Pharmacokinetic‐based failure of a detergent virucidal for severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) nasal infections: A preclinical study and randomized controlled trial

Esther, Charles R.; Kimura, Kyle S.; Mikami, Yu; Edwards, Caitlin E.; Das, Suman; Freeman, M.H.; Strickland, Britton A.; Brown, Hunter M.; Wessinger, Bronson C.; Gupta, Veerain; Wahlde, Kate Von; Sheng, Quanhu; Huang, Li; Bacon, Daniel R.; Kimple, Adam J.; Ceppe, Agathe; Kato, Takafumi; Pickles, Raymond J.; Randell, Scott H.; Baric, Ralph S.; Turner, Justin; Boucher, Richard C.

doi:10.1002/alr.22975

Cited by 6 publications

(2 citation statements)

References 34 publications

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“…It reported the pharmacokinetic failure of the intervention to reduce viral load but did not discuss the apparently superior resolution of clinical symptoms apart from one graph without statistical parameters. 41 Huijghebaert et al raise multiple plausible mechanisms by which a salinated nasal biome might reduce symptoms irrespective of viral load: improved mucociliary clearance, reduced risk of microaspiration, and two mechanisms reducing viral ACE2/TMPRSS2 uptake, reduced furin cleavage and shunting viral particles to the mucosal surface. 42 A study of 170 hospital workers found only 1.2% of those doing oral and nasal rinses became symptomatic and PCR positive, compared to 12.7% in the control group ( P = 0.0039).…”

Section: Discussionmentioning

confidence: 99%

Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients

et al. 2022

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Objective To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity. Methods Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive. Results Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation ( X2 = 8.728, P = .0031) regardless of additive. Conclusion SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate.

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Section: Discussionmentioning

confidence: 99%

Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients

et al. 2022

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“…For the current study, we first included participants with confirmed COVID-19 enrolled as part of a randomized controlled trial (RCT) examining the effect of several types of nasal irrigations on COVID-19-related outcomes. The detailed methods for this RCT have been reported previously [14][15][16]. Inclusion criteria included age ≥18 years, a qualitative PCR test positive for SARS-CoV-2 performed at Vanderbilt University Medical Center (VUMC) or one of its affiliated centres, planned self-quarantine after being diagnosed with COVID-19, and residence within a 30 mile radius of the main VUMC campus in Nashville, Tennessee.…”

Section: Overview Of the Study Designmentioning

confidence: 99%

Upper respiratory tract microbiota dynamics following COVID-19 in adults

et al. 2023

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To date, little is known about the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic, on the upper respiratory tract (URT) microbiota over time. To fill this knowledge gap, we used 16S ribosomal RNA gene sequencing to characterize the URT microbiota in 48 adults, including (1) 24 participants with mild-to-moderate COVID-19 who had serial mid-turbinate swabs collected up to 21 days after enrolment and (2) 24 asymptomatic, uninfected controls who had mid-turbinate swabs collected at enrolment only. To compare the URT microbiota between groups in a comprehensive manner, different types of statistical analyses that are frequently employed in microbial ecology were used, including ⍺-diversity, β-diversity and differential abundance analyses. Final statistical models included age, sex and the presence of at least one comorbidity as covariates. The median age of all participants was 34.00 (interquartile range=28.75–46.50) years. In comparison to samples from controls, those from participants with COVID-19 had a lower observed species index at day 21 (linear regression coefficient=−13.30; 95 % CI=−21.72 to −4.88; q=0.02). In addition, the Jaccard index was significantly different between samples from participants with COVID-19 and those from controls at all study time points (PERMANOVA q<0.05 for all comparisons). The abundance of three amplicon sequence variants (ASVs) (one Corynebacterium ASV, Frederiksenia canicola , and one Lactobacillus ASV) were decreased in samples from participants with COVID-19 at all seven study time points, whereas the abundance of one ASV (from the family Neisseriaceae ) was increased in samples from participants with COVID-19 at five (71.43 %) of the seven study time points. Our results suggest that mild-to-moderate COVID-19 can lead to alterations of the URT microbiota that persist for several weeks after the initial infection.

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