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Currently, there are 14 ongoing clinical studies on low dose radiotherapy(LDRT) for COVID-19 pneumonia. An underlying assumption is that irradiation ofabout 1 Gy is effective at ameliorating viral pneumonia. Its rationale,however, relies on early human case series or animal studies mostly obtained inthe pre-antibiotic era, where rigorous statistical analyses were not performed.It therefore remains unclear whether those early data support such assumptions.With standard statistical survival models, and based on a systematic literaturereview, we re-analyzed 14 radiobiological animal datasets in which animalsreceived mostly fractionated doses of radiation before or after bacterial/viralinoculation, and assessing various health endpoints (mortality, pneumoniamorbidity). In most datasets absorbed doses did not exceed 7 Gy. Variousdifferent model systems and types of challenging infection are considered. For7 studies that evaluated post-inoculation radiation exposure (more relevant toLDRT for COVID-19 pneumonia) the results are heterogeneous, with 2 studiesshowing a significant increase (p<0.001) and another showing a significantdecrease (p<0.001) in mortality associated with radiation exposure. Forpre-inoculation exposure the results are also heterogeneous, with 6 datasetsshowing a significant increase (p<0.01) in mortality risk associated withradiation exposure and the other 2 showing a significant decrease (p<0.05) inmortality risk. Collectively, these data do not provide clear support forreductions in morbidity or mortality associated with post-infection radiationexposure. For pre-infection radiation exposure the inconsistency of directionof effect makes this body of data difficult to interpret. Nevertheless, onemust be cautious about adducing evidence from the published reports of theseold animal datasets.

Pneumonia after bacterial or viral infection preceded or followed by  radiation exposure -- a reanalysis of older radiobiological data and  implications for low dose radiotherapy for COVID-19 pneumonia