This is an interesting question. COVID-19 is associated with ARDS and septic shock. I fear that stellate gangion block would likely increase the vasopressor and inotrope requirements in patients with COVID-19. This would probably offset any beneficial effect on ARDS.

However, there is some suggestion that beta-blockade may improve outcomes in patients with septic shock. This is currently being investigated in the STRESS L trial which uses an infusion of the short acting beta blocker landiolol.

Faced with the choice I would prefer to try the beta blocker...

The stellate block is a good idea and it would probably help. Even better would be a thoracic epidural block. The most practical treatment, however, would be the familiar intravenous magnesium sulphate treatment, which has been successfully employed by obstetricians to control eclampsia in pregnant women. Such treatment would undoubtedly be as successful in treating viral pneumonia as it is for eclampsia, because both eclampsia and viral pneumonia are essentially the same phenomenon: hyperactivity of the body's "stress mechanism" induced by environmental stress that causes disease.

In essence, viral pneumonia, bacterial pneumonia, ARDS, multi-organ failure syndrome, eclampsia, and the surgical stress syndrome are one and the same: they all represent hyperactivity of the "stress mechanism" that repairs tissues and regulates hemodynamic physiology. Hyperactivity of this mechanism is the cause of all forms of disease.

The lung is a "target organ" for stress for two reasons:

1. lung tissue is chock full of "tissue factor" that activates blood enzyme factor VII to initiate tissue repair. The factor VII enzyme is "labile" and cannot express its enzymatic activity unless it is stabilized by tissue factor. The vascular endothelium is a single layer of specialized cells that isolates tissue factor in extravascular tissue from factor VII in flowing blood. Bacteria, viruses, toxic gases etc. can increase the permeability of the vascular endothelium and increase contact between TF and factor VII. Thus activated, factor VII generates thrombin, which energizes the release of cellular hormones that cause inflammation as the initial event in the normal process of tissue repair. To make matters worse, factor VII acts as a "trigger" for the activities of factors VIII, IX and X, all of which engage in an elegant enzymatic interaction that exaggerates thrombin generation.

2. lung tissue is densely and directly innervated by sympathetic nerve endings that release von Willebrand factor (VWF) from the vascular endothelium into flowing blood. VWF lacks enzymatic properties, but it binds to enzymatic factor VIIIC, which is "labile" like factor VII and cannot express its enzymatic activity unless it is stabilized by VWF. The huge VWF molecule binds to the huge VIIIC molecule to form a chimeric molecular complex known as "factor VIII" so that the two molecules circulate together and exert their individual properties in concert. The factor VIII chimera interacts with factors VII, IX and X to accelerate thrombin generation to energize its enzymatic generation of factor XIII, which converts soluble fibrin to insoluble fibrin to facilitate coagulation, which is the first observable event in the tissue repair process.

Those seeking greater detail may consult my website: www.stressmechanism.com, where free copies of my published papers may be downloaded directly from the Internet.

"Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution. The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction."

----Rudolf Virchow

“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.”

---Rudolf Virchow

Today's "modern" medicine is controlled and corrupted by corporate power, politics, and privilege that seeks to profit at the expense of public health. Much like war is the health of the state (and ironically the mainspring of medical progress), sickness translates to profits for medical corporations. As a result, the most powerful and practical medical treatment modalities revealed by wartime research have been abandoned and forgotten. Vital medical information has been banished from textbooks, and banned from modern journals and medical school curricula. Medical research has been diverted down a primrose path toward a dead end called "genomics". This is the reason that Americans no longer dominate the Nobel Prize for medicine, why there is no cure for cancer, and why medical progress has halted in its tracks. Witness the abandonment of streptokinase as a cheap, reliable, predictable, and effective cure for infarction in favor of expensive and counterproductive coronary artery bypass surgery, soon supplanted by similarly useless and expensive angioplasty.

Madness is rare in individuals - but in groups, parties, nations, and ages it is the rule. ----Friedrich Nietzsche

As Hans Selye noted during the recent (but now forgotten) era of stress research: it's not stress that kills us; it's the body's reaction to stress. This is the key to effective treatments for viral pneumonia. If the body's reaction to the virus is controlled, and the "vicious cycle" of pulmonary reaction to the virus is disrupted so as to restore homeostasis and normal physiological function, then the body will quickly and efficiently eradicate the virus and cure the pneumonia.

100 years ago George Washington Crile recognized the role of nervous activity in causing what was then called "shock." Crile should be remembered as the father of modern anesthesia, and anyone interested in medicine should read his classic book "anoci-association"

also:

(https://archive.org/details/anociassociation00criluoft/page/n6/mode/2up)

https://www.ommegaonline.org/article-details/Four-Forgotten-Giants-of-Anesthesia-History/468

Crile demonstrated that supplementing general anesthesia with morphine improves surgical outcome. He treated sepsis and peritonitis with massive intramuscular doses of morphine that rendered patients comatose for a week, without the help of intravenous fluids, and this reliably cured the sepsis and peritonitis (gasp!). This treatment would be similarly effective for viral pneumonia, but today we have improved machines, monitors and medications that offer even better treatments. Critically ill viral pneumonia victims should be managed using elective intubation (which isolates the virus contagion from medical workers), "permissive" hypercarbia (which optimizes oxygen transport and delivery to cells), and synthetic opioids (which inhibit nociception that exaggerates harmful sympathetic hyperactivity). Thoracic epidural block would be even more effective than opioids, and a combination of epidural block plus intravenous opioids would be still more effective. Success would be still further enhanced by supplementation with intravenous MgSO4, EDTA (chelation therapy) or trisodium citrate, all of which directly inhibit harmful thrombin hyperactivity generated by the interaction of factors VII, VIII, IX and X. With these powerful treatments used in combination, it should be possible to quickly cure the illness and eliminate the need for ventilators and prolonged intensive care.

Anyone interested in learning more may consult my website www.stressmechanism.com where they can download my published papers free of charge.

I am currently toiling to complete two books that present recent advances in the stress theory of Hans Selye. Medicine is now poised at the threshold of the greatest theoretical advance in its history, if only the obstacles of government and corporate interests can be overcome. The opportunity for profitable pharmaceutical development guided by effective theory cannot be comprehended by corporate moral and mental midgets. Government has created the present predicament, and only government can cure it.

Thank you Lewis S. Coleman for your answer. Being part time ENT with also specialty neural therapy and part time quality management auditor I am shocked that the simple, old and good treatments seem to be forgotten in COVID-19 times and not only then. One of my teachers (Prof. Lorenz Fischer) and all his colleagues showed me in my neural therapy formation, that it can be so simple to do good medicine. It seems that using a cheap local anesthesia like Procain 1% in a very simple injection technique or infusion of Mg or or or is just to simple for modern medicine. And thinking about the adjuvant possibilities in the beginning of viral pneumonia not even getting to the vicious cycle...

I offered to start adjuvant treatment of people with starting symptoms in the private practice I am working, but nobody is interested. I offered my work in the hospital nearby, no reply so far. Fact is, that ambulant medicine, also in ENT, elective medicine is not needed right now, so what have I done all the time before as ambulant ENT specialist, if it is not needed in a crisis? Yes, as medical specialists we also cure because we listen and I love my job, but right now I have to rethink a lot to be honest!

Invasive neuraxial procedures in patients with sepsis are relatively contraindicated because of the risk of seeding infection to the site of the procedure. An epidural infection would be particularly problematic. This is particularly problematic with bacterial infections. In critically ill patients with Covid-19 the incidence of concurrent bacterial infection is unknown. I would strongly advise against the performance of epidural blockade in patients with sepsis.

I understand your remark Rajkumar Rajendram concerning deep injection techniques, but superficial injection techniques with a known antiinflammatory local anesthetic like procain and no allergies against local anesthetics of the patient?

I have similar though as Stefanie Meyle. Check my hypothesis presentation.

https://www.slideshare.net/SanjivHyojuMD/potential-covid19-treatment

Thank you Sanjiv K Hyoju for your slides. You could add on Slide 23

mild: series of wheals dorsal or ventral in the segments C8-Th4 using the cutivisceral reflex path (e.g. injection of Procain 1% intracutanously, each wheal with 0.5 to 1ml)

mild and moderate: Lidocain 1% and or Procain 1% (5-20ml in 500ml NaCl 0.9%) under EKG control

A Lidocain 1% or Procain 1% dose aerosol is too hard to develop and will take too long.

Thank you all for the discussion. As you can see in our paper "Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block..." there are nearly no changes in hemodynamic etc. parameters. And the procain itself is antiseptic(!), see papers Cassuto et al 2006 etc. Because the tecnique can be done with very fine needles (and pressure after the injection) so anticoagulation must not be an absolute contraindication. In our paper we propose stellate ganglion blocks in heart (and lung) diseases...It is a pity that this possibility is not often used as a therapeutic option...

It will block the pulmonary afferents through the SG to Dorsal root ganglia (DRG) to spinal cord and to brain, that initiate the hypersympathetic response and neurohumoral cascade of exaggerated inflammatory response and will block the sympathetic efferent.

And finally the publication to my question, thanks a lot to Lorenz Fischer!

Article Regulation of acute reflectory hyperinflammation in viral an...

Ganglion block sym supply to cranium not lungs

Dear Shalendra Singh, read the whole publication please.