SARS-CoV-2, the virus wreaking havoc across the globe by causing the COVID-19 pandemic, is quite similar to the SARS-CoV. Povidone Iodine (PVP-I), a potent antimicrobial iodine complex, has been shown in previous in vitro studies to be highly effective against SARS-CoV. Treatment of SARS-CoV with different preparations of PVP-I was found to decrease the viral activity to undetectable levels.¹

It is well known that the oropharynx and nasopharynx are potential target sites of the SARS-CoV-2 virus and that the saliva carries a high viral load to the extent of 1.2 × 10⁸ infective copies/per ml.²

Even a small amount of saliva can contaminate the instruments used in healthcare practice with several thousands of infectious viral particles. Additionally, evidence suggests that viral shedding may begin even before the appearance of the first symptoms.³

PVP-I is a potential antiviral compound with better antiviral activity in comparison with other antiseptics, such as chlorhexidine.⁴

A recent study evaluated the tolerability of PVP-I in patients and in healthcare workers. Patients were advised to put PVP-I drops in nose and rinse mouth with PVP-I gargle before examinations. For endoscopic procedure (nasal and throat), nasal douching and gargling were advised to be initiated one day prior. Douching and rinsing were to be repeated before procedures. Overall, 315 patients underwent nose and throat endoscopies. All of them, except 7, were comfortable with PVP-I gargles and nasal drops. Seventeen healthcare workers used the PVP-I nasal drops and gargles. The patients and healthcare workers tolerated PVP-I well and no allergy was noted. Investigators thus proposed the use of PVP-I Gargle in healthcare workers and their patients to minimize the risk of transmission besides the recommended PPE.⁴

In the face of the COVID-19 pandemic which has caused a great deal of morbidity and mortality, it is of utmost importance for the clinicians to consider added protective measures that will provide an additional barrier of safety. There are three layers of safety. The first layer of defense is personal protective equipment including gloves, eyeglasses and masks. The second layer of defense is regular use of oral antiseptic rinse. The third layer is the use of HEV and HEPA filters. The American Dental Association and the Centers for Disease Control and Prevention have recommended oral rinsing with antimicrobial rinses or gargles such as PVP iodine. There are in-vitro studies which have shown that PVP-I oral antiseptic formulations inactivated SARS-CoV-2 virus in vitro. This strengthens the clinical strategy of using oral PVP-I gargle as an additional personal protection for patient and health care providers during the COVID-19 pandemic. ⁵

Use of PVP-I Gargle during the ongoing COVID-19 pandemic could potentially limit the spread of infection from patients to healthcare workers and vice versa.

References

1. Kariwa H, Fujii N, Takashima I. Inactivation of SARS Coronavirus by Means of Povidone-Iodine, Physical Conditions and Chemical Reagents. Dermatology 2006;212:119–123.
2. To KK-W, Tsang OT-Y, Yip CC-Y, et al. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clinical Infectious Diseases 2020;71(15):841–843.
3. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nature Medicine 2020;26:672–675.
4. Khan MM, Parab SR, Paranjape M. Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic. American Journal of Otolaryngology  2020;41(5):102618.
5. Bidra AS, Pelletier JS, Westover JB, Frank S, Brown SM, Tessema B. Rapid in-vitro inactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using povidone-iodine oral antiseptic rinse. Journal of prosthodontics. 2020; 1-5. doi: 10.1111/jopr.13209.