This old-fashioned remedy may ease covid: Gargle with salt water

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A common home remedy of gargling with salt water and rinsing nasal passages may ease the symptoms of a covid-19 infection and help keep people out of the hospital, according to new research presented this week at a scientific meeting.

“It’s a very simple intervention that is universally available, cheap and easy to use,” said Jimmy Espinoza, professor of obstetrics, gynecology and reproductive sciences at the University of Texas at Houston’s McGovern Medical School, who conducted the study. “I think it can make a difference, especially when it comes to comfort.”

Infectious-disease experts not involved in the study described the findings as interesting but said more research is needed. They stressed that gargling and nasal washing should never be used as a substitute for vaccination or treatment with medications, such as Paxlovid.

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The facts

The study tracked 55 adults with covid who were assigned to use a low or high dose of saline for gargling and rinsing nasal passages. One dose was equal to about a third of a teaspoon of salt, and a higher dose equaled about a full teaspoon of salt – both dissolved in eight ounces of warm water.

Participants were told to gargle and rinse their nasal passages four times a day for 14 days. The participants were compared with a reference group of 9,398 people who also had covid but hadn’t been instructed to gargle or rinse nasal passages.

The study showed that people instructed to gargle and nasal rinse had significantly lower hospitalization rates than the reference group, suggesting they had less severe symptoms. There was no difference in hospitalization rates in the low- and high-saline regimens.

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The background

The findings support evidence from earlier small studies that suggest that saline irrigation of the mouth and nose can reduce covid viral load and help clear it from the throat and nasal passages.

The results of the trial were released during the annual scientific meeting of the American College of Allergy, Asthma and Immunology in Anaheim, Calif., and haven’t yet been published in a peer-reviewed medical journal.

Infectious-disease experts said more study is needed in larger patient populations.

“It’s an interesting concept and idea, and a potential adjunct preventative along with other non-pharmaceutical interventions,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development. He was not involved in the research.

“However, gargling with salt water should still be considered secondary relative to the importance of having high or adequate levels of virus-neutralizing antibodies from covid vaccinations,” he said.

The study excluded subjects with chronic hypertension, and patients with high blood pressure should not use a salt water gargle, since they could inadvertently swallow some of the salt, said Dean Blumberg, chief of the division of pediatric infectious diseases at UC Davis Health, also not involved in the research. Salt in excess – specifically the sodium in salt – can narrow and stiffen blood vessels, raising blood pressure.

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The best way to gargle and nasal rinse

Espinoza said he conceived the study idea after reading reports that salt water gargling helped prevent respiratory tract infections among Hajj pilgrims – and wondered whether it could have an impact on covid.

If people want to try it, they can buy a sterile saline solution. To use water from home, he recommends boiling the water first, then letting it cool until it is warm. Boiling the water first is important “because the nasal passages are prone to infection” from contaminants that may be in the water, he said.

He suggested alternating gargling with the nasal rinse. Take the eight ounces of water and separate the gargling water from the nasal rinse water. Gargle for one minute, then run the other water through your nose using a neti pot. Then gargle again. And if you can tolerate it, run any remaining water through your nose a second time.

He said “the amount of nasal rinsing really just depends on how much you can stand because it can get uncomfortable.”

If you don’t have a neti pot, you can put some of the water in your clean hands, hold one nostril closed with your finger and pour the water into the other one, then switch. The whole process each time should take no more than five minutes, he said.

He also suggests people use the lower salt dose. “I actually tried it myself when I got infected,” he said of his two bouts, neither resulting in hospitalization. “I tried both to compare and found the high dose a little uncomfortable.” But, he said: “It really helped a lot with congestion. I could breathe better, and rest better.”

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The caveats

The hospitalization rates in both groups studied were unusually high, probably because of demographics, more covid risk factors and the fact that overall vaccination rates in all the groups were relatively low.

It’s not known whether gargling and nasal rinsing would have a similar effect in mostly vaccinated patients. In this study, the researchers found that about 20 percent of those who gargled were hospitalized, compared with about a 60 percent hospitalization rate in the reference group.

Moreover, the research did not have a blinded placebo “control” group: that is, a study arm in which some participants received an alternative treatment or no treatment at all.

Matthew Rank, chair of allergy, asthma and clinical immunology at the Mayo Clinic in Arizona, who was not part of the study, said the lack of a placebo control group limits the conclusions that can be drawn from the research. He said he wouldn’t yet recommend the practice either for treating covid in infected patients or for preventing it among healthy individuals.

“I don’t think the current evidence is strong enough to recommend it for infection,” he said. “Although patients could choose to do this, as the harm is likely low in trying it.”

Espinoza acknowledged the limitations of the research but noted it would be difficult to have a true placebo control group because participants would know whether they were gargling with salt water.