Post-hoc secondary analysis of data from our recent Edinburgh and Lothians Viral Intervention Study (ELVIS) pilot randomised controlled trial (RCT) indicates that hypertonic saline nasal irrigation and gargling (HSNIG) reduced the duration of coronavirus upper respiratory tract infection (URTI) by an average of two-and-a-half days. As such, it may offer a potentially safe, effective and scalable intervention in those with Coronavirus Disease-19 (COVID-19) following infection with the betacoronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [
ELVIS was undertaken in 66 adults with URTI. Results have been reported in detail elsewhere [
We also recently reported that epithelial cells mount an antiviral effect by producing hypochlorous acid (HOCl) from chloride ions [
In COVID-19, high titres of SARS-CoV-2 are detectable in the upper respiratory tract of asymptomatic and symptomatic individuals [
Photo: Nasal irrigation and gargling. (from the ELVIS study video, used with permission).
The duration of illness was lower in the intervention arm compared to the control arm in the subset of patients infected with coronavirus (mean days (SD): 5.6 (1.4) vs 8.1 (2.9)). Using a two-sample
Number of days for self reported symptom improvement in the control and intervention arms infected by a coronavirus
Variable label | Treatment | N | Mean | SD | Difference in mean (intervention – control) (95% CI for difference) | |
---|---|---|---|---|---|---|
Blocked nose |
Intervention |
7 |
4.0 |
2.2 |
-3.1 (-6.0, -0.2) |
0.0362 |
Blocked nose |
Control |
8 |
7.1 |
2.9 |
||
Chest congestion |
Intervention |
7 |
1.9 |
1.2 |
-0.8 (-2.7, 1.2) |
0.4056 |
Chest congestion |
Control |
8 |
2.6 |
2.1 |
||
Cough |
Intervention |
7 |
2.7 |
1.3 |
-3.3 (-5.9, -0.7) |
0.0179 |
Cough |
Control |
8 |
6.0 |
3.0 |
||
Head congestion |
Intervention |
7 |
3.4 |
1.9 |
-1.9 (-5.0, 1.1) |
0.1931 |
Head congestion |
Control |
8 |
5.4 |
3.3 |
||
Hoarseness |
Intervention |
7 |
2.4 |
1.6 |
-2.9 (-5.6, -0.3) |
0.0325 |
Hoarseness |
Control |
8 |
5.4 |
2.9 |
||
Scratchy throat |
Intervention |
7 |
2.6 |
1.0 |
-2.1 (-5.1, 1.0) |
0.1712 |
Scratchy throat |
Control |
8 |
4.6 |
3.6 |
||
Sneezing |
Intervention |
7 |
3.9 |
1.7 |
-1.0 (-3.8, 1.8) |
0.4469 |
Sneezing |
Control |
8 |
4.9 |
3.0 |
||
Sore throat |
Intervention |
7 |
3.6 |
1.9 |
-1.1 (-4.4, 2.3) |
0.5139 |
Sore throat |
Control |
8 |
4.6 |
3.7 |
||
Runny nose |
Intervention |
7 |
4.4 |
1.3 |
-1.6 (-4.1, 0.9) |
0.1999 |
Runny nose |
Control |
8 |
6.0 |
2.8 |
||
Feeling tired |
Intervention |
7 |
3.6 |
1.8 |
-2.1 (-5.1, 1.0) |
0.1671 |
Feeling tired | Control | 8 | 5.6 | 3.3 |
SD – standard deviation, CI – confidence interval
Response to global severity question and severity of symptoms. Response from participants over the study period: Each line represents response of a participant over 14 days. Data are shown by treatment group (Top panel – Control Arm; Bottom panel – Intervention Arm). The global severity question was “How unwell do you feel today”. The responses were graded from 0 (Not unwell), 1 (very mildly), 3 (mildly), 5 (moderately) and 7 (severely unwell). Likewise, each symptom was graded 0 (no symptom) to 7 (severe). WURSS-21 Score was the sum of the severity of individual symptoms.
The individual in the control arm with a co-existing rhinovirus infection could have affected the results. Excluding this individual, the duration of illness in the control arm was a mean of 7.3 days (SD = 1.8). The impact on the intervention control comparison was to reduce the size of the difference to -1.7 days (95% CI = -3.6, 0.2;
In the absence of a suitable antiviral agent or a vaccine, we need a safe and effective intervention that can be globally implemented. Our