Pandemics Caused by Airborne Viruses: Can Enhanced Oronasal Hygiene Help Mitigate the Impact?

“ Cite:

Najbauer J. Pandemics Caused by Airborne Viruses: Can Enhanced Oronasal Hygiene Help Mitigate the Impact? LinkedIn Article, 2025 Feb 13. https://lnkd.in/d74Zdf5e

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The oral cavity and the nasal passages are the main portals of entry for airborne pathogens infecting the respiratory system and causing thousands or millions of fatalities or serious illness with long-term complications. Clearly, more research should be done to find safe and effective approaches to improve the physiological defenses with which the upper respiratory tract is equipped to ward off infections by airborne and non-airborne pathogens (Figure 1). The saliva, mucus and the mucosal immune system of the oral and nasal airways can trap, neutralize or kill various pathogens that are poised to enter the lower respiratory tract (Figure 2), and may cause mild or serious illness, or in many cases, death. In the wake of the recent COVID-19 pandemic with millions of fatalities and long-COVID cases, the yearly seasonal influenza outbreaks, and the present threat from avian influenza (H5N1) or other zoonotic pathogens, should prompt us to utilize every means available to prevent the outbreaks and pandemics, or if they occur, to mitigate their impact. Of prime importance are effective monitoring, international collaboration, vaccination programs, travel restrictions, social distancing, hygiene, and facial mask wearing, among others. Here, I argue that, in addition to these measures, we might want to further explore and implement on a wider scale a simple, cost-effective and safe method for improving the oronasal hygiene and thus decreasing (or eliminating) the pathogen load of the upper and lower respiratory tracts by Oronasal Saline Rinse (OSR).

Data from published research (detailed below) suggest that OSR may be a simple, cost-effective, and safe method for decreasing (or eliminating) the pathogen load of the respiratory tract and improve the clinical outcomes of patients infected with SARS-CoV-2.

Benefits of oronasal saline rinses

1. Clears mucus and debris: Saline rinses help to clear out mucus and debris from both the nasal passages and the oral cavity, making it easier to breathe and maintain oral hygiene.
2. Moistens nasal passages and mouth: They moisten the nasal passages and the mouth, which can become dry due to indoor air or other environmental factors.
3. Removes allergens: Saline rinses can remove allergens such as dust, pollen, and other debris from the nasal passages and the oral cavity, reducing irritation and inflammation.
4. Thins mucus: They help to thin out stubborn, thick mucus in both the nasal passages and the mouth, making it easier to expel while blowing your nose, coughing, or spitting.
5. Reduces inflammation: Saline rinses can reduce inflammation in the mucous membranes of the nasal passages and the mouth, providing relief from symptoms of sinus infections, allergies, colds, and flu.
6. Improves mucociliary clearance: They enhance mucociliary clearance in the nasal passages and help maintain oral hygiene, keeping the airways clear of pathogens and debris.
7. Prevents infections: Regular use of saline rinses can help prevent infections by reducing the pathogen load in both the nasal passages and the oral cavity. ??

(compiled with the help of Copilot AI)

Additional research could determine whether regular use of OSR would be effective also at preventing coronavirus and seasonal influenza infections, or respiratory tract infections by other viruses and bacteria. Investigation of the functioning of the mucosal immune system and developing mucosal immunization methods are of high priority.

An international collaborative research effort to further investigate the structure and function of the respiratory mucosal immune system and the possibility of enhancing its protective potential, and exploring the possibility of utilizing well-characterized symbiotic bacteria for repopulating the oral cavity for enhanced protection deserves further discussion and careful evaluation. Such a project could involve close collaboration and data sharing by experts from wide-ranging fields, including: infectious disease experts, epidemiologists, microbiologists, virologists, microbiome researchers, immunologists, vaccinologists, bioengineering scientist, clinicians, ear-nose-throat doctors, pulmonologists, family physicians, dentists, pharmacologists, medicinal chemists, AI experts, public health officials, science project managers, as well as the World Health Organization, among others. Such research could potentially yield significant advances in protecting the global community from infectious disease outbreaks and pandemics.

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Key facts about recent pandemics and current threats

1.???? COVID-19 pandemic (data as of Jan 5, 2025, WHO)

a)???? Total cumulative number of cases = 777 million

b)???? Total cumulative number of deaths = 7.1 million

c)???? An estimated 6% of people with symptomatic SARS-CoV-2 infections developed long-COVID symptoms = 46.6 million

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2.???? Seasonal influenza (data as of Oct 3, 2023, WHO)

a)???? Average number of cases globally per year = 1 billion

b)???? Respiratory deaths annually = 290?000 to 650?000

c)???? Cases of severe illness annually = 3–5?million

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3.???? Influenza (avian and other zoonotic) (WHO website)

Humans can be infected with avian, swine and other influenza viruses. Currently circulating zoonotic influenza viruses have not yet demonstrated sustained person-to-person transmission. However, there is a risk that avian (H5N1) and other zoonotic influenza viruses will become airborne and may cause a pandemic in the future.

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A hypothetical scenario

It should be noted that a 10%, 5% or just 1% decrease in outcomes resulting from regular use of Oronasal Saline Rinse (OSR), and using the above numbers as examples, many precious lives could be saved or severe illnesses and long-lasting complications averted.

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NOTE

Any of the ideas presented here regarding mouth rinsing/gargling or nasal irrigation with saline, or other ideas, should be first discussed with the health care provider.

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References

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Espinoza SR, Trauffler L, Shamshirsaz A, Espinoza A, Espinoza J, O'Brien A. Double-blind randomised trial of saline solution for gargling and nasal rinsing in SARS-CoV-2 infection. J Glob Health. Dec 30 2024;14:05044. doi:10.7189/jogh.14.05044

Huijghebaert S, Parviz S, Rabago D, et al. Saline nasal irrigation and gargling in COVID-19: a multidisciplinary review of effects on viral load, mucosal dynamics, and patient outcomes. Front Public Health. 2023;11:1161881. doi:10.3389/fpubh.2023.1161881

Man WH, de Steenhuijsen Piters WA, Bogaert D. The microbiota of the respiratory tract: gatekeeper to respiratory health. Nat Rev Microbiol. May 2017;15(5):259-270. doi:10.1038/nrmicro.2017.14

Nesbitt H, Burke C, Haghi M. Manipulation of the Upper Respiratory Microbiota to Reduce Incidence and Severity of Upper Respiratory Viral Infections: A Literature Review. Front Microbiol. 2021;12:713703. doi:10.3389/fmicb.2021.713703

Pantazopoulos I, Chalkias A, Mavrovounis G, et al. Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial. Can Respir J. 2022;2022:8794127. doi:10.1155/2022/8794127

Pantazopoulos I, Chalkias A, Miziou A, et al. A Hypertonic Seawater Nasal Irrigation Solution Containing Algal and Herbal Natural Ingredients Reduces Viral Load and SARS-CoV-2 Detection Time in the Nasal Cavity. J Pers Med. Jul 03 2023;13(7)doi:10.3390/jpm13071093

Rajasekaran JJ, Krishnamurthy HK, Bosco J, et al. Oral Microbiome: A Review of Its Impact on Oral and Systemic Health. Microorganisms. Aug 29 2024;12(9)doi:10.3390/microorganisms12091797

Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. Jun 2020;10(1):010332. doi:10.7189/jogh.10.010332

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Further reading

Alqahtani SAM. Mucosal immunity in COVID-19: a comprehensive review. Front Immunol. 2024;15:1433452. doi:10.3389/fimmu.2024.1433452

Einav T, Gentles LE, Bloom JD. SnapShot: Influenza by the Numbers. Cell. Jul 23 2020;182(2):532-532.e1. doi:10.1016/j.cell.2020.05.004

Gustafsson JK, Hansson GC. Immune Regulation of Goblet Cell and Mucus Functions in Health and Disease. Annu Rev Immunol. Jan 03 2025;doi:10.1146/annurev-immunol-101721-065224

Hewitt RJ, Lloyd CM. Regulation of immune responses by the airway epithelial cell landscape. Nat Rev Immunol. 2021;21(6):347-362.

Mercer J, Lee JE, Saphire EO, Freeman SA. SnapShot: Enveloped Virus Entry. Cell. Aug 06 2020;182(3):786-786.e1. doi:10.1016/j.cell.2020.06.033

Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 09 2020;17(9):543-558. doi:10.1038/s41569-020-0413-9

Oberfeld B, Achanta A, Carpenter K, et al. SnapShot: COVID-19. Cell. May 14 2020;181(4):954-954.e1.Zdoi:10.1016/j.cell.2020.04.013

?z?am M, Lynch SV. The gut-airway microbiome axis in health and respiratory diseases. Nat Rev Microbiol. Aug 2024;22(8):492-506. doi:10.1038/s41579-024-01048-8

Vabret N, Britton GJ, Gruber C, et al. Immunology of COVID-19: Current State of the Science. Immunity. 06 2020;52(6):910-941. doi:10.1016/j.immuni.2020.05.002