DISCUSSION
respiratory tract infection, infection, disesases
RESPIRATORY TRACT INFECTION, INFECTION, RESPIRATORY TRACT INFECTIONS, INFLAMMATION
In this pilot clinical trial among 84 vaccinated people the buccopharyngeal mucosal administration of 2 mL of high polyphenolic olive oil twice daily (equivalent extent of 0.75 mg of olive oil polyphenols twice daily) compared with no treatment significantly shortened time to resolution of symptoms. These findings suggest that the use of oromucosal administered high polyphenolic olive oil has a high potential to be an effective immune strategy to shorten duration of symptoms in mild COVID‐19.Pilot studies are small‐scale studies that are necessary first steps in exploring novel interventions and novel applications of interventions, this pilot study revolve around the feasibility of a novel immune strategy against COVID‐19 consisting of the buccopharyngeal administration of tiny quantities of high polyphenolic olive oil. In science if one does not first understand the fundamentals of basic research, then there can not be any movement on advanced applications. Which is to say if one does not know to which port one is sailing no wind is favorable. The three main basic principles obtained from fundamental research that have guided this clinical pilot study have been the importance of understanding how respiratory mucosa immunity respond to infection, the immunomodulatory properties of olive polyphenols and the adequacy of the buccopharyngeal mucosal route.To the authors' knowledge, there are no previous clinical studies on clinical outcomes after buccopharyngeal administration of olive polyphenols in respiratory tract infections.Mucosal innate immune response key role in early warning the immune system in respiratory tract infection by SARS‐CoV‐2 is a point of fundamental importance.Many natural and synthetic compounds and medications have immunomodulatory activity, however, only few of them also possess a scientific basis. Olive polyphenols are bioactive substances with immunomodulatory properties via various mechanisms, such as the regulation of mucosal immunity and inflammation.While the concept of mucosal innate immunity as an early warning system is not new, we believe its full clinical potential is not been realized. Should mucosal immunomodulation with olive polyphenols be able to overcome viral suppression of mucosa innate host defenses, then it can be a useful strategy in this regard. But it is neither practical nor safe to go directly from basic research to testing on patients. Pilot studies aim to provide a safer transition. This pilot study tries to humbly bridge the gap between basic and clinical research on this issue. Biomedical science is so complex that it is only through collaboration of basic and clinical research that advances can be made. Although a precise definition of the intimate mechanisms that involve innate mucosal immunomodulation by olive polyhenols rest to be done, the clinical data rigorously obtained in this pilot study should not be neglected. To assert that olive polyphenols are able to counteract effectively SARS‐CoV‐2 main immune evasion mechanisms will need for sure of deeper pure research. Such work, while important, exceeds the clinical capacities of the authors and the scope of the study. Nonetheless, this pilot study would have achieved its modest goals if it is able to draw our attention to the appropriateness of further deep research both basic and clinical on the use of buccopharyngeal route administered high polyphenolic olive oil as an effective immune strategy against COVID‐19.This pilot clinical trial, like other studies conducted in the same time period, has the strength of having been done in the midst of the pandemic with unique epidemiological conditions. Another strength is the time follow‐up, the clinical surveys on participants for 3 months allowed the investigators to get a precise clinical picture of the studied sample. Moreover, the median of time to resolution of symptoms in the control group of our study, 7 days, coincides with the mean duration of symptoms in other published studies with much larger population samples.There were no significant differences in the proportion of patients who got severe symptoms by the WHO scale in this study. Even so the authors still suspect that the intervention must produce a better outcome given the direct relation between duration and severity of disesases. In any case, a bigger population should be studied to demonstrate this issue.