Impact of saline irrigations in nonhospitalized patients with COVID-19

Introduction: Response to the COVID-19 pandemic has primarily focused on pharmacologic interventions, including antivirals, convalescent sera, and vaccinations, with each critical in the fight against COVID-19. Given previous studies demonstrating varying efficy of saline irrigations on other viral diseases, we conducted a randomized controlled trial to evaluate the effect of nasal irrigations on upper respiratory symptoms and viral load in patients with COVID-19. Method: This was a randomized control trial conducted from May 2020 to December 2020. Patients with a positive reverse transcriptase polymerase chain reaction SARS-CoV-2 test were enrolled within 24 hours of testing and given swabs, viral preservation media, and a symptom diary incorporating a modified version of the validated Wisconsin Upper Respiratory Symptom-21 Survey. Patients were randomized to 1 of 3 treatment arms: (1) twice-daily irrigations with hypertonic saline, (2) twice-daily irrigation with hypertonic saline with 1% surfactant, and (3) a non-intervention group. Participants performed scheduled midturbinate swabs and recorded daily temperatures and symptom scores over the 21-day study duration. Results: The full set of results is to be discussed at the conference. Interim analysis demonstrated a trend toward earlier symptom resolution in the intervention groups compared with the control group (P = .16), although this was not seen when all study participants' data were completed. At completion of the study and following full viral load analysis, there was no statistically significant effect on viral load between the groups. Conclusion: Our hypothesis, that saline irrigations would decrease viral load and improve symptoms in patients with COVID-19, was ultimately not supported by this study. There was no significant difference between the intervention groups and the control group when analyzing viral load and symptomatology. Although essentially a negative study, this is the most comprehensive study evaluating efficy of saline irrigations in COVID-19 and implies that saline irrigations are unlikely to significantly affect patients in the setting of COVID-19.