GLOBAL HEALTH AND LIFE COALITION - COMUSAV

CHLORINE DIOXIDE:

a safe and potentially eCective solution

to overcome Covid-19

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 September

SUMMARY

LIST OF ABBREVIATIONS AND ACRONYMS 3

1. INTRODUCTION 4
1.1. Background 4
1.2. A brief summary of chlorine dioxide 6
1.3. Key points for reAection 9
1.4. What is Chlorine Dioxide Solution (CDS) and what are the diIerences
with Miracle Mineral Solution (MMS)? 11
Unnecessary controversy and its consequences 11
EFFECTIVENESS, SAFETY AND TOXICITY OF CHLORINE DIOXIDE 13
2.1. Action against viruses 13
2.2. Pre-clinical studies 13
2.3. Clinical studies 15
Toxicity 20
3.RECOMMENDATIONS, PRECAUTIONS AND CONTRAINDICATIONS
FOLLOWING MEDICAL EXPERIENCE 22
4. LEGAL FACTS AND INTERNATIONAL HUMAN RIGHTS 23
5. FINAL CONSIDERATIONS 29
6. REFERENCES 32
7. ANNEXES 39
Experience report: the case of Bolívia 39

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 LIST OF ABBREVIATIONS AND ACRONYMS

AEMEMI Ecuadorian Association of Doctors Expert in Integrative Medicine

CDS Chlorine dioxide solution

Cl Chlorine

ClO2 Chlorine Dioxide

COMUSAV Global Health and Life Coalition

COVID-19 From English, Corona virus disease -2019

ELA Amyotrophic lateral sclerosis

FDA From the Food and Drug Administration

H2O Água

HCl Hydrochloric acid

mL milliliter

MMS From 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

OMC World Trade Organization

PAHO/WHO/ From Spanish, World Health Organization.

WHO

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 From the Spanish, Pan-American Health Organization.

From English, World Health Organization

pH Hydrogen Potential

ppm Part per million

RNA Ribonucleic acid

SARS-CoV-2 Acute respiratory syndrome of coronavirus type 2

TCLI Free and Informed Consent Term

HIV Human immunodeCciency virus

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 world economy

was compromised. Undoubtedly, this is a problem that requires an urgent

solution and the commitment of everyone, especially health personnel, in the

search for its prompt solution.

In order to identify a solution to this problem and also based on the scientiCc

evidence already published and clinical experiences of use of chlorine dioxide

(ClO2) by physicians and researchers, we made an assessment of the main

information to support our proposal for the use of chlorine dioxide solution (CDS),

following the protocol standardized by Andreas Ludwig Kalcker as a safe and

eTective alternative to combat SARS-COV2 infection.

From January to July 2020, a review survey was conducted on the use of chlorine

dioxide in the indexed international literature and as an example, if we analyze

only the PubMed website (National Library of Medicine 2020), we observe that just

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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 scientiGc database. The Grst red arrow indicates the descriptor used for the
search and the second the number of documents published.
Source: https://pubmed.ncbi.nlm.nih.gov/?term=chlorine+dioxide&sort=pubdate. Access
date: 07/24/2020.

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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) patent for the treatment of neurodegenerative diseases such as amyotrophic

lateral sclerosis (ALS), Alzheimer's disease and multiple sclerosis (McGrath MS

2011);

4) Taiko Pharmaceutical's patent (2008) for human coronavirus;

5) the patent on um method and composition "for treating cancerous tumors" for

treating cancerous tumors (Alliger 2018);

6) pharmaceutical composition patent for the treatment of internal inXammation.

(Kalcker LA, 2017);

7) the patent on the pharmaceutical composition for the treatment of acute

intoxication (Kalcker LA, 2017) and;

8) patenting 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 scienti`c database. The `rst red arrow indicates the descriptor used for the
search and the second the number of documents published.

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Source: https://pubchem.ncbi.nlm.nih.gov/#query=chlorine%20dioxide. Access date:
07/24/2020.

Therefore, with these initial data alone, we note that research on ClO2 is nothing

new, that it is a chemical molecule already known for more than 200 years and

marketed for 70 years with various uses: treatment of water for human

consumption, treatment of contaminated water, for bioJlm control in cooling

towers and in the processing of food and vegetable disinfection. In addition, there

are preclinical and clinical studies conducted, as well as studies that allow us to

understand its toxicological and safety characteristics especially for human use

(Lubbers et al 1984, Ma et al 2017).

1.2. A brief summary of chlorine dioxide

The chemical formula of chlorine dioxide is ClO2 and according to the 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 chlorine dioxide molecule. These 3 atoms are held together by

electrons to form the ClO2 molecule. It can be used as a saturated gas in distilled

water and can therefore be drunk or applied directly to the skin and mucous

membranes, with appropriate dilutions. Andreas Ludwig Kalcker, Biophysicist and

Researcher, standardized a saturation of the gas in distilled water called chlorine

dioxide solution or CDS (National Library of Medicine 2020).

The discovery of the ClO2 molecule in 1814 is attributed to the scientist Sir

Humphrey Davy. ClO2 is di\erent from the element chlorine (Cl), both in its

chemical and molecular structure, as well as its behavior. ClO2, as has already

been widely reported, can have toxic e\ects if the necessary care is not observed

for its various uses and the appropriate recommendations for human

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consumption are not respected. It is more than well known that ClO2 gas is toxic

to humans if inhaled pure and/or ingested in quantities higher than

recommended (Lenntech 2020, IFA 2020).

ClO2 is one of the most eDective biocides against pathogens such as bacteria,

fungi, viruses, bioGlms and other species of microorganisms that can cause

disease. It acts by disrupting the synthesis of the pathogen's cell wall proteins.

Being a selective oxidant, its mode of action is very similar to phagocytosis, where

a mild oxidation process is used to eliminate all types of pathogens (Noszticzius et

al 2013, Lenntech 2020). It is worth mentioning that 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 Gt

for human consumption, since it leaves no toxic residues (EPA 2000, WHO 2002).

When applied at appropriate concentrations, ClO2 does not form any halogenated

products and its residual ClO2 by-products are normally within the limits

recommended by EPA (2000, 2004) and WHO (2000, 2002). Unlike chlorine gas, it

does not hydrolyze readily, remaining in the water as a dissolved gas. Also in

contrast to chlorine, ClO2 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 classiGable in terms of human carcinogenicity) (IARC

2001, EPA 2009). According to the U.S. Department of Health and Human Services

2004, the FDA recommends that ClO2 be allowed for use as a permitted food

additive and as an antimicrobial agent (disinfectant).

Many continue to confuse ClO2 with sodium hypochlorite (NaClO - Bleach) and the

latter with sodium chlorite (NaClO2), as well as other chemical compounds,

leading to frequent inappropriate comments both in the media and among

professionals due to lack of knowledge of elementary chemistry. NaClO (bleach),

for example, is a potent corrosive agent and the danger due to chronic and

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massive exposure to NaClO is well known. It is believed that asthma symptoms

developed by professionals working in contact with that substance may be due to

continuous exposure to lye and other irritants. In contact with fats, sodium

hydroxide (NaOH) degrades fatty acids into glycerol and soaps (fatty acid salts),

which reduces the surface tension of the remaining fat-solution interface. NaClO

is responsible for the dissolution of 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 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 physicians of the Ecuadorian Association of Specialists in

Integrative Medicine (AEMI) are not surprising: who state that the administration

of CDS in appropriate and safe dilutions is an eXective 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 by COVID-19 mostly, up to 4

days (AEMEMEMI 2020).

Using evidence from available scienti[c publications demonstrating the e\cacy of

ClO2 in eliminating diXerent pathogens (Kullai-Kály et al 2020), including SARS-

CoV (Tables 1, 2, 3 and 4; Taiko Pharmaceutical patent 2008), as well as the work

con[rming the safety of the use of chlorine dioxide for water potabilization and,

more recently, the aforementioned work of AEMEMEMI, we evaluate positively

and with great biocidal potential the use of aqueous ClO2 solution (CDS) to

combat coronaviruses (AEMEMEMI 2020, EPA 2000, WHO 2005, WHO 2002).

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In this context, we are surprised that o3cial 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 it, draw attention

to its toxicity and danger, but, in their speeches, do not clearly indicate in what

form and by what route of administration ClO2 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 formula standardized by Kalcker: the aqueous solution of

chlorine dioxide (CDS), at 3,000 ppm.

Thus, in order to help clarify the concepts, we invite all o3cial bodies to learn

about Andreas Kalcker's work with the aqueous solution containing gaseous

chlorine dioxide (CDS). Certainly, after having this knowledge, we believe that

deRnitely, these Organisms, who appreciate health, will naturally understand the

potential of this solution for human use and from then on, they can revise their

documents that may be at odds with the published scientiRc reality and current

medical experiences and maybe they can oSer this information in a clearer and

more assertive way in their articles published on o3cial websites or even in their

documents.

1.3. Key points for reUection

In view of the serious scenario to which the whole world is exposed with the

coronavirus pandemic, we address the following questions to the authorities and

institutions responsible for human health that lead the main institutions:

✔ What may be the purpose/impact of disclosing a document with information

that can be misinterpreted?

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✔ Is there a purpose to hide and/or translate scienti2c knowledge in a way that

causes doubt or harm to the health of thousands of people, and prevent them

from bene2ting from something that can really save lives?

✔ What is the purpose for not using so-called "unconventional" but potentially

promising options with proven clinical evidence by physicians on the front line

with COVID-19?

With the legally established purpose of saving lives, it is neither logical, nor

healthy, nor even less a humanitarian and compassionate action, in the face of a

global public emergency situation, that misunderstandings in the translation of

scienti2c knowledge occur for any purpose other than the preservation of life. We

consider that these concepts that generate misunderstandings may be caused

due to lack of knowledge of the existing literature (even though it is open for

public consultation). As a reminder: 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 writing the oPcial documents, the

articles, the reports published on the websites of oPcial bodies such as

PAHO/WHO of the member countries, the Ministries of Health and the health

regulatory bodies, were not aware 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 bene2ts of chlorine dioxide for human health and that,

therefore, these teams in charge still do not consider the potential of ClO2 for the

2ght against coronavirus type 2, as the AEMEMI and the team of Doctors and

Researchers who sign this dossier have done, we invite you to reUect on the

following:

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✔ There are many scienti.c bases for public access, with many articles freely

available, containing the necessary information for the production of a

document to support a decision in public management, why were these bases

not consulted or poorly 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 global public emergency to overcome COVID-19.

✔ How is it possible that the legally responsible oIcial health agencies made

such an important decision without a thorough analysis of the eJects of

banning a substance that could simply end the pandemic quickly, safely and

eJectively?

✔ The fact is that any neophyte in the matter who reads the diJerent oIcial

publications coming from some health organizations about ClO2 will naturally

be afraid of consuming this product because he thinks that it is toxic and

harmful to health, and that it could endanger his life. Likewise, a health

professional would also be afraid to use it in his therapeutic practice, since the

ultimate goal of any health professional is to preserve life and he would not be

able to oJer the patient something life-threatening.

Based on the dissonant and inconsistent information when compared to what is

actually known about CDS and its potentiality is that we, health professionals in

the intention to respectfully give our contribution for the governing institutions of

health to review their documentation and oIcially published guidelines to

promote the most clear and truthful information on the use, eIcacy and safety of

ClO2 for oral human consumption (CDS), according to the standardized by Kalcker

(2020 - On evaluation: /11136-CH_Antrag_auf_Patenterteilung.pdf), we share

below a summary of the key scienti.c facts and evidence that CDS is eJective

against several pathogens, including human coronavirus type 2, the etiological

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agent of SARS-CoV2. Unfortunately, the way in which information on ClO2 is

disseminated raises doubts and above all reveals to those who understand the

scientiAc aspects of the subject that the misinformation generated is somewhat

surprising.

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

More than 13 years ago, Andreas Ludwig Kalcker initiated scientiAc research to

study the applicability of ClO2 and its dilutions, so that it can be safely used for

human consumption. On these studies, he 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 toxicology database Gestis (IFA 2020),

and take into account other reference studies already developed, for example, by

WHO (2000, 2005) and EPA (2000). These studies conArm 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 drinking water. Kalcker's 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-COV

2. In this speciAc recommendation, the consumption of 30 mg/day, divided into 10

doses of 100 mL, which is safe and non-toxic based on recognized scientiAc

references (Lubbers & Bianchine 1984; Ma et al 2017), is allowed at the end.

Unnecessary controversy and its consequences

Contextualizing the origin of the misguided controversy that has arisen over the

"chlorine dioxide" issue, 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

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"medicine". We often see news stories on the Internet confusing "miracle mineral

solution" (MMS = citric acid + sodium chlorite + water) with "chlorine dioxide

solution" (CDS = hydrochloric acid + sodium chlorite + water) and the latter with

sodium hypochlorite (bleach). The main diDerences between MMS and CDS can be

conferred in Table 1:

Table 1 - General characteristics that di2erentiate Miracle Mineral Solution

(MMS) from Chlorine Dioxide Solution (CDS).

General characteristics MMS CDS

ClO2 concentration (part per million - ppm) Not known 3,000 ppm
Ph Acid Neutral (7)
Residues Chlorates, No residues

chloride

The consequences and impact of these failures in the translation of scientiTc

knowledge at a time of global public health emergency, when the lives of many

people are at risk, are of great concern. Therefore, it is urgent that all institutions

are alert through the prior qualiTcation of the information that is published so

that there are no failures in the translation of scientiTc knowledge, thus

generating space for doubts and misinterpretations through the media, with

serious consequences and negatively inVuencing the decision making of

managers.

If we were to use sodium hypochlorite (NaClO) with hydrochloric acid in water, the

solution would contain Cl2 + NaCl + H2O . Cl2 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 well-established biochemical diDerences, many still confuse

some chemicals with ClO2 (Table 2):

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 Table 2: Summary of the main biological and chemical characteristics of
chlorine dioxide and derived compounds.

CHEMICAL COMPOSTS
BIOCHEMICAL Sodium Sodium Chlorite of Hypochlori Sodium Chlorine Chlorine
CHARACTERISTI perchlorate chlorate sodium te chloride dioxide
CS sodium

Structure

Chemical
NaClO4 NaClO3 NaClO2 NaClO NaCl Cl2 ClO2
formula

Molecular 70.9 67.45

122.44 g/mol 106.44 g/mol 90.44 g/mol 74.44 g/mol 58.44 g/mol
weight g/mol g/mol

Fnte: PubChem. available at: https://pubchem.ncbi.nlm.nih.gov/#query=chlorine

%20dioxide. Access date: 07/24/2020.

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

virus nucleic acid are responsible for replication of the genetic material in the

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capsid, a structure whose function is to protect the viral genome during its

transfer from cell to cell and to aid in its transfer between host cells. When ClO2

encounters an infected cell, a denaturation process occurs that is very similar to

phagocytosis because it is a selective oxidant (Noszticzius et al 2013).

Pre-clinical studies

Pre-clinical studies exploring the toxicity of ClO2 do not usually Gnd adverse

eHects when animals are exposed to diHerent concentrations of this biocide. Here

are some of the most important ones. Ogata (2007) exposed 15 rats to 0.03 ppm

of gaseous ClO2 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

gaseous ClO2 for 5 hours per day, 5 days per week for a period of 10 weeks. No

adverse eHects were observed. They concluded that the "no observed adverse

eHect level" (NOAEL) of gaseous chlorine dioxide is 1 ppm, a level believed to be

nontoxic to humans and exceeding the reported concentration of 0.03 ppm to

protect against inUuenza virus infection.

In studies on rats, Haller and Northgraves (1955) found that long-term exposure

(2 years) to 10 ppm chlorine dioxide produced no adverse eHects. 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 oxidation of hemoglobin to methemoglobin. However, when 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 daily chlorine dioxide in drinking water at

concentrations as high as 1000 ppm for 2 months did not produce

methemoglobin. Richardson (2004) reported that high doses of oral sodium

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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 consuming 10 ppm ClO2

solution for 6 months had no adverse health eMects. When exposure was

increased to 100 ppm, the only diMerence between the treatment and control

groups was a slower weight gain in the treatment group. In an eMort 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, 7 days a week for

a period of 6 months. They concluded that for rats whole body exposure to

chlorine dioxide gas up to 0.1 ppm for a period of 6 months is not toxic.

Higher doses of ClO2 solution (e.g., 50-1000 ppm) can produce hematological

changes in animals, including decreased red blood cell counts,

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 gavage or indirectly

through their prey drinking water (US Department of health and human service,

2004).

Moore & Calabrese (1982) studied the toxicological eMects of ClO2 in rats and

observed that when rats were exposed to a maximum level of 100 ppm via

drinking water and neither A/J nor C57L/J rats showed any hematological changes.

It was also found that rats exposed to up to 100 ppm sodium chlorite (NaCIO2) in

their drinking water for up to 120 days could not demonstrate any

histopathological changes in kidney structure.

Shi e Xie (1999) indicated that an acute oral LD50 value (expected to result in

death in 50% of dosed animals) for stable chlorine dioxide was >10,000 mg/kg in

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mice. In rats, 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 receiving chlorine

dioxide in drinking water for 90 days at concentrations resulting in doses up to

approximately 11.5 mg/kg/day in males and 14.9 mg/kg/day in females (Daniel et

al 1990).

2.3. Clinical studies

According to the U.S. Environmental Protection Agency (EPA), the short-term

toxicity of ClO2 was evaluated in human studies by Lubbers et al (1981, 1982,

1984a and Lubbers & Bianchine 1984c). In the Xrst 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 portions, separated by 4 hours) of a 0 or 24 mg/L

chlorine dioxide solution (0.34 mg/kg, assuming a baseline 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 physiologically relevant changes

in general health (observations and physical examination), vital signs (blood

pressure, pulse rate, respiratory rate and body temperature), clinical serum

chemistry parameters (including glucose, urea nitrogen and phosphorus levels),

alkaline phosphatase and aspartate and alanine aminotransferase), serum

triiodothyronine (T3) and thyroxine (T4), or hematological parameters were found

in any study (EPA, 2004).

Michael et al (1981), Tuthill et al (1982) and Kanitz et al (1996) examined the e\ects

of drinking water disinfected with ClO2. Michael et al (1987) found no signiXcant

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abnormalities in hematologic parameters or serum chemistry. Tuthill and

coworkers (1982) retrospectively compared data on newborn morbidity and

mortality in two communities: one using chlorine and one using ClO2 to purify

water. In reviewing this study, the EPA found no diHerences between these

communities (US Department of Health and Human Service, 2004).

Kanitz et al (1996) studied births in two Italian hospitals where water was puriRed

with chlorine or ClO2. Although the authors concluded that infants born to

mothers who consumed ClO2-treated drinking water during pregnancy were at

increased risk of neonatal jaundice, reduced head circumference and body length,

the EPA wrote that confounding variables precluded the possibility of drawing

conclusions from this study (US Department of Health and Human Service, 2004).

Two studies conducted at The Ohio State University College of Medicine evaluated

the short-term safety of ClO2 in humans. In the Rrst study, 10 healthy adult males

drank 1,000 mL (divided into two 500 mL portions, separated by 4 hours) of 0 or

24 ppm ClO2 solution. In the second study, groups of 10 adult men drank 500 mL

of water containing 0 or 5 ppm ClO2 for 12 weeks. Neither study found any

adverse eHects.

Haag (1949) exposed groups of rats to ClO2 in drinking water for two years at

concentrations resulting in estimated doses of 0.07, 0.13, 0.7, 1.3, or 13

mg/kg/day. The results indicated no signiRcant diHerences in mortality between

the control group and the treated group up to the highest exposure level tested.

Survival was not signiRcantly decreased in the groups of rats exposed to chlorite

(such as sodium chlorite) in drinking water for two years at concentrations

resulting in estimated doses of chlorite up to 81 mg/kg/day. In another study,

Kurokawa et al. (1986) observed that survival was not adversely aHected in rats

receiving sodium chlorite in drinking water at concentrations resulting in

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estimated chlorite doses 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 chlorite doses of up to 90 mg/kg/day did not aCect survival

(Kurokawa et al. 1986).

According to Lubbers et al 1981, there were no signs of adverse hepatic eCects (as

assessed by serum chemistry tests) in adult males who consumed ClO2 in

aqueous solution resulting in a dose of approximately 0.34 mg/kg or in other

adult males who consumed approximately 0.04 mg/kg/day for 12 weeks. The

same investigators administered chlorite to healthy adult males and found no

evidence of adverse hepatic eCects after each individual consumed a total of

1,000 mL of a solution containing 2.4 mg/L chlorite (approximately 0.068 mg/kg)

in two doses (separated by 4 hours), or in other normal or G6PD-deUcient males

who consumed approximately 0.04 mg/kg/day for 12 weeks (Lubbers et al 1984a,

1984b). No signs of ClO2- or chlorite-induced impairment of liver function were

observed among rural villagers who were exposed for 12 weeks via ClO2 in

drinking water to measured weekly concentrations of 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

ClO2 levels in the drinking water before and after the treatment period were

<0.05 mg/L. The chlorite level in the drinking water was 0.32 mg/L before ClO2

treatment. One week and two weeks after discontinuation of treatment, chlorite

levels dropped to 1.4 and 0.5 mg/L, respectively.

In its oZcial document entitled "Laboratory Biosafety Manual" (page 93), WHO

(2005) discusses ClO2:

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"Chlorine dioxide (ClO2) is a powerful, fast-acting germicide, disinfectant and oxidant

that is usually active at concentrations lower than those needed for chlorine bleach.

The gaseous form is unstable and decomposes into chlorine gas (Cl2) and oxygen gas

(O2), producing heat. However, ClO2 is soluble in water and stable in aqueous

solution.

It can be obtained in two ways:

1) By in situ generation, mixing two diHerent components, hydrochloric acid (HCl) and

sodium chlorite (NaClO2), or 2) By in situ generation, mixing two diHerent components,

hydrochloric acid (HCl) and sodium chlorite (NaClO2).

(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 are consumed by most organic compounds. In contrast, ClO2

reacts only with reduced sulfur compounds, secondary and tertiary amines and other

highly reduced and reactive organic compounds. Therefore, a more stable residue can

be obtained with ClO2 at much lower doses than when chlorine or ozone is used. If

properly generated, ClO2, because of its selectivity, can be used more eHectively than

ozone or chlorine in cases of higher organic load."

Based on the WHO Strategy on Traditional Medicine 2014-2023 (WHO 2013),

which recognizes practices related to traditional, complementary and integrative

or "non-conventional" medicine as an important part of health services, in order

to continuously integrate them with the various member countries signatory to

this initiative, we put here the potential of ClO2 aqueous solution (Kalcker 2017) as

a potent biocide and, therefore, as a safe complementary alternative to combat

SARS-CoV2. ClO2 can combat viruses by the process of selective oxidation through

denaturation of the capsid proteins and subsequent oxidation of the genetic

material of the virus, 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, making it a promising treatment for any strain of virus.

Page 21of 51
There is scienti+c evidence that ClO2 is e3ective against SARS-CoV-2 coronavirus

and others:

✔ Wang and co-workers (2005) will study the persistence conditions of SARS-

CoV-2 in di3erent environments and its complete inactivation by the e3ect

of oxidants such as ClO2;

✔ The Department of Microbiology and Medicine at the University of New

England investigated the inactivation of human and simian rotaviruses (SA-

11) by ClO2. Experiments were carried out at 4°C in standard phosphate-

carbonate bu3er. Both viruses were rapidly inactivated in only 20 seconds

under alkaline conditions, with ClO2 concentrations 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 in\uenza virus,

measles, canine distemperosis virus, human herpesvirus, human

adenovirus, canine adenovirus, feline calicivirus and canine parvovirus;

✔ ClO2 at concentrations ranging from 1 to 100 ppm produced powerful

antiviral activity, inactivating > or = 99.9% of viruses in only 15 seconds of

treatment. The antiviral activity of ClO2 was approximately 10 times

greater than that of NaClO (Sanekata et al 2010).

✔ The Italian University of Parma has conducted studies on the inactivation

of viruses resistant to oxidizing agents, such as Coxsackie virus, hepatitis A

virus (HAV) and feline calicivirus: the data obtained from the studies show

the following: For complete inactivation of HAV and Feline calicivirus,

Page 22of 51
 concentrations > or = 0.6 mg / L. 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 hepatitis A virus (HAV)

inactivation using ClO2, observing complete destruction of antigenicity

after 10 minutes of exposure with 7.5 mg ClO2 per liter (Li et al 2004);

✔ The Department of Biology at New Mexico State University (USA)

conducted a study on the inactivation of polioviruses with ClO2 and iodine.

It concluded that ClO2 inactivated poliovirus by reacting with viral RNA and

a]ecting the ability of the viral genome to act as a template for RNA

synthesis (Alvarez ME & O'Brien RT 1982);

✔ Taiko Pharmaceutical Co, Ltd, Seikacho, Kyoto, Japan demonstrates in this

study that ClO2 gas at extremely low concentrations, without any harmful

e]ect on human health, produces a strong deactivating e]ect on bacteria

and viruses, signidcantly reducing the amount of viable microbes in the air

in a hospital surgical center (Taiko Pharmaceutical 2016).

Toxicity

Page 23of 51
The LD50 toxicity (acute toxicity index) established by the German toxicology

database GESTIS 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, ClO2 acts rapidly when it enters the

human body. ClO2 is rapidly converted to chloride ions, which in turn are broken

down into chloride ions. The body uses these ions for many normal purposes.

These chloride ions leave the body within hours or days, primarily through urine

(EPA 1999).

The short-term toxicity of ClO2 has been evaluated in human studies by the

research groups of Lubbers et al:

In the Trst 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 portions,

separated by 4 hours) of a ClO2 solution 0 or 24 mg/L (0.34 mg/kg, assuming a

baseline 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

ClO2 (0.04 mg/kg-day assuming a reference body weight of 70 kg) for 12 weeks.

No physiologically relevant changes in general health (observations and physical

examination), vital signs (blood pressure, pulse rate, respiratory rate, and body

temperature), clinical serum chemistry parameters (including glucose, urea

nitrogen, and phosphorus levels), alkaline phosphatase and aspartate and alanine

aminotransferase), serum triiodothyronine (T3) and thyroxine (T4), or hematologic

parameters were found in any study (EPA 2000).

Ma et al (2017) evaluated the e\cacy and safety of an aqueous ClO2 solution

containing 2,000 ppm. The 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 for 24h showed no mortality or abnormality in clinical

Page 24of 51
symptoms and/or lung and other organ function. A CLO2 concentration of up to

40 ppm in drinking water showed no 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, on various body

organs, at diLerent developmental stages of the animal specimens studied, and

reported a Lowest Observed Adverse ELect Level (LOAEL) for these eLects of 14

mg kg-1 day-1 of chlorine dioxide. While Orme, et al. (1985) identiQed a No

Observed Adverse ELect Level (NOAEL) of 3 mg kg-1 day-1. The clinical experience

of Latin American physicians, during the last six months, suggests that ingestion

of 30 mg day-1 of chlorine dioxide dissolved in one liter of water and drunk for ten

events throughout the day as a successful treatment for COVID-19, which is 6

times below the dose considered as NOAEL. Therefore, the literature review

conQrms that the use of chlorine dioxide ingested at a dose of 0.50 mg kg-1 day-1

does not pose a risk of human health toxicity by ingestion and does represent a

very plausible treatment for COVID-19.

Page 25of 51
3.RECOMMENDATIONS, PRECAUTIONS AND
CONTRAINDICATIONS FOLLOWING MEDICAL
EXPERIENCE

Based on medical experience, we have made the following recommendations:

✔ It is recommended to generate chlorine dioxide by mixing sodium chlorite

(NaClO2) and an activator (hydrochloric acid) or in its electrolytic form (the

ideal). What is used to make CDS is chlorine dioxide gas saturated 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 diIculties. In small quantities for a short

time it is harmless, as shown by Dr. Norio Ogata's studies;

✔ Preferably, do not mix CDS with: coMee, alcohol, bicarbonate, vitamin C,

ascorbic acid, orange juice, preservatives or supplements (antioxidants).

Page 26of 51
 Although they do not usually interact, they can neutralize the e4cacy of

chlorine dioxide;

✔ We recommend taking care of food content and quantity;

✔ The =rst recommendation should be: Chlorine Dioxide (ClO2) should be

administered by prescription and medical follow-up, self-treatment is not

encouraged.

4. LEGAL FACTS AND INTERNATIONAL HUMAN

RIGHTS

Scienti=c advances and discoveries are constant, and in the =eld of health,

prompt access to them by health personnel and patients becomes primordial and

urgent, being logical and obligatory, out of pure humanitarian sense and in

accordance with scienti=c rigor, to test substances such as Chlorine Dioxide (ClO2)

for which there is proven evidence of its e4cacy and usefulness. In the history of

Page 27of 51
medicine, the supremacy of the criterion of the "compassionate remedy" over the

criterion of the "perfectly proven remedy" has been constant.

Art 32 and 37 of the 1964 Declaration of Helsinki so permit in the case of

"Unproven Intervention" (INC), "When in the care of a patient proven

interventions do not exist or other known interventions have proved ineLective,

the physician, after seeking expert advice, with the informed consent of the

patient or a legally authorized representative, may be permitted to use unproven

interventions, if, in his judgment, this gives some hope of saving life, restoring

health or alleviating suLering."

Doctors, according to the Geneva Declaration of 1948, when faced with

patients whose health and life are in danger, have the obligation to use all the

means and products available to them, which oLer evidence of eLectiveness and

to a greater extent in a medical emergency, since according to the duty of

fraternity and humanitarian aid, the use of Chlorine Dioxide (ClO2), whose non-

toxicity has been documented and whose eLectiveness and safety has been

demonstrated in the studies and practices carried out in diLerent countries,

cannot be limited or denied. To the same extent, States, Institutions and

Organizations cannot restrict or prevent its use in the face of existing clinical

evidence, otherwise they would be in breach of the obligations assumed in

international and national texts, thus violating fundamental rights such as the

right to life and health as well as the right to patient self-determination and

professional autonomy and clinical independence.

In accordance with the above, the practice of the medical profession

implies a vocation of service to humanity, being its greatest concern the health

and life of the patient, having to watch over the beneVt of the interests of the

citizens, putting at their disposal the medical knowledge within the framework of

professional autonomy and clinical independence. Within the existing legal

framework, fully applicable and enforceable, the medical profession must have

professional freedom without interference in the care and treatment of patients,

Page 28of 51
having the privilege of using their professional judgment and discretion to make

the necessary clinical and ethical decisions.

Physicians are legally vested with 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

in=uence, and take appropriate measures to ensure that e>ective systems are in

place.

Every patient has the right to be cared for by a physician whom he/she

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 and their decisions must be

respected, being fully protected to prevent third parties from intervening in their

body without their consent, being adequately informed about the purpose of the

intervention, the nature, risks and consequences.

The right to health requires that governments comply with their

obligations under the aforementioned covenants, so that health goods and

services are available in suDcient quantity, with public access, and of good

quality, in accordance with General Comment 14 of the Committee on Economic,

Social and Cultural Rights.

All of this is covered by the provisions listed below, the essential contents

of which are summarized below;

- Universal Declaration of Human Rights, December 10, 1948.

- American Declaration of the Rights and Duties of Man, Bogotá, 1948.

- American Convention on Human Rights, San José (Costa Rica), November

7-22, 1969.

- International Covenant on Economic, Social and Cultural Rights of 16

December 1966.

Page 29of 51
 - The Convention for the Protection of Human Rights and Fundamental
Freedoms, Rome, November 4, 1950.

- International Covenant on Civil and Political Rights of 16 December 1966.

- Convention for the Protection of Human Rights and Dignity of the Human
Being with regard to the Application 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.

- WMA Statement on Physician Independence and Professional Freedom

1986.

- WMA Declaration of Madrid on Professional Autonomy and Self-

Regulation 1987.

- WMA Declaration of Seoul on Professional Autonomy and Clinical

Independence 2008.

- WMA Madrid Declaration on Professional Regulation 2009.

- WMA Statement 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 16

December 1966, signed by Ecuador on 24 September 1968 and ratiXed on 11 June

2010, recognizes the right of everyone to the enjoyment of the highest attainable

standard of physical and mental health; art. 12 "1. The States Parties to the present

Covenant recognize the right of everyone to the enjoyment of the highest attainable

standard of physical and mental health. "and the duty of the state to protect this

Page 30of 51
right by a comprehensive system of health care, available to all, without

discrimination and a8ordable, art. 2:

Each State Party to the present Covenant undertakes to take steps, individually

and through international assistance and cooperation, especially economic

and technical, to the maximum of its available resources, with a view to

achieving progressively the full realization of the rights recognized in the

present Covenant by all appropriate means, including particularly the adoption

of legislative measures".

The International Code of Medical Ethics of October 1949, in order to

enforce, among others, articles 36 and 59 of the aforementioned text;

Article 36 of Chapter VII on end-of-life medical care.

"The physician has the duty to try to cure or improve the patient, whenever
possible. When it is no longer possible, the obligation remains to apply the
appropriate measures to achieve the patient's well-being, even if this may
result in a shortening of life.

2. The physician should not undertake or continue diagnostic or therapeutic

actions that are harmful to the patient, without hope of beneFt, useless or
obstinate. He/she should withdraw, adjust, or not initiate a treatment when the
limited prognosis so advises. He must adapt diagnostic tests and therapeutic
and supportive measures to the clinical situation of the patient. It must avoid
futility, both quantitative and qualitative.

3. The physician, after adequate information to the patient, must take into
account the patient's willingness to refuse any procedure, including life-
prolonging treatments.

4. When the patient's condition does not allow him/her to make decisions, the
physician must take into consideration, in order of preference, the indications
previously made by the patient, the prior instructions and the opinion of the
patient in the voice of his/her representatives. It is the physician's duty to
collaborate with the persons whose task it is to ensure that the patient's wishes
are carried out."

- Article 59 of Chapter XIV on medical research;

"Medical research is necessary for the advancement of medicine and is a social

good that should be promoted and encouraged. Research involving human

Page 31of 51
 subjects should be carried out when scienti2c progress is not possible by other
alternative means of comparable e9cacy or in those phases of research in
which it is indispensable.

The research physician should take all possible precautions to preserve the
physical and psychological integrity of the research subjects. Special care
should be taken to protect individuals belonging to vulnerable groups. The
good of the human being who participates in biomedical research should
prevail over the interests of society and science.

Respect for the research subject is the guiding principle of the research.
Their explicit consent must always be obtained. The information should
contain, at least: the nature and purpose of the research, the objectives,
the methods, the expected bene>ts, as well as the potential risks and
discomfort that their participation may cause them. You should also be
informed of your right not to participate.

or to withdraw freely at any time from the investigation, without being

prejudiced thereby.

The physician-researcher has the duty to publish the results of his research
through the normal channels of scienti>c dissemination, whether they are
favorable or unfavorable. It is unethical to manipulate or conceal data,
whether for personal or group bene>t, or for ideological reasons."

The 1981 WMA Declaration of Lisbon on the Rights of the Patient, "Every patient

has the right to be cared for by a physician whom he knows to be 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

concerning himself/herself. The physician shall inform the patient of the consequences

of his or her decision.

The mentally competent adult patient has the right to give or withhold

consent to any examination, diagnosis or therapy. The patient has the right to the

information necessary to make his or her decisions. The patient should clearly

understand what the purpose of any examination or treatment is and what the

consequences of withholding consent are."

Page 32of 51
 The WMA Statement on Physician Independence and Professional Freedom
of 1986, according to which: "Physicians should enjoy such professional freedom
as will enable them to care for their patients without interference. The physician's
privilege to use his or her professional judgment and discretion in making clinical
and ethical decisions necessary for the care and treatment of his or her patients
should be maintained and defended. By guaranteeing independence and
professional freedom for physicians 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 Declaration of Madrid on Professional Regulation reaPrms

the Seoul Declaration on the professional autonomy and clinical independence of

physicians by stating "Physicians are vested with 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

in<uence."

The universal principles that permeate all regulations must comply with

respect for the humanitarian laws innate in the collective unconscious, as stated

in the maxim of the Hippocratic Oath "TO MAINTAIN the greatest respect for human

life from its very beginning, even under threat, and not to use medical knowledge

contrary to the laws of humanity. "Ethical values take precedence over limiting legal

provisions as is well recognized in the 2003 WMA Statement on the Relationship

between Law and Ethics, which states "When legislation and medical ethics con<ict,

physicians should seek to have the legislation changed. If such a con<ict occurs, ethical

responsibilities prevail over legal obligations."

When a patient, faced with an illness, seeks relief or to save his life and

requests to try a therapeutic option of which there are indications of usefulness,

as is the case with chlorine dioxide (ClO2), it is the duty of the physician to support

the patient, acquire knowledge, carry out studies, and disseminate it in

accordance with article 27 of the Universal Declaration of Human Rights of 1948,

Page 33of 51
in order for all to bene-t from scienti-c progress, information must be freely

shared so that it can be disseminated in all countries without restrictions,

"Everyone has the right freely to participate in the cultural life of the community, to

enjoy the arts and to share in scienti8c advancement and its bene8ts."

Page 34of 51
5. FINAL CONSIDERATIONS

In view of the historic moment facing all of humanity with the Coronavirus

pandemic and the urgent need to save lives, the recent developments related to

the treatment of COVID-19 in both the medical and academic @elds, and especially

the object of this paper, which is to provide the authorities with the correct

information on chlorine dioxide for correct and safe human use, it is worth

considering some fundamental issues related to human rights and medical

practice for reCection:

✔ Adherence to any treatment depends on the tacit agreement and

collaboration between the parties: the physician and the patient (or his/her

guardian when in special conditions that do not allow a conscious choice of

medical intervention, e.g., situations of memory loss, induced or trauma-

induced unconsciousness, in children). This agreement is freely and

spontaneously agreed upon;

✔ Based on his clinical experience, the physician is free to prescribe what he

considers appropriate for the patient, always communicating the correct

way to use a drug, the possible bene@ts and risks of a therapeutic

intervention. On the other hand, the patient, on the basis of the

explanations given, personal beliefs and complementary information, is

also free to accept or not any form of treatment indicated;

✔ Medical practice should always be based, whenever possible, on scienti@c

data to support the diagnostic and therapeutic behaviors employed.

However, in situations where scienti@c evidence is unavailable or

unreliable, it is up to the physician to use his or her knowledge, previous

Page 35of 51
 experience and common sense to conduct the clinical situation in the

manner that seems most appropriate. In this case, it is important for the

physician to 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 no

intervention or other known interventions have been ine8ective, 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 physician's judgment, it o8ers hope of saving lives,

restoring health, or alleviating su8ering. This intervention should be the

subject of research to evaluate its safety and eBcacy. In all cases, new

information should be recorded and, where appropriate, made publicly

available."

✔ Respecting the above aspects, we cannot underestimate the fact that there

is not enough evidence in the scientiIc literature indicating the use of SCDs

for prophylaxis or etiological treatment of COVID-19 cases of any severity,

when we observe, for example, the technical report of AEMEMI physicians

on the 97% eScacy of treatment of patients with COVID-19 in 4 days in

Guayaquil/Ecuador (AEMEMEMI 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 National Library of Medicine of the United

States/National Institute of Health, in Dr. Eduardo Insignares Carrione

(Genesis Foundation) and entitled "Determination of the EScacy of Oral

Chlorine Dioxide in the Treatment of COVID-19"

(https://clinicaltrials.gov/ct2/show/study/NCT04343742) and so far cannot

start its work because the regulatory institutions are making this confusion

in the translation of knowledge, thinking that chlorine dioxide is toxic;

Page 36of 51
 ✔ In the speci+c case of ClO2, currently available information and clinical

evidence point to the e;cacy of this substance against coronavirus

(AEMEMEMI 2020).

In summary:

● In view of the above, based on the evidence presented here with evident

experience by Scientists and Health Professionals, as well as already well

demonstrated in scienti+c 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 of doctors from several countries has proven to be

safe for human consumption and also eQective against COVID-19 when

consumed correctly in the 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 long process of debate

and resolution in the framework of the exercise of Human Rights and in the

framework of the Law of Participation and Social Control, the population has

demanded through its departmental and national assembly representatives the

Law that allows the authorization of the production, distribution with quality

control and compassionate use of Chlorine Dioxide. To date (September 13, 2020)

there are 4 departmental laws and 1 national law in process; in La Paz

Governmental Headquarters the Law was enacted on September 9, 2020.

Page 37of 51
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COV2 (COVID-19). May, 2020

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Special thanks:

Andreas Ludwig Kalcker and Helena Valladares from Liechtenstein Association for

Science and Health, Geneva/Switzerland for sharing the technical scientimc data

needed to compose this dossier.

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

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7. ANNEXES

Experience report: the case of Bolívia

BACKGROUND

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Epidemiological surveillance activated in the country for COVID-19, determines

the intervention of the health system in the face of suspected and con?rmed

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 disease and

transmissibility cycle of about 14 days, more or less 4 days after the onset of

symptoms; In addition to this responsibility, the lack of installed means of

diagnosis and treatment for the initial stages of the disease, the lack of laboratory

tests, added to the diEculties of geographical access have determined the few or

null probabilities of primary and secondary preventive care and consequent

treatment, with early detection and adequate containment.

This epidemiological background has allowed a group of independent health

professionals to become aware of and eIectively contribute to attenuate the

SARS-CoV2 transmissibility, adapting to the context capabilities, and rescuing the

experiences of medical professionals with the use of Chlorine Dioxide that date

back to more than 10 years ago throughout the country facing acute and chronic

pathologies; These professionals are provided with the CDS solution and after

informing about its properties and bene?ts, they have the informed consent of

the aIected 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/bene8t of prescribing the drugs

mentioned. The possible pharmacological strategies proposed to date are based on

studies with a low level of evidence, where con8dence in the expected e/ect is

limited, so that the true e<ect may be far from the expected one, which generates a

weak degree of recommendation (expert recommendations)." (P. 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 con?rmed COVID-19 patients is legally initiated.

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Two scenarios are envisaged for detection and containment in the Plurinational

State of Bolivia: house to house raids to listen, inform and sensitize people on the

importance of blocking the transmissibility of the disease in the family and in the

community, where there are no conditions for care and con?rmation diagnosis,

and even fewer basic conditions to follow the recommended actions of hand

washing and use of mask/mask (real precariousness in remote areas of the

country), although the attitude of the population to comply with these rules of

coexistence is evident.

The other scenario where it was possible to document the treatment with

Chlorine Dioxide had the support of services (Laboratory and CT) for diagnosis

and treatment. In both scenarios, the voluntary information and decision to sign

the Informed Consent form was complied with (ANNEX Nº 37: INFORMED

CONSENT FOR PHARMACOLOGICAL 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, probably NOT considered as SCIENTIFIC

EVIDENCE, but as VIVIENCIAL EVIDENCE, the aZected people are cured and we

contribute to blocking the transmissibility at least at the family level and

consequently for the community.

The cases that have been documented so far are 30, in the hospitalization

modality and about 35 in ambulatory care, these cases are being documented,

compiled and systematized by the Bioethics and Scienti?c Studies requirements

respecting the structures and procedures for the respective endorsement. As a

country, we are con?dent that these eminently administrative processes and

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procedures will be adjusted to the innovative requirements and demands for

timely responses to the merciless 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 PCR-RT and/or Elisa, Clinical

Laboratory, gasometry and others; Imaging studies, 22 patients have 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 average hospital stay was a mean of 8

days (Range 1 - 31).

The origin of patients (3 males and 3 females), has provided for 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 mining

center (altitude 4,266 m.a.s.l.), a population with a varying degree of

pneumoconiosis and therefore with a decreased oxygen saturation among other

aspects.), population with a diWerent degree of Pneumoconiosis and therefore

with a decreased oxygen saturation among other aspects; There is a documented

case aimed at 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 by conventional treatment, will be attached to the

publication of the conclusions to share the experience.

CONCLUSIONS

The responsibility and competencies assumed by each of the actors in the country

have led to act in the most eWective way in the face of the pandemic, the health

personnel in the framework of Medical Ethics and Deontology, assumes the

responsibility to join the attention to 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.

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Faced with the lack of control of the pandemic, the representatives of the

population (Neighborhood and Civic Boards, grassroots organizations,

associations, Bolivian Workers' Central, Bolivian Federation of Miners,

Departmental and National Assembly members), the latter have taken steps to

draft, discuss and enact the Law on the Production, Use and Distribution of

Chlorine Dioxide.

Finally, we appeal to scientiJc and bioethics societies and academic training

institutions to join this advance in the exercise of human rights in the face of the

population's decision to choose, autonomously and fairly, solutions to confront

the pandemic.

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