Nasal irrigation may help with COVID
Q: My doctor suggested I start using a nasal irrigation system to reduce buildup of pollens that trigger allergic reactions. Could this also mitigate the risk of getting sick with COVID-19 by removing some virus particles before they are activated? Or maybe keep infection less severe?
A: Nasal irrigation is the personal hygiene practice in which mucus and inhaled particulates are gently flushed from the nostrils. It's done with a small, spouted vessel filled with warm, sterile salt water. The spout goes into one nostril and, with the help of gravity and a tilted head, the solution seeps through the nasal passages and exits the other nostril. In the process, the water moistens the tiny cilia, or hairs, that line the nasal passages and clears them of accumulated dust, dirt, pollen, bacteria and other debris.
Nasal irrigation is an ancient practice with roots in the Ayurvedic medical traditions of India. It may sound a bit bizarre, but studies have shown it to be effective at managing a range of sinus problems. These include sinus congestion and inflammation, as well as the allergies your doctor is working with you to address.
When it comes to COVID-19, there's a certain logic to the idea that nasal irrigation could reduce the risk of infection. We now know that SARS-CoV-2, which is the virus that causes COVID-19, is airborne. Virions, which is what complete virus particles are called, are inert and cannot move on their own. In airborne transmission, virions are carried in the microscopic droplets that are created when an infected individual coughs, sneezes, speaks, laughs or even exhales.
It has also become clear that SARS-CoV-2 enters the body primarily through the nose, which is part of the upper respiratory tract. That's why, in addition to nasal irrigation, the use of a saline gargle has been proposed. And, while interest in these interventions has led to clinical trials, it's too soon to say whether or not either a nasal rinse or saline gargle are effective at preventing or lessening the severity of infection.
There is some evidence, which has come out of several smaller studies, that nasal irrigation may be helpful for people who are already infected with SARS-CoV-2. It may reduce the duration of illness, and also may reduce the amount of virus that someone sheds.
Nasal irrigation is a safe and inexpensive treatment that can be performed at home. That said, it's important that it be done correctly. Be sure to follow the instructions that come with the device or system that you purchase. If you're still unsure, your health care provider can offer additional guidance.
Always use sterilized water, and be sure it's not too hot. Take care to let the saline solution drain naturally from the nasal passages. Blowing your nose or using a strenuous exhale can force water into the nearby eustachian tubes in the ears. It's possible for saline solutions to dry out and irritate the mucosa in the nose, so it is recommended that nasal irrigation be limited to once a day.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.