“The supreme art of war is to subdue the enemy without fighting.” Strike the enemy while they are in preparation. – Sun Tzu, Art of War
Viruses need to multiply before they infect
Viruses have to multiply in the nose and throat to reach an infectious dose to cause disease. It can be any respiratory virus like SARS-CoV-2, influenza, RSV, or adenovirus. Symptoms like runny nose, scratchy throat, cough, sneezing start once the infectious dose is reached.
Coughing and sneezing spread the viruses to other people. At the same time, the viruses spread to other organs like the host’s lungs. High viral loads can stimulate the immune system to overreact, and this presents as a cytokine storm where the lungs get flooded, and multi-system organ failure happens.
Everyone that I know that did nasal rinsing and gargling recovered right away. However, there is a right way to rinse the nose properly because the anatomy of the nasopharynx has certain peculiarities. This article also lists what you can use.
How to Rinse the Nose
The cavity behind the nose is complicated. It has conchas on the side, and it extends back to the throat. The picture below shows the inner side.
And the front.
Viruses replicate in the whole cavity, and that is why effective nasal rinsing has to cover all the nooks and crannies. That is why I prefer nasal rinse compared to just inserting a soaked Q tip into the nose.
Where to nasal rinse
Near a sink. Nasal rinsing can get messy, and Povidone Iodine can stain, and hydrogen peroxide can bleach anything it touches. Consider what you are wearing or use a bib.
The proper position when nasal rinsing
Bend forward. When rinsing the right side of the nose, turn your head to the left and spray or rinse. That will assure coverage of all three conchas. Some of the solution may also enter the maxillary sinus. Turn your head to the right when rinsing the left nostril. You can get upright right away. Make sure you have a tissue or something clean to wipe your face.
If someone cannot bend (elderly or back problems), use a basin. You can use the following to dispense the nasal rinse:
- 3, 5, or 10 ml syringes ( no needles, of course)
- Neti pot
- Nasal aspirator
- Nasal aspirator or ear wax bulb syringe
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Do nasal rinsing once after being with other people indoors for several hours. Three to four times a day if with symptoms.
How much rinsing should I do?
On the Front Line COVID-19 Critical Care Alliance (FLCCC) Early Prevention and Treatment protocol, the recommended is 4 to 5 drops per nostril.
I tend to be more aggressive so that the whole nasopharynx gets wet.
What to use for nasal rinsing
Povidone Iodine
Povidone Iodine (PI) is commonly known by its brand name Betadine. PI prevents the attachment of the influenza virus, and in SARS-CoV-2, it enters the viral nucleus and destroys the genetic material inside.
Nasal Povidone-Iodine Works Great for the Prevention and Early Treatment of COVID-19!
PI is available as a nasal spray or in a 10% solution. PI has to be diluted to 1%. To do that, mix 1 part of 10% with nine parts water. You can use distilled water, but tap water can be used if your are homebound due to quarantine or lockdown. Povidone-iodine is used to sterilize a surgical field before the surgeon cuts. It kills any germ it touches.
The inner lining of the nose is sensitive. If it stings, you can dilute the PI with some more water. 0.5% also works [1]. Another study shows that 0.23% of povidone-iodine has 99.99% virucidal activity against any virus.
That means 1 part of povidone-iodine can be diluted with 20 parts water or one teaspoon plus 1/4 cup water to get around 0.5%
or 1 part PI and 40 parts of water to get 0.23% (one teaspoon of PI plus a cup of water)
Lugol’s solution which is 2% iodine, can also be used. Earthclinic has this recipe.
Lugol’s Iodine Nasal Solution
To get enhanced protection from the coronavirus, do the following:
1. Fill a small shot glass (for whiskey) half full of purified water.
2. Add four drops of 5% Lugol’s iodine (or nine drops if you have 2% Lugol’s iodine) to the water in the shot glass. Stir well with a clean spoon.
3. In each nostril, add one dropper-full of the iodine/water mixture and then gently sniff it into the nasopharynx region at the back of the nose.
Be careful when you sniff the solution. Too much of the solution and a forceful sniff may go to the lungs and make you cough.
Hydrogen peroxide
Hydrogen peroxide is available as a 3% solution as oral rinse (mouthwash, 1.5%), and/or nebulization (0.2%).
- To get 1.5%, add an equal amount of clean water.
- Add seven parts water to one part 3% to get 0.2%
A nebulizer is used for asthma patients. It can be purchased over the counter, and a nebulizer without a tube is available now.
Hypertonic Saline solution
If you don’t have povidone iodine or hydrogen peroxide, salty water is also useful and is recommended for coronavirus infections. [4] I suppose everyone has salt at home.
Hypertonic saline solution washes away debris from the nose and makes breathing better. It also shrinks the swollen membranes inside. Once cleaned, the tiny hairs that removes germs and debris are free to do their job.
Recipe from the University of Michigan
- Choose a one-quart glass jar that is thoroughly cleansed.
- Fill it with distilled or bottled water. It should not contain chlorine or other chemicals in high concentrations.
- Add 2-3 heaping teaspoons of pickling/canning salt, not table salt as it contains a large number of additives. Add 1 teaspoon Arm & Hammer Baking Soda (pure bicarbonate).
- Mix ingredients together and store them at room temperature. Discard after one week. If you find this solution too strong, you may decrease the amount of salt to 1 to 1½ teaspoon. With children, it is often best to start with a milder solution and advance slowly.
Deep gargle
Mouthwash is not enough. A deep gargle is needed for the antiseptic to reach the back of the throat. Tilt your head back and blow air gently from the throat. It’s better done near the sink too.
You can use the following in no particular order
- Cetylopyridinium chloride or CPC Scope, Colgate and Crest are examples.
- Listerine
- Hydrogen Peroxide as diluted to 1.5% or you can use Colgate Peroxyl
- Hypertonic saline (see recipe above)
- Povidone-iodine Betadine Antiseptic Sore Throat Gargle, Mint Flavor, 8 oz Bottle.
- Chlorine Dioxide CloSYS Sensitive Antimicrobial Mouthwash
- Chlorhexidine at 0.12–0.2%. It can cause tooth pigmentation, and taste alteration.
How about other alcohol like whisky?
It’s ok as long as it is limited to one drink or about 30 ml. That’s because alcohol can lower the antibody response and prevent the development of adaptive immunity.
Nasal rinse and gargling is part of the I-MASK+ Prevention & Early Outpatient Treatment Protocol for COVID-19 and World Council of Health at home treatment of COVID-19 you can print the link here.
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References:
- Bidra AS, Pelletier JS, Westover JB, Frank S, Brown SM, Tessema B. Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide and Povidone-Iodine Oral Antiseptic Rinses. J Prosthodont. 2020 Aug;29(7):599-603. doi: 10.1111/jopr.13220. Epub 2020 Jul 24. PMID: 32608097; PMCID: PMC7361576.
- Caruso AA, Del Prete A, Lazzarino AI, Capaldi R, Grumetto L. Might hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection?. Infect Control Hosp Epidemiol. 2020;41(11):1360-1361. doi:10.1017/ice.2020.170
- Arefin MK. Povidone Iodine (PVP-I) Oro-Nasal Spray: An Effective Shield for COVID-19 Protection for Health Care Worker (HCW), for all [published online ahead of print, 2021 Apr 8]. Indian J Otolaryngol Head Neck Surg. 2021;1-6. doi:10.1007/s12070-021-02525-9
- Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. 2020;10(1):010332. doi:10.7189/jogh.10.010332
- Xu C, Wang A, Hoskin ER, Cugini C, Markowitz K, Chang TL, Fine DH. Differential Effects of Antiseptic Mouth Rinses on SARS-CoV-2 Infectivity In Vitro. Pathogens. 2021; 10(3):272. https://doi.org/10.3390/pathogens10030272
- Pottage T, Garratt I, Onianwa O, Carter J, Bennett AM. Rapid inactivation of SARS-CoV-2 after exposure to vapour hydrogen peroxide. J Hosp Infect. 2021;118:77-78. doi:10.1016/j.jhin.2021.10.007
- Chen MH, Chang PC. The effectiveness of mouthwash against SARS-CoV-2 infection: A review of scientific and clinical evidence [published online ahead of print, 2021 Oct 8]. J Formos Med Assoc. 2021;S0929-6646(21)00469-1. doi:10.1016/j.jfma.2021.10.001
- ABA San Martín, CO Gonzales. Determination of the Effectiveness of Chlorine Dioxide in the Treatment of COVID-19. Journal of Molecular and Genetic Medicine 15, S2
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