The germ theory of disease does not consider the functional state of the tissue where the inflammatory response takes place. This is vastly determined by the elements that comprise the extracellular matrix and their crosstalk. Local anesthetics can modify the communication between the cells of the ECM and due to their anti-inflammatory properties mitigate inflammation without suppressing the immunity. This is especially important in the Covid19 infection where the “cytokine storm” may lead to major complications like severe acute respiratory distress syndrome and even death. Animal models provide enough support for the use of local anesthetics in case of acute lung injury and ARDS. The intravenous administration of local anesthetics [e.g. lidocaine] seems to be a practical and efficient way to control inflammation and prevent complications through clinical trials in humans are still missing. Some other uses of LA are proposed as well.

Keywords: Covid19; Extracellular matrix; Local anesthetics; Cytokine storm; Acute respiratory distress syndrome; Lung injury; Intravenous lidocaine

“The microbe is nothing, the terrain is everything.” The last words of Louis Jean Pasteur (Father of the “Germ Theory” of Disease)
“It is what we know already that often prevents us from learning” Claude Bernard (Founder of the terrain-concept).