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0 0.5 1 1.5 2+ Mortality 67% Improvement Relative Risk ICU admission 67% Oxygen therapy 80% Viral clearance 42% Alkalinization  Pantazopoulos et al.  LATE TREATMENT  RCT Is late treatment with alkalinization beneficial for COVID-19? RCT 56 patients in Greece (June - December 2022) Improved viral clearance with alkalinization (p=0.042) Pantazopoulos et al., J. Personalized .., Jul 2023 Favors alkalinization Favors control

A Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients Reduces Viral Load and SARS-CoV-2 Detection Time in the Nasal Cavity

Pantazopoulos et al., Journal of Personalized Medicine, doi:10.3390/jpm13071093, NCT05729204
Jul 2023  
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RCT 56 severe COVID-19 patients, showing significantly decreased viral load with Sinomarin Plus Algae nasal irrigation. Sinomarin Plus Algae is a hypertonic seawater solution with algal and herbal natural ingredients with a pH of 7.5-8
The treatment group received nasal irrigation every 4 hours, 16 hours per day, for 2 days. Nasopharyngeal swabs were taken at baseline and 48 hours later to measure viral load. The treatment group showed a significant increase in cycle threshold values, indicating decreased viral load, while no difference was seen in the control group. The treatment was well tolerated with only mild adverse effects.
Alkalinization is one possible mechanism of action - SARS-CoV-2 requires acidic pH for infection Kreutzberger and the solution has pH 7.5-8. Other possible mechanisms include antiviral activity of ingredients (e.g., fucoidan from Undaria pinnatifida) and physical removal of viral particles.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects (early treatment may be more beneficial).
risk of death, 66.7% lower, RR 0.33, p = 1.00, treatment 0 of 28 (0.0%), control 1 of 28 (3.6%), NNT 28, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of ICU admission, 66.7% lower, RR 0.33, p = 1.00, treatment 0 of 28 (0.0%), control 1 of 28 (3.6%), NNT 28, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of oxygen therapy, 80.0% lower, RR 0.20, p = 0.49, treatment 0 of 28 (0.0%), control 2 of 28 (7.1%), NNT 14, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), high flow nasal cannula or non-invasive ventilation.
risk of no viral clearance, 42.1% lower, RR 0.58, p = 0.04, treatment 11 of 28 (39.3%), control 19 of 28 (67.9%), NNT 3.5.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Pantazopoulos et al., 3 Jul 2023, Single Blind Randomized Controlled Trial, Greece, peer-reviewed, mean age 63.6, 7 authors, study period June 2022 - December 2022, trial NCT05729204 (history).
Contact: (corresponding author),,,,,,
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A Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients Reduces Viral Load and SARS-CoV-2 Detection Time in the Nasal Cavity
Ioannis Pantazopoulos, Athanasios Chalkias, Angeliki Miziou, Michalis Spanos, Efrosyni Gerovasileiou, Erasmia Rouka, Konstantinos Gourgoulianis
Journal of Personalized Medicine, doi:10.3390/jpm13071093
Nasal irrigation is thought to decrease the viral load present in the nasal cavity. Our aim was to assess the effect of a hypertonic seawater solution [with algal and herbal natural ingredients (Sinomarin ® )] on the viral load of nasopharynx in patients hospitalized with severe COVID-19 pneumonia. We conducted a prospective, randomized, controlled trial from June 2022 to December 2022. We allocated 56 patients with COVID-19 pneumonia into two groups (28 in each group)-the hypertonic seawater group [nasal irrigations with a hypertonic seawater solution (Sinomarin ® ) every 4 h for 16 h per day, for two consecutive days] and the control group (no nasal irrigations). A second nasopharyngeal swab was collected 48 h after the baseline nasopharyngeal swab (8 h after the last wash in the hypertonic seawater group) to estimate the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values. In the hypertonic seawater group, the mean Ct values significantly increased two days after the initial measurement [∆Ct 48-0 h = 3.86 ± 3.03 cycles, p < 0.001 (95%CI: 2.69 to 5.04)]. No significant differences in the Ct values were observed in the control group [∆Ct 48-0 h = -0.14 ± 4.29, p = 0.866 (95%CI: -1.80 to -1.52)]. At follow-up, 17 patients from the hypertonic seawater group had negative test results compared to only 9 patients from the control group (p = 0.03). Nasal irrigations with a hypertonic seawater solution containing algal and herbal natural ingredients significantly decreased nasopharyngeal viral load and the detection time of SARS-CoV-2 in the nasal cavity.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Conflicts of Interest: The authors declare no conflict of interest.
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Late treatment
is less effective
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