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1.
Epidemiol Health ; 43: e2021032, 2021.
Article in English | MEDLINE | ID: covidwho-1726410

ABSTRACT

OBJECTIVES: To evaluate the effectiveness of hydrogen peroxide (H2O2) in the form of mouthwash and nasal spray as an auxiliary treatment for coronavirus disease 2019 (COVID-19). METHODS: Forty hospitalized patients who tested positive for severe acute respiratory syndrome coronavirus 2 using a reverse-transcription polymerase chain reaction test were evaluated. They were randomly divided into an experimental group (n= 20; gargling with 1.0% H2O2 and nasal wash with 0.5% H2O2) or a control group (n= 20). The solutions were used for 7 days and the patients were monitored every 2 days, for a total of 8 days. At check-ups, patients were asked about their symptoms and possible adverse effects of the solutions. The presence and severity (mild, moderate, or severe) of symptoms were recorded. Data were compared using the Student test and the Fisher exact test (α= 0.05). RESULTS: There was no significant difference between the 2 groups in the length of hospital stay (p= 0.65). The most frequent symptom on day 0 was coughing (72.0% in the experimental group and 76.5% in the control group), which abated over time. There was no significant difference between the groups in the evaluated symptoms. Most (75.0%) of the patients in the experimental group presented a reduction in dyspnea between days 0 and 2. Few patients reported adverse effects from the use of the solutions. CONCLUSIONS: H2O2 as a mouthwash and nasal spray is safe to use. There is insufficient evidence to demonstrate that H2O2 is effective as an auxiliary treatment for hospitalized COVID-19 patients.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , COVID-19/drug therapy , Hydrogen Peroxide/administration & dosage , SARS-CoV-2 , Adult , Brazil , COVID-19/virology , Double-Blind Method , Female , Hospitalization , Humans , Male , Middle Aged , Mouthwashes/administration & dosage , Nasal Sprays , Severity of Illness Index , Treatment Outcome
2.
Retina ; 41(11): 2215-2220, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1483570

ABSTRACT

PURPOSE: To investigate the bacterial growth in the surgical face masks used by patients who received intravitreal injections and study the effect of povidone-iodine on the periocular area (PA) of masks. METHODS: Forty patients who attended for intravitreal injections were divided in those with less (<4 hours) and more (>4 hours) than 4 hours of mask use. Each group was divided depending on the application or not of povidone-iodine in the PA of the mask. Bacterial load was studied on PA and mouth area samples. RESULTS: The bacterial load in the PA was higher in the >4 hours group compared with the <4 hours group (13.2 vs. 48.75 colony-forming units/µL; P = 0.03). The contamination in the PA significantly decreased after applying povidone-iodine in the >4 hours group (P = 0.01). The use or not of povidone-iodine was strongly correlated to a positive culture (OR = 9.0, P = 0.00. CI 1.63-49.44). CONCLUSION: Surgical face masks worn for more than 4 hours present higher contamination in the PA than those with less use. Bacterial load in the PA is reduced with povidone-iodine on masks used for more than 4 hours. This contamination should be considered in the asepsis protocol of intravitreal injections.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Bacteria/isolation & purification , COVID-19/epidemiology , Equipment Contamination , Masks/microbiology , SARS-CoV-2 , Aged , Aged, 80 and over , Anti-Infective Agents, Local/administration & dosage , Bacterial Load , Bacteriological Techniques , Female , Humans , Intravitreal Injections , Male , Middle Aged , Povidone-Iodine/administration & dosage , Prospective Studies , Retinal Diseases/drug therapy , Vascular Endothelial Growth Factor A/antagonists & inhibitors
4.
Future Microbiol ; 16: 119-130, 2021 01.
Article in English | MEDLINE | ID: covidwho-1389070

ABSTRACT

A review of nasal sprays and gargles with antiviral properties suggests that a number of commonly used antiseptics including povidone-iodine, Listerine®, iota-carrageenan and chlorhexidine should be studied in clinical trials to mitigate both the progression and transmission of SARS-CoV-2. Several of these antiseptics have demonstrated the ability to cut the viral load of SARS-CoV-2 by 3-4 log10 in 15-30 s in vitro. In addition, hypertonic saline targets viral replication by increasing hypochlorous acid inside the cell. A number of clinical trials are in process to study these interventions both for prevention of transmission, prophylaxis after exposure, and to diminish progression by reduction of viral load in the early stages of infection.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , Anti-Infective Agents, Local/therapeutic use , COVID-19/prevention & control , SARS-CoV-2/drug effects , COVID-19/transmission , Carrageenan/therapeutic use , Chlorhexidine/therapeutic use , Drug Combinations , Hydrogen Peroxide/therapeutic use , Nasal Sprays , Oils, Volatile/therapeutic use , Povidone-Iodine/therapeutic use , Salicylates/therapeutic use , Terpenes/therapeutic use , Viral Load/drug effects
6.
Drug Res (Stuttg) ; 71(6): 348-350, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1199340

ABSTRACT

During the next few months or years, vaccination against SARS-CoV-2 infection will significantly reduce the morbidity and mortality of COVID-19. However, additional measures are needed to protect those who are still not immunized. This is even more important in view of new viral mutations that result in increased transmission rates. We propose that the use of long-standing medicinal solutions based on hypochloric acid (HOCl) and intended for application on wounds may be effective as a gargling solution or nasal irrigation in blocking transmission of the virus. Here, we propose the use of HOCl-containing solutions for blocking the transmission of SARS-CoV-2 in combination with other prevention measures. This may constitute another important cornerstone in the fight against the COVID-19 pandemic.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , COVID-19/prevention & control , Hypochlorous Acid/administration & dosage , SARS-CoV-2/drug effects , Viral Load/drug effects , Administration, Oral , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Humans , Mouth Mucosa/virology , Nasal Lavage , Nasal Mucosa/virology , Nasal Sprays , Pandemics/prevention & control , SARS-CoV-2/isolation & purification
9.
Trop Biomed ; 37(4): 1141-1145, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-1058756

ABSTRACT

Coronavirus Disease 2019 (COVID-19) has infected more than 8 million people globally since its discovery in December 2019. For COVID-19 prevention, the World Health Organization recommended regular handwashing with soap, cough etiquette, mask wearing and social distancing. However, COVID-19 is rather difficult to contain because of its high transmissibility property. Gargling is effective for reducing infection in the respiratory tract. Most antiseptic gargles have antimicrobial properties against common respiratory pathogens. No published study on the effectiveness of antiseptic gargling among COVID-19 patients has been available to date. This article reviewed available literature on methods and solutions available for gargling and their effect on respiratory tract infections.


Subject(s)
Anti-Infective Agents, Local/therapeutic use , COVID-19/prevention & control , Anti-Infective Agents, Local/administration & dosage , Chlorhexidine/administration & dosage , Chlorhexidine/therapeutic use , Humans , Povidone-Iodine/administration & dosage , Povidone-Iodine/therapeutic use
11.
Future Microbiol ; 16: 119-130, 2021 01.
Article in English | MEDLINE | ID: covidwho-1034857

ABSTRACT

A review of nasal sprays and gargles with antiviral properties suggests that a number of commonly used antiseptics including povidone-iodine, Listerine®, iota-carrageenan and chlorhexidine should be studied in clinical trials to mitigate both the progression and transmission of SARS-CoV-2. Several of these antiseptics have demonstrated the ability to cut the viral load of SARS-CoV-2 by 3-4 log10 in 15-30 s in vitro. In addition, hypertonic saline targets viral replication by increasing hypochlorous acid inside the cell. A number of clinical trials are in process to study these interventions both for prevention of transmission, prophylaxis after exposure, and to diminish progression by reduction of viral load in the early stages of infection.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , Anti-Infective Agents, Local/therapeutic use , COVID-19/prevention & control , SARS-CoV-2/drug effects , COVID-19/transmission , Carrageenan/therapeutic use , Chlorhexidine/therapeutic use , Drug Combinations , Hydrogen Peroxide/therapeutic use , Nasal Sprays , Oils, Volatile/therapeutic use , Povidone-Iodine/therapeutic use , Salicylates/therapeutic use , Terpenes/therapeutic use , Viral Load/drug effects
13.
Am J Otolaryngol ; 42(2): 102880, 2021.
Article in English | MEDLINE | ID: covidwho-1009279

ABSTRACT

OBJECTIVES: STUDY DESIGN: Observational study. SETTING: Secondary care ENT Centre. METHODS: All patients attending the hospital for office ENT consultations from 15th April 2020 to 15th September 2020 were included in the study. A total of 6692 office patients were evaluated for feasibility, usability and tolerability of the 0.5% PVP-I gargles and nasal drops. RESULTS: Overall practicability of using 0.5% PVP-I gargles and nasal drops at office level was assessed in terms of feasibility and usability. Feasibility and usability was considered in terms of the ease of the dispensing method of the 0.5% PVP-I gargles and nasal drops by the health care workers to the patients prior to ENT examination. Tolerance was assessed in terms of altered taste, staining of teeth or nasal skin or irritation in the nose. None reported any serious reactions or adverse effects following use of 0.5% PVP-I. CONCLUSION: The study reports the successful feasibility and usability of 0.5% PVP-I gargles and nasal drops and bears the potential to provide benefits in preventing transmission from the patients to the health care workers and vice versa. LEVEL OF EVIDENCE: 4.


Subject(s)
Administration, Intranasal , Anti-Infective Agents, Local/administration & dosage , COVID-19/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Mouthwashes , Povidone-Iodine/administration & dosage , COVID-19/transmission , Feasibility Studies , Humans , Patient Comfort
14.
Trials ; 22(1): 2, 2021 Jan 04.
Article in English | MEDLINE | ID: covidwho-1007151

ABSTRACT

OBJECTIVE: General: To assess the virucidal efficacy of povidone iodine (PVP-I) on COVID-19 virus located in the nasopharynx Specific: i. To evaluate the efficacy of povidone iodine (PVP-I) to removeCOVID-19 virus located in the nasopharynx ii. To assess the adverse events of PVP-I TRIAL DESIGN: This is a single-center, open-label randomized clinical trial with a 7-arm parallel-group design. PARTICIPANTS: The study will be conducted at Dhaka Medical College Hospital, Dhaka, Bangladesh. INCLUSION CRITERIA: All RT-PCR-confirmed COVID-19 cases aged between 15-90 years with symptoms for the past 4 days will be screened. Those who give informed consent, are willing to participate, and accept being randomized to any assigned group will also be considered for final inclusion. EXCLUSION CRITERIA: Patients with known sensitivity to PVP-I aqueous antiseptic solution or any of its listed excipients or previously diagnosed thyroid disease or who had a history of chronic renal failure: stage ≥3 by estimated glomerular filtration rate (eGFR) Modification of Diet in Renal Disease (MDRD) or had acute renal failure (KDIGO ≥stage 2: creatinine ≥2 times from the baseline) or patients who required invasive or noninvasive ventilation or planned within the next 6 hours were considered for exclusion. Moreover, lactating or pregnant women will also be restricted to include here. INTERVENTION AND COMPARATOR: This RCT consist of seven arms: Arm-1 (intervention group): will receive povidone iodine (PVP-I) nasal irrigation (NI) at a concentration of 0.4% Arm-2 (intervention group): will receive PVP-I nasal irrigation at a concentration of 0.5% Arm-3 (intervention group): will receive PVP-I nasal irrigation at a concentration of 0.6%. Arm-4 (intervention group): will receive PVP-I nasal spray (NS) at a concentration of 0.5%. Arm-5 (intervention group): will receive PVP-I nasal spray at a concentration of 0.6%. Arm-6 (placebo comparator group): will receive distilled water through NI Arm-7 (Placebo comparator group): will receive distilled water through NS The intervention arms will be compared to the placebo comparator arms. Other supportive and routine care will be the same in both groups. MAIN OUTCOMES: The primary outcome is the proportion of cases that remain COVID-19 positive following the intervention. It will be assessed from 1 minutes to 15 minutes after the intervention. Any occurrence of adverse effects following the intervention will be documented as a secondary outcome. RANDOMIZATION: The assignment to the study (intervention) or control (comparator) group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and consenting procedures. BLINDING (MASKING): This is an open-label clinical trial, and no blinding or masking will be performed. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): A total of 189 confirmed cases of COVID-19 will be randomized into seven groups. In each arm, a total of 27 participants will be recruited. TRIAL STATUS: The current trial protocol is Version 1.5 from September 10, 2020. Recruitment began September 30, 2020 and is anticipated to be completed, including data analysis by February 28, 2021. TRIAL REGISTRATION: The trial protocol has been registered in the ClinicalTrials.gov on September 16, 2020. NCT Identifier number: NCT04549376 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting the dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , COVID-19/drug therapy , Nasopharynx/virology , Povidone-Iodine/administration & dosage , SARS-CoV-2/drug effects , Administration, Intranasal , Adolescent , Adult , Aged , Aged, 80 and over , Bangladesh , COVID-19/diagnosis , COVID-19/virology , Clinical Trials, Phase II as Topic , Dose-Response Relationship, Drug , Female , Humans , Male , Middle Aged , Nasal Lavage , Nasal Sprays , Nasopharynx/drug effects , Placebos/administration & dosage , Placebos/adverse effects , Povidone-Iodine/adverse effects , Randomized Controlled Trials as Topic , SARS-CoV-2/isolation & purification , Treatment Outcome , Young Adult
15.
J Otolaryngol Head Neck Surg ; 49(1): 77, 2020 Oct 27.
Article in English | MEDLINE | ID: covidwho-895035

ABSTRACT

BACKGROUND: The COVID-19 pandemic has raised concerns of inadvertent SARS-CoV-2 transmission to healthcare workers during routine procedures of the aerodigestive tract in asymptomatic COVID-19 patients. Current efforts to mitigate this risk focus on Personal Protective Equipment, including high-efficiency filtration as well as other measures. Because the reservoir for SARS-CoV-2 shedding is in the nasopharynx and nasal and oral cavities, the application of viricidal agents to these surfaces may reduce virus burden. Numerous studies have confirmed that povidone-iodine inactivates many common respiratory viruses, including SARS-CoV-1. Povidone-iodine also has good profile for mucosal tolerance. Thus, we propose a prophylactic treatment protocol for the application of topical povidone-iodine to the upper aerodigestive tract. CONCLUSION: Such an approach represents a low-cost, low-morbidity measure that may reduce the risks associated with aerosol-generating procedures performed commonly in otorhinolaryngology operating rooms.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Povidone-Iodine/administration & dosage , Adult , Aerosols , Anti-Infective Agents, Local/administration & dosage , COVID-19 , Coronavirus Infections/prevention & control , Humans , Mouth , Pneumonia, Viral/prevention & control , SARS-CoV-2
16.
Am J Otolaryngol ; 41(6): 102737, 2020.
Article in English | MEDLINE | ID: covidwho-799098

ABSTRACT

PURPOSE: Surgeons resuming elective procedures during the COVID-19 pandemic should consider strategies to mitigate risk of exposure. For otolaryngologists performing surgery on children, unique vulnerability to SARS-CoV-2 results from a regular interface with the upper respiratory tract mucosa. A growing interest in perioperative application of povidone­iodine (PVP-I) to the nasopharynx and oropharynx has emerged. The purpose of this review is to provide an evidence-based assessment of PVP-I in pediatric oral, nasal and pharyngeal surgery. METHODS: A contemporary literature review with algorithmic approach to the potential use of PVP-I in pediatric mucosal surgery. RESULTS: Several formulations of PVP-I have shown rapid in vitro virucidal activity against SARS-CoV-2. Antisepsis using 1.0% PVP-I mouthwash and 0.45% PVP-I throat spray can occur after 30 seconds of contact time. To date, in vivo effectiveness of PVP-I against SARS-CoV-2 has yet to be established and possible risks of its direct use on upper aerodigestive mucosa of children must be weighed. CONCLUSION: Further research is required prior to strongly recommending PVP-I use in preparation for nasal, oral or pharyngeal surgery in children.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , Coronavirus Infections/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Otorhinolaryngologic Surgical Procedures , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Povidone-Iodine/administration & dosage , Betacoronavirus , COVID-19 , Child , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Nasopharynx , Oropharynx , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2
17.
JAMA Otolaryngol Head Neck Surg ; 146(11): 1054-1058, 2020 11 01.
Article in English | MEDLINE | ID: covidwho-777326

ABSTRACT

Importance: Research is needed to demonstrate the efficacy of nasal povidone-iodine (PVP-I) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To evaluate the in vitro efficacy of PVP-I nasal antiseptic for the inactivation of SARS-CoV-2 at clinically significant contact times of 15 and 30 seconds. Interventions: The SARS-CoV-2, USA-WA1/2020 strain, virus stock was tested against nasal antiseptic solutions consisting of aqueous PVP-I as the sole active ingredient. Povidone-iodine was tested at diluted concentrations of 0.5%, 1.25%, and 2.5% and compared with controls. The test solutions and virus were incubated at mean (SD) room temperature of 22 (2) °C for time periods of 15 and 30 seconds. Design and Setting: This controlled in vitro laboratory research study used 3 different concentrations of study solution and ethanol, 70%, as a positive control on test media infected with SARS-CoV-2. Test media without virus were added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol, 70%, was tested in parallel as a positive control and water only as a negative control. Main Outcomes and Measures: The primary study outcome measurement was the log reduction value after 15 seconds and 30 seconds of given treatment. Surviving virus from each sample was quantified by standard end point dilution assay, and the log reduction value of each compound was compared with the negative (water) control. Results: Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact as measured by log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus. The ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact. The nasal antiseptics tested performed better than the standard positive control routinely used for in vitro assessment of anti-SARS-CoV-2 agents at a contact time of 15 seconds. No cytotoxic effects on cells were observed after contact with each of the nasal antiseptics tested. Conclusions and Relevance: Povidone-iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 at contact times as short as 15 seconds. Intranasal use of PVP-I has demonstrated safety at concentrations of 1.25% and below and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.


Subject(s)
Anti-Infective Agents, Local/administration & dosage , Infection Control/methods , Nose/virology , Povidone-Iodine/administration & dosage , SARS-CoV-2/drug effects , Administration, Intranasal , COVID-19/transmission , COVID-19/virology , Dose-Response Relationship, Drug , Humans
18.
Trials ; 21(1): 785, 2020 Sep 14.
Article in English | MEDLINE | ID: covidwho-757090

ABSTRACT

OBJECTIVES: 1- To compare the effectiveness of 1% Hydrogen peroxide, 0.2% Povidone-Iodine, 2% hypertonic saline and a novel solution Neem extract (Azardirachta indica) in reducing intra-oral viral load in COVID-19 positive patients. 2- To determine the salivary cytokine profiles of IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL- 17 among COVID-19 patients subjected to 1% Hydrogen peroxide, 0.2% Povidone-Iodine, 2% hypertonic saline or Neem extract (Azardirachta indica) based gargles. TRIAL DESIGN: This will be a parallel group, quadruple blind-randomised controlled pilot trial with an add on laboratory based study. PARTICIPANTS: A non-probability, purposive sampling technique will be followed to identify participants for this study. The clinical trial will be carried out at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. The viral PCR tests will be done at main AKUH clinical laboratories whereas the immunological tests (cytokine analysis) will be done at the Juma research laboratory of AKUH. The inclusion criteria are laboratory-confirmed COVID-19 positive patients, male or female, in the age range of 18-65 years, with mild to moderate disease, already admitted to the AKUH. Subjects with low Glasgow coma score, with a history of radiotherapy or chemotherapy, who are more than 7 days past the onset of COVID- 19 symptoms, or intubated or edentulous patients will be excluded. Patients who are being treated with any form of oral or parenteral antiviral therapy will be excluded, as well as patients with known pre-existing chronic mucosal lesions such as lichen planus. INTERVENTION AND COMPARATOR: Group A (n=10) patients on 10 ml gargle and nasal lavage using 0.2% Povidone-Iodine (Betadiene® by Aviro Health Inc./ Pyodine® by Brooks Pharma Inc.) for 20-30 seconds, thrice daily for 6 days. Group B (n=10) patients will be subjected to 10 ml gargle and nasal lavage using 1% Hydrogen peroxide (HP® by Karachi Chemicals Products Inc./ ActiveOxy® by Boumatic Inc.) for 20-30 seconds, thrice daily for 6 days. Group C will comprised of (n=10) subjects on 10ml gargle and nasal lavage using Neem extract solution (Azardirachta indica) formulated by Karachi University (chemistry department laboratories) for 20-30 seconds, thrice daily for 6 days. Group D (n=10) patients will use 2% hypertonic saline (Plabottle® by Otsuka Inc.) gargle and nasal lavage for a similar time period. Group E (n=10) will serve as positive controls. These will be given simple distilled water gargles and nasal lavage for 20-30 seconds, thrice daily for six days. For nasal lavage, a special douche syringe will be provided to each participant. Its use will be thoroughly explained by the data collection officer. After each use, the patient is asked not to eat, drink, or rinse their mouth for the next 30 minutes. MAIN OUTCOMES: The primary outcome is the reduction in the intra-oral viral load confirmed with real time quantitative PCR. RANDOMISATION: The assignment to the study group/ allocation will be done using the sealed envelope method under the supervision of Clinical Trial Unit (CTU) of Aga Khan University, Karachi, Pakistan. The patients will be randomised to their respective study group (1:1:1:1:1 allocation ratio) immediately after the eligibility assessment and consent administration is done. BLINDING (MASKING): The study will be quadruple-blinded. Patients, intervention provider, outcome assessor and the data collection officer will be blinded. The groups will be labelled as A, B, C, D or E. The codes of the intervention will be kept in lock & key at the CTU and will only be revealed at the end of study or if the study is terminated prematurely. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): As there is no prior work on this research question, so no assumptions for the sample size calculation could be made. The present study will serve as a pilot trial. We intend to study 50 patients in five study groups with 10 patients in each study group. For details, please refer to Fig. 1 for details. TRIAL STATUS: Protocol version is 7.0, approved by the department and institutional ethics committees and clinical trial unit of the university hospital. Recruitment is planned to start as soon as the funding is sanctioned. The total duration of the study is expected to be 6 months i.e. August 2020-January 2021. TRIAL REGISTRATION: This study protocol was registered at www.clinicaltrials.gov on 10 April 2020 NCT04341688 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2). Fig. 1 Flow diagram of study-participants' timeline.


Subject(s)
Azadirachta , Betacoronavirus , Coronavirus Infections , Hydrogen Peroxide/administration & dosage , Pandemics , Plant Extracts/administration & dosage , Pneumonia, Viral , Povidone-Iodine/administration & dosage , Saline Solution, Hypertonic/administration & dosage , Viral Load , Adult , Anti-Infective Agents, Local/administration & dosage , Betacoronavirus/drug effects , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Female , Hospitalization , Humans , Male , Monitoring, Immunologic/methods , Mouthwashes/administration & dosage , Nasal Lavage/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Randomized Controlled Trials as Topic , SARS-CoV-2 , Viral Load/drug effects , Viral Load/methods
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