Coronavirus disease or COVID-19 is continuing to spread globally, including in India. The numbers keep on climbing every day and have overwhelmed hospitals and healthcare systems at places across the world. Being prepared is the best defense against COVID-19 and such future pandemics. Capacity building, not just of the healthcare workers, but also the general public, is important. It empowers them and further augments the preparedness.

Person to person transmission through close contact is the primary mode of transmission of COVID-19. Therefore, bringing about a change in behavior, even when a vaccine is awaited, can limit the spread of infection. While isolation/quarantine and social distancing help to reduce spread, it is the individual behavior that will have significant effect in the community in terms of transmission.

Social engineering is a new concept in preventive health and involves helping people to know what they should do to prevent the transmission of disease. “Social engineering is a discipline in social science that refers to efforts to influence particular attitudes and social behaviors on a large scale, whether by governments, media or private groups in order to produce desired characteristics in a target population” (Wikipedia).

With regard to COVID-19, it can be applied to screening for infection. It is an inexpensive method of screening a person who comes to your home or office using five parameters. Look for temperature (low grade, does not respond to paracetamol), measure oxygen saturation (SpO2) using pulse oximeter (to detect happy hypoxia), give a rose to check for loss of smell, give jaggery to detect loss of taste (first taste to go is sweet taste) and assess the strength of hand grip. If any of these five is positive, ask the person to test for COVID-19.

In addition, the importance of other behaviors like hand hygiene and oral hygiene in day to day life cannot be overemphasized.

COVID-19 virus also spreads through surface transmission. Hand hygiene is one of the most important prevention measures to reduce transmission of microorganisms, including the COVID-19 virus, from one person to another or from one site to another on the same person. Hand washing is inexpensive and forms an integral part of infection control practices in healthcare. It is also essential for the general public. Hands should be washed with soap and water for at least 20 seconds whenever possible. The mantra is “before and after”, i.e. one should wash hands before and after eating food, after you have been in a public place or after touching potentially contaminated surfaces or objects, or after coughing, sneezing or blowing your nose, seeing a patient or after a bowel movement. An alcohol-based hand rub (at least 60% alcohol) can be used, if water and soap are not available.

According to the WHO, “community members can play a critical role in fighting COVID-19 by adopting frequent hand hygiene as part of their day-to-day practices”.

The oral cavity is home to millions of micro-organisms, which are commensals, but can become pathogenic in case of poor oral hygiene. Hence, it is also important to maintain good oral hygiene to prevent infections.

The British Dental Journal (Br Dent J.2020;228:569) suggests that oral hygiene is a risk factor for complications associated with COVID-19 infection, especially in patients who have underlying diabetes, hypertension or heart disease. It recommends improving oral hygiene to reduce the bacterial load in the mouth and the risk of a bacterial superinfection.

Besides the general recommendations for oral hygiene, such as regular tooth brushing, eating a healthy diet, avoiding smoking/alcohol/sugary beverages and snacks, gargling can help maintain oral hygiene. It has been shown to prevent upper respiratory tract infections (Am J Prev Med. 2005;29(4):302-7).

Gargling with an oral antiseptic such as povidone-iodine (PVP-I), which has the broadest spectrum of antimicrobial activity, may be advised as a preventive measure against the virus to people at risk of infection and to COVID-19 positive patients.

PVP-I has rapid and effective virucidal activity against SARS-CoV-2 virus. In a study published in the journal Infectious Diseases and Therapy (Infect Dis Ther. 2020;9(3):669-75), topical and oral PVP-I (antiseptic solution, skin cleanser, gargle and mouthwash) demonstrated 99.99% virucidal activity within a contact time of 30 sec. Another study in the Journal of Prosthodontics (J Prosthodont. 2020;29(6):529-33) reported virucidal activity as early as within 15 seconds. This study assessed three concentrations of oral PVP-I (0.5%, 1% and 1.5%), all of which completely inactivated the virus.

The SARS-CoV-2 virus enters the body through the nose and mouth. The throat is a source for the shed SARS-CoV-2 virus as the virus replicates here. Evidence has shown that even though gargling does not eliminate the virus from the throat of the infected patient, it may decrease the viral load and reduce droplet and air-borne transmission. Hence, gargling assumes particular importance in the times of COVID-19 and it should be complementary to the general oral hygiene routine. Similarly, hand hygiene with an antiseptic hand wash like PVP-I as an adjunct to regular hand washing as recommended by the WHO, can further reduce the risk of transmission of the virus.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA