Dear editor
Many people throughout the world have contended with a Severe Acute
Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. Researchers
have investigated some potential therapies to exploit against
coronavirus disease 2019 (COVID-19).1 Plasma medicine
is a novel field of treatment that has broad anti-microbial effects.
Cold plasma has been employed in this field to inactivate virus
functions.2,3 Recent studies have described potential
efficacy of cold plasma against different viruses.2Herein, we reported three patients with COVID-19 infection who were
treated with cold plasma and demonstrated a significant response. Cold
plasma (Cloudburst, Tose’eMadare Hiro Co, Iran) was applied in each
naris for 5seconds and in oropharynx for 10 seconds for at least three
consecutive days (Figure 1 )
Case 1. A 32-year-old male presented with fever, chills and
headache was referred for evaluation of COVID-19; the result of
nasopharyngeal PCR test was positive. His symptoms were aggravated and
he had experienced malaise, myalgia, diarrhea, dry cough and anosmia.
Consequently, a low-dose spiral lung computed tomography (CT) was
requested that showed bilateral patchy infiltrations compatible with
COVID-19 (Figure 2 a,b ). He was recommended to keep home
quarantine. On the 14th day of the onset of symptoms,
he was treated with nasal cold plasma and his symptoms improved
significantly. His anosmia on the day of treatment and other symptoms
gradually alleviated on the following days (Figure 2 c,d ).
Case 2 . A 33-year-old male patient was referred to our clinic
with fever 39ºC, headache, dry cough, myalgia, diarrhea and malaise. We
requested a nasopharyngeal PCR test for COVID-19 that was positive;
spiral lung CT scan was also compatible with COVID-19. During the
disease course, he experienced anosmia and also ageusia. We recommended
keeping self-isolation. Due to the persistence of symptoms, this patient
was also treated with nasal cold plasma on the 10thday. His symptoms especially anosmia diminished notably.
Case 3. A 38-year-old male patient with low grade fever, dry
cough, myalgia and anosmia was referred for nasopharyngeal PCR test for
COVID-19 that was positive. Patient had been treated with azithromycin
and naproxen for 6days. On the 7th day, nasal cold
plasma was administered daily for three days. Initially, he was
experienced exacerbation of dry cough after nasal cold plasma
application, probably due to the ozone gas effects. However, anosmia was
palliated on the first day of treatment significantly and other symptoms
were relieved gradually until the third day of cold plasma therapy.
During the COVID-19 pandemic, many investigators are assessing new
treatments against SARS-CoV-2. Cold plasma is a new field of therapy in
infectious diseases.1 The most important components of
cold plasma for its antimicrobial characteristics are UV radiation and
reactive oxygen and/or nitrogen species that can damage nucleic
acids.2 Recent studies have reported cold plasma as a
potential treatment for enteric viruses like norovirus, and adenovirus
as well as airborne respiratory viruses, such as respiratory syncytial
virus, and Influenza A(H5N2).2-4 It has been showed
that cold plasma also could inactivate viruses through water
decontamination.2 Recent studies investigated cold
plasma as a candidate treatment for COVID-19
infection.1,5
In all of our patients after using nasal cold plasma, their symptoms and
general condition gradually improved; however, they were experienced
mild symptoms of COVID-19 infection. To the best of our knowledge, this
is the first report of using cold plasma as an adjunctive treatment for
COVID-19 infection. Cold plasma may be suggested as a potential
adjunctive therapy for treatment of patients with COVID-19 under
mechanical ventilation to prevent upper respiratory infections. However,
more clinical investigations are demanded to evaluate the efficacy and
safety of cold plasma in treatment of SARS-CoV-2 infection.
Funding: This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-profit sectors.
Competing interests: The authors declare no conflict of
interest.
Acknowledgments: We thank the patients and their families for
the willingness to provide these images. We also thank all the members
of healthcare team who are involved in the care of COVID-19 patients.
The patients in this manuscript have given written informed consent to
publication of their case details.