One of the biggest news topics at the turn of the decade has been the discovery and spread of a new form of Coronavirus. Massive efforts are underway to contain the pathogen, and prevent a global pandemic spreading from Wuhan, Hubei Province, China to the rest of the world.
Any communicable disease is of immediate concern for the dental profession, particularly with the close proximity and prolonged exposure to patient respiration and airborne saliva droplets inherent to the nature of dental care.
With the cacophony of worldwide discourse, it can be difficult to find answers to important questions; social media is rife with varying degrees of hysteria, misinformation and conspiracy theories.
While the 2019 novel coronavirus (2019-nCoV) has so far been very limited in the U.S., and significant containment and quarantine efforts are underway, medical and dental professionals need to be prepared for the possibility of a pandemic.
How can you inform your staff and patients on proper protocols to protect everyone who walks into your door? Incisor has distilled the most credible information to help inform the dental profession.
What is Coronavirus?
Coronaviruses are not new, but a virulent new strain, 2019-nCoV, is the subject of recent concerns. According to the World Health Organization (WHO), “Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.”
Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and even death.
How Does the Virus Spread?
According to the CDC:
Much is unknown about how 2019-nCoV, a new coronavirus, spreads. Current knowledge is largely based on what is known about similar coronaviruses.
Most often, spread from person-to-person happens among close contacts (about 6 feet). Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. It’s currently unclear if a person can get 2019-nCoV by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.
Typically, with most respiratory viruses, people are thought to be most contagious when they are most symptomatic (the sickest).
It’s important to note that how easily a virus spreads person-to-person can vary. Some viruses are highly contagious (like measles), while other viruses are less so. There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV, and investigations are ongoing.
How Dangerous is the Resulting Illness?
Current symptoms reported for patients with 2019-nCoV include mild-to-severe respiratory illness with fever, cough, and difficulty breathing. Symptoms are similar to those of influenza, and constitute a serious public health threat; older adults and persons with underlying health conditions or compromised immune systems might be at higher risk. However, the CDC reports that additional information on disease severity is needed.
Fortunately, due to an unprecedented, multilayered response by the U.S. health system and governing agencies, the CDC reports that, “For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low at this time.”
How Can You Protect Yourself and Your Patients?
WHO offers a downloadable PDF, Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected, which is adapted from similar recommendations for past SARS-CoV and MERS-CoV outbreaks, combined with current knowledge of the nCoV situation in China and other countries.
WHO urges that the following respiratory hygiene measures be used:
- Ensure that all patients cover their nose and mouth with a tissue or elbow when coughing or sneezing
- Offer a medical mask to patients with suspected 2019-nCoV infection while they are in waiting/public areas or in cohorting rooms
- Perform hand hygiene after contact with respiratory secretions. HCWs should apply the WHO’s My 5 Moments for Hand Hygiene approach before touching a patient, before any clean or aseptic procedure is performed, after exposure to body fluid, after touching a patient, and after touching a patient’s surroundings.
- Hand hygiene includes either cleansing hands with an alcohol-based hand rub (ABHR) or with soap and water
- Alcohol-based hand rubs are preferred if hands are not visibly soiled
- Wash hands with soap and water when they are visibly soiled
The recommendation is for patients suspected of infection to wear masks, which help trap virus-infected particles, such as droplets, mitigating potential exposure of healthy individuals to the disease. More specialized masks, such as an N95 respirator, may provide healthcare professionals with increased protection. However, due to the small number of cases in the U.S., the CDC does not currently recommend the use of a mask or respirator (as of the writing of this article). Dr. Schaffner also points out that the N95 masks require training for proper use and make breathing very difficult.
WHO details a variety of additional precautionary measures, triage, early recognition and source control, such as, “Use of appropriate personal protective equipment (PPE) according to risk assessment, injection safety practices, safe waste management, proper linens, environmental cleaning and sterilization of patient-care equipment.”
Of course, travel to China, particularly Hubei Province, where the virus outbreak began, is strongly discouraged (and in some cases, subject to specific bans) until further notice.
If you want to stay up to date on the latest for coronavirus, visit the John Hopkins website here. For additional information, FAQs, recommendations, and travel advisories, click on any of the links below.
The Centers for Disease Control (CDC) has created a landing page, Information for Public Health Professionals, with useful information.
Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance, updated October 2019. Geneva: World Health Organization; 2019 (WHO/MERS/IPC/15.1 Rev. 1; https://apps.who.int/iris/handle/10665/174652, accessed 17 January 2020).
Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care: WHO guidelines. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/10665/112656, accessed 17 January 2020).
Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential 2019 Novel Coronavirus (2019-nCoV) Exposure in Travel-associated or Community Settings, Centers for Disease Control.
Author: Kelly John Walker is Senior Writer and Editor with Strategic Dentistry, the parent company of DOCS Education. He holds a Master of Science (MS) degree in Environmental Science from New Mexico State University and a Bachelor of Arts (BA) in English Composition.