Effects of Povidone Iodine and Chlorhexidine on the Severe Acute Respiratory Syndrome Coronavirus-2 Viral Load in Saliva Among Patients Hospitalized With the Corona Virus-19 Disease

Abstract

Background Coronavirus infection is a current in progress endemic that presents mainly with respiratory symptoms to severe pneumonia with a worldwide fatality rate recorded at 3.4%. The Coronavirus Disease 2019 (COVID-19) has increased the awareness of transmission risks among health care workers. One of the key approaches in minimizing the threat of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is to reduce the viral load in the saliva of those infected. Considering that patients with SARS-CoV-2 infection can unknowingly spread the virus in the subclinical period the occupations at the highest risk of contracting COVID-19 include dental hygienists, assistants, and surgeons. Dental care professionals are those with the highest exposure to many aerosols from the oral cavity which can prove to be hazardous to other staff members as well as other patients. Despite the use of personal protective equipment, decreasing the salivary viral titers of COVID-19 could be a key approach in reducing transmission. The use of pre-procedural mouthwashes is, therefore, strongly advocated and this study aimed at investigating the influence of Povidone Iodine (PI) and Chlorhexidine (CHX) mouthwashes on SARS CoV-2 positive patients. Main Objective To investigate the effect of Povidone Iodine (PI) and Chlorhexidine (CHX) mouthwashes on SARS COV-2 Viral loads in saliva among patients hospitalized with COVID-19. Study Design and Study area This was a randomized double blinded clinical trial that was carried out using a hospital-based population, where both the participants and primary investigator were blinded. The mouthwashes studied included PI, CHX in comparison to a control placebo of distilled water. xvii The study population included adult patients admitted with COVID-19 in selected hospitals in Nairobi County. These were patients with confirmed diagnosis of COVID-19 disease who were admitted to the isolation wards. Data collection All adult patients determined to be positive for SARS-CoV-2 and met the inclusion criteria were recruited to participate in the study. A screening form was used to exclude those who do not fit the inclusion criteria after which 92 participants were selected. Sociodemographic data was collected via a questionnaire for these patients. Participants were then randomly assigned to three groups, Group A (received a Povidone- Iodine mouthwash) Group B (Chlorhexidine mouthwash) and Group C (Control Group) received distilled water. Baseline saliva sample was collected (T0) after which a mouthwash was administered for 30 seconds, after which a second sample was collected after 30 mins (T1). The saliva samples were then transferred in a cool box to the laboratory where a reverse-transcriptase polymerase chain reaction (RT-PCR) assay was done where their cycle threshold (Ct) levels were determined at both T0 and T1 to monitor the viral loads. Data Management Data was collected, coded, entered the computer, then cleaned after which it was analyzed using the Statistical Packages for Social Sciences (SPSS) 20.0 for Windows. Descriptive statistics were computed which included measures of central tendency and dispersion for continuous variables. Effects of the mouthwashes on SARS-CoV-2 viral load levels were determined using Chi square test, t- test and ANOVA tests. The level of significance was set at p<0.05. Findings were then presented using text, tables, and figures. Results Amongst the 92 participants enrolled, 69 (75%) of the saliva samples found detectable levels of SARS-VoV-2 viral loads in saliva. This study showed that rinsing with PI and CHX resulted in better viral load, with 11% and 7.7 % reduction in salivary viral loads respectively for up to 30mins after rinsing. Whereas the placebo (distilled water) group xviii maintained a 2.2% reduction in salivary viral load, this change was not found to be clinically significant (p> 0.05). However, a statistically significant overall difference in viral loads was only found between Povidone-Iodine (PI) and distilled water (Placebo) (F=7.635, p=0.001). This infers that PI had a statistically significant effect on the participants’ SARS-CoV-2 viral loads post intervention. This study demonstrated that Povidone Iodine (PI) was effective in reducing SARS CoV-2 viral load after 30 mins of using the mouthwash (F=9, p-value < 0.05) at 11.4%. Conclusion PI mouthwash is beneficial in reduction of SARS-CoV-2 salivary viral loads. Recommendations PI can be used as a pre-procedural mouthwash as well as an adjunct to PPE to help reduce the salivary load of SARS CoV-2 in healthcare settings where saliva exposure is expected, such as dental practices as well as in situations involving close contact between people in domestic and public spaces. The results achieved suggest that Povidone Iodine (PI) can be useful in making of Mouthwash policy and protocol for COVID-19 prevention and treatment in health care settings