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Thailand has one of the lowest COVID-19 fatality rates anywhere. 

Thai people greet reach other with a gentle "wai" ("why"). Rather than thrusting their hand forward for a vigorous shake, the Thai put their palms together in front of their chest and slightly nod. It feels like a spiritual deep breath.

Thai people are also more likely to wear masks when they're sick. Lots of countries do both, and indeed they have lower infection rates. 

In addition, Thai people - along with a few other countries - use nasal irrigation when they're sick. A recent study (with a spectacular bibliography) noted that 80% of the population use nasal irrigation for a variety of ills. Just spray a saline solution at high volume with high flow (as from a squeeze bottle) into nasal passages; it's the most common and most effective at symptom reduction. 

Without rigorous testing, there are a huge number of reasons why nasal lavage (rinsing) should work well.

1) Viral load seems highly proportional to infectivity, so flushing out virus would logically (and empirically in lots of studies) reduce load,

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2) Sinus size: Younger patients have small/absent sinuses and they are less infected and much less severely. Men and people older than 70 have much larger nasal cavities and are infected more severely.

3) Mechanical reduction of cellular infection: The viral lipid layers need to fuse after the spike attaches to ACE2 receptors, so physical flow of nasal irrigation may reduce likelihood of intracellular fusion and thus infection,

4) Buying immunologic time: the possibility exists that reducing viral load through debriding could aid effective immune response in the same way that debriding burns reduces time of healing. 

5) It works for colds: Nasal lavage (rinsing) seems better than spray. Multiple RCTs show statistically significant results, and the mechanical concepts of COVID lend greater rationale than upper respiratory infections with shorter incubation periods. 

With all of this, nasal irrigation twice a day after exposure or initiation of symptoms may be way less dangerous than hydroxychloroquine.

Through this article, our hope is that, at a minimum, you will have something to try if you or someone you love gets sick, 

We thank Amy Baxter, MD, CEO and Chief Medical Officer, Pain Care Labs, for her inspirational thinking.