The current COVID-19 pandemic is the biggest global healthcare challenge in the last century, and the number of cases in the next 12 months is likely to increase. There is currently no proven treatment, chemoprophylaxis or vaccine against COVID-19, which exhibits a wide clinical spectrum from asymptomatic carriage to mild upper respiratory tract infection, severe viral pneumonia to acute respiratory distress syndrome and death. Key workers are at high risk of exposure highlighting the need for effective preventative strategies. SARS-CoV-2 is a positive-sense single-stranded enveloped RNA virus which transmits via droplets, aerosols and direct contact, to reach their target naso- and oropharyngeal epithelial cells through initial electrostatic interactions to cell surface heparan sulphate (HS) proteoglycans. Carrageenan mimics cell surface HS, thereby trapping the virus to allow mucociliary clearance and has demonstrated anti-viral activity in-vitro and in a number of common cold clinical trials when administered as a nasal spray. ICE-COVID a randomised, double blind, placebo-controlled phase III trial of the prophylactic efficacy of iota-carrageenan nasal and throat spray in preventing COVID-19 illness in at risk healthcare professionals. Participants (n=240) will be randomly allocated to either the treatment arm (verum Coldamaris plus, 0.12% iota-carrageenan plus 0.04% Kappa-Carrageenan in 0.5% saline) or placebo (Coldamaris sine, saline 0.5%) arm. The study's primary objective is the prevention of COVID-19 infection, confirmed by PCR swab or documented seroconversion. Secondary objectives are to determine if carrageenan sprays reduce the clinical severity of COVID-19 and symptomatic acute respiratory infection of other aetiologies (non-SARS-CoV-2).
Objectives:
The primary objective is to determine whether carrageenan nasal and throat sprays reduce the
risk of COVID-19 infection.
The secondary objectives are:
1. To determine whether carrageenan nasal and throat spray reduces the severity and/or
duration of COVID-19 infection;
2. To determine whether carrageenan nasal and throat spray reduces the risk of infection
with other respiratory viruses
3. To determine whether carrageenan nasal and throat spray reduces the severity and/or
duration of infection with other respiratory viruses
4. To determine the usability of carrageenan nasal and throat spray for long term
prophylaxis against respiratory viruses
5. To determine the effect on of using the spray on quality adjusted life years and cost
effectiveness
Study Design:
The study design consists of a double blind, randomised placebo-controlled trial. Of the 480
healthcare professionals recruited, 240 participants will be randomly allocated to each of
either the treatment arm (verum Coldamaris plus i.e. Iota-carrageenan 0.12% plus 0.04%
Kappa-Carrageenan in 0.5% saline) or placebo (Coldamaris sine i.e. 0.5% saline) arms.
Participants will use the spray prophylactically into each nostril and throat three times per
day for 8 weeks, during which time the participants will be invited to complete a daily
symptom tracker questionnaire. COVID-19 infection during the trial period will be confirmed
using viral PCR swabs (if symptomatic), SARS-CoV-2 serology at 14 days following onset of
symptoms as well as trial entry and exit serology to detect asymptomatic infection during the
study period.
Allocation to each group, treatment or placebo administration and data analysis will be
blinded to both participant and investigator. The primary outcome measure will be acquisition
of COVID-19 infection as confirmed by positive PCR swab taken at the time of symptoms or
positive serology measured 2 weeks after symptom onset or seroconversion at the end of the
trial (via trial entry and exit serology) to detect asymptomatic infection during the study
period. Secondary outcome measured will include symptom types, severity and duration
(recorded by the daily symptom tracker questionnaire), hospital admission and length of stay,
oxygen saturation and radiological lung changes on admission, need for ventilatory support
(oxygen therapy, CPAP, intubation & ventilation), haematological changes, intensive care
admission and length of stay, mortality, subsequent familial/household COVID-19 infection and
acquisition of non-COVID-19 upper respiratory tract infections.
Deliverables:
1. This trial will help us to determine whether carrageenan nasal sprays significantly
affect the primary outcome measure of acquisition of COVID-19 infection as confirmed by
positive PCR swab taken at the time of symptoms or positive serology measured 2 weeks
after symptom onset or at the end of the study.
2. It will also determine the effect of carrageenan nasal sprays on secondary outcome
measures which include types, severity and duration of symptoms, hospital admission and
length of stay, need for ventilatory support and intensive care admission, mortality as
well as familial or household COVID-19 infection and acquisition of other respiratory
tract infections.
3. We will also investigate whether haematological changes (FBC, CRP, U&E, Ferritin, LFT,
LDH, Clotting, D-dimer, FDP, Vitamin D level) and demographic questionnaire findings can
offer a predictive value for acquiring COVID-19 infection or determining severity and/or
duration of resultant infection.
4. To determine any associations between symptom severity and/or duration and prognosis in
those with COVID-19.
5. Determine usability and acceptability of nasal and throat spray as prophylaxis and
affect on quality adjusted life years and cost effectiveness
Device: Carrageenan nasal and throat spray
Iota-carrageenan nasal and throat spray (verum Coldamaris plus i.e. Iota-Carrageenan 0.12% plus 0.04% Kappa-Carrageenan in 0.5% saline)
Device: Saline nasal and throat spray
Saline nasal and throat spray (placebo Coldamaris sine i.e. 0.5% saline)
Inclusion Criteria:
- Age ≥18 years;
- Study participants who have given informed consent, and received a copy of signed
consent form prior to any study related procedures;
- Healthcare professionals (nurses, doctors, allied health professionals, health care
assistants, operating department practitioners) working in Swansea Bay University
Health Board initially as well as any other volunteers >18 years who have not
previously tested positive for COVID19 or been vaccinated.
- Subjects agree to refrain from taking over the counter products intended to prevent,
intervene in, or treat colds/flu, starting at study entry and continuing through week
10 of the study.
Exclusion Criteria:
Capacity, consent and conflicts of interest:
- The person lacks capacity;
- The subject is related to any study personnel or has any other close ties or conflicts
of interest with the research team or the study sponsor;
- The subject has received any investigational drug or participated in a clinical trial
within 4 weeks of entry to this study.
- Unable to complete the daily symptom tracker
- Unable to communicate in English or Welsh
Comorbidities:
- Known hypersensitivity or allergy to any component of the test product;
- Severe cardiovascular, endocrinological, neurological, respiratory, gastrointestinal
disease, immune deficiency, autoimmune disease or a history or any current disease
that is considered by the investigator as a reason for exclusion;
- Severe nasal septal deviation, nasal polyps or other non-infectious condition that
could cause nasal obstruction;
- A history of any nasal or sinus surgery in the past that in the opinion of the
investigator may influence the symptoms or spray administration;
- An unrelated infection that in the opinion of the investigator may influence symptoms
(gastrointestinal infection, other viral diseases such as measles, mumps);
COVID-19 Status:
- Participants with proven COVID-19 infection (previous positive serology and/or viral
PCR swab)
- Participants that have already received their vaccination or already booked in for
their vaccination
Medications:
- Recent treatment of common cold that in the opinion of the investigator may influence
symptoms (see Table 2)
- Participants taking any of the medications outlined in Table 2 during the trial period
will be excluded
Joint Clinical Research Facility
Swansea, United Kingdom
Zita M Jessop, MBBChir PhD, Principal Investigator
Swansea University