Effect of nasal irrigation in adults infected with Omicron variant of COVID-: A quasi-experimental study
Senthil Kumaran Satyanarayanan, Barani Kumar Rajendran, Amani Odeh, Liang Su, Li Liu, Shuangshuang Xie, Cheng Li, Chengbao Zhu
Objective: To investigate the effect of nasal irrigation on the duration of symptoms and nucleic acid conversion in adults infected with the Omicron variant of COVID-. Methods: This quasi-experimental study enrolled patients diagnosed with asymptomatic, mild, or moderate Omicron infection at the Shandong Public Health Clinical Center between April , and May , . Patients were divided into two groups to receive Lianhua Qingwen granules and traditional Chinese medicine (TCM) prescriptions (conventional group) and % hypertonic saline nasal irrigation based on conventional treatment (nasal irrigation groups), respectively. Primary outcomes were symptom disappearance time and nucleic acid negative conversion time. Secondary outcomes were peripheral blood white blood cell (WBC), lymphocyte (LYM) count, neutrophil (NEU) count, C-reactive protein (CRP) level, and chest CT examination findings. Results: Eighty patients were included ( patients/group). Multiple linear regression analysis showed that, after adjustment for comorbidities, smoking history, LYM count, and Ct values of N gene, the patients in the nasal irrigation group were more likely to get lower nucleic acid negative conversion time (β = -. , % CI: -. -. , P < . ) compared with the conventional group. The symptom disappearance time showed no significant improvement (P > . ). Subgroup analysis for treatment-naïve patients in the nasal irrigation group showed similar nucleic acid negative conversion time improvement (P = . ).
Conclusion: Early nasal irrigation shortens the nucleic acid negative conversion time in adults infected with the Omicron variant but without improvements in symptom disappearance time.
Ethics statement The studies involving human participants were reviewed and approved by Shandong Public Health Clinical Center. The patients/participants provided their written informed consent to participate in this study.
Author contributions LL carried out the studies, participated in collecting data, and drafted the manuscript. LS and CZ performed the statistical analysis and participated in its design. SX
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh. 2022.1046112/full#supplementary-material
References
Chen, Deng, Fang, Sun, Wu, Epidemiological characteristics and transmission dynamics of the outbreak caused by the SARS-CoV-2 Omicron variant in Shanghai, China: a descriptive study, Lancet Reg Health West Pac,
doi:10.1016/j.lanwpc.2022.100592
Choudhary, Prajapat, Kumaravel, Prabha, Sarma et al., Update on omicron variant: what we know so far, Indian J Pharmacol,
doi:10.4103/ijp.ijp_955_21
Collie, Champion, Moultrie, Bekker, Gray, Effectiveness of BNT162b2 vaccine against Omicron variant in South Africa, N Engl J Med,
doi:10.1056/NEJMc2119270
Ding, Zeng, Li, Chen, Zhou et al., The Chinese prescription lianhuaqingwen capsule exerts anti-influenza activity through the inhibition of viral propagation and impacts immune function, BMC Complement Altern Med,
doi:10.1186/s12906-017-1585-7
Farrell, Klatt-Cromwell, Schneider, Benefits and safety of nasal saline irrigations in a pandemic-washing COVID-19 away, JAMA Otolaryngol Head Neck Surg,
doi:10.1001/jamaoto.2020.1622
Gray, Goga, Garrett, Champion, Seocharan, Effectiveness of Ad26.COV2.S and BNT162b2 vaccines against Omicron variant in South Africa, N Engl J Med,
doi:10.1056/NEJMc2202061
Halfmann, Iida, Iwatsuki-Horimoto, Maemura, Kiso et al., SARS-CoV-2 Omicron virus causes attenuated disease in mice and hamsters, Nature,
doi:10.1038/s41586-022-04441-6
He, Hong, Pan, Lu, Wei, SARS-CoV-2 Omicron variant: characteristics and prevention, MedComm,
doi:10.1002/mco2.110
Hui, Zumla, Advances in the epidemiology, clinical features, diagnosis, clinical management and prevention of coronavirus disease 2019, Curr Opin Pulm Med,
doi:10.1097/MCP.0000000000000875
Kuznetsov, Arukuusk, Hark, Juronen, Ustav et al., ACE2 peptide fragment interaction with different S1 protein sites, Int J Pept Res Ther,
doi:10.1007/s10989-021-10324-7
Li, Fan, Lai, Han, Li et al., Coronavirus infections and immune responses, J Med Virol,
doi:10.1002/jmv.25685
Lin, Frediani, Damhorst, Sullivan, Westbrook et al., Where is Omicron? Comparison of SARS-CoV-2 RT-PCR and antigen test sensitivity at commonly sampled anatomic sites over the course of disease, medRxiv,
doi:10.1101/2022.02.08.22270685
Liu, Yu, Zhao, He, Reduction in the infection fatality rate of Omicron variant compared with previous variants in South Africa, Int J Infect Dis,
doi:10.1016/j.ijid.2022.04.029
Marco, Orso, Pirronello, Verdiani, Termine et al., Assessment of T-cell reactivity to the SARS-CoV-2 Omicron variant by immunized individuals, JAMA Netw Open,
doi:10.1001/jamanetworkopen.2022.10871
Menni, Valdes, Polidori, Antonelli, Penamakuri et al., Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID study, Lancet,
doi:10.1016/S0140-6736(22)00327-0
Platten, Hoffmann, Grosser, Wisplinghoff, Wisplinghoff et al., SARS-CoV-2, CT-Values, and infectivity-conclusions to be drawn from side observations, Viruses,
doi:10.3390/v13081459
Rabago, Zgierska, Peppard, Bamber, The prescribing patterns of Wisconsin family physicians surrounding saline nasal irrigation for upper respiratory conditions, WMJ
Ramalingam, Cai, Wong, Twomey, Chen et al., Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels, Sci Rep,
doi:10.1038/s41598-018-31936-y
Ramalingam, Graham, Dove, Morrice, Sheikh, A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold, Sci Rep,
doi:10.1038/s41598-018-37703-3
Ramalingam, Graham, Dove, Morrice, Sheikh, Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19, J Glob Health,
doi:10.7189/jogh.10.010332
Raman, Patel, Ranjan, COVID-19: unmasking emerging SARS-CoV-2 variants, vaccines and therapeutic strategies, Biomolecules,
doi:10.3390/biom11070993
Shen, Li, Tu, Wu, Peng et al., Positive effects of lianhuaqingwen granules in COVID-19 patients: a retrospective study of 248 cases, J Ethnopharmacol,
doi:10.1016/j.jep.2021.114220
Sun, Zhang, Yang, Chen, Yue et al., Efficacy and safety of lianhua qingwen for patients with COVID-19: a systematic review and metaanalysis, Chin J Integr Med,
doi:10.1007/s11655-022-3578-8
Ural, Oktemer, Kizil, Ileri, Uslu, Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study, J Laryngol Otol,
doi:10.1017/S0022215108003964
Van Doremalen, Bushmaker, Morris, Holbrook, Gamble et al., Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1, N Engl J Med,
doi:10.1056/NEJMc2004973
Vito, Geremia, Fiore, Princic, Babudieri et al., Clinical features, laboratory findings and predictors of death in hospitalized patients COVID-19 in Sardinia, Italy, Eur Rev Med Pharmacol Sci,
doi:10.26355/eurrev_202007_22291
Wang, Qi, Traditional Chinese medicine to treat COVID-19: the importance of evidence-based research, Drug Discov Ther,
doi:10.5582/ddt.2020.03054
Wang, Sheng, Tu, Zhang, Association between peripheral lymphocyte count and the mortality risk of COVID-19 inpatients, BMC Pulm Med,
doi:10.1186/s12890-021-01422-9
Who, Classification of Omicron (B.1.1.529
Wiersinga, Rhodes, Cheng, Peacock, Prescott, Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19): a review, JAMA,
doi:10.1001/jama.2020.12839
Xia, Zhao, Shah, Wang, Baloch, Composition, Clinical Efficiency, and Mechanism of NHC-Approved "Three Chinese Medicines and Frontiers in Public Health frontiersin.org Three Chinese Recipes" for COVID-19 Treatment, Front Pharmacol,
doi:10.3389/fphar.2021.781090
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"abstract": "<jats:sec><jats:title>Objective</jats:title><jats:p>To investigate the effect of nasal irrigation on the duration of symptoms and nucleic acid conversion in adults infected with the Omicron variant of COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This quasi-experimental study enrolled patients diagnosed with asymptomatic, mild, or moderate Omicron infection at the Shandong Public Health Clinical Center between April 1, 2022 and May 1, 2022. Patients were divided into two groups to receive Lianhua Qingwen granules and traditional Chinese medicine (TCM) prescriptions (conventional group) and 3% hypertonic saline nasal irrigation based on conventional treatment (nasal irrigation groups), respectively. Primary outcomes were symptom disappearance time and nucleic acid negative conversion time. Secondary outcomes were peripheral blood white blood cell (WBC), lymphocyte (LYM) count, neutrophil (NEU) count, C-reactive protein (CRP) level, and chest CT examination findings.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eighty patients were included (40 patients/group). Multiple linear regression analysis showed that, after adjustment for comorbidities, smoking history, LYM count, and Ct values of N gene, the patients in the nasal irrigation group were more likely to get lower nucleic acid negative conversion time (β = −11.052, 95% CI: −8.277–13.827, <jats:italic>P</jats:italic> &lt; 0.001) compared with the conventional group. The symptom disappearance time showed no significant improvement (<jats:italic>P</jats:italic> &gt; 0.05). Subgroup analysis for treatment-naïve patients in the nasal irrigation group showed similar nucleic acid negative conversion time improvement (<jats:italic>P</jats:italic> = 0.038).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Early nasal irrigation shortens the nucleic acid negative conversion time in adults infected with the Omicron variant but without improvements in symptom disappearance time.</jats:p></jats:sec>",
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