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Can Nasal Antiseptics Help Prevent COVID-19?

Older woman using nasal spray

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Key Takeaways

  • In lab studies, an iodine solution has shown promise for destroying the virus that causes COVID-19. However, it hasn't been studied in the human nose and mouth.
  • There are currently several nasal antiseptic products, some of which include iodine, on the market.
  • Some experts say that the products are safe, but others would like to see more research on their safety and efficacy against the COVID-19 virus.

Nasal antiseptics are gaining popularity as people look for different approaches to prevent COVID-19. These products seem to be a promising way to thwart the virus because people touch their faces about 23 times an hour—reaching for the nose area about one-third of the time.

A July study published in the journal Infectious Diseases and Therapy looked at the use of a povidone-iodine (PVP-I) nasal antiseptic solution to combat SARS-CoV-2, the virus that causes COVID-19. 

In a controlled lab environment, PVP-I killed SARS-CoV-2 in 15 seconds. The researchers did not explore the use of the product in the human mouth and nose.

Samantha Frank, MD, a resident at UConn Health in Connecticut who has studied PVP-I, says that iodine-based antiseptics have already been used in patients with chronic rhinosinusitis (inflammation of the sinuses and nasal cavity).

“They are not new or unique to COVID-19, but fortunately inactivate SARS-CoV-2 as well. I would imagine they would gain popularity due to their effectiveness against the novel coronavirus,” Frank tells Verywell. Her research on the subject was published last month in JAMA Otolaryngology-Head & Neck Surgery.

What This Means For You

There are different types of nasal antiseptics on the market promising protection from COVID-19, but the evidence that they work in humans is lacking. If you're having symptoms, talk to your healthcare provider about the best treatment.

Iodine Nasal Antiseptics

PVP-I is a betadine solution that can destroy bacteria, fungi, and viruses. It has been used against:

  • Methicillin-Resistant Staphylococcus Aureus (MRSA)
  • Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)
  • Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV)
  • Influenza H1N1
  • Rotavirus

“Over-the-counter [OTC] nasal antiseptics, particularly those based on povidone-iodine, have been used prior to surgery, as part of infection control measures in hospitals, and as part of chronic rhinosinusitis treatment protocols for more than a decade,” Samuel Barone, MD, a founding board member for Halodine, a product that contains PVP-I and was used in the JAMA study, tells Verywell.

“They are increasing in popularity now as the COVID-19 pandemic has caused an increased awareness in infection control and a greater acceptance by the general public of measures that had been traditionally only used in healthcare settings,” Barone says.

Other Nasal Antiseptics

Other nasal sprays use benzalkonium chloride—also known as BAC, BZK, or BKC—as an active ingredient. Benzalkonium chloride differs from PVP-I.

“It is the active ingredient in many antibacterial wipes, hand sanitizers, and some nasal sprays,” Michael D. Seidman, MD, a professor of otolaryngology, head and neck surgery at the University of Central Florida, tells Verywell.

However, people would likely have to walk around with an antiseptic swab up their nose at all times to prevent COVID-19. “There is some evidence that you could swab your nose with BKC or other antiseptics and that they can last in the nasal mucosa eight to 12 hours," Seidman says. "So you could argue swabbing or spraying your nose every eight hours, but the data frankly just doesn’t exist."

A new nasal antiseptic, NanoBio, is set to launch in CVS stores across the U.S. in November. Its active ingredient is BZK. The clear film is applied to the outer area of the nose, and the positively charged nanodroplets stay active on the skin for up to 8 hours. The nanodroplets are supposed to attract the negatively charged germs and kill them on contact. The company claims the product kills 99.99% of germs on contact that causes infections and has killed SARS-CoV-2 in the lab.

Preventive Properties

SARS-CoV-2 infects, replicates, sheds, and gets transmitted from the nose. OTC nasal antiseptics sanitize the nose and inactivates the virus in the nose. That reduces the potential for spread and infection of nasal cavities.

Barone says that nasal antiseptics give people “an added layer of chemical protection at the site of COVID-19 infection, decreasing [the] risk of contracting the virus if exposed, and inactivating any virus particles in the nose before they can be expelled from the nose."

Frank is optimistic that nasal antiseptics can help prevent the spread of COVID-19 in three ways:

  • By helping to prevent asymptomatic patients from spreading COVID-19
  • By preventing the absorption of the virus if it’s on or in your nose
  • By possibly limiting the severity of COVID-19 if there is less spread from the virus in the nose to the lungs

Safety Precautions

General safety considerations for OTC nasal antiseptics are based on the active ingredient and the planned frequency of use. “There is evidence of toxicity to nasal epithelial cells with alcohol, benzalkonium chloride, and concentrations of povidone-iodine above 2.5%,” Barone says. “Lower concentrations of povidone-iodine have not shown any deleterious effects even with long-term exposure.”

Barone adds that “OTC nasal antiseptics have broad applicability and would benefit almost all, but individuals should always check with their physicians if there are specific questions."

OTC nasal antiseptics are best employed as preventative measures to help reduce the risk of infection. For example, Barone notes that if you already had a cold and were using a nasal decongestant, it’s unlikely there would be a problem.

There might even be benefits from using both, as the decongestant could reduce symptoms and clear mucous, which would allow an OTC nasal antiseptic better access to the mucosal surfaces for decontamination. 

“There is no proof that these products [PVP-I] would help fight a cold,” Frank says. “However, in respiratory infections such as COVID-19, there have been suggestions that products like these can worsen the severity as there is thought to be spread from the nose to the lungs, so therefore these products may worsen the severity of similar respiratory illnesses.”

Frank says that PVP-I antiseptics have a completely different mechanism of action than decongestants, meaning that the products should not interact. 

Currently, a trial is underway to look at how a nasal spray and oral rinse could be used in health care workers and hospital patients to protect them from COVID-19.

Alexandra E. Kejner, MD, an assistant professor of head and neck surgical oncology at the University of Kentucky, is studying PVP-I on healthcare workers and patients.

“In vitro tests have demonstrated virucidal activity but its ability to kill COVID in the human nasal cavity is why we are studying it,” Kejner tells Verywell. “The particular preparation we are using in our study is a compounded solution and not commercially available in this formulation in the United States. There is a similar formulation that is available in Canada, Hong Kong, Singapore, and Malaysia from the Betadine company.”

Amira Roess, PhD

I do worry that there is a lot of hype and misinformation out there and that people may end up hurting themselves—especially if they put homemade concoctions in their nasal cavities.

— Amira Roess, PhD

Kejner says that the preparation gained popularity during the first SARS outbreak, though it had long been used as a nasal irrigation treatment for people with chronic sinusitis, as well as for oral antisepsis for procedures with documented safety data.

Certain patients should not use the preparation, including:

  • People with thyroid disorders or cancers
  • Those with an allergy to shellfish/iodine/contrast dye
  • People who are pregnant or breastfeeding

Frank adds that people undergoing active radioactive iodine treatment should not use these products, nor should children because the safety profile has yet to be established.

Excessive dosing with iodine can be potentially harmful, Kejner says, adding that people should only use iodine-containing products when under the care of a physician. 

“The current preparation (which is a dilute solution) is currently under study to assess its efficacy at preventing the spread of COVID-19,” Kejner says, adding that the team hopes to wrap up their study soon.

Warning on Nasal Antiseptics

Amira Roess, PhD, a professor of global health and epidemiology at George Mason University in Virginia, is leery about nasal antiseptics as prevention for COVID-19.

“There is still a lot that we don't know about these potential treatments and we should wait until the recommendations are clear about who should use them," Roess tells Verywell.

Early results indicate that it might make sense for healthcare providers to use the products if they are directly dealing with COVID-19 patients, but Frank says that there's still research left to be done. “Although in vitro studies have proven effectiveness [of PVP-I], and other studies have demonstrated safety, there are not yet large-scale in vivo studies proving efficacy," Frank says.

Even if treatments are found to offer protection, any method is likely to come with some risk.

“Remember that there are beneficial microbes living in our nasal cavity and we don't want to kill all of these off,” Roess says. “I do worry that there is a lot of hype and misinformation out there and that people may end up hurting themselves—especially if they put homemade concoctions in their nasal cavities."

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Article Sources
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