Viral infections begin when the virus is implanted at a portal of entry and begins replicating. The most common portals are the nose, throat and upper airways,1 which led to a recent initiative to educate people on the importance of nasal hygiene.2
A virus is either DNA or RNA and requires another living cell to replicate, which ultimately leads to symptoms. There are several factors that determine viral transmission, which include the size of the virus and the size of the respiratory aerosol.3 The largest viruses are 500 nanometers (nm) in diameter, just visible “under a light microscope on the highest resolution,” according to Britannica.4
The COVID-19 virus is 100 nm in diameter,5 far smaller than the holes in a standard cloth mask can filter,6 which is just one of the reasons mask mandates are not effective.
Viruses don't move on their own, but depend on people, the environment and other pieces of equipment to gain access to a host.7 Once a virus like the influenza virus is inhaled, if it's not neutralized it can invade the respiratory tract and airway cells.8
Viruses that cause the common cold are spread through the air and close personal contact with respiratory secretions or stool of a person who is infected.9 Shaking hands or touching a contaminated surface, and then touching your eyes, nose or mouth, can inoculate your membranes with the virus.
SARS-CoV-2 is known to enter the body through the nasal epithelial cells.10 The “Sanitize Your Nose”11 campaign was launched by Global Life Technologies, maker of Nozin Nasal Sanitizer.12
Nasal Decontamination Is Not New
The Sanitize Your Nose campaign was launched in mid-2020 to raise public awareness that together with routine hand washing, the practice of reducing viral load in the nasal cavity may help to reduce the spread of viruses.
According to their press release,13 9 out of 10 Americans understand handwashing helps reduce the risk of infection, but only 3 out of 10 understand that reducing the viral and bacterial load in the nasal cavity may also help reduce the risk.
The active ingredient in Nozin Nasal Sanitizer is 62% ethyl alcohol in combination with natural oils, including coconut oil, jojoba, lauric acid and vitamin E.14 The company's website states:15
“… the formula combines the safe, proven, antiseptic power of ethyl alcohol with the emollient, antioxidant benefits of natural oils. [and] … does not promote antibiotic resistance as it utilizes the non-selective antiseptic action of ethanol.”
The nasal spray has been in use to reduce the spread of Staphylococcus aureus16 but is now being advertised by the company to help reduce SARS-CoV-2 viral load and thus impact the potential for an active infection.
Each ampule is approved for one-time use for adults and children over 12 years. Once opened, the sleeve is squeezed to wet the swab tip and then swabbed around the outside of the nostril six times in each direction.17
Application of the ethanol alcohol and natural oils mixture has demonstrated a broad-spectrum efficacy against pathogenic organisms for up to eight hours. Specifically, it was shown to reduce colonization of S. aureus and other nasal bacteria.18
New Antiviral Nose Spray Promises 99.9% of Viruses Killed
The Health Ministry in Israel recently approved the production19 of an at-home antiviral the inventors claim is effective within two minutes to reduce 99.9% of viruses in the nasal cavity. Biochemist Gilly Regev, Ph.D., invented the product and cofounded the company SaNOtize, which is based in Canada.
Israel will be the first country where the product will be sold and has been given approval for sale in people aged 12 and up.20 It has also been approved in New Zealand and the company is seeking approval in other countries, including the U.K. The product delivers a physical barrier in a combination with nitric oxide, known to kill viruses.21,22
The product will be sold under the brand name Enovid,23 for which clinical trials were recently completed demonstrating the antiviral treatment was effective in preventing the transmission of SARS-CoV-2, shortening the course of the disease and reducing the severity of symptoms in people who were infected. Chief science officer and co-founder Chris Miller, Ph.D., said in a press release:24
“Our novel formulation of Nitric Oxide for use in humans is designed to kill viruses in the upper airways, preventing them from incubating and spreading to the lungs. The pharmacology, toxicity, and safety data for use in humans has been well-established for decades. Our innovative product design also allows the treatment to be self-administered effectively and affordably.”
In a separate press release announcing the results of the clinical trials,25 the company said it was applying for emergency use authorization in the U.K. and Canada, which would facilitate a nearly immediate return to work, school and society, well ahead of the anticipated return following full vaccinations.
In addition to reducing infection in those who have not been vaccinated, the nitric oxide nasal spray (NONS) also reduced infectivity or the transmission of the virus. Regev said:26
“Now that NONS has been demonstrated to be safe and effective in clinical trials, we must move with urgency to get it into the hands of the public where it can help bring an end to the pandemic, accelerate a return to normality, and prevent future outbreaks of COVID-19 and its variants.
The human toll of this disease cannot be expressed simply in numbers, and each day compounds the frustration, fear and loss suffered by millions around the world. Combined with the roll-out of vaccines, NONS can help get the world back on its feet.”
In a video27 describing Enovid, Regev stressed that one day COVID-19 would no longer be a threat, but the product would continue to be an effective deterrent for any type of viral infection, including flu or the next pandemic.
History of Sanitizing Your Nose to Lower Infection
The Centers for Disease Control and Prevention28 currently recommends hospitals use strategies to reduce the colonization of S. aureus before major surgeries to reduce the risk of post-surgical infection. Sue Barnes, infection control specialist, is a member of the Sanitize Your Nose advisory board. In a press release, she said:29
“Health care professionals have long recommended that patients have their noses sanitized before surgeries and other periods of heightened vulnerability to help prevent infections. Now is the perfect time to look beyond the health care setting and encourage everyone to incorporate sanitizing the nose into their regular routines, especially when they are heading into higher risk environments, such as crowded public places.”
However, most of the research has been done on reducing bacterial nasal contamination prior to surgical procedures and not the reduction of viral transmission. A study published in Cochrane Database of Systematic Reviews30 in 2017 looked at surgical site infection rates and the potential for nasal decontamination to reduce post-surgical infections, specifically from S. aureus colonizing the nasal cavity.
A literature search located two studies that were included in the review. The authors concluded there was limited evidence from randomized controlled trials that nasal decontamination could prevent surgical infections.
Another study31 evaluated the use of the antibiotic mupirocin to eliminate S. aureus before open-heart surgery. The intervention group received the medication four times a day for 48 hours before the surgery. The evidence suggested mupirocin lowered the incidence of sternal wound infection but did not change the frequency of skin infections or pneumonia after open-heart surgery.
A third study32 found preoperative nasal decontamination for S. aureus significantly decreased postoperative infections following surgery for adolescent idiopathic scoliosis.
A literature review33 assessing the relationship between S aureus colonization in the nose and the development of post-surgical infection again found a positive trend, but the researchers acknowledged the samples were too small to demonstrate the efficacy of pretreatment to eradicate post-surgical infection.
In a letter to the editor,34 anesthesiologist Dr. Duncan McGuire proposed that decolonization of the nasal cavity in the hospital may not be effective. He pointed out past research demonstrated reducing S. aureus may help prevent surgical site infections, but research has not presented “substantive evidence that nasal/oral decontamination would actually reduce viral transmission.”35
The letter followed the release of a study36 demonstrating the application of povidone-iodine may contribute to infection control and operating room management strategies. The data also showed 42% of the participants experienced short term thyroid dysfunction with the intervention that resolved after treatment was discontinued.
McGuire’s concern was the application of povidone-iodine can induce sneezing and thus increase the spread of viral particles. The use of chlorhexidine mouth rinse can induce coughing, which can also raise the risk of viral spread before the virus was inactivated by the povidone-iodine.
Routine Nasal and Sinus Irrigation May Lower Viral Load
It’s possible that regularly rinsing your nasal cavity and sinuses, where the viral load of SARS-CoV-2 tends to reside, would help clear the pathogen and prevent it from gaining a strong foothold. Past research has shown that nasal irrigation can reduce the symptoms and duration of other viral conditions such as seasonal flu and the common cold.
In one randomized controlled trial,37 participants who used nasal irrigation and gargling with hypertonic saline reduced duration of the common cold by 1.9 days and transmission within the household by 35% when the intervention was started within 48 hours of the onset of symptoms.
Dr. Amy Baxter, a pediatric emergency medicine physician in Atlanta, Georgia, suggests38 irrigating your sinuses any time you’ve been exposed to an infected individual or test positive for COVID-19. She recommends flushing your sinuses using a mixture of boiled lukewarm water (8 ounces) and povidone-iodine (half a teaspoon).
Povidone-iodine has been shown to effectively kill not only Klebsiella pneumoniae and Streptococcus pneumoniae bacteria, but also rapidly inactivates SARS-CoV, MERS-CoV, H1N1 influenza virus A and rotavirus after 15 seconds of exposure.39
The mixture used in this study — 7% povidone-iodine diluted 1-to-30, bringing the total concentration to 0.23% povidone-iodine — inactivated over 99% of the coronaviruses causing SARS and MERS.40
Either a neti pot or sinus rinse bottle can be used. The water pressure you get from a sinus rinse bottle can provide a more effective flush. However, if higher pressure is uncomfortable, a neti pot, which relies on gravity, may be a more comfortable choice.
Nasal and sinus irrigation using a neti pot is another way of physically removing allergens that trigger seasonal allergic reactions. The water is administered through one nostril, flows through the nasal passages and sinuses and out the other nostril.
It is crucial you do not use tap water in your neti pot as it burns and could trigger a deadly brain infection from an amoeba that's commonly found in the lakes, rivers and hot springs that feed the tap water supply.41 Instead, use a saline solution of distilled water and salt.
Preventive Strategy Using Nebulized Hydrogen Peroxide
One of my favorite preventive strategies you can use at home is nebulized hydrogen peroxide. The treatment was first conceived and championed by Dr. Charles Farr42 in the early 1990s. Since then, thousands of doctors have used the treatment for upper respiratory infections.
In March 2021, I interviewed Dr. David Brownstein, who has a clinic just outside Detroit, Michigan, where he has successfully treated over 200 patients with nebulized hydrogen peroxide. When the treatment is initiated within the first couple days of infection, Brownstein has found it significantly reduces the number of patients who will experience long-haul syndrome from COVID-19.
In the article linked above, he shared that in his initial 107 patients, just 2% develop long-haul syndrome, which is in stark contrast to the 20% to 40% reported elsewhere. In my interview with Dr. Vladimir Zelenko, in which we discussed hydroxychloroquine treatment, he also found that none of the patients treated within the first five days of symptoms went on to develop long-haul syndrome.
In March 2020, Dr. Thomas Levy published guidance43 on how to use nebulized hydrogen peroxide for the prevention and treatment of all viral respiratory infections, including COVID-19.
To use the protocol, you'll want to use food-grade peroxide, which comes in concentrations of 12% and must be diluted to 1% or less before use. This is administered with a nebulizer that emits a fine mist and a face mask that covers your mouth and nose. The mist can be comfortably inhaled deep into your nostrils, sinuses and lungs where it inactivates viral pathogens.
For more information about how it works, and a video demonstrating how to mix the solution and use a nebulizer, see “How Nebulized Peroxide Helps Against Respiratory Infections.”