Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients
MD Amy L Baxter, MPH Kyle R Schwartz, MPH, MA Ryan W Johnson, PhD Ann-Marie Kuchinski, PhD Kevin M Swartout, Arni S R Srinivasa Rao, PhD, FAOTA Robert W Gibson, MD Erica Cherian, BA Taylor Giller, BA Houlton Boomer, MD Matthew Lyon, MD Richard Schwartz
Ear, Nose & Throat Journal, doi:10.1177/01455613221123737
Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in highrisk 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. Secondary outcomes compared symptom resolution by irrigant additive. Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. 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. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). 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 (X 2 = 8.728, P = .0031) regardless of additive. Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.
Ethical approval The study was approved by the institutional review board at Augusta University in Augusta, Georgia and was registered at Clinical-Trials.gov NCT04559035.
Informed consent Verbal informed consent was obtained from the patient(s) for their anonymized information to be published in this article.
ORCID iDs Amy L Baxter https://orcid.org/0000-0001-7123-0733 Taylor Giller https://orcid.org/0000-0002-0350-8243 Richard Schwartz https://orcid.org/0000-0003-0947-3034
Supplemental Material Supplemental material for this article is available online.
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