COVID-19 is a viral disease caused by the SARS-CoV-2 virus. The COVID-19 pandemic has presented unprecedented challenges to healthcare systems globally. While vaccine rollouts have started in some countries, it doesn’t mean that people can become complacent, stop wearing masks or stop taking other preventive measures.

This highly contagious disease is transmitted largely through respiratory droplets.¹ The nasal cavity, nasopharynx, oral cavity and oropharynx carry high viral load.² Decontamination of these surfaces using virucidal agents thus appears to be a potential approach to reduce the burden of the virus.

Povidone-iodine (PVP-I), an antimicrobial agent, is extensively used as a mouthwash.³ Use of PVP-I may serve as an effective way of quick reduction of viral load in the upper aerodigestive tract, thus minimizing the risk of virus transmission.²

While there are no recommendations for routine use of PVP-I as anti-viral prophylaxis, the American Dental Association (ADA) recommends the use of preprocedural mouthwashes before any oral procedures, which includes povidone mouthwash.⁴ 

PVP-I is a rapidly virucidal agent and has been shown to inactivate coronaviruses, including SARS-CoV and Middle East Respiratory Syndrome (MERS).⁵ Studies by Bidra et al and Anderson et al have shown it to be effective against SARS-CoV-2 as well.^6,7 While Anderson et al noted that PVP-I attained ≥ 99.99% virucidal activity against this novel coronavirus, Bidra and colleagues demonstrated that it could inactivate SARS-CoV-2 within 15 seconds of contact time.

The first in vivo tests with PVP-I have shown that a PVP-I rinse could decrease the viral load in patients with SARS-CoV-2 infection, which persisted for 3 hours.⁸ It can be safely used in the mouth at concentrations up to 2.5% for as long as 5 months.⁵

PVP-I has been in use for over 6 decades as a topical antiseptic and has potent virucidal activity against an array of viruses, including the coronaviruses. Both in vitro and in vivo studies have shown its potential to inactivate SARS-CoV-2. 

PVP-I mouthwash thus seems to be a potential virucidal agent that can be used alongside other preventive measures to decrease the risk of transmission.

References

1. Mohapatra RK, Pintilie L, Kandi V, et al. The recent challenges of highly contagious COVID‐19, causing respiratory infections: Symptoms, diagnosis, transmission, possible vaccines, animal models, and immunotherapy. Chem Biol Drug Des. 2020 Jul 26 : 10.1111/cbdd.13761.
2. Naqvi SHS, Citardi MJ, Cattano D, et al. Povidone-iodine solution as SARS-CoV-2 prophylaxis for procedures of the upper aerodigestive tract a theoretical framework. Journal of Otolaryngology - Head & Neck Surgery volume 49, Article number: 77 (2020).
3. Castro-Ruiz C, Vergara-Buenaventura A. Povidone–iodine solution: A potential antiseptic to minimize the risk of COVID-19? A narrative review. J Int Soc Prevent Communit Dent. Available from: https://www.jispcd.org/article.asp?issn=2231-0762;year=2020;volume=10;issue=6;spage=681;epage=685;aulast=Castro%2DRuiz.
4. ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission. Available from: https://www.zerodonto.com/en/wp-content/uploads/2020/04/ADA_COVID_Int_Guidance_Treat_Pts.pdf.
5. Frank S, Capriotti J, Brown SM, Tessema B. Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era. Ear Nose Throat J. 2020 Nov;99(9):586-593.
6. Bidra AS, Pelletier JS, Westover JB, et al. Rapid In-Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Using Povidone-Iodine Oral Antiseptic Rinse. J Prosthodont. 2020 Jul;29(6):529-533.
7. 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 Sep;9(3):669-675.
8. Martínez Lamas L, Diz Dios P, Pérez Rodríguez MT, et al. Is povidone-iodine mouthwash effective against SARS-CoV-2? First in vivo tests. Oral Dis. 2020 Jul 2;10.1111/odi.13526.