Nasal Calcium-Rich Salts for Cleaning Airborne Particles from the Airways of Essential Workers, Students, and a Family in Quarantine

Edwards, David A.; Salzman, Jonathan; Devlin, Tom; Langer, Robert

doi:10.1142/s2529732520400040

Cited by 13 publications

(15 citation statements)

References 16 publications

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“…Our finding that the proportion of small respiratory droplets [the majority of particles exhaled in all subjects, as has been previously observed (23)] increased at the peak of COVID-19 infection in NHPs (Fig. 4) confirms a previously published observation (17) from the exhaled aerosol profile of a single COVID-19 positive human subject, and suggests that, at peak infection, there may be an elevated risk of the airborne transmission of SARS-CoV-2 by way of the very small droplets that transmit through conventional masks and traverse distances far exceeding the conventional social distance of 2 m.…”

Section: Discussionsupporting

confidence: 92%

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Exhaled aerosol increases with COVID-19 infection, age, and obesity

Edwards

Ausiello

Salzman

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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195

143

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COVID-19 transmits by droplets generated from surfaces of airway mucus during processes of respiration within hosts infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. We studied respiratory droplet generation and exhalation in human and nonhuman primate subjects with and without COVID-19 infection to explore whether SARS-CoV-2 infection, and other changes in physiological state, translate into observable evolution of numbers and sizes of exhaled respiratory droplets in healthy and diseased subjects. In our observational cohort study of the exhaled breath particles of 194 healthy human subjects, and in our experimental infection study of eight nonhuman primates infected, by aerosol, with SARS-CoV-2, we found that exhaled aerosol particles vary between subjects by three orders of magnitude, with exhaled respiratory droplet number increasing with degree of COVID-19 infection and elevated BMI-years. We observed that 18% of human subjects (35) accounted for 80% of the exhaled bioaerosol of the group (194), reflecting a superspreader distribution of bioaerosol analogous to a classical 20:80 superspreader of infection distribution. These findings suggest that quantitative assessment and control of exhaled aerosol may be critical to slowing the airborne spread of COVID-19 in the absence of an effective and widely disseminated vaccine.

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Section: Discussionsupporting

confidence: 92%

“…In a companion article ( 17 ), exhaled aerosol particle numbers from a COVID-19−infected human subject were reported between 8 and 12 d postsymptoms. These results were compared with exhaled aerosol particle numbers from three family members in quarantine.…”

Section: Discussionmentioning

confidence: 99%

Exhaled aerosol increases with COVID-19 infection, age, and obesity

Edwards

Ausiello

Salzman

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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195

143

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“…On the other hand, delivery of hypertonic salt droplets to the trachea and main bronchi increases water content both by the delivery of water mass and the hypertonicity of the water delivered. Our recent work (32,(37)(38)(39) indicates that when the salts are divalent they prolong the stabilization effect of the mucus surface for 4 -6 hours relative to 1-2 hours on the breathing of humid air or the delivery of sodium chloride salt to the same anatomical regions.…”

Section: Discussionmentioning

confidence: 99%

“…Hydration of the upper airways by the delivery of hypertonic divalent salts therefore reduces respiratory droplet generation in the upper airways to 4-6 hours (32,(38)(39)(40) relative to a suppression of exhaled respiratory droplets of 60 to 90 minutes on the breathing of humid air or the delivery of normal saline droplets (32).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 symptoms reduce with targeted hydration of the nose, larynx and trachea

George

Scheuch²,

Seifart

et al. 2021

Preprint

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Dirty air and poor access to healthcare threatens the lives of billions of people in low-income regions of the world. We investigated whether upper-airway hydration might alter two-phase flow in the airways on normal tidal breathing and be a useful, safe, easily distributed non-drug intervention for limiting risks of COVID-19. In observational human volunteer studies involving 464 human subjects in Marburg, Germany (357 normal subjects), Boston, US (20 healthy subjects), and Bangalore, India (87 subjects recently tested positive for COVID-19), we find that respiratory droplet generation increases by up to 4 orders of magnitude with up to 1% total body mass dehydration (n=20), and in dehydration-associated states of advanced age (n=357), elevated BMI-age (n=148), and SARS-CoV-2 infection (n=87). Hydration of the nose, larynx and trachea in a protocol of exercise-induced dehydration by the nasal inhalation of calcium-rich hypertonic salt droplets of mean diameter 8-12 μm diminished respiratory droplet numbers and increased oxygenation relative to a non-treatment control (P<0.05). In a randomized double-blinded nasal-saline control study, thrice-a-day delivery of the calcium-rich hypertonic salts (active) over three days suppressed respiratory droplet generation by 51% +/- 11% and increased oxygen saturation by 48.08% ± 9.61% (P<0.001) in COVID-19 positive subjects (n=20), while no changes in exhaled aerosol (P=0.235) or oxygen saturation (P=0.533) were observed in the nasal-saline control group (n=20). In the active group 47% of patients discharged with no self-reported symptoms while all of the subjects in the nasal saline group discharged with lingering symptoms. Hydration of the upper airways appears promising as a non-drug approach for reducing risks of lower respiratory-tract infections such as COVID-19.

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“…Presenting exhaled aerosol data as we do in figure 1 in ref. 2, from highest to lowest exhaled aerosol number, illustrates that individuals in the study exhaled a continuum of respiratory droplet numbers across several orders of magnitude, as appears to be common to large groups of human subjects (3,4). Our distinction, in the article, of two groups, superspreaders and low spreaders (of exhaled aerosol), is based on the observation that ∼20% of the individuals exhaled ∼80% of the aerosol-a classical superspreader distribution of airborne infectious disease (5).…”

mentioning

confidence: 87%