Supplementary Data — Nasopharyngeal/oropharyngeal treatment for COVID-19: real-time meta-analysis of 42 studies

@CovidAnalysis, October 2026, Version 29V29

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October 2026

Nasopharyngeal/oropharyngeal treatment COVID-19 outcomes

StudyImprovementRR · 95% CIOutcomeTreatmentControlRelative Risk

Mohamed (RCT)86%0.14 · 0.01–2.21viral+0/53/5 Mukhtar (RCT)86%0.14 · 0.01–2.69death0/463/46CT² Mukhtar (RCT)86%0.14 · 0.01–2.69ventilation0/463/46CT² Mukhtar (RCT)18%0.82 · 0.63–1.07viral+28/4335/44CT² Mukhtar (RCT)14%0.86 · 0.76–0.98viral+37/4344/44CT² Choudhury (RCT)88%0.12 · 0.03–0.50death2/30317/303 Choudhury (RCT)84%0.16 · 0.09–0.28hosp.12/30377/303 Choudhury (RCT)96%0.04 · 0.02–0.07viral+8/303213/303 Guenezan (RCT)63%0.37 · 0.06–1.63viral load12 (n)12 (n) Jayaraman50%0.50 · 0.23–1.08viral+3/66/6Short term viral Winchester (DB RCT)42%0.58 · 0.36–0.94no improv.8/1523/25 Winchester (DB RCT)51%0.49 · 0.32–0.75viral load40 (n)40 (n) Aref (RCT)63%0.37 · 0.22–0.61recov. time57 (n)57 (n) Aref (RCT)56%0.44 · 0.29–0.66recov. time57 (n)57 (n) Aref (RCT)69%0.31 · 0.17–0.56recov. time57 (n)57 (n) Aref (RCT)64%0.36 · 0.21–0.60recov. time57 (n)57 (n) Aref (RCT)79%0.21 · 0.07–0.71viral+3/5714/57 Aref (RCT)36%0.64 · 0.52–0.80viral time57 (n)57 (n) Campione47%0.53 · 0.38–0.72viral time32 (n)32 (n) Campione56%0.44 · 0.29–0.66viral time32 (n)28 (n) Pablo-Marcos29%0.71 · 0.32–1.56viral load31 (n)40 (n) Pablo-Marcos9%0.91 · 0.20–4.16viral load31 (n)40 (n) Yilmaz (SB RCT)86%0.14 · 0.01–2.65hosp.0/303/30 Yilmaz (SB RCT)62%0.38 · 0.00–15561viral load30 (n)30 (n) Yilmaz (SB RCT)43%0.57 · 0.00–2148239viral load30 (n)30 (n) Poleti (DB RCT)29%0.71 · 0.53–0.96no recov.29/5952/75 Poleti (DB RCT)22%0.78 · 0.63–0.97no recov.38/5962/75 Poleti (DB RCT)46%0.54 · 0.30–0.98no recov.12/5928/75 Poleti (DB RCT)32%0.68 · 0.42–1.09no recov.17/5932/75 Sulistyani (SB RCT)6%0.94 · 0.45–1.96viral load15 (n)15 (n) Sulistyani (SB RCT)11%0.89 · 0.42–1.88viral load15 (n)15 (n) Elsersy (DB RCT)91%0.09 · 0.01–1.62hosp.0/1005/100CT² Elsersy (DB RCT)15%0.85 · 0.76–0.96recov. time100 (n)100 (n)CT² Elsersy (DB RCT)49%0.51 · 0.42–0.62recov. time100 (n)100 (n)CT² Elsersy (DB RCT)48%0.52 · 0.43–0.63recov. time100 (n)100 (n)CT² Elsersy (DB RCT)68%0.32 · 0.22–0.49viral+21/10065/100CT² Elsersy (DB RCT)90%0.10 · 0.01–0.77viral+1/10010/100CT² Elsersy (DB RCT)29%0.71 · 0.62–0.81viral+70/10099/100CT² Elsersy (DB RCT)92%0.08 · 0.05–0.14transmission12/194173/227CT² Elsersy (DB RCT)94%0.06 · 0.03–0.12transmission8/194157/227CT² Panatto (RCT)37%0.63 · 0.12–3.38progression2/203/19 Panatto (RCT)85%0.15 · 0.01–2.65progression0/183/19 Panatto (RCT)67%0.33 · 0.06–1.83progression2/383/19 Panatto (RCT)29%0.71 · 0.54–0.93viral+34 (n)15 (n) Panatto (RCT)30%0.70 · 0.56–0.88viral+34 (n)15 (n) Tandon (DB RCT)68%0.32 · 0.09–1.12no improv.3/6410/69 Tandon (DB RCT)67%0.33 · 0.11–0.97no improv.4/6413/69 Tandon (DB RCT)42%0.58 · 0.33–1.01no improv.14/6426/69 Tandon (DB RCT)22%0.78 · 0.32–1.89no improv.8/10510/102 Tandon (DB RCT)18%0.82 · 0.39–1.75no improv.11/10513/102 Tandon (DB RCT)9%0.91 · 0.60–1.38no improv.30/10532/102 Tandon (DB RCT)20%0.80 · 0.75–0.86viral load64 (n)69 (n) Tandon (DB RCT)14%0.86 · 0.83–0.90viral load105 (n)102 (n) Tandon (DB RCT)26%0.74 · 0.52–1.05viral time64 (n)69 (n) Tandon (DB RCT)6%0.94 · 0.70–1.25viral time105 (n)102 (n) Valerio-.. (DB RCT)61%0.39 · 0.24–0.63no recov.61 (n)40 (n)ACCROS-I Valerio-.. (DB RCT)67%0.33 · 0.09–1.24no recov.3/616/40ACCROS-I Valerio-.. (DB RCT)89%0.11 · 0.01–0.87no recov.1/616/40ACCROS-I Valerio-.. (DB RCT)53%0.47 · 0.23–0.95no recov.10/6114/40ACCROS-I Valerio-.. (DB RCT)67%0.33 · 0.06–1.71no recov.2/614/40ACCROS-I Valerio-.. (DB RCT)59%0.41 · 0.14–1.16no recov.5/618/40ACCROS-I Valerio-.. (DB RCT)74%0.26 · 0.12–0.58PASC55 (n)46 (n)ACCROS-I Valerio-Pascua54%0.46 · 0.36–0.58recov. time330 (n)330 (n)ACCROS-II Karaaltin (RCT)83%0.17 · 0.05–0.62viral load30 (n)30 (n) Karaaltin (RCT)86%0.14 · 0.05–0.46viral load30 (n)30 (n) Karaaltin (RCT)82%0.18 · 0.02–1.71viral load30 (n)30 (n) Karaaltin (RCT)91%0.09 · 0.03–0.30viral load30 (n)30 (n) Matsuyama (RCT)69%0.31 · 0.10–0.93viral+4/13913/140 Matsuyama (RCT)38%0.62 · 0.42–0.92viral+139 (n)140 (n) Sanchez-.. (DB RCT)87%0.13 · 0.01–2.46hosp.0/322/13 Bryan (DB RCT)−1%1.01 · 0.21–4.95progression3/2613/263 Bryan (DB RCT)11%0.89 · 0.71–1.11recov. time261 (n)263 (n) Jing (DB RCT)79%0.21 · 0.11–0.39OGD10/12056/140OGD CT² Jing (DB RCT)97%0.03 · 0.00–0.57severe case0/12015/140CT² Jing (DB RCT)95%0.05 · 0.00–0.78severe case0/12011/140CT² Jing (DB RCT)83%0.17 · 0.02–1.34severe case1/1207/140CT² de Gabory (RCT)75%0.25 · 0.12–0.54progression7/8231/91SeaCare de Gabory (RCT)68%0.32 · 0.15–0.71progression7/8224/91SeaCare de Gabory (RCT)35%0.65 · 0.27–1.57progression7/8212/91SeaCare de Gabory (RCT)24%0.76 · 0.60–0.96recov. time82 (n)91 (n)SeaCare de Gabory (RCT)17%0.83 · 0.76–0.91recov. time82 (n)91 (n)SeaCare de Gabory (RCT)26%0.74 · 0.57–0.97recov. time82 (n)91 (n)SeaCare de Gabory (RCT)29%0.71 · 0.57–0.87recov. time82 (n)91 (n)SeaCare de Gabory (RCT)26%0.74 · 0.61–0.92recov. time82 (n)91 (n)SeaCare de Gabory (RCT)14%0.86 · 0.68–1.09recov. time82 (n)91 (n)SeaCare de Gabory (RCT)11%0.89 · 0.70–1.13recov. time82 (n)91 (n)SeaCare de Gabory (RCT)−2%1.02 · 0.80–1.29recov. time82 (n)91 (n)SeaCare de Gabory (RCT)25%0.75 · 0.56–0.99recov. time82 (n)91 (n)SeaCare de Gabory (RCT)3%0.97 · 0.77–1.21recov. time82 (n)91 (n)SeaCare de Gabory (RCT)14%0.86 · 0.68–1.09recov. time82 (n)91 (n)SeaCare de Gabory (RCT)37%0.63 · 0.19–2.09viral+4/827/91SeaCare Friedland (DB RCT)60%0.40 · 0.18–0.93viral load10 (n)13 (n) Friedland (DB RCT)52%0.48 · 0.25–0.92viral load10 (n)13 (n) Ponphaib.. (DB RCT)36%0.64 · 0.46–0.89no recov.25/5342/57CT² Ponphaib.. (DB RCT)24%0.76 · 0.64–0.89no recov.43/5955/57CT² Ponphaib.. (DB RCT)14%0.86 · 0.77–0.97no recov.50/5956/57CT² Ponphaib.. (DB RCT)30%0.70 · 0.59–0.84no recov.40/5955/57CT² Carvallo96%0.04 · 0.00–0.63cases0/13111/98see notes CT² Carvallo100%0.00 · 0.00–0.02cases0/788237/407see notes CT² Chahla (RCT)95%0.05 · 0.00–0.80m/s case0/11710/117CT² Chahla (RCT)84%0.16 · 0.04–0.46cases4/11725/117CT² Reznikov45%0.55 · 0.32–0.94casesn/an/a Reznikov59%0.41 · 0.25–0.68casesn/an/a Reznikov29%0.71 · 0.44–1.15casesn/an/a Seet (CLUS. RCT)45%0.55 · 0.38–0.80symp. case42/73564/619OT¹ Seet (CLUS. RCT)31%0.69 · 0.52–0.92cases338/735433/619OT¹ Figueroa (DB RCT)80%0.20 · 0.05–0.78symp. case2/19610/198CARR-COV-02 Shmuel76%0.24 · 0.06–1.02cases2/8316/160 Almanza-R.. (RCT)94%0.06 · 0.02–0.25cases2/11433/117 Almanza-R.. (RCT)49%0.51 · 0.33–0.81misc.21/11442/117 Brito-Reia54%0.46 · 0.20–1.08cases6/1,15344/3,887 Gutiérrez-G.. (RCT)91%0.09 · 0.01–0.72symp. case1/8410/79 Miller75%0.25 · 0.14–0.43cases13/203108/422 Amoah93%0.07 · 0.00–1.13cases94 (n)372 (n) Amoah93%0.07 · 0.00–1.25cases0/9410/372 Amoah98%0.02 · 0.00–0.23cases0/862/458 Wang34%0.66 · 0.55–0.80cases44/70343/362 Song (SB RCT)81%0.19 · 0.08–0.48symp. case824 (n)299 (n) Song (SB RCT)62%0.38 · 0.23–0.62cases824 (n)299 (n) Daneshfard (RCT)34%0.66 · 0.49–0.89symp. case37/8953/84CT² Daneshfard (RCT)97%0.03 · 0.00–0.19symp. case1/8935/84CT² Daneshfard (RCT)66%0.34 · 0.11–1.04symp. case4/8911/84CT² Daneshfard (RCT)62%0.38 · 0.12–1.16symp. case4/8910/84CT² Daneshfard (RCT)26%0.74 · 0.50–1.09symp. case29/8937/84CT² Daneshfard (RCT)−6%1.06 · 0.43–2.62symp. case9/898/84CT² Daneshfard (RCT)79%0.21 · 0.07–0.59symp. case4/8918/84CT² Daneshfard (RCT)76%0.24 · 0.09–0.60symp. case5/8920/84CT² Daneshfard (RCT)98%0.02 · 0.00–0.31symp. case0/8925/84CT² Si78%0.22 · 0.10–0.48cases3,368 (all patients) Karami (DB RCT)45%0.55 · 0.24–1.22symptoms40 (n)40 (n) Karami (DB RCT)43%0.57 · 0.17–1.99symptoms36 (n)40 (n) Karami (DB RCT)42%0.58 · 0.22–1.51symptoms36 (n)40 (n) Karami (DB RCT)79%0.21 · 0.04–0.97symptoms36 (n)40 (n) Karami (DB RCT)18%0.82 · 0.22–2.96symptoms36 (n)40 (n) Karami (DB RCT)39%0.61 · 0.33–1.12cases11/4018/40

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¹ OT: comparison with other treatment

² CT: study uses combined treatment

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← Respiratory
tract treatment
reduces riskRespiratory
tract treatment
increases risk →

Fig. S1. All outcomes.

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Fig. S2. Comparison of results for RCTs versus observational studies. For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.