Background: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. Many efforts have been made and are currently being made to prevent and treat this global disease. Objectives: This study was designed to evaluate the efficacy and safety of nebulized ethanol (EtOH) in treating COVID-19. Methods: A randomized clinical trial (RCT) of 99 symptomatic and real-time polymerase chain reaction (RT-PCR)-positive patients admitted to a hospital receiving remdesivir-dexamethasone was conducted. They were randomly assigned to receive distilled water spray (control group (CG)) or 35% EtOH spray (intervention group (IG)). Both groups inhaled three puffs of spray (nebulizer) every six hours for a week. The primary outcome included Global Symptomatic Score (GSS) between the two groups at the first visit and on days three, seven, and 14. Secondary outcomes included the Clinical Status Scale (CSS; a seven-point ordinal scale ranging from death to complete recovery) and readmission rate. Results: A total of 44 and 55 patients were enrolled in the IG and CG, respectively. Although there was no difference at admission, the GSS and CSS improved significantly in the IG (p = 0.016 and p = 0.001, respectively). The IG readmission rate was considerably lower (0% vs. 10.9%; p = 0.02). Conclusions: Inhaled-nebulized EtOH is effective in rapidly improving the clinical status and reducing further treatment. Due to its low cost, availability, and absent/tolerable adverse events, it could be recommended as an adjunctive treatment for moderate COVID-19. Further research on curative effects in more serious cases and in prevention is advisable.

Background: Considering anti coronavirus effects of ethanol, the efficacy of its administration was evaluated in this research. Because of respiratory tract entrance of virus in COVID-19, this study was done by inhalation of nebulized ethanol. Methods: 99 positive SARS-CoV-2-PCR patients who had been admitted at a respiratory clinic were included in this study. Patients were randomly assigned to the control (distilled water spray) and intervention (35% ethanol spray) group. Both groups were instructed to inhale 3 puffs of spray and inhale it, every six hours for a week. Global symptomatic score (GSS), clinical status scale, Blood Oxygenation, and C-Reactive Protein (CRP) at the first visit and days 3, 7, 14 were measured and compared between groups. Results: The GSS decreased more and faster in the intervention group (ethanol) (1.4+1.4 vs 2.3+1.7, P=0.035) two weeks after starting intervention. On day 14, the odds of intervention group to have better clinical status was 5.715 times (95% CI, 2.47 to 13.19) than of control group a statistically significant effect, Wald χ2 (1) =16.67, P =0.001. Blood oxygen saturation also improved earlier in the ethanol group but without statistical significance difference. The readmission rate was lower in the intervention group (zero vs 10.9%, P=0.02). Conclusion: Inhaled ethanol seems to be effective in improvement, mitigating clinical symptoms and reducing the need to repeat treatment. Considering the low cost, availability and no significant adverse events of ethanol, research and additional efforts are recommended to evaluate its curative effects in the early stages of COVID-19.

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