The coronavirus disease 2019 (COVID-19) pandemic has ignited interest in viral transmission and prevention owing to the significant morbidity and mortality associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Investigations into SARS-CoV-2 pathophysiology suggest that, similar to other viral upper respiratory infections, infection occurs primarily in the nasal and nasopharyngeal mucosa with high viral loads early in disease.1 Within the otolaryngology–head and neck surgery community, recent reports of viral transmission through endoscopic endonasal surgical procedures have caused increased concern regarding how nasal biology affects viral transmission. Further questions have arisen on the possible therapeutic role of commonly used topical nasal therapies. Nasal irrigations may play a role in reducing viral severity and further transmission. However, it is not yet clear whether topical nasal saline irrigations provide viral mitigation effects or conversely have a potentiating effect on viral transmission. Additionally, there are concerns about the consequences of topical adjuncts, such as nasal corticosteroids, for viral nasal infections. In this Viewpoint, we have briefly reviewed the current evidence regarding the association of nasal saline irrigations and their adjuncts with viral upper respiratory illnesses.