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Alkalinization for COVID-19
14 studies with >6,000 patients
Serious outcome risk
Alkalinization
Control
Significantly lower risk for mortality, progression, recovery, and viral clearance.
11 studies from 10 independent teams in 8 countries show significant benefit.
COVID-19 Alkalinization studies · October 2026
SARS-CoV-2 requires acidic pH for endosomal entry1. Alkalinization of the respiratory mucosa may reduce risk. Studies to date typically use sodium bicarbonate. We also present an analysis focusing on sodium bicarbonate2.
Covid Analysis Alkalinization reduces COVID-19 risk: real-time meta-analysis of 14 studies (Version 15)
Significantly lower risk is seen for mortality, progression, recovery, and viral clearance. 11 studies from 10 independent teams in 8 countries show significant benefit. Meta-analysis using the most serious outcome reported shows..
Mar 7
2025
 Lumlertgul et al., Intensive Care Medicine Experimental, doi:10.1186/s40635-025-00739-7 The effects of urine alkalinization on kidney function in critically ill patients with COVID-19: a proof-of-concept randomized clinical trial
67% lower mortality (p=0.57) and 40% improvement (p=0.62). Early terminated RCT 16 critically ill COVID-19 patients showing no significant difference in AKI development or mortality with alkalinization using intravenous sodium bicarbonate. The intervention group achieved higher urine pH (75% vs 3..
Jun 3
2024
 Shafiee et al., Journal of Evidence-Based Integrative Medicine, doi:10.1177/2515690x241258403 Alkalinization Using Sodium Bicarbonate for COVID-19 Treatment: A Systematic Review and Meta-Analysis
27% lower mortality (p=0.02), 39% lower hospitalization (p=0.3), and 53% improved recovery (p=0.0005). Meta analysis of 7 studies showing significantly lower mortality, shorter hospitalization, and higher recovery with alkalinization using sodium bicarbonate for COVID-19.
Apr 3
2024
 Polyakova et al., Dentistry Journal, doi:10.3390/dj12040093 The Effect of Oral Care Foams and a Spray on Salivary pH Changes after Exposure to Acidic Beverages in Young Adults
Randomized study showing that rinsing with Coca-Cola significantly lowered salivary pH, with an average of 27 minutes to return to baseline, and rinsing with tested oral care products or water after exposure increased the minimum salivary..
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..
Jan 9
2024
 Karami et al., Iranian Journal of Nursing and Midwifery Research, doi:10.4103/ijnmr.ijnmr_38_23 A Comparison of the Effects of Chlorhexidine and Sodium Bicarbonate Mouthwashes on COVID-19–Related Symptoms
45% lower progression (p=0.14) and 39% fewer cases (p=0.16). RCT 116 healthcare workers comparing 0.2% chlorhexidine mouthwash (n=36), 7.5% sodium bicarbonate mouthwash (n=40), and placebo (n=40) twice daily for 2 weeks, with symptoms followed for 4 weeks. There were lower symtoms and cases in both..
Dec 15
2023
 Donzelli, A., MDPI AG, doi:10.20944/preprints202312.1178.v1 Neglected Effective Early Therapies against COVID-19: Focus on Functional Foods and Related Active Substances. A Review
Review of a group of compounds with efficacy shown in RCTs, safety, favorable opportunity costs, biological plausibility, and accessibility without major conflicts of interest. The compounds include curcumin, nigella sativa (black seed), ..
Aug 10
2023
 Haddrell et al., Nature Communications, doi:10.1038/s41467-024-47777-5 (date from preprint) Ambient carbon dioxide concentration correlates with SARS-CoV-2 aerostability and infection risk
In vitro study showing that elevated ambient CO2 levels, such as those found in poorly ventilated indoor spaces, can significantly increase the airborne stability and infectivity of SARS-CoV-2 by preventing respiratory droplets from reach..
Jul 3
2023
 Pantazopoulos et al., Journal of Personalized Medicine, doi:10.3390/jpm13071093 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
42% improved viral clearance (p=0.04). 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..
Mar 15
2023
 Wang et al., Frontiers in Public Health, doi:10.3389/fpubh.2023.1145669 Efficacy of nasal irrigation and oral rinse with sodium bicarbonate solution on virus clearance for COVID-19 patients
39% shorter hospitalization (p=0.0009). RCT 55 mild/moderate patients in China, showing shorter hospitalization with sodium bicarbonate nasal irrigation and oral rinsing. Oral rinse with 5% sodium bicarbonate solution three times daily. Nasal irrigation two times with the solut..
Dec 31
2022
 Kalayan et al., European Journal of Respiratory Medicine, doi:10.31488/EJRM.132 Safety and Efficacy of Nebulised Anti-Inflammatory Solution of Alkaline Hypertonic Ibuprofen (AHI) for Treatment of SARS-Cov-2 Infection: A Compassionate Study with a Comparator Arms
79% lower mortality (p=0.0009). Retrospective 99 COVID-19 patients in Argentina showing significantly lower mortality with inhaled alkaline hypertonic ibuprofen (AHI) treatment. The treatment has a pH of 8.5. 3 times daily for 7-10 days.
Nov 18
2022
 El-Badrawy et al., Current Therapeutic Research, doi:10.1016/j.curtheres.2025.100801 (date from preprint) Efficacy and safety of nebulized Sodium Bicarbonate in adults with COVID-19 (SODIC): a randomized, single center, double-blinded, controlled trial
23% lower mortality (p=0.26) and 28% faster recovery (p<0.0001). RCT 546 patients showing significantly faster recovery and lower mortality with sodium bicarbonate (inhaled and nasal drops). The reduction in mortality is only statistically significant when excluding baseline critical cases. Authors hyp..
Sep 30
2022
 Kreutzberger et al., Proceedings of the National Academy of Sciences, doi:10.1073/pnas.2209514119 SARS-CoV-2 requires acidic pH to infect cells
Real-time 3D single-virion tracking study showing that SARS-CoV-2 infection requires an acidic pH. Authors find the mean pH of the airway-facing surface of the nasal cavity to be 6.6, compatible with fusion. These results suggest a benefi..
Aug 25
2022
 Baxter et al., Ear, Nose & Throat Journal, doi:10.1177/01455613221123737 Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients
Small RCT 79 PCR+ patients 55+ comparing pressure-based nasal irrigation with povidone-iodine and sodium bicarbonate, showing significantly lower hospitalization when compared with CDC data.
Jun 12
2022
 El-Badrawy et al., Indian Journal of Respiratory Care, doi:10.4103/ijrc.ijrc_48_21 Role of Sodium Bicarbonate as Adjuvant Treatment of Nonsevere Computed Tomography-identified COVID-19 Pneumonia: A Preliminary Report
57% lower mortality (p=0.37), 39% lower progression (p=0.52), and 19% improved recovery (p=0.03). Prospective study of 182 COVID-19 pneumonia patients, 127 treated with sodium bicarbonate inhalation and nasal drops, showing significantly faster recovery and improved CT scores with treatment. Authors note that contacts of index cases a..
May 31
2022
 Calonico et al., National Bureau of Economic Research, doi:10.3386/w30084 Causal Inference During a Pandemic: Evidence on the Effectiveness of Nebulized Ibuprofen as an Unproven Treatment for COVID-19 in Argentina
49% lower mortality (p=0.01). Retrospective 5,146 hospitalized COVID-19 patients in Argentina, showing lower mortality associated with nebulized ibuprofen (NaIHS) treatment. Doubly robust inverse probability weighting estimators were used to control for confounding. A..
May 31
2022
 Liu et al., VIEW, doi:10.1002/VIW.20220004 Nanoantidote for repression of acidosis pH promoting COVID‐19 infection
In vitro study showing that acidosis-related low pH increases SARS-CoV-2 pseudovirus infection in HEK293T-ACE2 and human umbilical vein endothelial cells (HUVECs). Authors find that low pH of 6.8 (simulating acidosis in COVID-19 patients)..
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
23% lower mortality (p=0.13). RCT mechanically ventilated patients in Croatia, 42 treated with sodium bicarbonate inhalation, and 52 control patients, showing no significant difference in mortality with treatment. Treated patients showed a lower incidence of gram-posi..
Jan 28
2022
 Akash et al., Frontiers in Drug Delivery, doi:10.3389/fddev.2023.1164671 (date from preprint) On a model-based approach to improve intranasal spray targeting for respiratory viral infections
Computational fluid dynamics study of nasal spray administration in 2 subjects showing 100x improvement in nasopharyngeal drug delivery using a new spray placement protocol. The study also found the optimal droplet size range for nasophar..
Dec 29
2021
 Soares et al., Brazilian Journal of Development, doi:10.34117/bjdv7n12-039 Preliminary observation of the use of sodium bicarbonate solution as an adjunct in the treatment of coronavirus 2019 disease (COVID-19): prognosis improvement in patients requiring intensive care
76% lower mortality (p=0.0001). Analysis of 76 ICU patients in Brazil, 44 treated with bronchoalveolar lavage using 3% sodium bicarbonate, showing significantly lower mortality with treatment. Bronchoalveolar lavage with 10ml of sodium bicarbonate solution directly into..
Nov 19
2021
 Yilmaz et al., Laryngoscope Investigative Otolaryngology, doi:10.1002/lio2.686 Effects of hypertonic alkaline nasal irrigation on COVID‐19
86% lower hospitalization (p=0.24) and 62% improved viral clearance (p=0.87). RCT 60 outpatients with mild COVID-19 showing improved viral clearance with hypertonic alkaline (pH 9.3) nasal irrigation. All patients received HCQ. The nasal irrigation group had no hospitalizations, while 3 patients in the control grou..
Aug 30
2021
 Salva et al., Infectious Diseases and Therapy, doi:10.1007/s40121-021-00527-2 Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program
45% lower mortality (p=0.009) and 14% shorter hospitalization (p<0.0001). Retrospective 383 hospitalized COVID-19 patients in Argentina showing signifcantly lower mortality and shorter hospital stay with nebulized sodium ibuprofenate compared to 195 contemporaneous controls. The treatment appears to be the same..
Aug 20
2021
 Jimenez et al., Frontiers in Medicine, doi:10.3389/fmed.2021.637885 Acid pH Increases SARS-CoV-2 Infection and the Risk of Death by COVID-19
In vitro study showing lower pH increased ACE2 expression and viral load on SARS-CoV-2 infection, and retrospective study showing proton pump inhibitor use, which is correlated with low gastric pH-related diseases, was associated with hig..
Jul 7
2021
 Mahto, M., Indian Journal of Critical Care Medicine, doi:10.5005/jp-journals-10071-23901 Gargling with 7.5% Sodium Bicarbonate Solution for SARS-CoV-2 Viremia Clearance: Our Institutional Clinical Experience
Report on 10 patients treated with sodium bicarbonate gargling, suggesting no significant improvements. There was no control group and gargling only, without inhalation or nasal spray/rinse.
Mar 19
2021
 Mody, K., Acta Scientific Orthopaedics, 4:4 Effect of 8.4% Soda-Bicarbonate Steam Inhalation on the Course of Disease in Mild to Moderate Cases of Covid-19
64% greater improvement (p=0.0007). RCT 60 hospitalized patients in India, showing significantly greater clinical improvement with inhaled sodium bicarbonate. Nasal and oral inhalation of nebulized 50ml 8.4% sodium bicarbonate for 5 minutes twice daily for 5 days.
Oct 27
2020
 Mir et al., Farmacia, doi:10.31925/farmacia.2020.5.1 Lysosomotropic properties of sodium bicarbonate and COVID-19
Review exploring the use of sodium bicarbonate as a lysosomotropic agent against SARS-CoV-2 based on its widespread use during the 1918 Spanish flu pandemic. Authors suggest that the careful use of sodium bicarbonate could help restrain S..
Oct 14
2020
 Rashedi et al., Advanced Pharmaceutical Bulletin, doi:10.34172/apb.2021.047 Sodium Bicarbonate Nebulized Therapy in Patients with Confirmed COVID-19
Proposal for nebulized sodium bicarbonate therapy for prevention of SARS-CoV-2 infection by raising endosomal pH and inhibiting viral entry into cells. Author proposes that inhalation of nebulized sodium bicarbonate solution (<5%) several..
May 19
2020
 Wardeh et al., Journal of Clinical Intensive Care and Medicine, doi:10.29328/journal.jcicm.1001029 Case reports of observed significant improvement in patients with ARDS due to COVID-19 and maximum ventilatory support after inhalation of sodium bicarbonate
Case series of four ventilated COVID-19 patients treated with sodium bicarbonate inhalation, all showing clinical and radiological improvement, with 2 patients extubated within 24-72 hours.
Oct 31
2004
 Darnell et al., Journal of Virological Methods, doi:10.1016/j.jviromet.2004.06.006 Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV
In vitro study showing effective inactivation of SARS-CoV-1 through multiple methods including UV light, heat, pH extremes, and chemical treatments in Vero E6 cells. Authors found that UVC light (254 nm) completely inactivated the virus a..
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