In an emergency, what can we do if “firemen” (trialists) come late to combat the covid-19 pandemic? What stops hypertonic saline for nasal rinsing and gargling from being an early, universal adjunctive weapon to combat SARS-CoV-2?
In an emergency, what can we do if “firemen” (trialists) come late to combat the covid-19 pandemic? What stops hypertonic saline for nasal rinsing and gargling from being an early, universal adjunctive weapon to combat SARS-CoV-2?
The editorial from Kamran Abbasi prompted me to underline the current issues related to covid-19 mass testing that incorporate untold screening programmes, scientific and public confusion about possible treatments, and health policy engineered to meet political ends “often divorced from science and evidence”. [1] As Margaret McCartney forcefully argues, “we need better evidence for non-drug interventions for covid-19”. [2] Among these, we would give priority to nasal rinsing and gargling with hypertonic saline (HS), a cost-free treatment without adverse events that should be a safe, early addition to handwashing and social distancing option for everyone worldwide. [3,4]
A pre-print report from Brazil, highlights HS’s in vitro effects in inhibiting SARS-CoV-2, [5] already reinforcing sparse clinical data from previous publications. [6,7] While waiting for safe and efficacious vaccines, what is missing to prevent HS – a “democratic”, cost-free expedient -- from becoming part of a comprehensive strategy to control community SARS-CoV-2 transmission, thus keeping the persistent and damaging pandemic under control? Ongoing trials should provide robust evidence on HS’s clinical efficacy and safety before 2020 ends. [8,9] The current emergency epidemic calls for urgent action. Therefore, as the next step, we respectfully suggest that the WHO now delete HS from myth-busters. [10] They should also revise questioning merely about “saline” failing to help in “preventing the new coronavirus”, and instead publicise regular HS to treat early coronaviruses. [10,11] Meanwhile, we urgently need further trials based on the known robust biological background supporting available clinical evidence on how regularly rinsing the nose and gargling with HS safely and effectively hastens recovery from coronaviruses and SARS-CoV-2 early infections. [3,4,5,7]
1 Abbasi K. Covid-19: shooting for the moon. BMJ 2020;370:m3509. doi.org/10.1136/bmj.m3509
2 McCartney M. We need better evidence on non-drug interventions for covid-19. BMJ 2020;370:m3473. doi: 10.1136/bmj.m3473 pmid: 32895223
3 Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep 2019;9:1015. doi.org/10.1038/s41598-018-37703-3
4 Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for Covid-19. J Glob Health 2020;10:010332. doi:10.1038/s41564-020-0695-z. [32123347]
5 Machado RRG, Glaser T, Araujo DB, Petiz LL, Oliveira DBL, Durigon GS, et al. Hypertonic saline solution inhibits SARS-CoV-2 in vitro assay. 2020 (pre-print). doi: https://doi.org/10.1101/2020.08.04.235549https://www.biorxiv.org/content/10.1101/2020.08.04.235549v2#disqus_thread
6 Rosati P, Giordano U, Concato C. Hypertonic saline nasal irrigation and gargling as an inexpensive practical adjunctive weapon to combat asymptomatic SARS-CoV-2 infections. A case report. Trends Med 2020;20:1-3. doi: 10.15761/TiM.1000249
7 Farrell NF, Klatt-Cromwell C, Schneider JS. Benefits and safety of nasal saline irrigations in a pandemic - washing COVID-19 away. JAMA Otolaryngol Head Neck Surg. 2020;Jul. doi: 10.1001/jamaoto.2020.1622.
8 NCT. Hypertonic Saline Nasal Irrigation and Gargling in Suspected or Confirmed COVID-19 (ELVIS COVID-19). 2020;https://clinicaltrials.gov/ct2/show/NCT04382131
9 NCT. Hypertonic Saline for COVID-19 Symptoms. 2020;https://clinicaltrials.gov/ct2/show/NCT04465604
10 World Health Organization. Coronavirus disease (COVID-19) advice for the public: Mythbusters. 2019; https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-f...
11 Bale BF, Doneen AL. Homemade saline solution that could help abate COVID-19. 2020;https://baledoneen.com/blog/homemade-saline-solution-that-could-help-aba...
Rapid Response:
In an emergency, what can we do if “firemen” (trialists) come late to combat the covid-19 pandemic? What stops hypertonic saline for nasal rinsing and gargling from being an early, universal adjunctive weapon to combat SARS-CoV-2?
The editorial from Kamran Abbasi prompted me to underline the current issues related to covid-19 mass testing that incorporate untold screening programmes, scientific and public confusion about possible treatments, and health policy engineered to meet political ends “often divorced from science and evidence”. [1] As Margaret McCartney forcefully argues, “we need better evidence for non-drug interventions for covid-19”. [2] Among these, we would give priority to nasal rinsing and gargling with hypertonic saline (HS), a cost-free treatment without adverse events that should be a safe, early addition to handwashing and social distancing option for everyone worldwide. [3,4]
A pre-print report from Brazil, highlights HS’s in vitro effects in inhibiting SARS-CoV-2, [5] already reinforcing sparse clinical data from previous publications. [6,7] While waiting for safe and efficacious vaccines, what is missing to prevent HS – a “democratic”, cost-free expedient -- from becoming part of a comprehensive strategy to control community SARS-CoV-2 transmission, thus keeping the persistent and damaging pandemic under control? Ongoing trials should provide robust evidence on HS’s clinical efficacy and safety before 2020 ends. [8,9] The current emergency epidemic calls for urgent action. Therefore, as the next step, we respectfully suggest that the WHO now delete HS from myth-busters. [10] They should also revise questioning merely about “saline” failing to help in “preventing the new coronavirus”, and instead publicise regular HS to treat early coronaviruses. [10,11] Meanwhile, we urgently need further trials based on the known robust biological background supporting available clinical evidence on how regularly rinsing the nose and gargling with HS safely and effectively hastens recovery from coronaviruses and SARS-CoV-2 early infections. [3,4,5,7]
1 Abbasi K. Covid-19: shooting for the moon. BMJ 2020;370:m3509. doi.org/10.1136/bmj.m3509
2 McCartney M. We need better evidence on non-drug interventions for covid-19. BMJ 2020;370:m3473. doi: 10.1136/bmj.m3473 pmid: 32895223
3 Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Sci Rep 2019;9:1015. doi.org/10.1038/s41598-018-37703-3
4 Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for Covid-19. J Glob Health 2020;10:010332. doi:10.1038/s41564-020-0695-z. [32123347]
5 Machado RRG, Glaser T, Araujo DB, Petiz LL, Oliveira DBL, Durigon GS, et al. Hypertonic saline solution inhibits SARS-CoV-2 in vitro assay. 2020 (pre-print). doi: https://doi.org/10.1101/2020.08.04.235549 https://www.biorxiv.org/content/10.1101/2020.08.04.235549v2#disqus_thread
6 Rosati P, Giordano U, Concato C. Hypertonic saline nasal irrigation and gargling as an inexpensive practical adjunctive weapon to combat asymptomatic SARS-CoV-2 infections. A case report. Trends Med 2020;20:1-3. doi: 10.15761/TiM.1000249
7 Farrell NF, Klatt-Cromwell C, Schneider JS. Benefits and safety of nasal saline irrigations in a pandemic - washing COVID-19 away. JAMA Otolaryngol Head Neck Surg. 2020;Jul. doi: 10.1001/jamaoto.2020.1622.
8 NCT. Hypertonic Saline Nasal Irrigation and Gargling in Suspected or Confirmed COVID-19 (ELVIS COVID-19). 2020;https://clinicaltrials.gov/ct2/show/NCT04382131
9 NCT. Hypertonic Saline for COVID-19 Symptoms. 2020;https://clinicaltrials.gov/ct2/show/NCT04465604
10 World Health Organization. Coronavirus disease (COVID-19) advice for the public: Mythbusters. 2019; https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-f...
11 Bale BF, Doneen AL. Homemade saline solution that could help abate COVID-19. 2020;https://baledoneen.com/blog/homemade-saline-solution-that-could-help-aba...
Competing interests: No competing interests