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Covid-19: Is Nasal Irrigation More Important Than Hand-Washing?

By now, you probably understand the importance of hand-washing to prevent the spread of infectious illness. But did you know flushing your sinuses might be an even better way to inhibit the progression of a viral illness such as COVID-19? In an April 20, 2020, article,1 MSN’s Best Life features the recommendations of Dr. Amy Baxter, a pediatric emergency medicine physician in Atlanta, Georgia.

Nasal irrigation, she says, is a rarely discussed strategy that can help reduce the progression of illness in those who have tested positive for COVID-19 infection. In an April 2, 2020, response2 to a BMJ paper about the lack of personal protection equipment on COVID-19 frontlines, professor Robert Matthews also brought up the importance and potential usefulness of oropharyngeal washing to protect health care workers from infection. As reported by MSN Best Life:3

“Nasal irrigation, or a nasal wash, has long been considered an effective way to remove viruses or bacteria from sinus cavities. Baxter has multiple reasons for believing that this approach can be effective in preventing the spread of coronavirus from worsening in a sick patient.”

Why Nasal Irrigation?

As noted by Baxter, researchers have found that the viral load of SARS-CoV-2 tends to be heaviest in the sinuses and nasal cavity. Regularly rinsing your sinuses therefore makes sense since it would help clear out the pathogen and prevent it from gaining a strong foothold and migrating into your lungs. 

The age and gender discrepancies observed in COVID-19 also supports nasal irrigation. Children are at virtually no risk from COVID-19, while death rates among the elderly are at their highest. More men than women also die from the infection.  

“Children don't develop full sinuses until teens; males have larger cavities than women, and the cavities are largest [in those] over 70 years,” Baxter notes.

Research has previously demonstrated that nasal irrigation reduces the symptoms and duration of other viral illnesses such as the seasonal flu and common cold. 

In one randomized controlled trial,4 nasal irrigation and gargling with hypertonic saline were found to reduce the duration of the common cold by 1.9 days and reduce transmission within the household by 35% by reducing viral shedding when done within 48 hours of symptom onset.

While it has not yet been studied as a preventive method for COVID-19 specifically, there’s reason to suspect nasal irrigation might be helpful. 

Baxter points out that COVID-19 death rates in Southeast Asian countries such as Thailand, Vietnam and Laos have been surprisingly low, and nasal irrigation is common practice in those areas. According to Baxter, some 80% of the Southeast Asian population do it. 

How to Irrigate Your Sinuses 

Baxter suggests irrigating your sinuses any time you’ve been exposed to an infected individual or test positive for COVID-19. She recommends flushing your sinuses in the morning using a mixture of boiled lukewarm water (8 ounces) and povidone-iodine (half a teaspoon). 

Povidone-iodine has been shown to effectively kill not only Klebsiella pneumoniae and Streptococcus pneumoniae bacteria, but to also rapidly inactivate SARS-CoV, MERS-CoV, H1N1 influenza virus A and rotavirus after 15 seconds of exposure.5

The mixture used in this study — 7% povidone-iodine diluted 1-to-30, which equates to a total concentration of 0.23% povidone-iodine — inactivated over 99% of the coronaviruses causing SARS and MERS.

Either a neti pot or NeilMed sinus rinse bottle can be used. The water pressure you get from a sinus rinse bottle can provide a more effective flush. If higher pressure is uncomfortable, a neti pot, which relies on gravity, may be a more comfortable choice. In the evening, Baxter recommends flushing your sinuses again with a mixture of:

  • 8 ounces of boiled lukewarm water
  • 0.5 teaspoon baking soda
  • 1 teaspoon table salt
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