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Practitioners specialized in oral health and coronavirus disease 2019: Professional guidelines from the French society of stomatology, maxillofacial surgery and oral surgery, to form a common front against the infectious risk
Abstract
Medical as well as non-medical practitioners specialized in oral health are at high risk of infection with the Coronavirus-19 (Covid-19) because of the proximity with potentially infected biological fluids. This risk is permanent, especially during examination, care and transfer of patients. Regarding the pandemic progression of Covid-19, efficient protocols of prevention are urgently needed. Based on our experience and on the recently reported guidelines from the French National Agency for Public Health (ARS, March 5, 2020), the French Society of Hospital Hygiene (SFHH, March 4, 2020) and the Department of Infectious Risk Prevention of the Hospitals of Paris-Public Assistance (APHP, March 6, 2020), we provide several recommendations for practitioners specialized in oral health, to protect themselves from nosocomial infections, especially Covid-19.
... Several other articles have been published on the necessary reorganization of surgical departments during the COVID-19 pandemic and the decline in surgical activity resulting from the medical measures implemented in response to this pandemic [13][14][15][16][17][18][19][20][21] . However, none of them has precisely evaluated the decline in trauma cases, and especially in maxillofacial trauma cases. ...
... However, none of them has precisely evaluated the decline in trauma cases, and especially in maxillofacial trauma cases. Some academic societies of maxillofacial surgery have worked on recommendations to be taken into consideration when dealing with the COVID-19 pandemic: The French Society of Stomatology, Maxillofacial Surgery and Oral Surgery has recently published guidelines for protocols relating to the infectious risk and recommendations for practitioners specialized in oral health, in order to protect themselves and their patients from the risk of nosocomial infection 16 . In the United Kingdom, Holmes et al. 22 published recommendations on the management of acute facial injuries during the COVID-19 pandemic. ...
... However, in parallel with the measures enforced and despite the pandemic, it has been necessary to continue to deal with emergencies in an optimal manner. Thus, in many surgical departments and in particular in maxillofacial surgical units, non-COVID-19 patients have also had to be managed according to the recommendations written by national and international academic societies, derived from the practical experiences of other medical teams around the world 2,16,22,23 . Patients requiring urgent or semi-urgent maxillofacial care have therefore been treated in specific units by specialized staff. ...
The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed. © 2020 International Association of Oral and Maxillofacial Surgeons
... 1,29,36,[39][40] Thus, confirmed by the widespread agreement of the premise of using complete and suitable PPE for any procedures for cancer patients, taking care of the dental environment is a fundamental measure for the control of cross infection. 3,5,[7][8][14][15][16][17] This care needs to start in the reception environment 3,16 through notices that instruct patients on the cough and sneeze label 16 , the removal of potentially contaminating objects, guidance for disposing of utensils in a trash bin, immediately after use and ensuring the hygiene of the leaving 70% alcohol available, in addition to offering bags for electronic devices and bags to be left in this environment. 3,17,31 Spatial separation of at least 1 to 2 meters must be maintained between patients 3,16,19 or limit one patient in the waiting room at a time 21 , avoiding delays in their appointments so as not to increase the number of patients in the waiting room. ...
... 3,5,[7][8][14][15][16][17] This care needs to start in the reception environment 3,16 through notices that instruct patients on the cough and sneeze label 16 , the removal of potentially contaminating objects, guidance for disposing of utensils in a trash bin, immediately after use and ensuring the hygiene of the leaving 70% alcohol available, in addition to offering bags for electronic devices and bags to be left in this environment. 3,17,31 Spatial separation of at least 1 to 2 meters must be maintained between patients 3,16,19 or limit one patient in the waiting room at a time 21 , avoiding delays in their appointments so as not to increase the number of patients in the waiting room. ...
... In clinical dental practice, in this context, procedures should be done cautiously. So that they should produce as few aerosols as possible [14][15][16][17][18][19][20] , it being preferable, in these circumstances, to resort to the use of the high power suction with the vacuum pump, absolute isolation and low rotation with refrigeration instead of high rotation when possible. 5,[20][21] Manual instruments instead of water-cooled or ultrasonic decontamination devices. ...
Como citar: Martins AG, Rodrigues JLSA, Ribeiro FS, Lobo LN, Oliveira MC, Cerqueira JDM. Guidelines for Clinical Dental Practice for Oncology patients and COVID-19. REVISA. 2020; 9(Spe.1): 618-30. Doi: https://doi.org/10.36239/revisa.v9.nesp1.p618a630 RESUMO Objetivo: realizar uma revisão integrativa a fim de compilar os conceitos vigentes sobre a prática odontológica para pacientes oncológicos e o COVID-19. Método: para a construção deste artigo foram realizadas buscas bibliográficas eletrônicas utilizando a base de dados Pubmed que abordassem o tema proposto até 2020. A busca dos artigos foi realizada em maio e junho de 2020 e para tanto, foi utilizada a string de busca (sars-CoV-2 OR coronavirus OR covid-19) e (dentistry OR oral health OR dental practice OR dental education). Resultados: foram selecionados 25 artigos lidos em sua versão completa, sendo ao final selecionados 16 artigos que apresentaram com clareza o protocolo clínico para atendimento odontológico durante a pandemia do COVID-19 e outros 09 artigos que relacionaram o atendimento odontológico de pacientes oncológicos durante a pandemia e perspectivas futuras. Conclusão: o protocolo para o atendimento odontológico em meio a pandemia do COVID-19 demanda adequação no ambiente de trabalho odontológico, um criterioso protocolo de equipamentos de proteção individual, bem como, uma mudança na relação com o paciente, lembrando sempre de humanizar o atendimento dos pacientes oncológicos.
... No está permitida la entrada de visitas al hospital. Se puede autorizar un solo acompañante que no presente síntomas 33 . El paciente no podrá salir de su habitación, salvo para la realización de pruebas diagnósticas o medidas terapéuticas. ...
... It is also recommended to perform a complementary nasal wash with gauze or nasal swabs impregnated with the same substances. The use of rotating material (handpiece), electric scalpel, ultrasonic material and piezoelectric devices should be avoided as much as possible to minimize the formation of aerosols 7,33 . ...
... Visits to the hospital are not allowed. A single companion who does not present symptoms can be authorized 33 . The patient may not leave his room, except for diagnostic tests or therapeutic measures. ...
The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of oral and maxillofacial surgery departments in Spain, delaying routine patient care and elective surgical interventions. Oral and maxillofacial surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and oropharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in outpatient clinic, ambulatory, elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the oral and maxillofacial surgeon, health workers and patients. This document aims to clarify the most significant aspects and create a common protocol for the management of patients with COVID-19 in oral and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country.
... Fuerte en contra Los pacientes y equipo de salud en odontología están expuestos a microorganismos patógenos, incluidos virus y bacterias que infectan la cavidad oral y el tracto respiratorio. El entorno de atención bucal invariablemente conlleva el riesgo de infección COVID-19 debido a la especificidad de sus procedimientos, especialmente cuando los pacientes están en el período de incubación y no saben que están infectados o eligen ocultar su infección, lo que implica el riesgo a la exposición a saliva, sangre y otros fluidos corporales, y el manejo de instrumentos y equipos biomédicos que generan aerosoles en la atención odontológica 250 . ...
... Por otro lado, en el marco actual de la pandemia generada por COVID-19, es importante resaltar la necesidad de equilibrar los contextos sociales y los biológicos de la práctica odontológica, de manera que el ejercicio de la odontología no menoscabe ninguno de estos contextos. Es claro que, en el momento histórico actual resulta mandatorio la aplicación de medidas que garanticen la salud y la vida desde el punto de la mitigación de la propagación y el contagio de COVID-19 para el personal de salud, como de la comunidad en general, mediante la racionalización y coherencia en la prestación de los servicios, implementación estricta de protocolos de bioseguridad, aseo y desinfección, pero siempre articulados a las necesidades de la población en materia de salud 250 . ...
SECCION X. Prevención y control de la infección por SARS – COV-2/COVID-19
... Fuerte en contra Los pacientes y equipo de salud en odontología están expuestos a microorganismos patógenos, incluidos virus y bacterias que infectan la cavidad oral y el tracto respiratorio. El entorno de atención bucal invariablemente conlleva el riesgo de infección COVID-19 debido a la especificidad de sus procedimientos, especialmente cuando los pacientes están en el período de incubación y no saben que están infectados o eligen ocultar su infección, lo que implica el riesgo a la exposición a saliva, sangre y otros fluidos corporales, y el manejo de instrumentos y equipos biomédicos que generan aerosoles en la atención odontológica 250 . ...
... Es importante en este sentido, crear y mantener acciones en pro de la progresiva reducción de las desigualdades sociales, de salud y de pobreza253 .Por otro lado, en el marco actual de la pandemia generada por COVID-19, es importante resaltar la necesidad de equilibrar los contextos sociales y los biológicos de la práctica odontológica, de manera que el ejercicio de la odontología no menoscabe ninguno de estos contextos. Es claro que, en el momento histórico actual resulta mandatorio la aplicación de medidas que garanticen la salud y la vida desde el punto de la mitigación de la propagación y el contagio de COVID-19 para el personal de salud, como de la comunidad en general, mediante la racionalización y coherencia en la prestación de los servicios, implementación estricta de protocolos de bioseguridad, aseo y desinfección, pero siempre articulados a las necesidades de la población en materia de salud250 .Finalmente, existe en odontología, un espacio desde la promoción de la salud y la prevención de la enfermedad, que puede y debe incorporarse dentro del ejercicio profesional durante la era de la pandemia, factible sin involucrar aerosoles y controlando por aislamiento social el riesgo de infección por COVID-19 en el equipo profesional y en los pacientes, pero a su vez, favoreciéndose de la efectividad demostrada de medidas de educación en salud oral y medidas preventivas para el control de la caries dental, principalmente en los grupos poblacionales de mayor riesgo a esta patología oral, como son los preescolares, escolares y adultos mayores, favoreciéndose también la aplicación de la teleodontología 208,254-262 . ...
... In watery environments, the virus might survive several days. 43 Clinical and virologic studies suggest that the viral load is particularly high in the superior respiratory tract, nose, and throat in the first 3 days after the onset of symptoms. 44,45 However, the virus has also been found in several body fluids, including faeces, and, thus, the risk of faecal-oral transmission cannot be dismissed. ...
... The clinical signs and symptoms of COVID-19 vary widely, from asymptomatic or subsymptomatic presentations to a flu-like syndrome 43 to severe respiratory insufficiency requiring mechanical ventilation in ICUs, which may ultimately lead to death. 75 The most common signs and symptoms are fever, dry cough, and tiredness. ...
COVID-19, a viral disease declared as a pandemic by the World Health Organization in March 2020, has posed great changes to many sectors of society across the globe. The virulence and rapid dissemination have forced the adoption of strict public health measures in most countries, which, collaterally, resulted in economic hardship.
This paper is the first in a series of three and aims to contextualize the COVID-19 clinical impact for the dental profession. It presents the epidemiological conditions of SARS-CoV-2, namely, its modes of transmission, incubation and transmissibility period, signs and symptoms, immunity, immunological tests, and risk management in dental care.
Individuals in dental care settings are exposed to three potential sources of contamination with COVID-19: close interpersonal contacts (<1 meter), contact with saliva, and aerosol-generating dental procedures. Thus, we propose a risk management model for the provision of dental care, depending on the epidemiological setting, the patient's characteristics, and the type of procedures performed in the office environment.
Although herd immunity seems hard to achieve, a significant number of people has been infected throughout the first 9 months of the pandemic and the vaccination has been implemented, which means that there will be a growing number of presumable “immune” individuals that might not require precautions that differ from those before COVID-19.
In conclusion, dental care professionals may manage their risk by following the proposed model, which considers the recommendations by local and international health authorities, thus providing a safe environment for both professionals and patients.
... Several guidelines and strategies have been suggested to prevent and control the disease at three levels: the case-related population, the general population, and the national level. These include the maintenance of hand hygiene, disinfection of surfaces, and adherence to basic cough etiquette [14,15]. Similarly, the National Health Commission of China (NHCC) issued disinfection protocols for the elderly and rural area populations that can be applied all over the world [13][14][15][16][17]. ...
... These include the maintenance of hand hygiene, disinfection of surfaces, and adherence to basic cough etiquette [14,15]. Similarly, the National Health Commission of China (NHCC) issued disinfection protocols for the elderly and rural area populations that can be applied all over the world [13][14][15][16][17]. The World Health Organization (WHO) also suggested guidelines for the reduction of viral load through the cleaning and disinfection of surfaces and wastes with the help of disinfectants, such as 0.1% sodium hypochlorite, 0.5% hydrogen peroxide, or 62%-71% ethanol [18,19]. ...
The world is currently facing a pandemic crisis due to a novel coronavirus. For this purpose, acquiring updated knowledge regarding prevention and disinfection during the current pandemic is necessary for every dental practitioner. In our study, we aimed to evaluate globally the level of knowledge and the attitude of dental practitioners related to disinfection. A total of 385 participants out of 401 participants from 23 different countries across the world were included in the final analysis after the exclusion of incomplete responses. The majority of the dentists who responded were females (53.8%) and were practicing at private health institutes (36.4%). The mean knowledge score of the participants was estimated to be 4.19 ± 1.88 out of 12, reflecting insufficient knowledge, and the mean attitude score of the participants was estimated to be 12.24 ± 3.23 out of 15, which shows a positive attitude toward disinfection practices during coronavirus 2019 (COVID-19). Thus, the current study indicated a lack of knowledge in fundamental aspects of disinfection protocols with a significant and positive attitude from dental health professionals toward disinfection regarding the coronavirus 2019 (COVID-19) pandemic.
... It is also recommended to perform a complementary nasal wash with gauze or nasal swabs impregnated with the same substances. The use of rotating material (handpiece), electric scalpel, ultrasonic material and piezoelectric devices should be avoided as much as possible to minimize the formation of aerosols 7,33 . ...
... Visits to the hospital are not allowed. A single companion who does not present symptoms can be authorized 33 . The patient may not leave his room, except for diagnostic tests or therapeutic measures. ...
... This is a unique moment in which surgeons should consider alternative treatments and practice conservation for greater functionality of the health system. French [6] have instructed home isolation of the patient for fourteen days after hospital discharge. It is worth emphasizing that the urgency of a procedure in front of the present momentary health situation must be decision based on critical clinical judgment, and to be defined case by case. ...
... So parameters need to be imposed by limitation of professionals involved in surgery, restriction of staff and material turnover in the transoperative period. Considering that the contamination risk would be increased by the aerosols of engines, drills, piezoelectric, fluid leak from intubation tubes, to prevent viral dispersion to the aspiration of saliva and other potentially contaminated secretions, needs to be continuous and high power [6]. ...
... Several guidelines and strategies have been suggested to prevent and control the disease at these levels: the case-related population and the general population. These include the maintenance of hand hygiene, disinfection of surfaces, and adherence to basic cough etiquette [14], [15]. Similarly, the National Health Commission of China (NHCC) issued disinfection protocols for the elderly and rural populations that can be applied worldwide [16], [17]. ...
Aim:
Sanitation and cleanliness are essential factors in reducing the spread of pathogens and preventing healthcare-associated infections. Disinfectants are associated with better hygiene outcomes to reduce pathogen transmission risk and minimize risks to healthcare workers (HCWs) and patients.
Methods:
A literature search was undertaken using the electronic databases Scopus, Web of Science, Ovid and Google Scholar. The inclusion criteria for this study are observational and original research studies dating from the five-year period 2017-2021. Other inclusion criteria are full text, English language, qualitative or quantitative studies relevant to the research question. The exclusion criteria are animal studies, systematic reviews, conference proceedings, abstracts, projection modelling studies, in-vivo or in-vitro studies, and books.
Results:
Five study nations included the United States of America (USA), the United Kingdom (UK), China, India and South Korea, together with Malaysia. These nations have existing policies, regulations and guidelines regarding the use of disinfectants. HCWs should be aware of the national laws and guidelines that govern the purchase, distribution and use of disinfectants. They should also understand the different roles of the agencies involved, so the context for the guidance provided is clear. Coordination and collaboration across various stakeholders are required for creating solid policies.
Conclusion:
Product research and innovation are indispensable, as appropriate personal protective equipment and safety measures for HCWs and patients have top priority in every nation. Hence, clear guidelines for handling disinfectants, in addition to health education about scientific-evidence-based disinfectants, are required.
... So far, according to consensus, power air-purifying respirators (PAPR), which were scarcely available during the outbreak, have not been considered mandatory to safely avoid aerosol-borne transmission in OMFS [23]. At present, N95/FFP2 for AGPs and N99/FFP3 masks with valves [23] for surgery in infected patients, respectively, are most frequently recommended, instead [127][128][129][130][131]. ...
Various dental, maxillofacial, and orthopedic surgical procedures (DMOSP) have been known to produce bioaerosols, that can lead to the transmission of various infectious diseases. Hence, a systematic review (SR) aimed at generating evidence of aerosols generating DMOSP that can result in the transmission of SARS-CoV-2, further investigating their infectivity as well as assessing the role of enhanced personal protective equipment (PPE) an essential to preventing the spreading of SARS-CoV-2 during aerosol-generating procedures (AGPs). This SR was performed according to PRISMA guidelines based on a well-designed PICOS framework and various databases were searched to retrieve the studies which assessed potential aerosolization during DMOSP. This SR included 80 studies (59 dental and 21 orthopedic) with 7 SR, 47 humans, 5 cadaveric, 16 experimental, and 5 animal studies that confirmed the generation of small-sized <5µm particles in DMOSP. One study confirmed that HIV could be transmitted by aerosolized blood generated by electric saw and bur. There is sufficient evidence that DMOSP generates an ample amount of bioaerosols, but the infectivity of these bioaerosols to transmit diseases like SARS-Cov-2 generates very weak evidence but still, this should be considered. Confirmation through isolation and culture of viable virus in the clinical environment should be pursued.As a consequence, any evidence provided by the current review was gathered by extrapolation from available experimental and empirical evidence not based on SARS-CoV-2. The results of the present review, therefore, should be interpreted with great caution.
... Several guidelines have been recommended to prevent and control the disease at various levels of populations. The WHO also advocated recommendations for the decrease in viral load via the disinfection and cleaning [127][128][129] ...
The hustle and bustle of the planet Earth have come to a halt thanks to the novel coronavirus. The virus has affected approximately 219 million people globally; taken the lives of 4.55 million patients as of September 2021; and created an ambiance of fear, social distancing, and economic instability. The purpose of this review article is to trace the historical origin and evolution of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The virus is highly contagious with a unique feature of rapid mutations—the scientific research is paving the way for discoveries regarding novel coronavirus disease (COVID-19) diagnosis, features, prevention, and vaccination. The connections between the coronavirus pandemic and dental practices are essential because COVID-19 is transmitted by aerosols, fomites, and respiratory droplets, which are also produced during dental procedures, putting both the patient and the dentist at risk. The main emphasis of this paper is to highlight the psychological, economic, and social impact of this pandemic on dental practices throughout the world and under what circumstances and guidelines can dental health care be provided. In the current situation of the pandemic, an appropriate screening tool must be established either by using rapid molecular testing or saliva point-of-care technology, which will be effective in identifying as well as isolating the potential contacts and carriers in hopes to contain and mitigate infection. The blessing in disguise is that this virus has united the leaders, scientists, health care providers, and people of all professions from all around the world to fight against a common enemy.
... It is worth mentioning that the knowledge of students majoring in oral medicine was higher than others. This could be influenced but the fact that novel coronavirus is mainly transmitted by respiratory droplets and contact (35), and that oral students are educated that close contact with the mouth, nose, or eyes of a person (36) has a high risk of infection through proximity with potentially infected biological fluids (37), especially during an examination, care, and transfer of patients (38). Therefore, compared with other majors, oral medical students had more knowledge about COVID-19. ...
Background: The ongoing coronavirus disease (COVID-19) outbreak has placed the healthcare system and student training under considerable pressure. However, the plights of healthcare students in the COVID-19 period have drawn limited attention in China.
Methods: A cross-sectional on-line survey was undertaken between January and March 2020 to explore the COVID-19 knowledge, attitude, and practice (KAP) survey among Chinese healthcare students. Demographic information and data on KAP were obtained using a self-reported questionnaire. The percentage KAP scores were categorized as good or poor. Independent predictors of good knowledge of COVID-19 were ascertained to use a logistic regression model.
Results: Of the 1,595 participants, 85.9% (1,370) were women, 53.4% were junior college students, 65.8% majoring in nursing, and 29.8% had received training on COVID-19. The overall median percentage for good KAP was 51.6% with knowledge of 28.3%, attitude 67.8%, and practice 58.6%, respectively. Independent predictors of good knowledge of COVID-19 were being students ≥25 (95% CI = 0.27–0.93, P = 0.02), those taking bachelor degrees (95% CI = 1.17–2.07, P = 0.00), and those having participated in COVID-19 treatment training.
Conclusions: The result of this study revealed suboptimal COVID-19-related KAP among healthcare students in China. To effectively control future outbreaks of COVID-19, there is a need to implement public sensitization programs to improve the understanding of COVID-19 and address COVID-19-related myths and misconceptions, especially among healthcare students.
... Four observers (GLI, AM, EP, GS) assessed nine guidelines closely fitting the inclusion criteria (Table 2). [10][11][12][13][14][15][16][17][18] The evaluators found AGREE II simple and recognized it as helpful for refereeing the quality of the guidelines. A multinational collaboration produced only 1 guideline. ...
Background
A project to benchmark the consensus statements, guidelines, and recommendations on surgical management in the course of the COVID-19 pandemic was developed to assess the methodology used. Standard and practical approaches for COVID-19 management in surgical patients to date are not accessible, despite the magnitude of the pandemic. A plethora of consensus statements, guidelines, and recommendations on surgical management in the course of COVID-19 epidemic have been rapidly published in the last three months.
Methods
Each manuscript was scored on a seven-point scale in the different items and domains with the Appraisal of Guidelines for Research and Evaluation II.
Results
Nine guidelines that met the inclusion criteria were assessed. Transnational cooperation produced only one guideline. Multivariable analysis showed that improved scores of stakeholders’ involvement were related to internationally developed guidelines. Clarity of presentation was related to the contribution of scientific societies due to greater rigor of development. The rigor of development produced guidelines with a high overall value. Higher healthcare expenses did not produce superior guidelines.
Conclusions
Evaluated by the Appraisal of Guidelines for Research and Evaluation II, the methodological characteristic of consensus statements, guidelines, and recommendations on surgical management during COVID-19 pandemic was relatively low. International development should be recommended as a model for the development of best methodological quality guidelines.
... In a well-documented set of guidelines, the French Society of Stomatology, Maxillo-facial Surgery and Oral Surgery has summarized recommendations for the adoption of efficient protocols of prevention for medical and non-medical practitioners specialized in oral health to protect themselves from coronavirus disease 2019 (COVID-19). The recommendations are based on the own experience of the society fellows and on reported guidelines from French normative agencies [1]. We fully agree with the contents of the document. ...
... Oral and maxillofacial surgery specialty have been affected by the COVID-19 pandemic as well. There have been changes in the maxillofacial prac ces according to various guidelines to 11,12 combat COVID-19. In our study, the majority of cases were in the third decade of life (38.4%, ...
Introduction: Maxillofacial injuries are one of the most common injuries seen in trauma patients. Road traffic accidents (RTA) are the most common cause of maxillofacial injuries all over the world. RTA are supposed to decrease due to lockdown which has become a usual phenomenon during the COVID- 19 pandemic. Changes in the etiology of maxillofacial injuries are supposed to dictate their pattern as well. Objectives: The objective of this study was to assess the pattern of maxillofacial injuries during the COVID-19 Pandemic at Birat Medical College and Teaching Hospital. Methodology: A cross-sectional study was conducted among the patients attending Birat Medical College and Teaching Hospital for the treatment of maxillofacial injuries from 1 May to 31 July 2020. Consecutive sampling was used to collect data from 52 study participants. Results: A total of 52 patients with maxillofacial injuries were studied. The age of patients ranged from 1 year to 73 years with a median age of 26 years. There were 69.2% (n=36) males with a male to female ratio of 2.25:1. The most common etiology was Road Traffic Accidents (50%, n=26). Laceration (70.7%, n=29) was the most common soft tissue injury. Parasymphysis fracture (23.8%, n=5) was the most common site of mandible fracture. The most common midface fracture was the zygomaticomaxillary complex (ZMC) fracture (40.9%, n=9). Conclusion: RTA still remains the most common etiology of maxillofacial injuries in spite of COVID-19 and the pattern of maxillofacial injuries has not changed much either.
The COVID-19 pandemic has been declared since March 11, 2020. Until December 2020, the absence of specific treatments or vaccines for COVID-19 implied the need to use non-pharmacological strategies to reduce infection rates. This study aimed to track and compare the policy responses of countries with the highest number of COVID-19 deaths in the world. Was performed a scoping search in five databases (PubMed, Scopus, LILACS, Web of Science and Google Scholar) between December 1, 2019 and April 30, 2020. Information on policy and health on official websites of the listed countries was also searched. After the selection process, which was carried out independently by two evaluators following the previously established criteria, 55 titles were included. Of the 18 documents of national health societies, 13 addressed the prevention of COVID-19. The most reported country was Italy (17). The strategies most cited by the studies are: traveler monitoring, international travel controls, social distancing orders, closure schools and universities, partial and total lockdown. Until the end of April, all countries evaluated, United States, Italy, the United Kingdom, Spain, France, Belgium, Germany, Iran, Brazil and the Netherlands, have adopted measures such as social distancing orders and the closure of schools and universities. Except for Iran, all these countries have adopted some type of lockdown. So far (August, 2022), Germany has already been cited as an example of a successful country in controlling the pandemic, while the United States still has the highest numbers in the world in total cases, total deaths and new deaths weekly from COVID-19.
A large number of scientific articles have been published regarding impact of COVID-19 infection on dental practice, dental professionals, and the mode of spread of infection via dental procedures. The present systematic review was planned with an aim of evidence mapping and quality analysis of published research on the dental aspects of COVID-19 infection.The protocol was registered at https://share. osf.io/registration/46221-C87-BA8. The search was performed in Scopus, PubMed, Cochrane, and Embase databases till 15th July 2020. There was no restriction of year of publication and language. All types of published articles related to Dentistry, Dentist, Dental practice, and Oral health education on COVID-19 were included. The Joanna Briggs Institute's (JBI) Critical Appraisal Tools were used for the risk of bias analysis of included studies. A total of 393 articles were short-listed and were checked for eligibility and finally, 380 articles were included. Among the 380 research articles published (till July 15, 2020), the majority of the included articles belonged to the lowermost strata of the evidence pyramid. There were 54 original research articles with no randomized clinical trial, systematic review or, meta-analysis pertaining to the dental perspective of COVID-19 infection. The level of available evidence about dentistry and COVID-19 infection is very low with a lack of researches of highest quality. The guidelines/recommendations for dental professionals, proposed by the different scientific organizations/societies regarding COVID-19 infection are only consensus-based necessitating the need to formulate evidence-based guidelines. There is a need to identify essential research questions and strengthen the study designs in most of the aspects related to the dentistry and COVID-19 pandemic.
Background:
This review was conducted in order to learn the latest information about how to prevent cross-infection of COVID-19 in dentistry. The aim of this study is offer a clinical protocol to reduce the risk of infection of COVID-19 in dental settings.
Material and methods:
We carried out a review based on the PRISMA guide (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We used the following three databases: PubMed, Embase and Scopus. The search strategy was performed in the three databases applying the search terms "COVID-19 AND dental", "COVID-19 AND dentistry", selecting human studies published from November 2019 to May 2020. English publications regarding COVID-19 as the central topic of the research were eligible for inclusion, regardless of study design. There are very few published studies on the association between COVID-19 and dentistry, for that reason we also included the English abstract of two studies written in Chinese. The following exclusion criteria were established: animal studies and in vitro studies.
Results:
The search identified a total of 212 articles, of which 54 were preselected, and 23 were finally included in the review on the basis of the inclusion and exclusion criteria. We collected all the information about routes of general and oral infection, dental patient evaluation and cross-infection control in Dental Clinic in the selected studies.
Conclusions:
Cross infection in the dental clinic involve a very important risk due to the return to dental settings after periods of social isolation of the population after the epidemic outbreak of SARS-CoV-2. Therefore, we must take adequate and sufficient security measures to protect the patients and the dental clinic staff. Key words:COVID-19, COVID-19 cross infection risk, COVID-19 prevention in Dentistry, COVID-19 in Dental Clinic.
Background
Dental and oral health workers have direct contact with respiratory aerosols of patients during procedures. This study aimed to determine the main concerns of dental and oral health workers globally during COVID-19 outbreaks and the coping strategies that help the resilience of dental and oral healthcare system.
Methods
This scoping study was conducted in August 2020. After adjusting the search strategy, a systematic search of five databases (PubMed, ISI Web of Science, Scopus, ProQuest and EMBASE) was conducted. Data was extracted using Microsoft Excel and the contents of retrieved articles were analysed through a qualitative thematic analysis applying MAX QDA 10 .
Results
Most articles were either editorial/letters to the editor/commentary formats (34%), or literature reviews (26%). About half of the articles belonged to three countries of Italy, China and the USA (each 16% and totally 48%). Thematic analysis of included papers led to the identification of four main global concerns and 19 sub-concerns. Economic, ethical, social and professional concerns are among dental and oral health concerns. Other results indicate on three main themes and 13 sub-themes as the coping strategies including patient management, infection control and virtual strategies.
Conclusion
Dental and oral health care workers have many concerns relating to COVID-19 including economic, ethical, social and professional factors. Resolution of concerns may involve enhancing coping strategies relating to patient management and infection control strategies as well as using new technologies for virtual contact with the patient without any risk of infection.
Facing the COVID-19 challenge on a global level, dental care professionals are encouraged to optimize universal precautions and adopt measures that ensure protection against infection by contaminated aerosols and droplets. Although aerosol transmission is possible, direct contact through large droplets is probably responsible for the vast majority of transmissions.[1, 2]
This paper is the 2nd of a series of three on the management of COVID-19 in clinical dental care settings and aims to describe PPE selection and use by DCP, with consideration of the level of risk associated with the planned procedures. PPE selection depends directly on the local epidemiological setting, the patient's characteristics, and the level of risk of the planned procedures. The procedures performed in the office environment are classified as low-, moderate-, or high-risk. Moderate risk includes two further sublevels associated with the cleaning, disinfection, and sterilization of materials for clinical procedures that do not generate aerosols. The training of DCP on how to properly don (put on) and doff (remove) PPE is as important as choosing the appropriate PPE since it can be associated with a risk of infection.
When there is limited availability of PPE, measures should be adjusted to the risk associated with the intervention. Assuming that an effective vaccine will be developed, once it becomes available for DCP, PPE requirements will likely be different.
The proper use of PPE, together with the adoption of other operational procedures, can provide effective protection against microorganisms being transmitted via body fluids or in the air
The COVID-19 pandemic dramatically changed all aspects of life. In the context of clinical dental care, a significant number of new recommendations have been implemented in order to comply with public health policies, ensuring the safety of dental care professionals, staff, and patients, and preventing further spread of the virus.
This paper is the 3rd in a series of three on the management of COVID-19 in clinical dental care and presents a set of recommendations and standards to be implemented in the context of the COVID-19 pandemic. These include remote contact with all patients for triage and guidance before scheduling a clinical visit to know if they have COVID symptoms or are COVID positive, if they belong to a risk group, and if there is a suggestion that aerosol-generating procedures (AGP) will be required during their visit. It also reviews additional precautionary measures in the waiting room and reception area, where the environment is reorganized in order to protect patients and clinical staff, avoiding situations that could result in cross contamination. The dental office operate under a strict set of guidelines, namely, use of personal protective equipment by professionals, contact with patients, a strategy to avoid AGP, as well as disinfection procedures for the dental office before, during, and after each patient visit.
The implementation of these protocols to mitigate cross-infection and spread of SARS-CoV-2 in the dental office will help improve safety and restore the confidence required to provide dental care to patients during the COVID-19 pandemic.
Patients with cleft lip and palate have important trouble in breastfeeding due to the difficulty of performing suction properly. Within this context, the development of the newborn is usually compromised due to low weight gain.1, 2 The treatment of patients with cleft lip and palate is surgery, which commonly occurs in the sixth month of life.
Background:
On 30 January 2020, a public health emergency of international concern was declared as a result of the new COVID-19 disease, caused by the SARS-CoV-2 virus. This virus is transmitted by air and, therefore, clinical practices with the production of contaminant aerosols are highly at risk. The purpose of this review was to assess the effectiveness of bio-inspired systems, as adjuvants to nonsurgical periodontal therapy, in order to formulate bio-inspired protocols aimed at restoring optimal condition, reducing bacteremia and aerosols generation.
Methods:
A comprehensive and bibliometric review of articles published in English. Research of clinical trials (RCTs) were included with participants with chronic or aggressive periodontal disease, that have compared benefits for nonsurgical periodontal therapy (NSPT).
Results:
Seventy-four articles have been included. For probing depth (PPD) there was a statically significant improvement in laser, probiotic, chlorhexidine groups, such as gain in clinical attachment level (CAL). Bleeding on probing (BOP) reduction was statistically significant only for probiotic and chlorhexidine groups. There were changes in microbiological and immunological parameters.
Conclusions:
The use of bio-inspired systems in nonsurgical periodontal treatment may be useful in reducing risk of bacteremia and aerosol generation, improving clinical, microbiological and immunological parameters, of fundamental importance in a context of global pandemic, where the reduction of bacterial load in aerosols becomes a pivotal point of clinical practice, but other clinical trials are necessary to achieve statistical validity.
(Frontiers in Dental Medicine)
The coronavirus disease 2019 (COVID-19) is an acute infectious disease that has led to a global pandemic. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for this infection. This virus enters the body through the mucous membranes (oral, nasal, or conjunctival ocular) or the skin and replicates in the respiratory system (nasal cavity, throat, and the lung) but may cause damage to other systems and organs. Main transmission is through saliva droplets and oral fluids (OF) including saliva and non-salivary elements that contain infective viral loads of the virus. SARS-Cov-2 enters cells via receptor angiotensin-converting enzyme II (ACE2) and the action of an enzyme (furin) that cleaves the viral envelope and enhances the infection of the host cells. Although the origin, mechanism, and dynamics of SARS-CoV-2 in OF remain to be elucidated, its presence in OF is now established. Therefore, OF might be a diagnostic or monitoring tool for COVID-19 either alone or in combination with other tests in addition to the clinical examination. Moreover, the presence of SARS-CoV-2 in OF raises the question of the management of the infectious risk for dental practice. There is an urgent need to inform the dental community and ensure measures to protect dentists and dental staff from the new SARS-CoV-2. This comprehensive review of COVID-19 and oral health depicts the roles of OF in the transmission dynamics of SARS-CoV-2 and discusses the value of OF as a diagnostic tool and focuses on the management of risk transmission related to OF in dental practice.
Purpose
Coronavirus Disease 2019 (COVID-19) has caused suffering and death around the world. Careful selection of facial protection is paramount for preventing virus spread among healthcare workers and preserving mask and N95 respirator supplies.
Methods
This paper is a comprehensive review of literature written in English and available on Pubmed comparing the risk of viral respiratory infections when wearing masks and N95 respirators. Current international oral and maxillofacial surgery guidelines for mask and N95 respirator use, patient COVID-19 disease status, aerosol producing procedures were also collected and incorporated into a workflow for selecting appropriate facial protection for oral and maxillofacial surgery procedures during the current pandemic.
Results
Most studies suggest N95 respirators and masks are equally protective against respiratory viruses. Some evidence favors N95 respirators, which are preferred for higher risk procedures when aerosol production is likely or when the COVID-19 status of a patient is positive or unknown. N95 respirators may also be used for multiple patients or reused depending on the type of procedure and condition of the respirator after each patient encounter.
Conclusion
N95 respirators are preferred over masks against viral respiratory pathogens, especially during aerosol generating procedures or when a patient’s COVID-19 status is positive or unknown.
The Coronavirus disease 2019 (COVID-19) pandemic suddenly took the world by storm and Italy was one of the hardest hit countries. Maxillo-facial surgery and dentistry procedures had to be significantly reorganized, since they are considered high-risk procedures. Protocols had to be changed and interdepartmental cooperation was put in place to plan surgical interventions and maintain high standards. Various improvements have been made to prevent and reduce the risks of spreading the infection. Even if the situation seems to have improved, being unprepared is not an option. In this paper the experience gained during these months has been shared and possible future challenges has been highlighted, suggesting practical adjustments based also on new guidelines and recommendations.
Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is “social distancing” with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients’ selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children’s acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.
In late December 2019, a cluster of unexplained pneumonia cases has been reported in Wuhan, China. A few days later, the causative agent of this mysterious pneumonia was identified as a novel coronavirus. This causative virus has been temporarily named as severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and the relevant infected disease has been named as coronavirus disease 2019 (COVID‐19) by the World Health Organization respectively. The COVID‐19 epidemic is spreading in China and all over the world now. The purpose of this review is primarily to review the pathogen, clinical features, diagnosis, and treatment of COVID‐19, but also to comment briefly on the epidemiology and pathology based on the current evidences.
This article is protected by copyright. All rights reserved.
Health professions preventing and controlling Coronavirus Disease 2019 are prone to skin and mucous membrane injury, which may cause acute and chronic dermatitis, secondary infection and aggravation of underlying skin diseases. This is a consensus of Chinese experts on protective measures and advice on hand‐cleaning‐ and medical‐glove‐related hand protection, mask‐ and goggles‐related face protection, UV‐related protection, eye protection, nasal and oral mucosa protection, outer ear and hair protection. It is necessary to strictly follow standards of wearing protective equipment and specification of sterilizing and cleaning. Insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier. At the same time, using moisturizing products is highly recommended to achieve better protection.
This article is protected by copyright. All rights reserved.
Abstract An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV), the coronavirus disease 2019 (COVID-19) has spread throughout China and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the COVID-19 epidemic as a public health emergency of international concern. The emergence of SARS-CoV-2, since the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century. As of 1 March 2020, a total of 87,137 confirmed cases globally, 79,968 confirmed in China and 7169 outside of China, with 2977 deaths (3.4%) had been reported by WHO. Meanwhile, several independent research groups have identified that SARS-CoV-2 belongs to β-coronavirus, with highly identical genome to bat coronavirus, pointing to bat as the natural host. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. Importantly, increasingly evidence showed sustained human-to-human transmission, along with many exported cases across the globe. The clinical symptoms of COVID-19 patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes, which may be associated with acute respiratory distress syndrome (ARDS) and cytokine storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the latest research progress of the epidemiology, pathogenesis, and clinical characteristics of COVID-19, and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
Objective
Previous meta‐analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs).
Methods
We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta‐analyses were conducted to calculate pooled estimates by using RevMan 5.3 software.
Results
A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory‐confirmed influenza (RR = 1.09, 95% CI 0.92‐1.28, P > .05), laboratory‐confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70‐1.11), laboratory‐confirmed respiratory infection (RR = 0.74, 95% CI 0.42‐1.29) and influenzalike illness (RR = 0.61, 95% CI 0.33‐1.14) using N95 respirators and surgical masks. Meta‐analysis indicated a protective effect of N95 respirators against laboratory‐confirmed bacterial colonization (RR = 0.58, 95% CI 0.43‐0.78).
Conclusion
The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory‐confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh‐risk medical staff those are not in close contact with influenza patients or suspected patients.
Involving Antimicrobial Stewardship Programs in COVID-19 Response Efforts: All Hands on Deck - Michael P. Stevens, Payal K. Patel, Priya Nori
Background
An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 95 333 confirmed cases as of March 5, 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced.
Methods
We combined a stochastic transmission model with data on cases of coronavirus disease 2019 (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January, 2020, and February, 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. To estimate the early dynamics of transmission in Wuhan, we fitted a stochastic transmission dynamic model to multiple publicly available datasets on cases in Wuhan and internationally exported cases from Wuhan. The four datasets we fitted to were: daily number of new internationally exported cases (or lack thereof), by date of onset, as of Jan 26, 2020; daily number of new cases in Wuhan with no market exposure, by date of onset, between Dec 1, 2019, and Jan 1, 2020; daily number of new cases in China, by date of onset, between Dec 29, 2019, and Jan 23, 2020; and proportion of infected passengers on evacuation flights between Jan 29, 2020, and Feb 4, 2020. We used an additional two datasets for comparison with model outputs: daily number of new exported cases from Wuhan (or lack thereof) in countries with high connectivity to Wuhan (ie, top 20 most at-risk countries), by date of confirmation, as of Feb 10, 2020; and data on new confirmed cases reported in Wuhan between Jan 16, 2020, and Feb 11, 2020.
Findings
We estimated that the median daily reproduction number (Rt) in Wuhan declined from 2·35 (95% CI 1·15–4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41–2·39) 1 week after. Based on our estimates of Rt, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population.
Interpretation
Our results show that COVID-19 transmission probably declined in Wuhan during late January, 2020, coinciding with the introduction of travel control measures. As more cases arrive in international locations with similar transmission potential to Wuhan before these control measures, it is likely many chains of transmission will fail to establish initially, but might lead to new outbreaks eventually.
Funding
Wellcome Trust, Health Data Research UK, Bill & Melinda Gates Foundation, and National Institute for Health Research.
Background
The unique characteristics of long-term care facilities (LTCFs) including host factors and living conditions contribute to the spread of contagious pathogens. Control measures are essential to interrupt the transmission and to manage outbreaks effectively.
Aim
The aim of this systematic review was to verify the causes and problems contributing to transmission and to identify control measures during outbreaks in LTCFs.
Methods
Four electronic databases were searched for articles published from 2007 to 2018. Articles written in English reporting outbreaks in LTCFs were included. The quality of the studies was assessed using the risk-of-bias assessment tool for nonrandomized studies.
Findings
A total of 37 studies were included in the qualitative synthesis. The most commonly reported single pathogen was influenza virus, followed by group A streptococcus (GAS). Of the studies that identified the cause, about half of them noted outbreaks transmitted via person-to-person. Suboptimal infection control practice including inadequate decontamination and poor hand hygiene was the most frequently raised issue propagating transmission. Especially, lapses in specific care procedures were linked with outbreaks of GAS and hepatitis B and C viruses. About 60% of the included studies reported affected cases among staff, but only a few studies implemented work restriction during outbreaks.
Conclusions
This review indicates that the violation of basic infection control practice could be a major role in introducing and facilitating the spread of contagious diseases in LTCFs. It shows the need to promote compliance with basic practices of infection control to prevent outbreaks in LTCFs.
Hospital-associated transmission is an important route of spreading the 2019 novel coronavirus (2019-nCoV) infection and pneumonia (Corona Virus Disease 2019, COVID-19) [1] . Healthcare workers (HCWs) are at high risk while combating COVID-19 at the very frontline, and nosocomial outbreaks among HCWs are not unusual in similar settings; the 2003 severe acute respiratory syndrome (SARS) outbreak led to over 966 HCW infections with 1.4% deaths in mainland China [2] . As of 11 February 2020, 3019 HCWs might have been infected with 2019-nCov in China, 1716 HCW cases were confirmed by nucleic acid testing [3] , and at least 6 HCWs died, including the famous whistleblower Dr Li Wenliang. In view of this severe situation, we are recommending urgent interventions to help to protect HCWs.
PurposeCoronavirus disease (COVID-19) has rapidly emerged as a global health threat. The purpose of this article is to share our local experience of stepping up infection control measures in ophthalmology to minimise COVID-19 infection of both healthcare workers and patients.Methods
Infection control measures implemented in our ophthalmology clinic are discussed. The measures are based on detailed risk assessment by both local ophthalmologists and infection control experts.ResultsA three-level hierarchy of control measures was adopted. First, for administrative control, in order to lower patient attendance, text messages with an enquiry phone number were sent to patients to reschedule appointments or arrange drug refill. In order to minimise cross-infection of COVID-19, a triage system was set up to identify patients with fever, respiratory symptoms, acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 14 days. Micro-aerosol generating procedures, such as non-contact tonometry and operations under general anaesthesia were avoided. Nasal endoscopy was avoided as it may provoke sneezing and cause generation of droplets. All elective clinical services were suspended. Infection control training was provided to all clinical staff. Second, for environmental control, to reduce droplet transmission of COVID-19, installation of protective shields on slit lamps, frequent disinfection of equipment, and provision of eye protection to staff were implemented. All staff were advised to measure their own body temperatures before work and promptly report any symptoms of upper respiratory tract infection, vomiting or diarrhoea. Third, universal masking, hand hygiene, and appropriate use of personal protective equipment (PPE) were promoted.Conclusion
We hope our initial experience in stepping up infection control measures for COVID-19 infection in ophthalmology can help ophthalmologists globally to prepare for the potential community outbreak or pandemic. In order to minimise transmission of COVID-19, ophthalmologists should work closely with local infection control teams to implement infection control measures that are appropriate for their own clinical settings.
Background:
Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients.
Methods:
We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death.
Results:
The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission.
Conclusions:
During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).
Background
Little is known about COVID-19 outside Hubei. The aim of this paper was to describe the clinical characteristics and imaging manifestations of hospitalized patients with confirmed COVID-19 infection in Wenzhou, Zhejiang, China.
Methods
In this retrospective cohort study, 149 RT-PCR confirmed positive patients were consecutively enrolled from January 17th to February 10th, 2020 in three tertiary hospitals of Wenzhou. Outcomes were followed up until Feb 15th, 2020.
Findings
A total of 85 patients had Hubei travel/residence history, while another 49 had contact with people from Hubei and 15 had no traceable exposure history to Hubei. Fever, cough and expectoration were the most common symptoms, 14 patients had decreased oxygen saturation, 33 had leukopenia, 53 had lymphopenia, and 82 had elevated C reactive protein. On chest computed tomography, lung segments 6 and 10 were mostly involved. A total of 287 segments presented ground glass opacity, 637 presented mixed opacity and 170 presented consolidation. Lesions were more localized in the peripheral lung with a patchy form. No significant difference was found between patients with or without Hubei exposure history. Seventeen patients had normal CT on admission of these, 12 had negative findings even10 days later.
Interpretation
Most patients presented with a mild infection in our study. The imaging pattern of multifocal peripheral ground glass or mixed opacity with predominance in the lower lung is highly suspicious of COVID-19 in the first week of disease onset. Nevetheless, some patients can present with a normal chest finding despite testing positive for COVID-19. Funding: We did not receive any fundings.
A previously unknown coronavirus was isolated from the sputum of a 60-year-old man who presented with acute pneumonia and subsequent renal failure with a fatal outcome in Saudi Arabia. The virus (called HCoV-EMC) replicated readily in cell culture, producing cytopathic effects of rounding, detachment, and syncytium formation. The virus represents a novel betacoronavirus species. The closest known relatives are bat coronaviruses HKU4 and HKU5. Here, the clinical data, virus isolation, and molecular identification are presented. The clinical picture was remarkably similar to that of the severe acute respiratory syndrome (SARS) outbreak in 2003 and reminds us that animal coronaviruses can cause severe disease in humans.
Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress that has been made towards understanding the virus-SARS coronavirus (SARS-CoV)-and the disease. We will also highlight the progress that has been made towards developing vaccines and therapies The concerted and coordinated response that contained SARS is a triumph for global public health and provides a new paradigm for the detection and control of future emerging infectious disease threats.
Background
Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.
Methods
In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.
Findings
191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.
Interpretation
The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/L could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Funding
Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
A novel coronavirus has caused thousands of human infections in China since December 2019, raising a global public health concern. Recent studies (Huang et al., Chan et al., and Zhou et al.) have provided timely insights into its origin and ability to spread among humans, informing infection prevention and control practices.
Background:
In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed.
Methods:
We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus.
Findings:
The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues.
Interpretation:
2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation.
Funding:
National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.
Coronaviruses are pathogens with a serious impact on human and animal health. They mostly cause enteric or respiratory disease, which can be severe and life threatening, e.g., in the case of the zoonotic coronaviruses causing severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) in humans. Despite the economic and societal impact of such coronavirus infections, and the likelihood of future outbreaks of additional pathogenic coronaviruses, our options to prevent or treat coronavirus infections remain very limited. This highlights the importance of advancing our knowledge on the replication of these viruses and their interactions with the host. Compared to other +RNA viruses, coronaviruses have an exceptionally large genome and employ a complex genome expression strategy. Next to a role in basic virus replication or virus assembly, many of the coronavirus proteins expressed in the infected cell contribute to the coronavirus-host interplay. For example, by interacting with the host cell to create an optimal environment for coronavirus replication, by altering host gene expression or by counteracting the host's antiviral defenses. These coronavirus-host interactions are key to viral pathogenesis and will ultimately determine the outcome of infection. Due to the complexity of the coronavirus proteome and replication cycle, our knowledge of host factors involved in coronavirus replication is still in an early stage compared to what is known for some other +RNA viruses. This review summarizes our current understanding of coronavirus-host interactions at the level of the infected cell, with special attention for the assembly and function of the viral RNA-synthesising machinery and the evasion of cellular innate immune responses.
We designed this study to compare the replication potential of turkey coronavirus (TCV) and its effect in chickens and turkeys and to study the effect of singleand combined infection of turkey poults with TCV and astrovirus. We studied the pathogenicity of TCV in experimentally inoculated turkey poults and chickens by observing the dinical signs and gross lesions. Two trials were conducted with 1-day-old and 4-wk-old specific-pathogen-free turkey poults and chickens. One-day-old turkey poults developed diarrhea at 48 hr postinoculation. Poults euthanatized at 3, 5, and 7 days postinoculation had flaccid, pale, and thin-walled intestines with watery contents. The 4-wk-old turkeys had no clinical signs or gross lesions. One-day-old and 4-wk-old chicks developed no clinical signs or gross lesions although the TCV was detected in gut contents of the birds throughout the experimental period (14 days). In another experiment, mean plasma D-xylose concentrations in 3-day-old turkey poults inoculated with TCV, turkey astrovirus, or a combination of both viruses were significantly lower than in the uninoculated controls.
Infectious bronchitis virus (IBV), the coronavirus of the chicken (Gallus gallus), is one of the foremost causes of economic loss within the poultry industry, affecting the performance of both meat-type and egg-laying birds. The virus replicates not only in the epithelium of upper and lower respiratory tract tissues, but also in many tissues along the alimentary tract and elsewhere e.g. kidney, oviduct and testes. It can be detected in both respiratory and faecal material. There is increasing evidence that IBV can infect species of bird other than the chicken. Interestingly breeds of chicken vary with respect to the severity of infection with IBV, which may be related to the immune response. Probably the major reason for the high profile of IBV is the existence of a very large number of serotypes. Both live and inactivated IB vaccines are used extensively, the latter requiring priming by the former. Their effectiveness is diminished by poor cross-protection. The nature of the protective immune response to IBV is poorly understood. What is known is that the surface spike protein, indeed the amino-terminal S1 half, is sufficient to induce good protective immunity. There is increasing evidence that only a few amino acid differences amongst S proteins are sufficient to have a detrimental impact on cross-protection. Experimental vector IB vaccines and genetically manipulated IBVs--with heterologous spike protein genes--have produced promising results, including in the context of in ovo vaccination.
Severe acute respiratory syndrome (SARS) originated in Southern China in November 2002, and was brought to Hong Kong in February 2003. From Hong Kong, the disease spread rapidly worldwide but mostly to Asian countries. At the end of the epidemic in June, the global cumulative total was 8422 cases with 916 deaths (case fatality rate of 11%). People of all ages were affected, but predominantly females. Health care workers were at high risk and accounted for one-fifth of all cases. Risk factors for death included old age and comorbid illnesses, especially diabetes. The disease is caused by a novel coronavirus and is transmitted by droplets or direct inoculation from contact with infected surfaces. Contaminated sewage was found to be responsible for the outbreak in a housing estate in Hong Kong affecting over 300 residents. The mean incubation period was 6.4 days (range 2-10). The duration between onset of symptoms and hospitalisation was from 3 to 5 days. The relatively prolonged incubation period allowed asymptomatic air travellers to spread the disease globally. The number of individuals infected by each case has been estimated to be 2.7. Effective control of nosocomial transmission included early detection of disease, strict isolation of patients, practice of droplet and contact precautions and compliance with the use of personal protective equipment. Effective control of disease spread in the community included tracing and quarantine of contacts. Development of a validated diagnostic test and an effective vaccine as well as elimination of possible animal reservoirs are measures needed to prevent another epidemic.
Recommandations relatives à la pré vention et à la prise en charge du COVID-19 chez les patients à risque de formes sé vè res
- Avis Hcsp
- Provisoire
HCSP. Avis provisoire. Recommandations relatives à la pré vention et à la prise
en charge du COVID-19 chez les patients à risque de formes sé vè res. Paris:
Haut Conseil de la Santé Publique; 2020.
Covid-19) : information aux professionnels de santé n
- Coronavirus
Coronavirus (Covid-19) : information aux professionnels de santé n.d. http://
www.iledefrance.ars.sante.fr/
coronavirus-covid-19-information-aux-professionnels-de-sante
(accessed
March 15, 2020).
SARS-CoV-2 : nettoyage des locaux d'un patient confirmé et protection des personnels. Paris: Haut Conseil de la Santé Publique
- Hcsp
- Coronavirus
HCSP. Coronavirus SARS-CoV-2 : nettoyage des locaux d'un patient confirmé et
protection des personnels. Paris: Haut Conseil de la Santé Publique; 2020.
COVID-19 : prise en charge des cas confirmé s. Paris: Haut Conseil de la Santé Publique
- Hcsp
HCSP. COVID-19 : prise en charge des cas confirmé s. Paris: Haut Conseil de la
Santé Publique; 2020.
Involving antimicrobial stewardship programs in COVID-19 response efforts: all hands on deck
- Stevens