Discussion:
Based upon our findings, COVID-19 does not significantly affect
individuals with CF. This can be due to infection control measures and
minimizing contact that hold true in many regions of the world but does
not apply to these two cases. One explanation for this observation can
be the CF medical therapy regimen that includes hypertonic saline.
Previous studies have shown that salt can affect viruses. In a study by
Zhang et. al. (4), high salt was identified as a crucial regulator of
signaling. In another study by Siber and Podgornik (5) the influence of
salt was shown on encapsidation of single- stranded viral RNA molecules.
This influence was also shown on double stranded RNA at 250 mM sodium
chloride. 5% hypertonic saline is equivalent to 0.85 mM NaCl. More
studies are needed to answer the therapeutic role of hypertonic saline
in treatment of COVID-19.
There can be additional protective factors in CF such as genetics or
immunological factors that remain to be identified. It appears that
patients with CF need an additional risk factor such as malnutrition or
severe airway obstruction that puts them at risk from COVID-19
infection. There is still significant unknowns in dealing with the
COVID-19 infection and there is no place for complacency. Until there is
more scientific data, social distancing and infection control measures
should be continued.