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NaCl for COVID-19
9 studies with >1,000 patients
Serious outcome risk
NaCl
Control
Significantly lower risk for progression and viral clearance.
6 studies from 6 independent teams in 4 countries show significant benefit.
COVID-19 NaCl studies · October 2026
Covid Analysis NaCl reduces COVID-19 risk: real-time meta-analysis of 9 studies (Version 6)
Significantly lower risk is seen for progression and viral clearance. 6 studies from 6 independent teams in 4 countries show significant benefit. Meta-analysis using the most serious outcome reported shows 23% [9‑36%] lower ris..
Aug 20
2025
 Huijghebaert et al., Frontiers in Public Health, doi:10.3389/fpubh.2025.1462286 Saline nasal irrigation and gargling in COVID-19: Part II. Outcomes in Omicron and risk–benefit for self-care
Systematic review of saline nasal irrigation (SNI) and gargling for COVID-19. Authors reviewed 14 studies with 2,389 patients with Omicron infection and found that early initiation of SNI and gargling consistently reduced viral loads and ..
Aug 1
2025
 Pecoraro et al., Medicina, doi:10.3390/medicina61081402 Nasal Irrigations: A 360-Degree View in Clinical Practice
Review of nasal irrigation as a safe, effective, and low-cost treatment for various upper respiratory conditions. High-volume, low-pressure saline irrigations are effective for removing infectious agents, allergens, and inflammatory media..
Dec 30
2024
 Espinoza et al., Journal of Global Health, doi:10.7189/jogh.14.05044 Double-blind randomised trial of saline solution for gargling and nasal rinsing in SARS-CoV-2 infection
RCT 58 outpatients showing similar frequencies and durations of COVID-19 symptoms between low-saline and high-saline gargling and nasal rinsing regimens. Both groups followed the same gargling and rinsing protocol for frequency and durati..
Dec 13
2024
 Yusuf et al., Journal of Global Health, doi:10.7189/jogh.14.05027 Hypertonic saline nasal irrigation and gargling for suspected or confirmed COVID-19: Pragmatic randomised controlled trial (ELVIS COVID-19)
19% improved recovery (p=0.66). RCT 576 adults in Pakistan with suspected or confirmed COVID-19 showing no significant difference in time to symptom resolution with hypertonic saline nasal irrigation and gargling vs. nasal washing and gargling with tap water. Authors re..
Dec 9
2024
 Graves et al., JDR Clinical & Translational Research, doi:10.1177/23800844241296840 A Cetylpyridinium Chloride Oral Rinse Reduces Salivary Viral Load in Randomized Controlled Trials
33% improved viral clearance (p=0.91). Two RCTs with a total of 247 recently diagnosed COVID-19 patients showing a significant reduction in salivary SARS-CoV-2 viral load 30 minutes after rinsing with a cetylpyridinium chloride (CPC) mouthwash compared to rinsing with saline o..
Sep 13
2024
 Gandhi et al., The Laryngoscope, doi:10.1002/lary.31761 Washing Illness Away: A Systematic Review of the Impact of Nasal Irrigation and Spray on COVID‐19
Review of the efficacy of nasal irrigation with saline, povidone-iodine (PVP-I), and intranasal corticosteroids (INCS) at reducing SARS-CoV-2 nasopharyngeal viral load (NVL) and transmissibility. Saline nasal irrigation (SNI) showed the g..
Feb 29
2024
 Yan et al., Translational Cancer Research, doi:10.21037/tcr-23-2384 Significance of saline nasalirrigation for COVID-19 infection: observations and reflections from nursing care of nasopharyngeal carcinoma
35% lower progression (p=0.002) and 6% fewer cases (p=0.25). Retrospective 518 participants (468 cancer patients and 51 healthcare workers) showing reduced fever rate and shorter fever duration with saline nasal irrigation in COVID-19 patients. Among COVID-19 infected patients, those receiving nasa..
Feb 20
2024
 de Gabory et al., European Archives of Oto-Rhino-Laryngology, doi:10.1007/s00405-024-08518-y Seawater nasal wash to reduce symptom duration and viral load in COVID-19 and upper respiratory tract infections: a randomized controlled multicenter trial
75% lower progression (p<0.0001), 24% faster recovery (p=0.02), and 37% improved viral clearance (p=0.54). RCT 355 adults with COVID-19 or other upper respiratory tract infections (URTIs). For COVID-19 patients there was lower progression and faster symptom resolution with alkaline seawater nasal wash (pH ~8) 4 times daily for 21 days. There w..
Nov 21
2023
 Jing et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcad262 Effective early strategy to prevent olfactory and gustatory dysfunction in COVID-19: a randomized controlled trial
71% lower progression (p<0.0001) and 97% lower severe cases (p<0.0001). RCT 379 mild COVID-19 cases showing significantly lower prevalence and severity of olfactory and gustatory dysfunction with budesonide nasal spray, chlorhexidine mouthwash, and saline nasal irrigation. The control group received no interv..
Oct 3
2023
 Beigmohammadi et al., Science Progress, doi:10.1177/00368504231203130 Effects of nebulized hypertonic saline on inflammatory mediators in patients with severe COVID-19 pneumonia: A double-blinded randomized controlled trial
RCT 60 severe COVID-19 pneumonia patients showing significant reduction in inflammatory markers (TNF-α, IL-6) and improved oxygenation with nebulized 5% hypertonic saline compared to distilled water. 50% vs. 36% were on noninvasive venti..
Sep 20
2023
 Tanni et al., Journal of Clinical Medicine, doi:10.3390/jcm12186075 Efficacy of BREATHOX® Device Inhalation on Acute Symptoms Associated with COVID-19 (BREATH Study): A Randomized Pilot Clinical Trial
75% lower hospitalization (p=0.34) and 10% worse recovery (p=0.7). RCT 98 outpatients in Brazil, showing faster recovery from cough with inhaled hypertonic saline. Authors note that the effect on coughing may hypothetically be related to a hyperosmotic response influencing the function of different membr..
Sep 10
2023
 Lin et al., World Journal of Pediatrics, doi:10.1007/s12519-023-00749-z Efficacy of physiological seawater nasal irrigation for the treatment of children with SARS-CoV-2 Omicron BA.2 variant infection: a randomized controlled trial
25% improved viral clearance (p=0.11). RCT 403 children in China with mild/asymptomatic COVID-19, showing significantly faster viral clearance with physiological seawater nasal irrigation.
Jun 17
2023
 Liu et al., Ear, Nose & Throat Journal, doi:10.1177/01455613231172337 Effect of Nasal Irrigation in Children With Omicron Variant of COVID-19 Infection
6% faster recovery (p=0.46) and 24% faster viral clearance (p<0.0001). Quasi-experimental study of 60 pediatric patients with Omicron COVID-19 infection showing significant reduction in nucleic acid conversion time with nasal saline irrigation compared to routine treatment. Children aged 3-13 years were divi..
Jun 16
2023
 Huijghebaert et al., Frontiers in Public Health, doi:10.3389/fpubh.2023.1161881 Saline nasal irrigation and gargling in COVID-19: a multidisciplinary review of effects on viral load, mucosal dynamics, and patient outcomes
Review examining the effects of saline nasal irrigation and gargling for COVID-19, finding evidence that regular use improves viral clearance and symptoms. Analysis of 33 clinical studies showed that saline irrigation reduces nasopharynge..
Mar 21
2023
 Bonn et al., Journal of Dental Research, doi:10.1177/00220345231156415 Efficacy of a Mouthwash Containing CHX and CPC in SARS-CoV-2–Positive Patients: A Randomized Controlled Clinical Trial
72% improved viral clearance (p=0.1). Prospective study of 61 COVID+ patients showing a significant reduction in viral load and infectivity with a mouthwash containing 0.05% cetylpyridinium chloride (CPC) and 0.05% chlorhexidine digluconate (CHX). Mouthwash containing 0.9% Na..
Jan 9
2023
 Liu et al., Frontiers in Public Health, doi:10.3389/fpubh.2022.1046112 Effect of nasal irrigation in adults infected with Omicron variant of COVID-19: A quasi-experimental study
3% faster recovery (p=0.69) and 40% faster viral clearance (p<0.0001). Quasi-experimental study of 80 COVID-19 patients showing shorter nucleic acid negative conversion time but no significant difference in symptom duration with hypertonic saline nasal irrigation in adults infected with Omicron variant. Data..
Sep 27
2022
 Pantazopoulos et al., Canadian Respiratory Journal, doi:10.1155/2022/8794127 Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial
85% lower ICU admission (p=0.24), 64% lower need for oxygen therapy (p=0.25), and 51% improved viral clearance (p=0.009). RCT 50 hospitalized COVID-19 pneumonia patients showing decreased SARS-CoV-2 viral load with nasopharyngeal washes using normal saline 0.9%. In the normal saline group, viral load decreased by 8.9% after 24 hours of treatment, while the c..
Jul 11
2022
 Chalageri et al., Indian Journal of Community Medicine, doi:10.4103/ijcm.ijcm_804_21 Impact of steam inhalation, saline gargling, and povidone-iodine gargling on clinical outcome of COVID-19 patients in Bengaluru, Karnataka: A randomized control trial
43% improved recovery (p=0.0004). RCT with 20 saline and 20 control low risk patients in India, showing faster recovery with saline gargling, but no significant difference in viral clearance.
Jun 30
2022
 Saud et al., Journal of Lipid Research, doi:10.1016/j.jlr.2022.100208 The SARS-CoV2 envelope differs from host cells, exposes procoagulant lipids, and is disrupted in vivo by oral rinses
In vitro study and small RCT of mouthwashes. The in vitro study characterized the lipid composition of the SARS-CoV-2 envelope and showed that oral rinses containing lipid-disrupting chemicals can reduce infectivity, meeting European viru..
May 28
2022
 Delić et al., Microorganisms, doi:10.3390/microorganisms10061118 Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
26% lower mortality (p=0.09). RCT mechanically ventilated patients in Croatia, showing no significant difference in mortality with saline inhalation. ICU mortality results are from [repozitorij.mefst.unist.hr].
Oct 20
2020
 Kimura et al., International Forum of Allergy & Rhinology, doi:10.1002/alr.22703 Interim analysis of an open‐label randomized controlled trial evaluating nasal irrigations in non‐hospitalized patients with coronavirus disease 2019
29% faster recovery (p=0.16). Interim analysis of an open-label RCT of 45 non-hospitalized COVID-19 patients showing nasal irrigation with hypertonic saline significantly reduced days to symptom resolution for nasal congestion and headache. The study compared three ar..
Jan 1
2008
 Šlapak et al., Archives of Otolaryngology–Head & Neck Surgery, doi:10.1001/archoto.2007.19 Efficacy of Isotonic Nasal Wash (Seawater) in the Treatment and Prevention of Rhinitis in Children
RCT 401 children aged 6-10, showing significant benefits with isotonic seawater nasal wash for treating and preventing upper respiratory tract infections.