The push for prophylaxis and treatment of SARS-CoV-2 oropharyngeal infection starts in the nose and mouth. A randomized trial by Choudhury et al. from Bangladesh has been overlooked by US public agencies but not the early treatment organizations around the world. In this prospective randomized controlled trial, n=606 high-risk subjects with incipient COVID-19 were randomized to 1% povidone-iodine (betadine) solution as a rinse was used for a target of every 4 hours versus lukewarm water for four weeks.
By day 7, the rates of positive nasal PCR for SARS-CoV-2 were 2.64% versus 70.3%, p<0.0001. The hospitalization rates and oxygen support and death rates were 3.3% vs. 20.8% and 0.66% vs. 5.61% (84% and 88% reductions, respectively) for the povidone-iodine vs. lukewarm water groups, p<0.0001. We know to apply these concepts to pre-exposure prophylaxis twice a day and postexposure four times a day. During active early treatment, it is reasonable to aim for every four hours with the goal of reducing viral load and reinoculation.
If there is iodine sensitivity or intolerance, then dilute hydrogen peroxide, dilute sodium hypochlorite, followed by Listerine or Scope mouthwash can be used in the mouth only with attention to not swallowing. For the nose, saline rinses, nasal ozone, and colloidal silver hydrosol can be used, but the randomized trial support is not present.
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https://www.bioresearchcommunications.com/index.php/brc/article/view/176
https://www.nycdentist.com/blog/cv/
https://www.memorialhermann.org/doctors/ophthalmologists/dr-richard-urso-md-1154316255