Home Noses and common sense in the time of COVID-19


We Americans don't give noses much respect.  If we don't want a cartoon character to be taken seriously, we give him/her a big nose, perhaps with prominent nostrils.  To be "nosy" is to be a type of pest.  One of the cardinal social sins is nose-picking in public.  And a favorite form of plastic surgery is a "nose job", invariably involving reduction of tissue.  But we're most irrational when it comes to nasal health problems, when squeamishness prevails over practicality.  An infected nose is dealt with indirectly in most cases, i.e., with pills or drinking fluids, and if it continues to misbehave, with anti-inflammatory weapons such as steroids, especially when appearance in public is imminent.  Sinus infections seem to come out of nowhere and doctors dread to treat them with antibiotics.  It's easy to conclude that we Americans think our noses are the enemy.

But now that SARS-CoV-2 has arrived in our country, the nose and its afflictions are no longer a laughing matter.  But there is a peculiar mental block about it.  Although tests for the presence of the virus involve nasal swabs and studies have been done involving measurements of viral loads in children's noses, we really don't think of the nose in terms of it being the entrance point of this germ.  Somehow, we seem to visualize the virus as making a dive for the lungs, even bypassing the throat, which is understandable given the symptoms that we need to watch for according to the authorities. 

On the other hand, many people with COVID-19 are mysteriously "asymptomatic" or "presymptomatic", which bewilders our public health experts.  Wearing masks has been shown to be effective in reducing the spread of the disease, but supposedly not because infecting agents vulnerable to attacks by any germ-killing substances might be lurking in the nose, making their presence felt by inflicting a special type of misery that should count as a symptom.  Unusually bad nose pain, perhaps spreading toward the throat or ears, is likely to be treated as a nuisance, rather than a warning sign of something much worse.  But shouldn't we wonder how to nip such an infection in the bud, before it progresses to other parts of our body?  Or is a direct approach, rather than one that merely relieves symptoms, too unpleasant to contemplate? 

A quick search on the Web shows that the most common treatments of nose infections are saline sprays, corticosteroids, antihistamines, decongestants, and over-the-counter pain relievers; of these, only saline sprays kill germs.  But infections aren't usually suspected when nose problems develop: allergies are typically assumed.  Sinusitis also pops up in this search, perhaps because it manifests itself as nasal problems.  It certainly makes sense that nose infections can lead to sinusitis and perpetuate it if not treated.  Typical medical advice for nose colds is systemic, though: get plenty of rest, drink lots of fluids, and use a humidifier. 

Could we treat our noses directly?  As of September 5, there was a clinical trial going on at the University of Wisconsin School of Medicine and Public Health (2020) studying the application of antiseptics to the nose and mouth.  But this intervention is just intended for preventive purposes by "our frontline healthcare workers" as a backup to wearing personal protective equipment (PPE) and hand-washing.   More recently, a promising method for the general public, reported by a paper with 12 authors, mostly from Erasmus University and Columbia University (McNeil, 2020), using a lipopeptide nose spray has shown success in an animal study.  Yet, one wonders, why shouldn't an antiseptic nose spray be just as effective?  But as (potential) patients trying to protect our noses, whether to prevent or to treat an infection, we're still on our own.  

It makes sense to assume the virus is everywhere, but in varying concentrations.  We still need to learn a lot about how to avoid places where the concentrations are highest, and what to do if we accidently encounter them and experience some ominous symptoms.  Masks might be our best bet right now, but they're merely containing the problem rather than fixing it.  At least until we get a safe and effective vaccine, we need something that could cut back on virus numbers as well as restrict its spread.  Why not tackle it at what is likely the main site of entry, the nose?

Copyright © 2020 by Dorothy E. Pugh.  All rights reserved. 


McNeil Jr. DG (2020) Nasal spray prevents covid infection in ferrets, study finds.  NY:The New York Times Company. Retrieved 6 Nov 2020 from https://www.nytimes.com/2020/11/05/health/coronavirus-ferrets-vaccine-spray.html

School of Medicine and Public Health, University of Wisconsin at Madison (July 28, 2020). UW study looks at new protections for frontline health care workers during COVID-19; recruitment open now. Retrieved 5 Sep 2020 from https://www.med.wisc.edu/news-and-events/2020/july/antiseptic-covid-19-prevention-study/.