Saline nasal irrigation and gargling in COVID-: a multidisciplinary review of e ects on viral load, mucosal dynamics, and patient outcomes
Senthil Kumaran Satyanarayanan, Alessandra Fioretti, Suzy Huijghebaert, Shehzad Parviz, David Rabago, Amy Baxter, Uday Chatterjee, Farhan R Khan, Cristoforo Fabbris, Konstantinos Poulas, Stephen Hsu
K and Hsu S ( ) Saline nasal irrigation and gargling in COVID-: a multidisciplinary review of e ects on viral load, mucosal dynamics, and patient outcomes.
Author contributions All authors of this Pro Bono Initiative, started by informal contacts per e-mail and Zoom, had pharmacological and/or clinical experience with saline irrigation in COVID-19 or related respiratory conditions. All the authors contributed by their knowledge, specific (pre)clinical research, or experiences (see reference list). Manuscript development occurred through the submission of work or description and discussion of mechanisms by e-mail and by Zoom meetings inviting all network members and coordinated by SH, SP, and DR. For completeness of the review, continuous searches for additional data were performed and new data were circulated by SH, while interpretations and problemsolving, development of lessons learned, and recommendations occurred through e-mail and discussion at the regular Zoom meetings. Integration of changes in the manuscript and revisions thereof were coordinated by SH, while regular feedback by e-mail to the Network and recirculation of the manuscript. All authors contributed to the development of consolidated knowledge, conception, and/or interpretation and helped in critical revision and resolving questions at each circulation until final consensus for submission. All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be..
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"abstract": "<jats:p>With unrelenting SARS-CoV-2 variants, additional COVID-19 mitigation strategies are needed. Oral and nasal saline irrigation (SI) is a traditional approach for respiratory infections/diseases. As a multidisciplinary network with expertise/experience with saline, we conducted a narrative review to examine mechanisms of action and clinical outcomes associated with nasal SI, gargling, spray, or nebulization in COVID-19. SI was found to reduce SARS-CoV-2 nasopharyngeal loads and hasten viral clearance. Other mechanisms may involve inhibition of viral replication, bioaerosol reduction, improved mucociliary clearance, modulation of ENaC, and neutrophil responses. Prophylaxis was documented adjunctive to personal protective equipment. COVID-19 patients experienced significant symptom relief, while overall data suggest lower hospitalization risk. We found no harm and hence recommend SI use, as safe, inexpensive, and easy-to-use hygiene measure, complementary to hand washing or mask-wearing. In view of mainly small studies, large well-controlled or surveillance studies can help to further validate the outcomes and to implement its use.</jats:p>",
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