The COVID-19 pandemic
caused by SARS-CoV-2 virus has spread to 215 countries with 3,525,116 confirmed
cases and 243,540 deaths1. As per the latest update by Ministry of
Health and Family Welfare (MoHFW), Government of India, COVID-19 cases continue to rise
in the country with 31967 active
cases and the state of Andhra Pradesh has 1717 confirmed cases and
36 deaths as of May 5, 2020. A major administrative and public health concern
is spread of COVID-19 in
slum communities as overcrowding, lack of basic amenities, poor nutrition and
ill health pose high risk of transmission and casualties to COVID-192,3.
Moreover, most of the residents are low income groups who venture outside for
daily wages or domestic work in peoples’ homes thereby further increasing the
chances of overall spread4. As COVID-19 is transmitted
via droplets, fomites and even fecal contamination, context based strategies
need to be implemented to prevent spread within and outside vulnerable slum
populations5,6. However, preventive measures advocated by the World
Health Organization and national nodal bodies, MoHFW and Indian
Council of Medical Research such as frequent hand washing, physical/social distancing and home
isolation maybe practically impossible in such communities7,8.
Additionally, SARS-CoV-2 is more transmissible in households than the earlier
SARS-CoV and Middle East Respiratory Syndrome coronavirus (MERS-CoV)9.
Highest risk exposure group are household contacts of COVID-19 cases and attack
rate is reported to be higher among household and non-household family contacts
than that in health care or other settings10. Transmission by infected persons even before symptom
onset, prolonged viral shedding and overburdened health facilities
necessitates early protection of household contacts where COVID-19 cases are
present11,12. In this context, Povidone Iodine (PVP-I),
a widely used antiseptic in the healthcare setting with virucidal activity has
the potential to contain the spread of COVID-19 from cases to household
contacts. Rapid virucidal activity of Povidone Iodine (PVP-I) has been reported
against Ebola virus (EBOV), the European reference virus (Modified vaccinia
virus Ankara; MVA), MERS-CoV, influenza virus A (H1N1) and SARS coronavirus
(SARS-CoV)13-15. In-vitro studies indicated that PVP-I products for
gargling and spraying the throat inactivated the MERS-CoV, H1N1 virus and
SARS-CoV in about 15 seconds to 2 minutes indicating the prophylactic role
during outbreaks16. The recommended diagnostic testing for COVID-19
requires collection of nasopharyngeal and oropharyngeal swab specimens and
higher viral load has been found in patient samples obtained from the
nasopharynx than that those from the oropharynx17,18. Hence
considering the routes of transmission which pose highest risk to close
contacts, particularly among household contacts where other preventive measures
mentioned earlier are difficult and healthcare staff who collect specimens for
COVID-19 testing, PVP-I could serve as a protective barrier against SARS-CoV-2
virus. PVP-I is readily available in the market and intranasal application,
oral gargles can be done easily by households and healthcare workers without
any demanding procedures. Hence, the present study is aimed to
assess the effectiveness of PVP-I in reduction of COVID-19 transmission from
cases to household contacts. The study has significant policy level
implications for community protection against COVID-19.
1. World Health Organization. Coronavirus
disease (COVID-19) Situation Report-106. May 5, 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200505
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2. Ahmed F, Ahmed NE,
Pissarides C, Stiglitz J. Why inequality could spread COVID-19. The Lancet
Public Health 2020. doi: 10.1016/S2468-2667(20)30085-2 [Epub ahead of print].
3. Krishnaiah K.“Tirupati City
With Many Slums ; An Ill Health Environment To The Piligirim Centre” in Martin
J. Bunch, V. Madha Suresh and T. Vasantha Kumaran, eds., Proceedings of the
Third International Conference on Environment and Health, Chennai, India, 15-17
December, 2003. Chennai: Department of Geography, University of Madras and
Faculty of Environmental Studies, York University. Pages 226 – 232.
J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, et al. Slum Health:
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Coronavirus disease (COVID-19) advice for the public; 2019. Available from: https://www.who.int/ emergencies/diseases/novel-coronavirus-2019/
advice-for-public [Last accessed on 2020 May 4].
6. GoI, MoH&FW, DGHS (EMR.
Revised Guidelines on Clinical Management of COVID – 19[Internet]. 2020 [cited
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7. Xu Y, Li X, Zhu B, Liang H,
Fang C, Gong Y et al. Characteristics of pediatric SARS-CoV-2 infection
and potential evidence for persistent fecal viral shedding. Nat Med
8. van Doremalen N, Bushmaker
T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface
stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med
9. Jing QL, Liu MJ, Yuan J,
Zhang ZB, Zhang AR, Dean NE, et al. Household Secondary Attack Rate of COVID-19
and Associated Determinants. medRxiv 2020. doi.https://doi.org/ 10.1101/2020.04.11
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Ng TC, Huang WT, Lin HH. Contact Tracing Assessment of COVID-19 Transmission
Dynamics in Taiwan and Risk at Different Exposure Periods Before and After
Symptom Onset. JAMA Intern Med. 2020. doi: 10.1001/jamainternmed.2020.2020.
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J, Wang F, Liu Y, et al. Community transmission of severe acute respiratory
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T, Eickmann M, Zorn J. In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash
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L, Ruan F, Huang M, Liang L, Huang H, Hong Z, Yu J, Kang M, Song Y, Xia J, Guo
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