Effects of hypertonic alkaline nasal irrigation on COVID‐19
Yetkin Zeki Yilmaz, Begum Bahar Yilmaz, Yusuf Emre Ozdemir, Bekir Sami Kocazeybek, MD Ridvan Karaali, Doğan Çakan, Hasan Ahmet Ozdogan, Aysegul Batioglu‐karaaltin
Laryngoscope Investigative Otolaryngology, doi:10.1002/lio2.686
Objective: The causative agent of COVID-19 is a novel member of coronaviridaes, SARS-CoV-2. It has been reported that the spike (S) protein of SARS-CoV-2 is responsible of infectivity. The S protein is demonstrated to be inactivated under environmental condition, such as hypertonicity and alkaline pH. The aim of the study was to investigate the effect of hypertonic alkaline nasal irrigation (HANI) on SARS-CoV-2. Methods: Sixty patients divided into two groups. The patients in Group 1 used hydroxychloroquine (HCQ), and the patients in Group 2 used HCQ and HANI. Nasopharyngeal samples were collected at the beginning, on 3rd and 7th day of the PCR test positivity. The nasopharyngeal viral load (NVL) changes analyzed with quantitative PCR. Results: NVL decrease in weekly period was statistically significant for both groups, when the difference between NVL day 0 and 3rd in Group 1 and NVL difference between day 0 and 3rd in Group 2 were compared. The difference between Groups 1 and 2 in terms of NVL change was statistically significant (P < 0.05).
Conclusion: We demonstrated a significant decrease in nasopharyngeal SARS-CoV-2 load with HANI solution and suggest that HANI may be promising modality for the COVID-19 treatment.
CONFLICT OF INTEREST Each of the authors has contributed to, read and approved this manuscript. None of the authors has any conflict of interest.
References
Cevik, Tate, Lloyd, SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis, Lancet Microbe,
doi:info:doi/10.1016/S2666-5247(20)30172-5Faul, Erdfelder, Lang, Buchner, G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences, Behav Res Methods,
doi:info:doi/10.3758/BF03193146Guan, Liang, Zhao, China medical treatment expert group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis, Eur Respir J,
doi:info:doi/10.1183/13993003.00547-2020Justo, Bueno, Barbosa, Comparison of viral load between saliva and nasopharyngeal swabs for SARS-CoV2: the role of days of symptoms onset on diagnosis, Mem Inst Oswaldo Cruz,
doi:info:doi/10.1590/0074-02760210018Lamas, Dios, Rodríguez, IS povidone iodine mouthwash effective against SARS-CoV-2? First in vivo tests, Oral Dis,
doi:10.1111/odi.13526Liu, Yi, Zhang, Lv, Zhu et al., Viral load dynamics in sputum and nasopharyngeal swab in patients with COVID-19, Laryngoscope Investigative Otolaryngology,
doi:info:doi/10.1002/lio2.686Porta-Etessam, Núñez-Gil, García, COVID-19 anosmia and gustatory symptoms as a prognosis factor: a subanalysis of the HOPE COVID-19 (health outcome predictive evaluation for COVID-19) registry, Infection,
doi:10.1007/s15010-021-01587-9Ramalingam, 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:info:doi/10.1038/s41598-018-37703-3Sarma, Kaur, Kumar, Virological and clinical cure in COVID-19 patients treated with hydroxychloroquine: a systematic review and meta-analysis, J Med Virol,
doi:info:doi/10.1002/jmv.25898Shameena, Khan, A comparative study of cost optimization model under parametric and nonparametric approach, J Inf Comput Sci
Tang, Cao, Han, Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial, BMJ,
doi:info:doi/10.1136/bmj.m1849Wilson, Norton, Young, Collins, Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review, Anaesthesia,
doi:info:doi/10.1111/anae.15093Wu, Nethery, Sabath, Braun, Dominici, Air pollution and COVID-19 mortality in the United States: strengths and limitations of an ecological regression analysis, Sci Adv,
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'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>The '
'causative agent of COVID‐19 is a novel member of coronaviridaes, SARS‐CoV‐2. It has been '
'reported that the spike (S) protein of SARS‐CoV‐2 is responsible of infectivity. The S '
'protein is demonstrated to be inactivated under environmental condition, such as '
'hypertonicity and alkaline pH. The aim of the study was to investigate the effect of '
'hypertonic alkaline nasal irrigation (HANI) on '
'SARS‐CoV‐2.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Sixty '
'patients divided into two groups. The patients in Group 1 used hydroxychloroquine (HCQ), and '
'the patients in Group 2 used HCQ and HANI. Nasopharyngeal samples were collected at the '
'beginning, on 3rd and 7th day of the PCR test positivity. The nasopharyngeal viral load (NVL) '
'changes analyzed with quantitative '
'PCR.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>NVL decrease in '
'weekly period was statistically significant for both groups, when the difference between NVL '
'day 0 and 3rd in Group 1 and NVL difference between day 0 and 3rd in Group 2 were compared. '
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'treatment.</jats:p></jats:sec><jats:sec><jats:title>Level of '
'evidence</jats:title><jats:p>IB</jats:p></jats:sec>',
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