Cornucopia and Highlights of Internet Resources on the Web for COVID-19

Dr. Chee-Hon Ng^1*, Dr. Cornelius Tan² and Prof. Leo FA Stassen^3
*Correspondence: Dr. Chee-Hon Ng, Department of Oral Maxillofacial Surgery, Novena Medical Centre, Republic of Singapore https://orcid.org/0000-0002-0454-0560, Singapore, Email:

Keywords

Coronavirus; COVID-19; Infection control; Dentistry; Oral Surgery; Internet

Introduction

Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family Coronaviridae and the order Nidovirales and broadly distributed in humans and other mammals [1,2]. A new coronavirus COVID-19 has emerged as the cause of unusual cluster of viral pneumonia cases in China on Dec 16, 2019 [2,3]. The situation has rapidly evolved into a global health emergency as declared by the World Health Organization [4]. Seven coronaviruses are known to cause disease in humans. Two strains Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have zoonotic origins and have been linked to outbreaks of severe respiratory illnesses in humans. Person to person transmission has been documented for COVID-19 [2,3,5,6]. For a review on Human coronaviruses, see Yin Y [7].

Most patients with COVID-19 infection present with fever (98%), cough (6%) and myalgia or fatigue (44%). Dyspnoea has been reported in 55% of the patients, developing in a median of eight days after the onset of the initial symptoms. Deaths have been reported [2,5]. At the time of writing, there were over 5.6 million confirmed cases and 348, 46 deaths around the world from the outbreak. It has spread to 213 countries outside China and 2 international conveyances (the Diamond Princess cruise and the MS Zaandam). United Kingdom recorded the first case on the 12 February this year. The Republic of Ireland reported its first case on the 29 February. Given the potential for rapid spread of the virus internationally, measures have been instituted to try to limit the spread [2,7-9]. On the 11 March, World Health Organization (WHO) declared the coronavirus outbreak a pandemic [10]. China has emerged from the crisis with a total of 84,536 confirmed cases and 4645 deaths. Currently China reports of zero to a single digit daily increase of COVID-19 cases [11] (Figure 1).

This paper provides a brief overview of all current recommendations worldwide to help the dental practitioners from being transmitted whilst caring for their patents. This is a first overview of internet resources on implications and measures for dentistry in a COVID-19 outbreak or pandemic.

Methods

The main search engines were used. These included Google, Yahoo and Bing. The search engines were used without time limit to trawl for websites with the search terms “COVID-19”, “SARS-CoV-2”, “Coronavirus” in conjunction with “Dentistry”, “Infection control” and “Dental Practice”. The difference in the surveys conducted with the three search engines was collected and duplications removed. The results were organized and tabulated over a 2-month period (1 Mar 2020 to 30 April 2020). The websites were assessed similarly for information and readability as in Hanna study [12]. The quality of information and readability was evaluated on a 5-pointed Likert-like scale and agreed by the three authors. Each item was scored on a scale ranging from 1 “very poor” to 5 “excellent” and grouped. Some of these websites found were highlighted in this article and represented as figures.

Results

There has been a big increase in the available literature on the internet and publication on the topic of coronavirus 2019. Just an observation, the number of published articles has increased each week since the week of January 13, 2020. Over five hundred journal articles were published electronically as February 24, 2020. This had swelled to 3883 by April 2, 2020. ByMay 16, the number was 12959 [13]. Table 1 depicts the tabulation of the websites found in this study. Most websites were ranked to have good to excellent information and readability. The table starts with basic information on COVID-19 and current updates, onto telemedicine and consultation prior to receiving the dental patient during the outbreak, to preparing requirements on receiving the patients especially personal protective equipment, to range of dental treatment to be rendered during this time, to post environment disinfection after dental treatments and finally ontoinformation regarding the resumption of dentistry after the outbreak.

Discussion

At press time, most dental practices worldwide remain on high alert to prevent COVID-19 transmission in their establishments. Most dental practitioners exercise Standard precautions. This was evolved from Universal precautions in 1996 by USA Center for Disease Control and Prevention (CDC) [14,15]. Figure 2 shows how Personal Protective Equipment (PPE) is worn from CDC website. Hand washing and the use of surgical masks are useful against some respiratory infections [16,17]. Coronavirus COVID-19 has been found in the saliva of infected persons [18]. Cleaning and disinfecting the environment surfaces are important as there has been reports of significant environmental contamination by COVID-19 patients through exhaled expiratory droplets [19,20]. When standard precautions alone cannot prevent transmission, a second tier of infection control known as transmission based protocol is used.

Not all dental settings are typically designed to carry out all of transmission based precautions. PPE is recommended for contact with critically ill patients with confirmed or suspected COVID-19. This includes fluid resistant gown, gloves, eye protection, full face shield and fit tested N95 respirators [21,22].

Most international guidances provide a flowchart for teledentistry and screening patient as well as patient risk assessment prior to the dental visit (Figure 3). The three most pertinent questions for initial screening should include any exposure to a person with known or suspected COVID-19 presentation, any recent travel history to an area with high incidence of COVID-19 or presence of any symptoms of febrile respiratory illnesses such as fever or cough [23].

Upon patient arrival at the dental practice, patients should complete a declaration and the patient’s temperature measured using a non-contact forehead thermometer. In suspected or confirmed cases of COVID-19 infections requiring treatment, patients should be referred to a specialist dental care centre to prevent spread of infection (Figure 4). Most current guidelines advised essential treatments for dental patients during the outbreak and non-essential treatments deferred [24,25] (Figures 5 and 6). Emergency dental treatment should be considered. Dental treatment should be carried out as minimally invasive as possible. Aerosol generating procedures should be avoided where possible. After treatment, clinic staff should make sure to disinfect inanimate surfaces using chemicals. Current specific guidelines and recommendations for oral and maxillofacial surgery are evolving. The most current recommendation was provided by Zimmermann and Nkenke [26]. Most elective procedures are advised to be deferred and emergency treatments i.e., trauma, haemorrhage and deep head and neck infections should proceed to treatment without delay. The guidelines also advised the test for COVID-19 to be carried out before taking the patient to the operating room. Special requirements will be needed with infected patients [26].

With increasing transmission and local and community spread of the COVID-19, exposure of the healthcare professional to the virus may seemed likely. Indeed, there were anecdotal accounts of a COVID-19 patients who underwent dental procedures when they were not confirmed of infection at the time of presentation during the outbreak. The COVID-19 pandemic puts pressure on the healthcare system. It is hoped that with information sharing with researchers and dental professionals on the disease COVID-19 can help in the management of dental care around the world amid the pandemic and provide further development in the guidelines [27-31].

Conclusion

We presented the highlights of the dentistry relevant internet resources on COVID-19 in this article. Many aspects are still unknown about this disease. The internet is a good source of up-to-date dental information, resource and tools. It is useful for the dissemination of information. The information available is vast. There has been unprecedented change in how dental patients are managed in a crisis. This paper provides a synopsis of the best available resource in Dentistry and guidance on the internet for COVID-19.

References

1. Ksiazek, G. Thomas, Dean Erdman, Cynthia S. Goldsmith, and Sherif R. Zaki, et al.  “A novel coronavirus associated with severe acute respiratory syndrome”. N Engl J Med 348 (2003): 1953-1966.
2. Chen, Huang, Wang Yang, Xianran Li, and, Ren Li, et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 395 (2020): 497-506.
3. World Health Organization. Novel coronavirus – China. Jan 12,2020. https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/ (accessed May 26, 2020).
4. World Health Organization.  Rolling updates on coronavirus disease (COVID-19). May 25,2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen (assessed May 26, 2020).
5. Wang, David,Bahar Hu, ChengjunHu, FengZhu, et al. “Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China”. J Am Med Assoc 323 (2020): 1061-1069.
6. Wong, E.L. John, Leo Ys, Chorh Chuan Tan. “COVID-19 in Singapore-Current Experience: Critical global issues that require attention and action”. J Am Med Assoc: in press. 2020.
7. Yin, Yadong, Wunderink R.G. Mers, “SARS and other coronaviruses as causes of pneumonia”. Respirology 23 (2018): 130-137.
8. Kanne, P. Jeffrey. “Chest CT findings in 2019 Novel Coronavirus (2019-nCoV) infections from Wuhan, China: Key points for the radiologist”. Radiology 295 (2020): 16-17.
9. Habibzadeh, Parham, Emily K. Stoneman. ”The novel coronavirus: a bird’s eye view”. Int J Occup Environ Med 11 (2020): 65-71.
10. World Health Organization.  WHO announces COVID-19 outbreak a pandemic. Mar 11,2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 (assessed May 26, 2020).
11. World Health Organization.  Coronavirus disease (COVID-19) Situation report -126. May 25,2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200525-covid-19-sitrep-126.pdf?sfvrsn=887dbd66_2 (assessed May 26, 2020).
12. Hanna, J. Keith,Daniel C.Brennan, Philip N. Sambrook, JasonArmfield. “Third molars on the Internet: A guide for assessing information quality and readability. Interact J Med  (2015) Res 4: e19.
13. Chen,Liu, Qing Zhou, YanguangLi, and Linda V. Garner, et al. ”Research and development on therapeutic agents and vaccines for COVID-19 and related human coronavirus diseases”. ACS Cent Sci 6(2020): 315-331.
14. World Health Organization.  Standard precautions in health care Aide-Memoire. Oct 2007. https://www.who.int/csr/resources/publications/standardprecautions/en/(accessed May 26, 2020).
15. Dental Council “Code of practice relating to infection control in dentistry: infection prevention and control. April 2015”. (2015)  https:// http://www.dentalcouncil.ie/g_crossinfection.php(accessed May 26, 2020).
16. Han, Ma. ”Hand hygiene and tuberculosis risk in Korea: an ecological association”. Asia Pac J Public Health 30 (2018): 67-74.
17. Johnson, F. Deborah, Julian D. Druce, Christopher Birch, Lindsay M. Grayson. ”A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection”. Clin Infect Dis 49 (2009): 275-277.
18. Turekian KK, Owen T. Tsang , Chik-Yan C. Yip, and  Chan KH, et al. “Consistent detection of 2019 novel coronavirus in saliva”. Clin Infect Dis: In Press. (2020)  doi:10.1093/cid/ciaa149.
19. Ong, S. W.  Xiang, Yen KhengTan, Po Y.Chia, and Tak H. Lee, et al. “Air, surface environmental and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient”. J Am Med Assoc 323 (2020): 1610-1612.
20. Peng,  Xiaogang, XuanXu, YanguangLi, and LamCheng, et al. “Transmission routes of 2019-nCoV and controls in dental practice.’’ Int J Oral Sci 12 (2020): 9.
21. CDC (2020) Interim infection prevention and control guidance for dental settings during the COVID-19 response. Apr 27, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html (accessed May 26, 2020).
22. World Health Organization.  Global Surveillance for human infection with novel coronavirus (2019-nCoV) Interim guidance. Jan 31, 2020. https://apps.who.int/iris/handle/10665/330857 (accessed May 26, 2020).
23. Wax, S. Randy, Michael D.Christian.  “Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients”. Can J Anaesth 67 (2020): 568-576.
24. AtherEnam, Bharat KC.Patel, Nikita BharatRuparel, Diogenes Aercius. “Coronavirus Disease 19 (COVID-19): Implications for clinical dental care”. J Endod 46 (2020): 584-595.
25. Alharbi, Ahmed,  SalehAlharbi, Shahad Alqaidi “Guidelines for dental care provision during the COVID-19 pandemic”. Saudi Dent J 32 (2020): 181-186.
26. Zimmermann, Michael, Emeka Nkenke. ”Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic”. J Craniomaxillofac Surg 48 (2020): 521-526.
27. Tien, H. Chuan,  Talat Chughtai, AjitJoglekar, Andrew B.Cooper, Brenneman Fred.  “Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS)”. Can J Surg 48 (2005): 71-74.
28. Yang Yiming,Ho Y. Soh , Zhenguang G.Cai, and XiaogangPeng, et al. “Experience of diagnosing and managing patients in oral maxillofacial surgery during the prevention and control period of the new coronavirus pneumonia”. Chin J Dent Res 23 (2020): 57-62.
29. KiranPanesar, Thomas B.Dodson, Henry T. Lynch, and Bryson C. Cahn, et al. ”Evolution of COVID-19 Guidelines for University of Washington Oral and Maxillofacial Surgery patient care”. J Oral Maxillofac: In Press. (2020).
30. Nayg. Chong Han,Jinn F. Yeo “Oral medicine and surgery interests on the Internet”. Sing Dent J 23 (2000): 64-67.
31. Gray F. Guest . “Internet resources for dentistry: utilization of the Internet to support professional growth, decision making, and patient care”. J Contemp Dent Pract 1 (1999): 31-35.