Everyone already knows about the Wuhan Coronavirus outbreak so I’ll skip an overview of what it is and why it’s dangerous. No doubt you’re also aware of the CDC’s recommended preventative measures of hand hygiene and avoiding close contact with those who may be infected. You may have also acquired items such as masks, goggles, or gloves (if you didn’t have enough already) as additional preventative measures, and those can help limit exposure when used properly, but they do not provide 100% protection either. You may also have considered social distancing, or even self-quarantine, but that’s not always possible – some will need to go to work, use public transportation, travel by plane, or otherwise interact in relatively close proximity with those that could be infected.
Given what is known so far about the Wuhan Coronavirus it’s probably premature, as well as somewhat socially unacceptable at this point, to don a full array of PPE before going to the grocery store or to the DMV to renew your driver’s license. But if you did suspect that you had been directly exposed to it, such as yourself or a loved one inadvertently getting too close to someone that was displaying the symptoms, is there anything you can do to lessen the chances of contracting it? Maybe, and if there was such a protocol it would be called post-exposure prevention, or PEP. As defined by wikipedia:
Currently there isn’t a PEP protocol from the CDC or other authorities for the Wuhan Coronavirus, but I’ll offer a plausible one based on studies done following the SARS and MERS coronavirus outbreaks, and based on those a suggestion for a new item or two you might consider adding to your Every Day Carry or Individual First-Aid Kits.
First, a few short quotes from just a couple of the studies that I’m basing these recommendations on. From a 2004 study on the SARS coronavirus:
“Because SARS-CoV is believed to be transmitted mainly through the airborne route, PVP-I products for gargling and spraying the throat may have a prophylactic effect on SARS during outbreaks.”
And a 2015 study on the Middle East Respiratory Syndrome (MERS-CoV), which similarly concluded that:
“These data indicate that PVP-I-based hand wash products for potentially contaminated skin, and PVP-I gargle/mouthwash for reduction of viral load in the oral cavity and the oropharynx, may help to support hygiene measures to prevent transmission of MERS”
Perhaps the most significant finding from the MERS-CoV study above was that a greater than log 4 reduction (>99.99%) in viral titer counts was seen following exposure to “PVP-I” in concentrations as low as 1%, and after only 15 seconds of contact time. While the tests were done in vitro and not in a live host, it still seems clear that PVP-I is a very effective agent against coronavirues.
If you’re unfamiliar with the PVP-I acronym, it’s probably because you just know it by other names, povidone-iodine or by the brand name Betadine. The active ingredient is iodine, and iodine is a strong antimicrobial agent with activity against many different bacteria, viruses, and fungi. It’s deserving of a place in your preparations for a number of reasons, maybe the most important of which is its sporicidal activity against the spores that can cause tetanus (C. tetani), anthrax (B. anthracis), and gas gangrene (C. perfringens). Without access to tetanus vaccinations or immunoglobulin, or long courses of antibiotics in the case of anthrax or gangrene, irrigation of contaminated wounds with solutions containing iodine may be one of the best preventative measures against these diseases in a prolonged worst-case scenario. Povidone iodine is also on the World Health Organization’s model list of essential medicines, “a list of the safest and most effective medicines needed in a health system”, and it might be wise to stock up on as many of those drugs as possible as they’ll likely be in short supply after a disaster.
Back on topic, but with a note of caution first: The 10% povidone-iodine topical prep solution referred to in the rest of this article is not the same as “tincture of iodine”, nor is it the same formulation of iodine found in some water purification tablets, nor should surgical scrub solutions containing povidone-iodine be used as a replacement in the steps below. These instructions are strictly for 10% povidone iodine without added soaps or detergents, and not iodine in any other form or formulation. While PVP-I has few contraindications to its use, particularly when diluted to a 1% strength, it would be wise to refer to your physician or other medical professional to determine if there is any risk to you, or the individuals in your family, from exposure to either iodine or PVP-I first. Contact with solutions containing iodine should NOT be assumed to be safe for all individuals.
With that said, the instructions for making a simple Post-Exposure Prevention (PEP) kit suitable for EDC or an IFAK. The items needed:
An empty “5 hour energy” sized bottle (2 fluid ounces/60mL, 3.25” H x 1.375” W), with screw-on cap
Syringe (with graduations in mL/cc)
Cotton swabs ( 3” in length, standard double-tipped “Q-Tip” type)
Distilled water, grocery store variety is fine, it doesn’t need to be sterile.
To make the 1% PVP-I solution:
Clean the 60mL bottle, screw-on cap, and the syringe thoroughly, and rinse with distilled water
Add 6 mL/cc of 10% PVP-I (measured and added using the syringe) to the bottle
Add distilled water, up to the “shoulder” of the bottle, which will add approximately 54mL of distilled water, yielding a 1% solution.
Insert 2-3 cotton swabs in the bottle, and secure the cap.
The top of the 3” cotton swabs extend into the mouth of the 3.25” tall bottle, so they don’t fall over inside the container, and are relatively easy to extract with a finger tip after opening the cap. A single 60mL bottle of 1% PVP-I solution should be enough for PEP for one person.
Directions for Using PEP:
1) Shake the bottle to ensure even distribution of the PVP-I in the solution.
2) If necessary, remove any suspected virus-laden fluids (as from a cough or sneeze) off the skin by applying some of the 1% PVP-I solution to an uncontaminated cloth, paper towel, or gauze pad (or use separate PVP-I prep pads) and wiping it away. If on the face, start the wiping action from nearest to the eyes, nose, or mouth and wipe in a single direction away from them. Repeat as needed, but use a new cloth/pad for each new wipe. If near the eyes, be sure to thoroughly coat the eyelids, eyelashes, and eyebrows with the solution with your eyes closed.
3) Disinfect your hands, either with a fraction of the PVP-I solution, an alcohol based hand sanitizer, or with soap and water.
4) Using the cotton swabs removed from the 1% PVP-I solution bottle, thoroughly clean the insides of each nostril. Use a twisting motion to clean/coat as much of the interior surface as deeply as is comfortably possible. Use a new swab for each nostril, and pay particular attention to cleaning the small cavity inside the tip of the nose. Do not re-dip a used swab back into the solution.
5) Use the remaining PVP-I solution in the bottle to gargle and vigorously swish around in your mouth for a minimum of 30 seconds, then spit it out (do not swallow the solution).
In case you were wondering about safety (or toxicity) at this point, PVP-I solutions for use both as a mouth wash and as a nasal cavity antiseptic are FDA approved and available in products such as 1% Betadine mouth wash and 3M skin and nasal antiseptic.
PVP-I Eye Drops
A second precaution you may wish to take is to obtain, or make, PVP-I eye drops. As recently reported, a Chinese physician believes he contracted the Wuhan Coronavirus via contamination though his eyes while treating patients without wearing eye protection. Contracting a respiratory virus through the eyes isn’t unique to 2019-nCoV, the nasolacrimal ducts act as the pathway that any virus can use to reach the respiratory system from the eyes. Luckily, PVP-I is also available in ophthalmic solutions (eye drops), such as Betadine 5% Ophthalmic Prep Solution. That product does require a prescription however, as well as being a stronger concentration than is required. A couple alternative possibilities for making your own 1% PVP-I ophthalmic solution are:
A.) The World Health Organization (WHO) first published information on the small scale manufacture of some ophthalmic solutions for use in rural clinics where access to commercial pharmaceuticals was limited in 1990. The instructions were later updated in 2002 and can be downloaded here. The instructions for making 1% PVP-I eye drops in that document are arguably the easiest of all the ophthalmic solutions listed, partly due to only having two ingredients and the over-the-counter availability of each, but also because sterilization of the final solution is not required since, quoting the WHO, povidone iodine “is such a strong antiseptic that it DOES NOT REQUIRE STERILIZATION”. Note that pre-sterilization of the eye drop container IS still required, and the instructions on how to do so are included in the document. Suitable eye drop bottles to hold and dispense the solution are available in glass or plastic from Amazon, as is the sterile 0.9% sodium chloride (normal saline) in pre-filled IV flush syringes.
B.) A much simpler method however would be to purchase over-the-counter “Artifical Tears” in 15 mL size bottles, and add 1.65 mL of 10% PVP-I to the bottle to obtain a 1% solution (with a final total volume of 16.5 mL). I purchased the artificial tears locally in the same 15 mL size, and because the bottles weren’t completely filled to the top there was enough remaining capacity to add the 1.65 mL of PVP-I without overflowing the container. The easiest, and cleanest, method to add the PVP-I is using a sterile syringe and needle, and ‘inject’ the correct amount of PVP-I through the opening in the top of the eye drop bottle (the same opening where the drops are dispensed from). I’m not a physician nor a pharmacist, but this process does appear to meet all the requirements for the 1% PVP-I drops from the WHO document in option A – being already a sterile solution in a sterile bottle, with PVP-I added, and no further sterilization required due to the strong antiseptic properties of iodine. At room temperatures the solution has a shelf life of 1 month (per the WHO).
If you choose to add 1% PVP-I eye drops to your PEP, instill 2-3 drops in each eye after cleaning the external area around the eyes, and then clean your hands, and then insert the drops.
In conclusion, this isn’t suggesting a therapy for treatment, but simply a plausible PEP protocol to be taken in the first minutes after having some reasonable suspicion that you’d been exposed to the virus. The goal being to inactivate as much of the virus as possible before they bind to your cells, giving your immune system a greater chance of fighting off the remainder successfully, and thus reducing the risk of developing a respiratory infection from the Wuhan Coronavirus. Of course, any additional warnings, recommendations, and/or clarifications would be most welcome as they could prove useful to refine the process to make it more effective, whether for use in the current Wuhan Coronavirus outbreak or some future pandemic.