Covid-19

A Covid Nose-Irrigation Primer

nasal-spray-recall
Over the counter nasal irrigation is being use to manage cold symptoms Thorsten Frenzel - Pixabay

A common-sense question: If the coronavirus travels via respiratory droplets; if it can hang around in the breathable air, and under the right conditions (bad ventilation, for example) travel more than 6 feet;  then is it reasonable to assume washing out the nostrils with the right product would temper the virus’ activity? Could someone flush the Covid-19 virus out before it makes them sick? 

Using the right stuff, say povidone-iodine, at the right concentration ( 1.25% or even less ) can inactivate the virus. Ethanol takes longer to do the same job; the WHO reminds us that ethanol is toxic. The WHO also says that rinsing the nose with saline won’t save people from contracting the virus either. Ah, these devilish details.

Justin Turner, MD, thought about this common-sense question a while ago. Dr. Turner is an associate professor of Otolaryngology (head, nose, and throat) at Vanderbilt University School of Medicine. He just published a research paper about the use of saline washes in those with Covid-19.

Dr. Turner's study is ongoing, but results in the first 45 people are already published. People in the study rinsed their noses twice daily using either saline or a mixture of saline and soap. Dr. Turner found that people doing nose washes felt better significantly earlier than those who didn’t. They reported shorter durations for common symptoms like cough and congestion as well as less obvious ones like headache and fatigue. Overall, the study found that people who used nasal irrigation felt better 7 to 9 days earlier than those who did not. 

This study wasn’t just about whether saline could help with Covid-19. It also examined the use of soap and saline. So far, there appears to be no advantage in symptom reduction when using soap and saline compared to only saline. Dr. Turner explained that in his more recent research on the saline washes, “ it seems like it likely helps with symptoms and reduces symptom burden, but it may not actually do a whole lot in terms of viral load.” 

So, although the viral load may be unchanged, for people who are under the weather Dr. Turner says that nasal irrigation, the technical term for rinsing the nose, can be beneficial in some cases.* 

Q.  Dr. Turner, should we all be washing out our noses? 

A. I don't know that everyone needs to be doing nasal saline irrigations. However, I think there is something to be said if you know you are starting to develop some symptoms of allergies, or if you feel like you're getting a cold, starting irrigations early in that scenario, may be beneficial to prevent the development of a more acute infection or a bacterial sinusitis.   

Q. What does a saline wash of the nose do?

A. We've been using saline irrigations for nasal and sinus disease for decades. For upper respiratory infections [and] for people that suffer from chronic sinusitis, saline irrigations have been one of the primary recommendations and standard therapy for years and years. In the case of upper respiratory infections, including viral upper respiratory infections, they help with symptom resolution when people have an acute infection.

Q. Can you overdo it? 

A. I think in theory...it's possible to overdo it. If you're just doing saline irrigations, this is a very benign substance that you're adding to your nose...and it really shouldn't cause any obvious harm. I would imagine that if you were doing it dozens of times a day that it might ultimately cause some irritation, just from the repeated sort of mild trauma of splashing fluid inside the nasal cavity. In general, we recommend people do it twice a day...and I think that's a reasonable intervention for most people.

Q. Can you put just anything up there? Do you need to protect the inside of your nose? 

A. There's definitely a very delicate balance with anything that you use intranasally. So the inside of the nose is composed of nasal epithelial cells...these are cells that have little hairs, little cilia, on them, and those cilia serve a very important role….For example, using a surfactant or soap is going to be fine to a point. But if you get to where there's a very high concentration of that surfactant, you may actually cause epithelial damage.

Q. Are there any risks for people with Covid-19 using nasal irrigation to help with symptoms?  

A. You have to be really cautious when you have people doing irrigation that have Covid, because irrigations tend to be somewhat messy, and so if you have other household contacts, you definitely have to be careful about spreading the virus to others through the irrigations themselves. 

Q. Will this cure a case of Covid-19? 

A. As we look at the effect of irrigations on viral load...it looks like there may not be that significant of an effect on the shedding of virus or viral load itself. So it seems like it likely helps with symptoms and reduces symptom burden, but it may not actually do a whole lot in terms of viral load. 

The Take Home

For people with upper respiratory symptoms like congestion or a runny nose, a nasal wash with a homemade or over the counter saline solution may help people feel better. Dr. Turner warned not to just add salt to water. Nasal washes need to be buffered, normally with the addition of baking soda, so they are not irritating. For people who want to go the DIY route, a recipe might be a good idea (Johns Hopkins has one ).  But, in terms of warding off Covid-19, or getting rid of a viral infection, nose washes may not be a cure-all. 

Of course, even though these products are over the counter, users should still seek the advice of a healthcare professional and stop if they cause pain or irritation. As Dr. Turner explained, the inside of the nose is its own complicated little universe. 

*This interview has been edited for length and clarity.

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