ABSTRACT
Introduction: Readily available, non-toxic and economical therapies are needed for patients during this pandemic illness. An open-label clinical study to determine the tolerance and efficacy of oral BSS therapy (Pepto-Bismol chewable tablets) was performed in 10 patients with acute, active COVID-19. Concurrent COVID-19 standard of care treatment was continued in these patients. Methods: Entry into the study required a positive salivary COVID-19 test, and the ability to chew Pepto-Bismol tablets. Demographics, vitals, comorbidities, COVID-19 related symptoms and concomitant medications were recorded. Sixteen (16) Pepto Bismol tablets were given per day for three days. The presence/absence of salivary SARS CoV-2 virus by RT-LAMP assay was measured daily. Results: After three days two groups emerged, 5 remaining COVID-19 positive and 5 COVID-19 negative (-) patients. Both groups were not demographically different. Medical vitals were similar, but the COVID-19+ patients trended to have more starting comorbidities and concomitant medications. COVID-19 related morbidities were similar between the groups. All patients studied showed an overall decrease in COVID-19 symptoms. The difference between the two groups of patients that became COVID-19- and those that remained virus + was the preexisting use of SSRI/SNRI/SARI or second-generation histamine receptor 1 (H1R) medications. None of the COVID-19 - group were on these medications and appeared to respond to administration of bismuth subsalicylate by clearing the virus from the saliva within days. None of the 10 BSS treated patients required escalation of care to an ICU. Conclusion: Bismuth subsalicylate is an over-the-counter intestinal medication. Bismuth has been shown to decrease SARS-CoV-2 viral replication through its effects on the viral helicase. Preexisting medications can impact its efficacy. BSS has potential to be used as a low cost and safe therapy in addition to standard of care for the treatment of mild/moderate COVID-19 patients. A placebocontrolled study has been planned..