Since its emergence as severe outbreak in China in December 2019, coronavirus disease 2019
(COVID-19) has spread so rapidly in the world that more than 780,000 cases have so far been
reported worldwide and since then the WHO has declared it as a pandemic. The rapid spread of
the disease is imposing major threats on healthcare systems in many countries in the world
The major threat to these healthcare systems so far has been the large number of patients who
will need respiratory support (ventilators) because of the severe lung injury associated with
COVID-19.This disease shares similar pathogenetic, epidemiological and clinical features to
the two previously reported coronavirus epidemics (severe acute respiratory syndrome [SARS]
and Middle East respiratory syndrome [MERS]) to COVID-19. However little is currently known
about SARS-CoV-2 with no established therapy or vaccine.
Lai et al in their 2005 publication showed that "Even with a relatively high virus load
(SARS-CoV) in the droplet, rapid loss of infectivity was observed for paper and cotton
material" and that "all disinfectants (used in the study) reduced the virus load (SARS-CoV)
by 13 log within 5 min after incubation". In addition, it has been shown that viruses
(including corona family of viruses) can be de-activated when they come in contact with
surfaces covered with sodium chloride (table salt). This can be explained by "physical
destruction of virus during recrystallization of coated salts. When the salt-coated fiber is
exposed to virus aerosols, salt crystals below the aerosol droplet dissolve to increase
osmotic pressure to virus. Due to evaporation, the salt concentration of the droplet
significantly increases and reaches the solubility limit, leading to recrystallization of
salt. As a consequence, virus particles are exposed to increasing osmotic pressure during the
drying process and are physically damaged by crystallization." In 1961, Spier et al showed
that viral replication is inhibited by the presence of chloride / halide salts. In addition,
a recent report showed that non-myeloid cells (e.g. epithelial, fibroblast and hepatic cells)
have an innate immune mechanism, which is augmented in the presence of salt (NaCl). The same
report also showed that, in cell culture models, DNA, RNA, enveloped and non-enveloped
viruses are all inhibited in the presence of NaCl. The antiviral effect was dependent on the
availability of chloride ions (and not sodium ions). In the presence viral infection and the
availability of NaCl, cells utilize the chloride ions to produce hypochlorous acid (HOCl).
Since HOCl is the active ingredient in bleach, which is known to have an antiviral effect,
the mechanism could be augmented by supplying chloride ions through NaCl to treat viral
infections. The Edinburgh and Lothians Viral Intervention Study (ELVIS), a pilot RCT of
hypertonic saline nasal irrigation and gargling (HSNIG) versus standard care in adults with
URTI showed a reduction in the duration of illness by 1.9 days (p = 0.01), less
over-the-counter medications use by 36% (p = 0.004), less disease transmission within
household contacts by 35% (p = 0.006) and less viral shedding by ≥0.5 log10/day (p = 0.04).
Hypertonic saline (HTS) has also been shown to have anti-inflammatory effects on lung
epithelium. In addition, inhaled HTS has been shown to have beneficial effects when used for
patients with lung diseases (e.g. cystic fibrosis).
Therefore, the combination of the antiviral properties on surfaces and the anti-inflammatory
effects of HTS renders such widely available, affordable and cheap therapy amenable for
exploring as potentially beneficial in reducing the severity of lung injury in patients with
symptomatic COVID-19 with very minimal risk to the patients.
This proposal aims at testing the effect of spraying the routinely used face masks (or for
that matter any material to cover nose and mouth) with HTS on the severity of respiratory
symptoms and signs of patients with confirmed COVID-19. In addition, the rate for ICU
utilization will be monitored.