After 2 long years of pandemic restrictions, the Indian government decided to drop all curbs from March 31, with the exception of mask wearing and maintaining physical distancing.¹ The message is loud and clear – The virus has not gone anywhere! The pandemic is not over yet! Just because the case numbers are decreasing, it does not mean that we can be complacent. 

We have seen time and again that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants can emerge and lead a fresh wave of coronavirus disease 2019 (COVID-19) pandemic. Hence, our individual efforts to contain the spread of the virus should remain in place.

One such measure is the use of antiviral mouthwash, as it may serve as a protective measure against the spread of the virus as a preprocedural mouth rinse in the healthcare settings and prevent community transmission of the virus.

Povidone-iodine (PVP-I) is a well-known antiseptic agent. It is a broad-spectrum antimicrobial which has virucidal potential. It is effective against coronavirus and tends to reduce the viral particles in respiratory droplets and saliva.² Several in vitro studies have confirmed the virucidal activity of PVP-I against SARS-CoV-2. Anderson et al noted in their study that various PVP-I formulations, including gargle and mouthwash, had  ≥99.99% virucidal activity against this virus, with ≥4 log₁₀ reduction of virus titer, within 30 seconds of contact time.³

Clinical studies have also shown the beneficial effects of PVP-I mouthwash in COVID-19. Gargling with PVP-I has been shown to attain early viral clearance in COVID-19 patients, as early as 4 days following intervention.⁴ A recent study by Seikai and colleagues has also shown reduction in viral titers after PVP-I gargle.⁵ The investigators obtained saliva samples of patients with COVID-19 before and up to 2-hour after gargling with PVP-I (immediately after gargling, and at 30, 60 and 120 minutes). They noted a significant reduction in viral RNA in the samples taken immediately after gargling and 30 and 60 minutes after gargling, in comparison with prior to gargling. Additionally, there was a significant reduction in viral titer immediately after gargling and 60 minutes after gargling. The study thus concluded that PVP-I gargling was effective at suppressing SARS-CoV-2 infectivity in saliva for 60 minutes and could therefore be used as a potential measure to reduce transmission and infection risk in healthcare settings, such as during dental procedures and oral examination.  

Therefore, with lifting of pandemic restrictions across the country, gargling with PVP-I could be an effective adjunct to wearing masks and maintaining physical distance, to check the spread of the virus, which is still circulating in the community. 

References

1. After two years, there will be no Covid restrictions from March 31 In India, Mask to Stay. Available from: https://www.indiatimes.com/news/india/india-announces-end-of-all-covid-restrictions-from-march-31-565117.html. Accessed March 28, 2022.
2. Chopra A, Sivaraman K, Radhakrishnan R, et al. Can povidone iodine gargle/mouthrinse inactivate SARS-CoV-2 and decrease the risk of nosocomial and community transmission during the COVID-19 pandemic? An evidence-based update. Jpn Dent Sci Rev. 2021;57:39-45.
3. Anderson DE, Sivalingam V, Kang AEZ, et al. Povidone-Iodine demonstrates rapid in vitro virucidal activity against SARS-CoV-2, the virus causing COVID-19 disease. Infect Dis Ther. 2020;9(3):669-75.
4. Mohamed NA, Baharom N, Sulaiman WSW, et al. Early viral clearance among COVID-19 patients when gargling with povidone-iodine and essential oils – a clinical trial. Available from:https://www.medrxiv.org/content/10.1101/2020.09.07.20180448v1.full.pdf. Accessed March 28, 2022.
5. Seikai T, Takada A, Hasebe A, et al.Gargling with povidone iodine has a short-term inhibitory effect on SARS-CoV-2 in patients with COVID-19. J Hosp Infect. 2022 Jan 15;S0195-6701(22)00006-8.