very little risk. Yes, I know it's heresy to suggest that nutrition might matter, but it's a heresy that I think needs more attention in science to give us better information to follow. 

Why don't I take N-acetyl cysteine regularly? It's a powerful antioxidant, but oxidants aren't all bad and antioxidants don't only do good. In fact, our immune system uses oxidants as part of its arsenal, and they may be useful in attacking cancer cells. There's a balance that is needed. So tanking up on antioxidants all the time might not be wise, though I make sure to get plenty of antioxidant-rich fruits and veggies in my diet. A good perspective on possible risks with steady N-acetyl cysteine intake is offered by Derek Lowe in "N-Acetyl Cysteine: A Warning Shot," Science Translational Medicine Blog, Oct. 4, 2019. 

I'm not a doctor or much of anything else, so use your brain, check things out yourself, and make your own decisions wisely. If that's not convenient, you can always just do whatever politicians and their experts tell you to do. But remember, as the famed scientist Richard Feynman said, "“Science is the belief in the ignorance of experts." That's actually a reasonable though maybe overly iconoclastic expression of what the scientific method is all about: healthy skepticism and a recognition that our past conclusions may be wrong.  Now get out there and follow the science -- which most certainly does not mean to just blindly follow whoever is trotted out by some politician as the expert of the day to tell us, for example, that schools are dangerous and can't be open while they send their kids to in-person classes at private schools, or who tell us that eating out and meeting with friends is deadly while they dine with their friends in five-star restaurants. Always because of science! 

P.S. -- While making dangerously irresponsible hypotheses, here's one more to consider. If the benefit of N-acetyl cysteine in reducing the impact of the cytokine storm that COVID can cause is due to its antioxidant effect, perhaps the underlying oxidative stress (higher level of oxidizing compounds) from obesity is one of the reasons why those who are obese seem to be at such high risk of harm due to COVID. Haven't done much review of the literature here, but I'd appreciate feedback on that hypothesis. Here's one study suggesting the impact of obesity on COVID outcomes may be connected with oxidative stress. Here's another one showing that oxidative stress is also present in obese children (so this effect alone of course doesn't explain why children tend to have so little risk of harm from COVID).