Excellent approach! Let me encourage you. Try searching for Pulmonary nontuberculous mycobacterial coronavirus

Use Google, and especially Google Scholar:

https://scholar.google.com/scholar?&q=Pulmonary+nontuberculous+mycobacterial+coronavirus

You can publish quickly at https://www.biorxiv.org/ OR at https://arxiv.org/

Be aware that Rifamycin is to treat bacterial infection, but coronavirus is obviously a virus. But then look at the results here: Article Antibiotics for the common cold and acute purulent rhinitis - 2002

This is also interesting reading: https://en.wikipedia.org/wiki/Off-label_use

For possible co-authors see https://www.researchgate.net/search.Search.html?type=project&query=Covid-19

For data about current parallel studies see https://www.researchgate.net/project/Scientific-Hypothesis-as-a-source-of-innovation-and-discovery

For other current studies see https://www.researchgate.net/search.Search.html?type=publication&query=Covid-19

Thank you! I realize that it is a virus, but it is not the virus that attacks the alveoli in the lungs. In fact, it is often bacteria that cause the distress syndrome.

I recomend

Article Analysis on the epidemic factors for the Corona Virus Disease

Article Deconstructing the Covid-19 Corona Virus

Article Management of corona virus disease-19 (COVID-19): the Zhejia...

Article Similarity in Case Fatality Rates (CFR) of COVID-19/SARS-COV...

https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200221-sitrep-32-covid-19.pdf?sfvrsn=4802d089_2

https://apps.who.int/iris/rest/bitstreams/1271387/retrieve

i supposed the same

Clinical management of respiratory syndrome in patients ...

www.ncbi.nlm.nih.gov › pmc › articles › PMC6048819

by A Bleibtreu - ‎2018 - ‎Cited by 4 - ‎Related articlesJul 16, 2018 - Middle East respiratory syndrome coronavirus (MERS-CoV) is a single-stranded ... in six and quinolones plus spyramicin or rifampicin in four.

Hi. I am md phd student. I came to your post while searchin for rifampicin in sars cov 2. Would it be possible to share some thougts with you? Isabelbogalho @tecnico.ulisboa.pt regards

Hi Isabel, yes, of course. I´ll send you my contact details via mail.

I assume those reading this will be familiar with Lawrence Bruxmeyer's work/publications on this topic. I include a link here just in case anyone is not familiar: https://www.academia.edu/42175251/ITALY_IN_CRISIS................................._by_Dr._Lawrence_Broxmeyer_MD

Google BCG.

It is an extremely interesting discussion, please, see a very relevant brief paper draft with the title:

"Can inhalation of aerosolized urea-containing microdroplets be an effective method for the prevention and treatment of SARS-CoV-2 induced pneumonia?"

You can find this ultra-brief draft preprint here:

https://www.researchgate.net/publication/340737975_Can_inhalation_of_aerosolized_urea-containing_microdroplets_be_an_effective_method_for_the_prevention_and_treatment_of_SARS-CoV-2_induced_pneumonia

The figures for the regions are anomalous. https://www.statista.com/statistics/1104580/coronavirus-cases-by-region-in-ukraine/ Which regions are the urea producers?

How can we control for other variables such as farming life, cut-off communities?

Can any other country provide similar results?

please see e.g. the coronavirus map file attached

Here is also the earlier coronavirus distribution map in Ukraine

Inhaled aerosols usually make a significant contribution to health problems.

Inhalation of cigarette smoke, inhalation of combustion products generated by forest fires, automobiles and thermal power plants, inhalation of aerosol particles of metal oxides, coal particles, ore particles by workers in the respective industries, all this is usually extremely harmful to human health. Inhalation of aerosolized microdroplets of saliva containing bacterial and viral pathogens is also extremely dangerous, for example, contributing to a pandemic influenza or coronavirus.

More or less large deposits, consisting of inhaled aerosol particles, can persist for a long time in the lungs, often contributing to chronic inflammation and carcinogenesis.

Recently, the incidence and mortality fromthe COVID-19 pneumonia has been shown to be significantly higher in patients previously exposed to prolonged exposure to ambient polluted air.

In fact, we can give very few examples where inhaling aerosolized micro or nanoparticles from the surrounding air and/or equipment by people or animals could be a health useful process, such as, for example, inhalations of aerosolized drug agents for stopping asthma attacks, see e.g.:

Article Inhaled aerosols: Lung deposition and clinical applications

The question arises whether such a relatively safe, but biochemically unique substance as urea, which is the final natural product of nitrogen metabolism in humans and animals, and which is at the same time super-large-capacity fertilizer used to significantly increase agricultural productivity throughout the world,

could play an important, unique role in the intrapulmonary antiviral immunity of humans and animals and make an accidental contribution to the high anticoronavirus protection of some human subpopulations subjected to chronic exposure of the relatively high concentrations of aerosolized urea.

Studying current statistics is easy to see that in the regions of Ukraine exposed to environmental impact from very large factories producing and shipping urea for the whole world, the incidence and mortality from COVID -19 was sharply reduced in comparison with other regions of Ukraine.

«the only region in Ukraine where a case of coronavirus infection has not yet been registered remains the Nikolaev region.

This was announced during an online briefing by the chief sanitary doctor of Ukraine Mr. Viktor Lyashko.

“Cases of suspected coronavirus disease have been reported in all areas. But, at the same time, the Nikolaev region is the only region in Ukraine in which not a single case of coronavirus disease has been registered,” he said.

According to Mr. Viktor Lyashko, this amazing fact is difficult to explain, but testing in Nikolaev city and the Nikolaev region is carried out on a regular basis.

"It is difficult to explain, but it is a pleasant thing, since testing for coronavirus is carried out in the region regularly, there are suspicions of coronavirus in Nikolayev region, but there are no confirmed cases. We will only be satisfied if there are no registered cases in at least one region of Ukraine, and the number of corona virus infection cases does not increase in other regions, ” Mr. Lyashko said.» [1].

It is, of course, possible that this fact is a mere coincidence.

But every day (!), for several decades, each such urea producing large plant generates approximately one ton or often even several tons of urea aerosol dust carried by the wind into the surrounding atmosphere

http://www.opz.odessa.net/

http://www.opz.odessa.net/prod-karbamid/

http://www.azot.lg.ua/

Article Exposure to Ammonia and Acute Respiratory Effects in a Urea ...

Article Energy Saving and Dust Management in Urea Bagging Plant

Article [Bronchial irritation syndrome following inhalation or urea....

Therefore, it can be assumed that the equilibrium residual concentration of urea in the lungs of the residents of such regions may be slightly increased.

But, as is well known from the old literature, urea is a very powerful denaturant and shows the ability to disrupt a correct coordination of the spike proteins in coronaviruses, significantly reducing their infectivity.

Urea high polar molecules aere capble of efficiently electrostatically concentrating onto the sharp spikes of coronavirus thereby destroing the infectivity optimal spike protein conformation, see e.g.

Cooper, P. D., Virology, 16, 485 (1962).

Scott, E. M., and Lauffer, M. A., Arch. Biochem., 11, 179 (1946).

Buckland, F. E., and Tyrrell, D. A. J., J. Gen. Microbiol., 32, 241 (1963).

DORMAN, D. Effect of Urea on A2 Influenza Virus. Nature 203, 789–791 (1964).

Article Inactivation and Reactivation of Semliki Forest Virus by Ure...

DAVID CAVANAGH AND PHILIP J. DAVIS

Coronavirus IBV: Removal of Spike Glycopolypeptide S1 by Urea Abolishes Infectivity and Haemagglutination but Not Attachment to Cells

J. gen. Virol. (1986), 67, 1443-1448.

CAVANAGH, D. Coronavirus IBV: structural characterization of the spike protein. Journal of General Virology (1983), 64, 2577-2583.

Perhaps it is also worth noting here that some clinically approved urea-based kinase inhibitors are proposed as broadly active antivirals, see e.g.:

Article RNAi-based small molecule repositioning reveals clinically a...

The presence of some minimal concentrations of active urease-positive mycobacterium tuberculosis in the lungs, for example, in the lungs of patients with latent tuberculosis (at least one third of the entire world population) or in the lungs of patients without a BCG vaccination background, naturally leads to continuous intrapulmonary local generation of relatively low, but constant concentrations of ammonia, which leads to a local small alkalization of phlegm, which can be relatively not critical for healthy patients, but It can be extremely dangerous for patients with the COVID-19 infection.

Article Impact of BCG vaccination on incidence of tuberculosis disea...

Such an urease-positive mycobacerium generated weak local intrapulmonary alkalization of red blood cells helps red blood cells more easily capture oxygen inside the lungs, but the same effect of the weak initial alkalization of red blood cells temporarily acquired by red blood cells in the lungs can significantly impede oxygen transfer to tissues, where increased red blood cell acidity is required for high oxygen transfer efficiency.

Thus, important, mycobacterium urease-induced mild or moderate hyperammonemia observed in the lungs may not be observed in the circulation and, especially, in the capillaries of hypoxic tissues, being easily compensated by the presence of elevated concentrations of carbon dioxide, but nevertheless, still causing relatively difficult oxygen transfer to hypoxic tissues due to Bohr effect.

It is well known from the relatively recent literature that inhaled aerosolized carbon 13 labeled urea has been used for diagnosing the intrapulmonary concentration and activity of urease-positive mycobacteria and for monitoring the effectiveness of tuberculosis therapy through controlling the relative concentration of expired carbon 13 isotopes.

Article A Proof of Concept Study to Detect Urease Producing Bacteria...

Article [C]-Urea Breath Test as a Novel Point-of-Care Biomarker for ...

Article Current tuberculosis diagnostic tools & role of urease breath test

Article Non-invasive detection of Helicobacter pylori in cystic fibr...

Article Microbial Urease in Health and Disease

Article Urease as a Virulence Factor in Experimental Cryptococcosis

Article The Emerging Role of Urease as a General Microbial Virulence Factor

https://www.nature.com/articles/ncomms5989

It is also well known from the literature that ammonia, a major product of micobacteria urease-induced urea hydrolysis, is a potent inhibitor of immunity, including local antiviral immunity, being particularly immunotoxic under conditions of hypoxia.

Finally, from very recent literature it is known that there is a strongest correlation between the incidence and mortality from Covid 19 pneumonia and the background of BCG vaccination and revaccination in these COVID 19 patients, see e.g.;

https://www.medrxiv.org/content/10.1101/2020.04.07.20053272v1.full.pdf+html

But, the greater the intrapulmonary equilibrium concentration of urease-positive mycobacterium tuberculosis, the lower the equilibrium concentration of the intrapulmonary potentially protective, anti-coronavisus active urea achieved in phlegm and then in sputum of COVID-19 patients.

Also, the greater the intrapulmonary equilibrium concentration of urease-positive mycobacterium tuberculosis, the greater the equilibrium concentration of intrapulmonary ammonia that is generated urease-positive mycobacteria and possessing high local immunosupressive potential to suppress the local intrapulmonary immunity, in particular, anti-coronavirus immunity.

Therefore, it seems that it would be reasonable to additionally test the effectiveness of either combined or single anti-tuberculosis agents and known urease inhibitors in therapy and prevention of the disease complications in COVID -19 patients.

However, other mechanisms are also possible that form a correlation between local equilibrium concentrations of urea and/ or the concentrations of intrapulmonary urease-positive mycobacteria (or other urease-positive intrapulmonary infections) and antivirus immunity, see e.g.:

https://reader.elsevier.com/reader/sd/pii/S1074761319304583?token=CDB80B8B9F8B2D8D346F7A0A891BA65CCA1F8E93EE29351690776ACE5538BA9A6DB64F95DDAE5B0AD1BC9656D3AA1F89

Moreover, returning to very old times, it is worth recalling that urea was actively investigated as an anti-tuberculosis agent, see e.g.:

The Treatment of Tuberculosis by the Administration of Urea.

Hospital (Lond 1886). 1901 Dec 14;31(794):182-183.

https://www.ncbi.nlm.nih.gov/pubmed/29819407

PURE UREA IN THE TREATMENT OF TUBERCULOSIS.

Henry Harper, M.D. R.U.I.

Published:June 15, 1901

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)89161-3/fulltext

UREA IN THE TREATMENT OF TUBERCULOSIS.

Seneca Egbert, M. D.

February 22, 1902

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)89532-5/fulltext

Although, studying statistics, we actually got a formal reason and a hint to analyze a number of the possible causes of the social, geographical and environmental differences in the distribution of morbidity and mortality from coronavirus disease in Ukraine and, possibly, also in other countries, but it seems more interesting to find out what is the true role of urease-positive microflora in the lungs of the COVID-19 patients with preliminary BCG vaccination or without BCG vaccination, as well as what is the role of wide variation of the intrapulmonary urea and ammonia concentrations in the range from physiological concentrations to pathological ones, in modulating intrapulmonary antivirus immunity.

Write the above into a quick paper for peer review. You can publish quickly at https://www.biorxiv.org/ OR at https://arxiv.org/ You will need a table for the roughly 2 dozen regions, sorted showing Urea production level per annum for each region as the independent variable and the ratio of confirmed cases to deaths as the dependent variable. Then you will need to calculate the r squared figure in a spreadsheet. (Assume a linear relationship.) If r squared is more than say 0.6 then something is going on. In your discussion state that confounding variables include rate of testing, degree of exposure to urea, reporting delay etc.

Thank you very much, dear Ian. I regard this unusual situation taking place in some Ukrainian regions only as an interesting hint to further constructive thinking. I think, in addition to this rather dubious, in my opinion, hypothesis, in this drat paper there are much more reliable and interesting facts and arguments regarding urea, ammonia, and working concentrations of urease-positive intrapulmonary co-infection, e.g. the intrapulmonary concentration of mycobacterium tuberculosis.. A certain physiological concentration of urea is always present in the blood and phlegm of the Covid-19 patients, regardless of the geographical location of the plants producing urea. If these patients additionally have co-infection of urease-positive mycobacterium tuberculosis, without a background of BCG vaccination, such patients can have some big additional problems associated with the local intrapulmonary production of ammonia that is capable of signigficantly suppresding local antivirus immunity, at the same time, contributing to an unusual form of hypoxia due to transitory intrapulmonary alkalization of red blood cells. So, inhibitors of urease and either the single or combined anti-tuberculosis agents could be probably used and helpfull in the prevention and therapy of severe form of the COVID-19 pneumonia, again regardless of the geographical location of the plants producing urea.

Ruediger Buchkremer I am a homeopath from India and keenly studying CoVID19 since its outbreak.

Dr.Samuel Hahnemann in his Organon of Medicine, 6th Edition, cites several illustrations where "Similar Diseases" when meet in an individual tend to annihilate each other. The "Similarity" between the diseases is limited to ONLY clinical manifestations, and not in terms of etiology or causative organism.

Further, homeopathy treats illnesses on the basis of Similarity and in the Homeopathic Pharmacopeia remedy prepared from Ultradiluted Mycobacterium Avium is called Tuberculinum Aviare. The symptomatology of which bears uncanny resemblances with COVID 19.

It will be therefore very intriguing to know what influence NMT has on prevelance & incidence of SARS.

We propose to use of Tuberculinum Aviare (Ultradiluted Mycobacterium Avium) as a possible remedy to treat CoVID 19.

Oleg Meshcheryakov Whatever you do will require experimental proof.

@Ian Kennedy Unfortunately, dear Ian, I am not familiar with clinicians who could afford to test my specific proposals outlined in this currently significantly modified and expanded draft paper of mine. If you know such clinicians, please invite them to do this, for example, in patients with a very poor prognosis. Thank you very much in advance!

Oleg Meshcheryakov Please seek help elsewhere, as I am not in contact with clinicians. Thank you.

Ian Kennedy@ Yes, dear Ian, of course, I will try. Thank you.

Update: I continued to study Rifamycins further and found a fascinating paper published in 1972 in which Rifamycins were examined in more detail https://www.ncbi.nlm.nih.gov/pmc/articles/PMC426685/pdf/pnas00131-0232.pdf .

In this paper, it is reported that this class of compounds exhibit strong activities against RNA polymerase. Green et al. explain, that, although many derivatives do not inhibit mammalian polymerases, lengthening the rifampicin 3-iminomethyl4-methyl-1-piperazine side chain by substitution of benzyl for methyl yields compounds lead to the inhibition of RNA-directed DNA polymerase (reverse transcriptase) of RNA tumor viruses.

The role of RNA polymerase is well described here https://link.springer.com/chapter/10.1007%2F978-3-319-46503-6_9 .

I have not found any COVID-19 tests with rifamycins in clinical trial databases, as of yet. Perhaps this information encourages molecular biologists, chemists, or medical practitioners to further discuss this class of compounds, as they have been found to exhibit activities against RNA polymerase.

So far, I have been approached by several medical practitioners from various countries concerning this question.

I want to point out that tests should never be carried out without medical supervision, as rifamycins can be problematic due to the many possible side effects https://www.msdmanuals.com/professional/infectious-diseases/bacteria-and-antibacterial-drugs/rifamycins .

BTW: I have submitted my analysis and proposal to test Rifamycins to a medical journal (as a “correspondence”). However, a "senior editor" has decided that it is of no interest to the medical community of the journal.

Retry elsewhere.

Update: Paper published about secondary bacterial infections - It took a while, but in the meantime, there are increasingly articles published concerning Covid-19 in which primarily secondary bacterial infections are covered, for example Article Bacteriophages Could Be a Potential Game Changer in the Traj...

BTW: I have not published any articles on this subject myself. It is not my primary focus. I am happy if my question on Researchgate, which has received much attention (so far more than 2,500 reads), can help doctors or patients.

You need to provide evidence in a clinical trial- One group receive antibiotics, and the control group receives institutional care for a patient with COVID-19.

Also, we need to look at other clinical parameters that have been observed in patients with COVID-19 such as gastrointestinal, and liver pathology, nervous system changes, immunological changes, laboratory findings. Have we found such changes or similar changes in patients with NTP? This is another aspect that needs to be examined.

Many thanks for the suggestion, Samy Azer; with everything I read about Covid-19, the full microbiome's metamorphosis deserves to be studied more thoroughly. We are currently conducting a systems medicine study on the mast cell activation syndrome, and we could certainly do the same thing in a big data study for Covid-19, but we are unable to obtain the data.

The possible role of bacteria in simultaneous COVID-19 in homozygous twins

It would be nice to find out that a microbiome change could lead to an improved coronavirus disease course. 

A recent publication in Annals of Internal Medicine reveals that (almost) identical homozygous twins experience completely different Covid-19 progressions. 

It is a striking indication that the causes for different progressions in COVID-19 do not only have genetic causes. The gut microbiome (bacteria, a. o.) likely plays a particular role in coronavirus disease.  

Background: Felony et al. reveal that diet and medication play a significant role in altering the microbiome (in addition to age and environment). 

Wu et al. show that only one day's diet change is enough to change the microbiome detectably.  

Therefore, I propose to conduct a microbiome study of COVID-19 patients. Our institute (ifid) would be able to analyze the data.

References: 

Wu, G. D., Chen, J., Hoffmann, C., Bittinger, K., Chen, Y.-Y., Keilbaugh, S. A., … Lewis, J. D. (2011). Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes. Science, 334(6052), 105–108. https://doi.org/10.1126/science.1208344

Falony, G., Joossens, M., Vieira-Silva, S., Wang, J., Darzi, Y., Faust, K., … Raes, J. (2016). Population-level analysis of gut microbiome variation. Science, 352(6285), 560–564. https://doi.org/10.1126/science.aad3503

Wu, G. D., Chen, J., Hoffmann, C., Bittinger, K., Chen, Y.-Y., Keilbaugh, S. A., … Lewis, J. D. (2011). Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes. Science, 334(6052), 105–108. https://doi.org/10.1126/science.1208344