Nasopharyngeal lavages with saline solutions in the prevention and treatment of upper respiratory tract infections. Could these methods also help in preventing and treating COVID-19??
Sheetu Singh, Neeraj Sharma, Udaiveer Singh, Tejraj Singh, Daya Krishan Mangal, Virendra Singh
The SARS-CoV-2 virus enters the human body either through the mouth, nose or eyes. Similar to hand washing, washing the nose and mouth can reduce viral load, transmission, intensity of symptoms, but also the duration of the disease. Reducing the viral load by gargling and nasal washing with hypertonic saline solutions, can lead to limiting the transmission of the virus to close contacts and subsequently prevent nasopharyngeal viral infections.
Japan was the second country affected by the coronavirus pandemic, after China. However, to the present day, it has a rather low infection and death rate, compared to most countries. Social distancing, protective mask and hand washing are the most important measures to stop the spread of the virus. In Japan, in addition to these measures, the gargle with warm saline solution for cleaning the throat was also included in the epidemic management guide.
The authors analysed eight studies that tested the effectiveness of gargling and nasal washes in treating and preventing acute upper respiratory tract infections (URTI). One of the hypotheses of scientists is that the above techniques can also work in the prevention and care of subgroups of patients with COVID-19.
The eight controlled studies compared treatment with nasal saline / gargling / steam inhalation with at least one other treatment method or placebo. The subjects were either children, adults or healthy elderly people, or groups suffering from various acute upper respiratory tract infections (rhinitis, rhinosinusitis, sinusitis, pharyngitis, otitis media, tonsillitis, common cold and flu).
Limitations and adverse effects
No adverse effects were observed in subjects who performed nasal washes and gargling with hypertonic saline solutions. A limitation of these treatments was the discomfort felt by the subjects, however, 87% of people endured the procedures.
Another disadvantage would be the possible transmission of viral infection through the equipment used and the area where the procedure is performed. This limitation could be easily solved, by maintaining strict rules-each person uses his/her own equipment, and the sink in which the procedure is performed must be cleaned afterwards.
Studies that tested the effectiveness of gargling and nasal washes with hypertonic saline solutions have shown that these procedures prevent symptoms, reduce transmission, reduce the need for symptomatic medication and viral load in patients with common colds.
However, the usefulness of treatment should be studied specifically in the case of SARS-CoV-2, which has significant mutations compared to coronaviruses causing the common cold or flu. But since it’s proven to work for a multitude of viruses, logically, it should work for SARS-CoV-2 as well. Alternative therapy with saline solutions should be studied as an additional, affordable way to prevent infection and reduce the transmission of the SARS-CoV-2 virus.