Hypertonic saline nasal irrigation and gargling as an inexpensive practical adjunctive weapon to combat asymptomatic SARS-CoV-2 infections. A case report

Background: Preventive policies and harmful lockdowns in Italy, Western Europe, the United States, as well as in other developing countries worldwide seem unable to contain the intensive care burden and deaths for severe acute respiratory syndrome coronavirus 2 (COVID-19), especially in nursing homes. Prompted by the limited evidence available, we wonder why until now only one publication (JAMA Otolaryngol Head Neck Surg doi:10.1001/jamaoto.2020.1622) has documented how repetitive nasal rinsing and gargling with hypertonic saline (a solution three to four times as salty as normotonic saline) could quickly contribute as an adjunctive cost-free weapon to current health policies for use against new coronavirus 2019 (SARS-CoV-2) infections at an early stage, also in quarantined people, and in developing countries. Case presentation: We report the case of a 54-year-old asymptomatic SARS-CoV-2 infected physician (positive nasopharyngeal swab test) quarantined in Rome in whom hypertonic saline nasal rinsing and gargling several times a day at home induced a rapid successful response. The infected physician remained asymptomatic, and serum immunoglobulin IgG for SARS-CoV-2 tested negative two months after the infection. Discussion and conclusions: Our case report, describing at more than two months after the SARS-CoV-2 infection negative serum IgG, seemingly supports recent evidence suggesting that asymptomatic subjects treated early with hypertonic saline solutions avoid multi-organ inflammation needing intensive care. In the current urgency state, health authorities could advocate hypertonic saline nasal rinsing and gargling as an adjunctive inexpensive procedure for SARS-CoV-2 “wash-out”. This proven, generally safe saline expedient might help as an adjunctive weapon like handwashing to combat the SARS-CoV-2 infection early in developed and developing countries, or returning as second COVID-19 waves.