{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:19:02Z","timestamp":1760015942698,"version":"3.44.0"},"reference-count":118,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The World Health Organization recommends at-home management of mild COVID-19. While our preliminary evaluation provided evidence for saline nasal irrigation (SNI) and gargling in COVID-19, an update and risk\u2013benefit assessment for self-care in Omicron infection is warranted, from treatment and preparedness perspectives, as new SARS-CoV-2 variants continuously emerge, while symptoms overlap with those of common colds and other upper respiratory tract infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic literature searches for preclinical and clinical studies involving Omicron infection and saline, bias assessment, and review of outcomes (benefits, risks).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 14 studies met eligibility criteria: one experimental proof-of-concept study, eight randomized clinical trials (RCTs), two quasi-experimental, two matched case\u2013control, and one controlled study (2,389 patients, 1,101 receiving saline). Study designs were highly heterogeneous, not allowing pooling of the data. In line with the pre-clinical findings, the clinical trials showed lower viral loads or faster viral clearance with SNI use; results were consistent, if SNI was started early in the infection. Individual studies supported reduced infectivity of saliva, inflammatory mediators and C-reactive protein, and increased lymphocytes. Symptoms resolved faster if severe at baseline, in line with the findings from pre-Omicron RCTs; the ability to perform daily activities was assessed in one RCT and improved significantly. Early initiation of daily SNI\/gargling before the onset of smell\/taste dysfunction prevented their development. Daily SNI hygiene was also associated with less frequent development of fever and a shorter duration of fever than observed among (non-irrigating) controls. Daily SNI modestly helped to reduce household transmission; a preliminary report suggests that reliable prophylaxis can be achieved, provided daily SNI is combined with strict use of personal protective measures. Hospitalization was virtually absent. Isotonic SNI was best tolerated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This analysis is consistent with prior review findings: early initiation of SNI\/gargling may help patients with mild COVID-19 feel better, irrespective of the variant. If clean water and irrigation materials are provided, SNI can reasonably be recommended as early self-care for COVID-19, as it is for the common cold. Larger prospective studies are required to determine optimal protocols and SNI\u2019s potential role in respiratory pathogen pandemic preparedness.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1462286","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T12:45:13Z","timestamp":1755693913000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Saline nasal irrigation and gargling in COVID-19: Part II. Outcomes in Omicron and risk\u2013benefit for self-care"],"prefix":"10.3389","volume":"13","author":[{"given":"S.","family":"Huijghebaert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Fabbris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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S.","family":"Chatterjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Rabago","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"year":"2023","key":"ref1"},{"year":"","key":"ref2"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1038\/s41467-024-45075-8","article-title":"Omicron spike confers enhanced infectivity and interferon resistance to SARS-CoV-2 in human nasal tissue","volume":"15","author":"Shi","year":"2024","journal-title":"Nat Commun"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1038\/s41564-022-01143-7","article-title":"SARS-CoV-2 omicron is an immune escape variant with an altered cell entry pathway","volume":"7","author":"Willett","year":"2022","journal-title":"Nat 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