Saline nasal irrigation and gargling in COVID-19: Part II. Outcomes in Omicron and risk–benefit for self-care

DOI record: { "DOI": "10.3389/fpubh.2025.1462286", "ISSN": [ "2296-2565" ], "URL": "http://dx.doi.org/10.3389/fpubh.2025.1462286", "abstract": "<jats:sec><jats:title>Background</jats:title><jats:p>The World Health Organization recommends at-home management of mild COVID-19. While our preliminary evaluation provided evidence for saline nasal irrigation (SNI) and gargling in COVID-19, an update and risk–benefit assessment for self-care in Omicron infection is warranted, from treatment and preparedness perspectives, as new SARS-CoV-2 variants continuously emerge, while symptoms overlap with those of common colds and other upper respiratory tract infections.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Systematic literature searches for preclinical and clinical studies involving Omicron infection and saline, bias assessment, and review of outcomes (benefits, risks).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 14 studies met eligibility criteria: one experimental proof-of-concept study, eight randomized clinical trials (RCTs), two quasi-experimental, two matched case–control, and one controlled study (2,389 patients, 1,101 receiving saline). Study designs were highly heterogeneous, not allowing pooling of the data. In line with the pre-clinical findings, the clinical trials showed lower viral loads or faster viral clearance with SNI use; results were consistent, if SNI was started early in the infection. Individual studies supported reduced infectivity of saliva, inflammatory mediators and C-reactive protein, and increased lymphocytes. Symptoms resolved faster if severe at baseline, in line with the findings from pre-Omicron RCTs; the ability to perform daily activities was assessed in one RCT and improved significantly. Early initiation of daily SNI/gargling before the onset of smell/taste dysfunction prevented their development. Daily SNI hygiene was also associated with less frequent development of fever and a shorter duration of fever than observed among (non-irrigating) controls. Daily SNI modestly helped to reduce household transmission; a preliminary report suggests that reliable prophylaxis can be achieved, provided daily SNI is combined with strict use of personal protective measures. Hospitalization was virtually absent. Isotonic SNI was best tolerated.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This analysis is consistent with prior review findings: early initiation of SNI/gargling may help patients with mild COVID-19 feel better, irrespective of the variant. If clean water and irrigation materials are provided, SNI can reasonably be recommended as early self-care for COVID-19, as it is for the common cold. Larger prospective studies are required to determine optimal protocols and SNI’s potential role in respiratory pathogen pandemic preparedness.</jats:p></jats:sec>", "alternative-id": [ "10.3389/fpubh.2025.1462286" ], "article-number": "1462286", "author": [ { "affiliation": [], "family": "Huijghebaert", "given": "S.", "sequence": "first" }, { "affiliation": [], "family": "Fabbris", "given": "C.", "sequence": "additional" }, { "affiliation": [], "family": "Baxter", "given": "A. L.", "sequence": "additional" }, { "affiliation": [], "family": "Parviz", "given": "S.", "sequence": "additional" }, { "affiliation": [], "family": "Chatterjee", "given": "U. S.", "sequence": "additional" }, { "affiliation": [], "family": "Rabago", "given": "D.", "sequence": "additional" } ], "container-title": "Frontiers in Public Health", "container-title-short": "Front. Public Health", "content-domain": { "crossmark-restriction": true, "domain": [ "frontiersin.org" ] }, "created": { "date-parts": [ [ 2025, 8, 20 ] ], "date-time": "2025-08-20T12:45:13Z", "timestamp": 1755693913000 }, "deposited": { "date-parts": [ [ 2025, 8, 20 ] ], "date-time": "2025-08-20T12:45:17Z", "timestamp": 1755693917000 }, "indexed": { "date-parts": [ [ 2025, 8, 21 ] ], "date-time": "2025-08-21T00:07:01Z", "timestamp": 1755734821902, "version": "3.44.0" }, "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2025, 8, 20 ] ] }, "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 8, 20 ] ], "date-time": "2025-08-20T00:00:00Z", "timestamp": 1755648000000 } } ], "link": [ { "URL": "https://www.frontiersin.org/articles/10.3389/fpubh.2025.1462286/full", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1965", 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