Nasal Irrigation (and Gargling) to Reduce the Severity of Viral Infections

For conditions like acute and chronic sinusitis, common cold, and allergic rhinitis, nasal irrigation can be advocated for rinsing the nasal cavity. The practice of nasal irrigation likely originated in India's Ayurvedic medical tradition called 'jala-neti' and one can purchase a "Neti-pot" at local drug stores or online. Can nasal irrigation reduce serious consequences of even Covid-19 infections? Now we know the answer is YES. 

STUDY

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To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity.

METHODS

Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. 

STUDY RESULTS

Seventy-nine high-risk participants were enrolled (mean age, 64). Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and NO hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths.

By comparison, of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. The total risk of hospitalization or death (11%) was 8.6 times that of enrolled nasal irrigation participants. 

Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation regardless of the additive.

STUDY CONCLUSIONS

SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.

The researchers say nasal washes are inexpensive and safe and can be administered at home using half a teaspoon each of salt and baking soda in a cup of boiled or distilled water

“In areas remote to healthcare, this simple intervention can reduce the likelihood of severe disease,” said the senior author.

Jala-neti has been a part of Indian yoga practices for thousands of years. So, it is nothing new to the Indian subcontinent," said a commentator. Many people add gargling with diluted mixtures of salt water, hydrogen peroxide, or povidone-iodine and many advocate using these practices 4 times a day during active infection and 1-2 times a day when in large crowds and increased risk of infectioin is perceived.