Many elders remember being told as youngsters to gargle with saltwater to avoid getting a cold or sore throat. Well, guess what? Grandma may not have known why this was a good idea scientifically, but that doesn’t make it any less effective.
We also know about the cleaning power of bleach and are using it to sanitize surfaces amid the Wuhan coronavirus. Have you ever wondered why this works? A certain chemical, hypochlorous acid (HOCL), in the bleach kills pathogens, including fungus, bacterium, and virus. Obviously, it is not safe to inhale or ingest bleach. However, we do have an easy and safe alternative.
Cells lining the nose and throat can produce HOCL when they are bathed with chloride. One of the easiest ways to accomplish this exposure is using sodium chloride, better known as salt or saline. The more chloride presented to the cells, the more HOCL they generate.
The process was clearly presented in 2018 by Dr. Sandeep Ramalingam and his colleagues, who said, “Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels.” Your white blood cells also produce HOCL, which plays a critical role in the initial immune response to a variety of infections, including COVID-19.
By cleansing your sinuses and breathing passages with hypertonic saline, you augment the natural killing mechanisms of your immune system. Theoretically, regular daily hypertonic saline nasal irrigation and gargle (HSNIG) could be a proactive step to kill the Wuhan coronavirus.
The Science Speaks for Itself
Evidence suggests HSNIG is effective with other respiratory viruses. In a 2019 study published in the peer-reviewed journal Nature, Ramalingam and his colleagues studied 61 people who had developed a common cold. Interestingly, 31 percent of these colds were caused by one of the common coronaviruses.
Half of the people used HSNIG, and the other half did not. The hypertonic saline users had milder symptoms, and the duration of their colds was significantly blunted. More importantly, saline significantly reduced the spread of the virus to others by 35 percent. This is an important finding in the context of trying to contain the spreading of the Wuhan virus.
A somewhat similar study was performed in 400 children 6-10 years old who developed colds and influenza. One-third of the children were treated with conventional medications while the other two-thirds used nasal saline spray.
After 12 weeks of observation, the children who used nasal saline regularly had quicker resolution of infection and less reappearance of illness. These studies indicate HSNIG can generate adequate levels of HOCL to mitigate the severity and duration of respiratory infections, and the HOCL levels are likely high enough to significantly reduce spreading the infections to others.
Recent evidence in COVID-19 biology indicates there is significant reproduction of the virus in the nose and throat during the first five days of symptoms. The research also indicates these newly produced viruses are highly infectious.
Additionally, we now know that patients can be highly infectious even in the absence of symptoms. Therefore, HSNIG might provide an opportunity to curtail the spread by killing these viruses during the initial asymptomatic incubation stage as well as the first five symptomatic days.
Thousands of people likely have occult COVID-19 infection, which means they can unknowingly infect others. Empirically, use of HSNIG by everyone, regardless of symptoms, could assist in stopping the pandemic. This prophylactic use of HSNIG is supported by a study in 46 adults followed for one year, which showed that using saline nasal rinse daily significantly reduced the incidence of upper respiratory infections.
The World Health Organization (WHO) says, “There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus.” The WHO is correct in that there have been no double-blind prospective trials of people with the Wuhan virus using HSNIG, and it is not referencing the saline solution concentration mentioned in the previous studies.
However, studies have shown this technique does inhibit all common cold viruses, including the coronavirus (HCoV 229E). It is reasonable to believe HOCL will kill the Wuhan virus. Waiting for a definitive randomized trial to show this safe, simple, inexpensive therapy is effective for the Wuhan coronavirus seems overly cautious in light of the science and danger from the ongoing pandemic.
Our country is taking bold actions to curtail the spread of COVID-19. In light of the tremendous transmission rate of the Wuhan virus, it is our recommendation that everyone practice HSNIG.
While this hypothesis needs to be confirmed, we do not see a downside to implementing this very safe self-care approach now, in addition to the current measures of social distancing and personal hygiene. Within two weeks, grandma may be smiling as she watches her remedy dramatically reduce the spread of COVID-19.
Homemade Hypertonic Saline Solution
- 4 cups of freshly boiled water (rolling boil for 3 minutes to purify)
- 2 tablespoons of sea salt or table salt (non-iodized salt preferred but not critical)
How to make:
- Wash your hands thoroughly.
- Choose a clean container or flask.
- Add the salt. Pour the freshly boiled water into the container and mix thoroughly until salt completely dissolves.
- Close the container with an airtight lid and store in the refrigerator.
- Make a fresh batch every 24 hours.
- To make a smaller batch, use 1 cup of water with 1 tablespoon of salt.
How to use: Go to this website for complete instructions on how to perform nasal irrigation and gargling.
Frequency of use:
- If you have symptoms or a confirmed case of COVID-19, repeat the usage up to every two hours during the first few days as symptoms are present.
- If you are asymptomatic and do not have known COVID-19, repeat the usage every four to six hours as a preventative measure.
- At the time of publishing this article, we recommend all people in the United States do this hypertonic saline nasal irrigation and gargle.
- We recommend continuation at least until the U.S. Centers for Disease Control no longer considers COVID-19 a serious threat in this country.
Dr. Bale is a professor at Texas Tech University and a specialist in prevention medicine. Dr. Vigerust is the president and chief scientific officer of ZDX Health, an infectious disease-focused health care company.