Promising Pandemic Protocols
by James Lange
“Jim, I want to say that you have done an amazing job of highlighting the number of proactive measures that each and every one of us can take in order to protect ourselves (and others) from exposure to, and transmission of, the deadly virus. BRAVO!!!”
Martha Stark, MD Faculty, Harvard Medical School
Founder and CEO, SynergyMed for MindBodyHealth: Integrating Traditional and Nontraditional Solutions™
This is the newsletter I wish my doctor sent me. There are under-publicized protocols for protecting yourself as well as others. We have compiled useful information to help you make smart decisions and stay safe or at least safer. My current passion is spreading the word about the first protocol listed above and getting people to actually use the gargle and nasal spray. We are working to see my dream become a reality by forming a 501(c)(3) organization. We are also fishing for comments and help with the 501(c)(3). If you have an interest in helping, please call Diana at 412-521-2732.
With the help of some friends and coworkers, my wife and I have assembled this guide outlining this under-publicized intervention along with some others that could help keep you safe. The measures we plan to take are listed and outlined in the box above. Please note we provide details on all of the above in the rest of this article. For a more complete description of items discussed in this article, information on proper usage of these items, and, as a suggestion, links to the products that I purchased for my family, go to https://paytaxeslater.com/endnotes.
I wish I could tell you all these protocols have been peer-reviewed and tested extensively and are 99.9% safe. They are not. As an example, people with certain thyroid conditions should not utilize the povidone-iodine gargle and nasal spray solution. Studies are in process and my reading is that they look promising. We reference and provide links to some of those studies to give you the opportunity to come to your own conclusions. That said, I think they all make sense, and my family and I are using them when appropriate.
Please keep in mind that the material provided in this article is general in nature and that time and additional studies could prove me wrong. I welcome additional information that contradicts, confirms, or adds to the information presented here. I consider this article to be a work in progress.
A natural objection to this entire article is that it is outside of my area of expertise and not given the scrutiny that it deserves. I plead guilty on both fronts. Truthfully, I would have liked it to have been written by an expert in infectious diseases and would have liked at least an additional month to work on it. I would have also liked it to have been reviewed by a lot more experts.
The problem with waiting is that, although large-scale vaccination efforts are already underway, the short-term outlook for this pandemic is extremely bleak. And, to me, that makes the additional safety protocols outlined here extremely timely. Frankly, I have decided to sacrifice closer scrutiny for speed. That said, hundreds of hours have gone into getting it to where it is now.
We have tried to make this information as accessible as possible. The mask is relatively easy to order but requires some fiddling to attach a filter to protect others. Safety goggles seem easy and obvious, but we include a link for the mask and the goggles that we chose. Mixing the povidone-iodine (Betadine® is one brand name) nasal/oral solution is the least familiar so we have attached links to papers that report on current research.
As with all of the health information I pass on, it is meant to offer readers some options to consider. Obviously, I am not a physician nor am I suggesting you use these protocols to go bar hopping and attend large indoor parties with strangers!
That said, I care about my “tribe” and want to keep you safe. I have been critically concerned about the virus since March. I have distributed 33,000 KN-95 masks mainly to charities and non-profits, but also many to family, friends, and clients. I’ve tried to be proactive in earlier emails providing information on building your immune system, washing your hands, and wearing KN-95 masks. So this is simply another effort on that continuum.
Please feel free to share this information with anyone you think might be interested.
In fact, we want to make it as easy as possible for anyone who is interested in sharing this information with friends, family, and coworkers. And to that end, we’ve posted a digital version of this article at https://paytaxeslater.com/covidsafety.
Please note the online version will likely evolve as we receive feedback from the scientific community.
It is our hope that any of our readers who are also medical professionals, scientific researchers, or public health professionals and who have subject-matter expertise in the arena of COVID-19 safety protocols will provide us with input (positive or negative) about the suggestions made in this article. And we are particularly interested in any additional information that these experts might want to contribute that could be incorporated into an updated and improved
version of the article. Our goal is to provide our readers with the most reliable and up-to-date information about the efficacy, or lack thereof, of these protocols.
So, without further ado, these are the steps you may want to seriously consider implementing to decrease your chances of contracting COVID-19 in higher-risk situations—indoors, in crowds, and for those who absolutely must travel, which goes against the current CDC recommendations.
Protocol 1: Experimental Povidone-iodine Gargle and Nasal Spray Prophylactic
The first intervention is using a povidone-iodine solution as a gargle and nasal spray. The idea that this could be taken prophylactically, which I am doing personally, even if we aren’t in a dangerous situation is intriguing, but the testing is scant. This course of action is being recommended in research articles for doctors, nurses, and patients. I’ve learned of some medical/dental practices that have implemented povidone-iodine gargle and nasal spray for their healthcare workers and patients as a preventative measure during this COVID-19 pandemic. There have been multiple papers written supporting the efficacy (in vitro) of the povidone-iodine solution for killing the novel coronavirus that causes COVID-19, although clinical trials are still recruiting patients for in vivo studies. Many of these papers also endorse the safety of this solution as a gargle and nasal spray treatment.
The CDC is not recommending it yet, because of the lack of clinical evidence, but “the absence of evidence is not the evidence of absence.”  If we insist on double-blind studies, it would likely be too late to prevent thousands of cases that this protocol might prevent. There are some organizations (e.g., dental associations in countries throughout the world, from Canada to Italy, from Switzerland to South Africa, and from Spain to Singapore) that are recommending the use of povidone-iodine in dental practices to help prevent transmission of coronavirus. 
This topic is on the edge of a research boundary—it is being studied, and some clinical trials are in the process—but the implications could be huge. And I chose to include information about it in this article because I think it could potentially reduce the risk of infection. The other reason I am so enthusiastic is it doesn’t seem to have a significant downside other than the risk of using iodine as a gargle and nasal spray. Of all the interventions in this article, this one could have the biggest impact.
Details and More Information about Experimental Povidone-iodine Gargle and Nasal Spray Prophylactic
Our research turned up multiple papers on the topic of using a 0.5% povidone-iodine solution as an oral rinse and a nasal spray prophylactically. Naturally, this topic is of particular interest to otolaryngologists (head and neck surgeons) who are performing aerosol-generating procedures. But in the absence of results from clinical trials, using the solution is considered experimental.
If you are curious, we have included links in the endnotes to the papers we found. There are many more available on the web if you search for “povidone-iodine COVID-19.” Though not approved through peer review, the protocol makes sense, has a history of being used against other viruses such as Severe Acute Respiratory Syndrome (SARS) and MRSA and doesn’t seem to have much of a downside.
Personally, with all my meetings on Zoom, I have very little exposure to people, but I still am using it twice a day.
Warning: The current research on a 0.5% povidone-iodine solution’s efficacy in killing the virus has only been conducted in vitro, but a posting on the NIH U.S. National Library of Medicine site is recruiting patients for clinical trials. It is contraindicated for people with an allergy to iodine, women who are pregnant, or people with active thyroid disease, and patients undergoing radioactive iodine therapy. For more details, please see endnotes.
The most authoritative peer-reviewed journal article I have found was published in print in July 2020, and online in September 2020 in a JAMA Otolaryngology-Head Neck Surgery publication entitled: In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2.
The objective was to evaluate the in vitro efficacy of PVP-1(povidone-iodine) nasal antiseptic for the inactivation of SARS-CoV-2 [technical name for the virus that causes COVID-19] after 15 and 30 seconds. They found that at concentrations (0.5%, 1.25%, and 2.5%), the iodine solutions completely inactivated the virus within 15 seconds of contact. After many more details—all of which you can read in the article—the bottom line was that:
“Widespread use of PVP-I nasal antiseptic in patients prior to intranasal procedures could significantly decrease risk of virus transmission via droplet and aerosol spread. Health care professionals may also consider instructing patients to perform nasal decontamination with PVP-I prior to presenting for their procedure, which can further decrease intranasal viral load and can prevent spread in waiting areas and other common areas…Therefore, transnasal viral inactivation may not only prevent person-to-person spread of SARS-CoV-2 but may also diminish the severity of disease in patients by limiting the spread and decreasing viral load delivered to the lungs. Povidone-iodine nasal irrigation may be beneficial for the population at large as an adjunct to mask usage as a means of virus mitigation.”
Using Povidone-Iodine (PVP-I) 10% as a Possible Safeguard Against COVID
Warning: PVP-I is contraindicated for people with an allergy to iodine, women who are pregnant, or people with active thyroid disease, and patients undergoing radioactive iodine therapy. PVP-I contains iodine which may stain dentures, some dental work, and clothing. This protocol is proposed for all suspected and confirmed COVID-19 patients admitted in the hospital, as well as health care workers interacting with these patients as a form of PPE.
Here is one formulation we found.
Supplies: Betadine®10% (or other PVP-I 10% product safe for oral use), distilled water, nasal atomizer, 1 mL and 10 mL oral syringes, 3 glasses
- Wash hands.
2. It is important to prepare the solution immediately before using it because the dilution we are going to do can change its properties over time.
3. Put distilled water in one glass and Betadine® in another.
4. Draw up 9.5 mL of distilled water and put into third glass.
5. Draw up 0.5 mL PVP-I and put into third glass with the 9.5 mL of distilled water, mix. (Result is a 0.5% PVP-I solution)
6. Take out 1 mL of the diluted Betadine® and put into the nasal atomizer. (Only using 0.6 mL of this 1mL)
7. That leaves 9 mL for the gargle.
8. Put into mouth.
9. For 30 seconds coat the inside of your mouth with the solution.
10. For 30 seconds hold in back of throat or gargle.
11. Then spit it out.
12. Spray 0.3 mL in each nostril with the nasal atomizer—that is typically 2 sprays for most atomizers.
13. Prime the pump by spraying into the air.
14. Spray 2 sprays in each nostril.
15. Breathe in gently.
16. Wait 30 seconds before blotting or gently blowing your nose.
Avoid eating and drinking for 30 minutes afterward.
You can repeat this every 2-3 hours, up to 4 times a day.
A list of the products we purchased is included in the endnotes.
Protocol 2: The Mask
The second intervention is to use an advanced filtering mask that looks like a WWI gas mask that offers better filtration than a standard cloth, a KN-95, or even an N-95 mask. Most advanced filtering masks of this type provide protection for you, but not others. So, we recommend a modification to protect others too. Directions for where you can buy the mask and what you can do to modify the mask follow.
Details and More Information about The Mask
With the help of the tech support at 3M we identified this advanced filtering mask as a good option: 3M™ Half Facepiece Respirator Assembly 6291/07002(AAD), Medium, with 3M™ Particulate Filters 2091/07000(AAD), P100. This 3M mask looks a little like a feminine version of a WWI gas mask, so don’t be surprised. The advantages of this mask are that (1) you can adjust it to have a tight seal against your face, (2) it uses P100 filters, which filter out 99.97% of airborne particles (N-95 masks filter out 95% of airborne particles), and (3) they are not reserved for healthcare workers. For very important information on the correct usage of this mask, please see the endnotes. This type of mask is especially important for high-risk situations. When you are in low-risk situations, we prefer KN95 masks to cloth masks.
The advanced filtering mask has an exhalation valve, so if you have COVID-19 people would not be protected against getting COVID from you. You would be exhaling your aerosol droplets through the valve.
Protocol 3: Add a Filter to the Mask
To combat this problem, the CDC has suggested using another mask to cover the exhalation valve. The CDC says: If only a respirator with an exhalation valve is available and source control is needed, cover the exhalation valve with a surgical mask, procedure mask, or a cloth face covering that does not interfere with the respirator fit. (3M is not recommending this…but didn’t seem to object.)
Another option would be to cut out a piece from a certified N-95 mask or use a similar sized piece cut from a piece of 3M Filtrete high-performance electrostatic air filter and either glue or tape the edges around the perimeter of the exhalation valve—inside or outside. This is what Cindy and I are doing.
Airlines and doctor’s offices are aware of the problem with exhalation valves and may not allow you to use any mask that has an exhalation valve. Most airlines have banned masks with these valves. Even though you will have added a filter to correct this issue on your mask, they will likely require you to switch to a different mask.
Protocol 4: Safety Goggles
The next intervention is to use protective safety goggles which are readily available, but we provide a source anyway.
Protocol 5: Masks and Other CDC Guidelines
Finally, we must continue to follow CDC guidelines. We are all now aware of the importance of washing our hands, wearing a mask that covers our nose and mouth, avoiding crowds, avoiding travel, keeping our distance from others, etc.
When washing your hands, the CDC recommends using soap and water and scrubbing for the required 20 seconds. If it is not possible to wash hands with soap and water, use a hand sanitizer that contains at least 60% alcohol.
For high-risk situations, I have encouraged the use of an advanced filtering type of mask. When in low-risk situations, while N95 masks continue to be reserved for healthcare personnel, we prefer the use of KN95 masks over cloth masks.
After I personally reviewed all of this information, I believe that following these protocols will probably reduce your risk of contracting COVID 19 more than if you did not follow them. In particular, the gargle and nasal spray seem to be the easiest to implement. I hope this information is helpful to you. I encourage you to review these protocols yourself and do your own research to determine if they make sense for you and your family as well.
We are in the initial stage of considering forming a 501(c)(3) for the purposes of educating people about these protocols as well as other topics, including different charitable gifting techniques.
We are looking for people to help with our efforts. Help from medical professionals and researchers could come in the form of improving the information provided in this article. Help could also come in the form of helping us disseminate this information to a larger audience of people who could benefit from it. Previous non-profit experience would also be valued. If you have any interest in assisting us with these efforts (no money exchanged), please call Diana at 412-521-2732.
Thank you for your support and I hope you have a safe holiday season.
*For all endnotes and links to additional information go to https://paytaxeslater.com/endnotes
On the site, you will be able to access all the studies, articles, papers, and other documents cited in this article. The endnotes also include links for those who are interested in purchasing some or all of the items listed in these protocols, as well as usage instructions.
Limit of Liability: The material provided in this article is general in nature and provided only as educational information. Neither the publisher nor the author nor any contributor shall be liable for any damages resulting from any information provided in this article.
Promising Pandemic Protocols
ENDNOTES for Promising Pandemic Protocol
** See notes 7, 8, 10, and 13 for all product information and for mask use/fit instructions. Povidone-iodine usage information is in the main body of the article.
 “My View: Searching for certainty in the absence of evidence,” Christopher Smiley, DDS, September 16, 2020 https://www.ada.org/en/publications/ada-news/2020-archive/november/my-view-searching-for-certainty-in-the-absence-of-evidence
 Examples of organizations recommending the use of povidone-iodine to reduce the spread of COVID-19.
Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents – A Rapid Review 24 July 2020
ADA COVID-19 Risk Management Guidance, August 2020 (Australia)
 Articles we reviewed regarding povidone-iodine as a part of PPE for COVID:
“The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection,” Kirk-Bailey.
“Repurposing 0.5% povidone-iodine solution in otorhinolaryngology practice in Covid 19 pandemic,” Kahn, June 18, 2020.
“The povidone-iodine solution as SARS-CoV-2 prophylaxis for procedures of the upper aerodigestive tract a theoretical framework,” Naqvi, October 27, 2020
“Povidone Iodine (PVP-I) mouth gargle/nasal spray may be the simplest and cost-effective therapeutic antidote for COVID-19 Frontier,” Khalil, July 2020.
“The use of Povidone Iodine nasal spray and mouthwash during the current COVID19 pandemic,” Levi, April 4, 2020.
“The use of Povidone Iodine nasal spray and mouthwash during the current COVID-19 pandemic may protect healthcare workers and reduce cross-infection.” Kirk-Bayley, March 27, 2020.
 Clinical Trials
Clinical Trial – COVID-19: Povidone-Iodine Intranasal Prophylaxis in Front-line Healthcare Personnel and Inpatients
List of other clinical trials studying COVID-19 and povidone-iodine
 Peer-reviewed journal article
“In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2,” Frank, September 17, 2020
 Formulation for povidone-iodine solution
“UConn Health Researchers Find a Simple Oral Rinse Can Inactivate the COVID-19 Virus,” Chandler, June 18, 2020.
 Products for Povidone Iodine Procedure
Below are the products that I purchased for the nasal spray and gargle that meet the requirements recommended by the research I have done.
Link to the nasal atomizer spray bottles:
The correct Betadine® solution. Betadine® makes various products so it is important to get the correct one:
 The Mask – specifications and instructions for use and fit
3M™ Half Facepiece Respirator Assembly 6291/07002(AAD), Medium, with 3M™ Particulate Filters 2091/07000(AAD), P100 is available from Amazon: https://www.amazon.com/gp/product/B01H1FSATY/ref=ppx_yo_dt_b_asin_title_o03_s00?ie=UTF8&psc=1
They are available on Amazon and other vendors for about $30, and replacement filters are also available.
The mask comes in three sizes, but tech support at 3M (Cindy’s new best friend) indicated that unless you have an unusually large or small face, the medium will fit most people.
How to Put the Mask On
You should be clean-shaven and have your hair pulled back to ensure a good seal.
Check your seal. https://www.youtube.com/watch?v=DzIDhYGnDIM and
Check your fit. https://www.youtube.com/watch?v=kzyV8s_wL1w
Clean after wearing. https://www.youtube.com/watch?v=aZgrMKODTqg
 CDC Instructions for Covering Exhalation Valves
 One Source for Purchasing a KN95 Mask to Cover the Exhalation Valve
To cover the exhalation valve on the mask, you could cut a piece of a KN95 mask like this one:
Or if you have received one of the masks I have sent out, you can cut one up to make the filter.
 Airlines Banning Masks with Exhalation Valves
“American Airlines becomes the final major US carrier to ban masks with valves,” Zach Griff, Aug 13, 2020.
 Goggles Recommended by Dr. Fauci
“Did Dr. Fauci Recommend Wearing Eye Shields, Goggles For Covid-19 Coronavirus?,” Bruce Y. Lee. Jul 30, 2020.
 One Source for Polycarbonate Protective Goggles
There are multiple available options for polycarbonate goggles, but they should cover the eyes and seal around the face. Also, if you wear glasses, you need to get a pair that fits over your glasses—you will definitely want to see peoples’ reactions to your safety apparel!