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COVID-19: A Public Health Approach for Health Professionals

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 81715

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Prof. Dr. Guglielmo Campus

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Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, CH-3010 Bern, Switzerland
Interests: community dentistry; oral epidemiology; public health; cariology; oral health prevention; pediatric dentistry
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Fabrizio Pregliasco

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Department of Biomedical Sciences for Health, University of Milan, IT-20142 Milan, Italy
Interests: public health; epidemiology; health management; infection prevention; environmental hygiene

Dr. Maria Grazia Cagetti

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Guest Editor

Director, Post-Graduated School in Pediatric Dentistry, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20142 Milan, Italy
Interests: pediatric dentistry; community dentistry; caries prevention; oral health promotion; caries epidemiology; oral health of special needs children
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the COVID-19 pandemic, the scientific and medical world has been involved in intensive research to face the SARS-CoV-2 outbreak. The human-to-human transmission of this new virus is produced through airborne droplets and direct contact with contaminated surfaces. The risk of cross-infection in dentistry is recognized to be high, since splatters and aerosols produced through the use of handpieces during dental treatments may represent vehicles for bacteria, fungi, and virus diffusion. Data on the real risk of virus diffusion during dental procedures is urgent, since this issue has not yet been addressed in the literature for any type of virus.

The stability of SARS-CoV-2 in aerosols has been investigated in experimental conditions showing that airborne transmission of the coronavirus is plausible, since it can remain viable and infectious in aerosols for hours. This finding might be a relevant professional hazard for dental personnel and patients.

Several recommended strategies to control SARS-CoV-2 transmission in the dental enviroment during the pandemic are provided from International Dental Associations and local Authorities, including the use of appropriate personal protection devices and the reduction, as much as possible, of treatments that can produce droplets or aerosols. These strategies will impose changes to the dental routine and a reorganization of public and private dental care providers activities.

Papers addressing these topics are invited for this Special Issue, including protocol papers on the health professional risks of COVID-19, the epidemiology of SARS-CoV-2 diffusion in health professionals and dental personnel, risk assessment for patients and health workers, risk management, and intervention studies aiming to control the virus diffusion in the dental setting.

Prof. Guglielmo Campus
Prof. Fabrizio Pregliasco
Assoc. Prof. Maria Grazia Cagetti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

COVID-19
SARS-CoV-2
Dental environment
Dental personnel
Patients
Cross-infection
Airborne
Aerosol
Public health
Dentistry

Related Special Issue

Second Edition of COVID-19: A Public Health Approach for Health Professionals in International Journal of Environmental Research and Public Health (12 articles)

Published Papers (11 papers)

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Research

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10 pages, 961 KiB

Open AccessArticle

Influence of the COVID-19 Pandemic on Dental Emergency Admissions in an Urgent Dental Care Service in North Italy

by Maria Grazia Cagetti, Araxi Balian, Nicole Camoni and Guglielmo Campus

Int. J. Environ. Res. Public Health 2021, 18(4), 1812; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041812 - 12 Feb 2021

Cited by 25 | Viewed by 3403

Abstract

A retrospective study was performed to verify if the number of admissions for urgent dental care in the Urgent Dental Care Service of San Paolo Hospital in Milan (Italy) was directly related to the different phases of the COVID-19 pandemic. Different periods were analyzed: 25 March–5 April 2019 (pre-COVID); 23 March–3 April 2020 (lockdown); 8 June–19 June 2020 (reopening); and November 9–November 20 (second wave). Raw data regarding admissions, diagnoses, and treatments were extracted. Descriptive and bivariate analyses were performed. The survey included 901 admissions, 285 in pre-COVID, 93 during lockdown, 353 in reopening, and 170 in the second wave. In each time period, statistically significant differences were found in the prevalence of each kind of diagnoses (χ²₍₃₎ = 20.33 p = 0.01 for endodontic emergencies, χ²₍₃₎ = 29.05 p < 0.01 for cellulitis/phlegmon, χ²₍₃₎ = 28.55 p < 0.01 for periodontal emergencies, Fisher’s Exact Test p < 0.01 for trauma, and χ²₍₃₎ = 59.94 p < 0.01 for all other kinds of diagnosis). A remarkable increase in consultations (+186.36%) and other treatments (+90.63%) occurred during reopening. Tooth extraction was the most frequently delivered treatment, but suffered the largest reduction during lockdown (−79.82%). The COVID-19 pandemic has highly affected dental activity in north Italy, underling the weaknesses of a private dental system in a pandemic scenario. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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14 pages, 3121 KiB

Open AccessArticle

The Impact of SARS-CoV-2 Outbreak on the Polish Dental Community’s Standards of Care—A Six-Month Retrospective Survey-Based Study

by Bartosz Dalewski, Lukasz Palka, Paweł Kiczmer and Ewa Sobolewska

Int. J. Environ. Res. Public Health 2021, 18(3), 1281; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031281 - 31 Jan 2021

Cited by 16 | Viewed by 3450

Abstract

Currently, SARS-CoV-2 is the primary pathogen worldwide, disrupting most of our everyday activities. The study aim was to evaluate its impact on the Polish dental community, standards of care, health, and welfare. Methods: A Google Forms survey was conducted among 303 dental practitioners. Results: Of respondents, 54.93% curbed the number of patients in the last six months, 34.21% declared no changes, and 10.86% reported an increase; whereas 70.7% of the respondents reported a treatment price increase within the same period (27.96% and 1.32% reported no changes and a decrease, respectively). Of the respondents, 15.5% did not close their businesses during the first wave of the pandemic. Most declared 1 or 2 month break, 30.7% and 34.7%, respectively. Some reported 3, 4, or 5 month breaks (15.84%, 1.32%, and 0.99%, respectively), and only two respondents (0.66%) did not admit patients at all. Headache episodes were more frequent among female dentists before the pandemic; after the pandemic, headache frequency increased among both sexes. Temporomandibular disorders (TMDs) were more frequent among women (p = 0.017). Conclusions: Most Polish dentists followed SARS-CoV-2 recommendations and restricted their practices to admitting only patients with pain or incomplete treatment. Decreased sleep parameters, head, back, and neck pain, were observed. This situation may affect dental health conditions in Polish society over time. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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12 pages, 524 KiB

Open AccessArticle

Psychological Distress and Post-Traumatic Symptomatology among Dental Healthcare Workers in Russia: Results of a Pilot Study

by Maria Sarapultseva, Alena Zolotareva, Igor Kritsky, Natal’ya Nasretdinova and Alexey Sarapultsev

Int. J. Environ. Res. Public Health 2021, 18(2), 708; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020708 - 15 Jan 2021

Cited by 28 | Viewed by 4683

Abstract

The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and PTSD among dental HCWs in Russia during the coronavirus disease 2019 (COVID-19) pandemic. The survey was carried out among 128 dental HCWs from three dental clinics of Ekaterinburg, Russia. The mean age of the sample was 38.6 years. Depression, anxiety, and stress were assessed using the Depression Anxiety and Stress Scale-21 (DASS-21); PTSD was assessed using the PTSD Symptom Scale-Self-Report (PSS-SR); subjective distress was assessed using the Impact of Event Scale-Revised (IES-R). The results indicated that 20.3–24.2% HCWs had mild to extremely severe symptoms of psychological distress, and 7.1–29.7% had clinical symptoms of PTSD. No differences between females and males were revealed. HCWs working directly with patients had significantly higher levels of PTSD symptoms and the risk of PTSD development compared to those working indirectly, whereas older HCWs had significantly higher levels of both psychological distress and PTSD symptoms compared to younger HCWs. Thus, dental HCWs are at high risk for psychological distress and PTSD symptoms during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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11 pages, 307 KiB

Open AccessArticle

Risk Perception, Protective Behaviors, and General Anxiety during the Coronavirus Disease 2019 Pandemic among Affiliated Health Care Professionals in Taiwan: Comparisons with Frontline Health Care Professionals and the General Public

by Wei-Po Chou, Peng-Wei Wang, Shiou-Lan Chen, Yu-Ping Chang, Chia-Fen Wu, Wei-Hsin Lu and Cheng-Fang Yen

Int. J. Environ. Res. Public Health 2020, 17(24), 9329; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249329 - 13 Dec 2020

Cited by 16 | Viewed by 2423

Abstract

This study aimed to compare risk perception, information sources, adoption of protective behaviors against coronavirus disease 2019 (COVID-19), and levels of general anxiety among affiliated health care professionals, frontline health care professionals, and the general public in Taiwan. We recruited participants via a Facebook advertisement. We determined the risk perception, information sources, adoption of protective behaviors against COVID-19, and levels of general anxiety among 1954 respondents. In total, 269 affiliated healthcare workers, 371 frontline healthcare workers, and 1314 members of the general public were recruited into this study. The results indicated that both affiliated and frontline health care professionals had a higher level of risk perception of COVID-19, and more adopted protective behaviors against COVID-19 than the general public. No significant differences in risk perception or the adoption of protective behaviors were identified between affiliated, and frontline, health care professionals. Affiliated health care professionals had a lower level of general anxiety than the general public, whereas frontline health care professionals exhibited no significant difference in level of general anxiety compared with the general public or affiliated health care professionals. As important members of COVID-19 treatment teams, the need for psychological and educational support in affiliated health care professionals should receive attention. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

12 pages, 698 KiB

Open AccessArticle

COVID-19 in Switzerland and Liechtenstein: A Cross-Sectional Survey among Dentists’ Awareness, Protective Measures and Economic Effects

by Thomas Gerhard Wolf, Oliver Zeyer and Guglielmo Campus

Int. J. Environ. Res. Public Health 2020, 17(23), 9051; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17239051 - 04 Dec 2020

Cited by 25 | Viewed by 4102

Abstract

The aim of this observational cross-sectional study was to gain information on the awareness; protective measures and economic effects of dentists in Switzerland during the global COVID-19 pandemic. All dentist were members of the Swiss Dental Association SSO from all over Switzerland—including all Swiss cantons and Liechtenstein—and received a previously calibrated questionnaire as an ad hoc online version. The questionnaire was divided into four parts: personal data; precautionary measures; awareness; perception. In total, 1324 questionnaires were analyzed; the response rate was 30.59% (n^total = 4328). Participants stated in less than 2% common symptoms/signs of COVID-19; of which only fatigue was statistically significant (p < 0.01). A small number of dentists reported a positive test (0.91%; n = 12) or having one or more symptoms (2.65%; n = 35) of COVID-19 during the pandemic; whereas only 6.71% (n = 87) of the participants reported having treated SARS-CoV-2 infected patients. High prevalence areas were only medium-large and large Swiss cantons (p < 0.01). Face filter (FFP2/FFP3) masks were used by about half of the dentists, while disposable visor was rarely used. The majority of dentists had to reduce the dental practice activity to a minimum of 0–10% (n = 923; 69.98%) due to the lockdown. This economic impact forced 1.4% (n = 18) to close their practice permanently or by the end of 2020 due to the economic situation. These results can be helpful to better prepare dental practices for future outbreaks of infection (e.g., prophylactic storage of additional protective measures), define the best strategy and organize the dental workforce. Political decision-makers should consider drastic economic effects when deciding on drastic measures such as “lockdown”, which can lead to practice closures and unemployment of dental staff after only a few weeks. This should be taken into account, especially with regard to possible financial assistance to severely impaired dental practices to maintain a high level of dental care. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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12 pages, 1187 KiB

Open AccessArticle

Blockchain in Healthcare: Insights on COVID-19

by Antonio Fusco, Grazia Dicuonzo, Vittorio Dell’Atti and Marco Tatullo

Int. J. Environ. Res. Public Health 2020, 17(19), 7167; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17197167 - 30 Sep 2020

Cited by 97 | Viewed by 11773

Abstract

The SARS-CoV2 pandemic has impacted risk management globally. Blockchain has been increasingly applied to healthcare management, as a strategic tool to strengthen operative protocols and to create the proper basis for an efficient and effective evidence-based decisional process. We aim to validate blockchain in healthcare, and to suggest a trace-route for a COVID19-safe clinical practice. The use of blockchain in combination with artificial intelligence systems allows the creation of a generalizable predictive system that could contribute to the containment of pandemic risk on national territory. A SWOT analysis of the adoption of a blockchain-based prediction model in healthcare and SARS-CoV-2 infection has been carried out to underline opportunities and limits to its adoption. Blockchain could play a strategic role in future digital healthcare: specifically, it may work to improve COVID19-safe clinical practice. The main concepts, and particularly those related to clinical workflow, obtainable from different blockchain-based models have been reported here and critically discussed. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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8 pages, 317 KiB

Open AccessArticle

Assessment of Mental Health Factors among Health Professionals Depending on Their Contact with COVID-19 Patients

by Paweł Wańkowicz, Aleksandra Szylińska and Iwona Rotter

Int. J. Environ. Res. Public Health 2020, 17(16), 5849; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165849 - 12 Aug 2020

Cited by 73 | Viewed by 9165

Abstract

It seems that the medical personnel in contact with patients infected with SARS-CoV-2 are at an especially high risk of adverse psychological effects. Therefore, the aim of this study was to assess the mental health factors among healthcare workers by quantifying the severity of anxiety, depression, and sleep disorders during the current SARS-CoV-2 pandemic, while taking into account coexisting diseases. The study involved 441 healthcare professionals including 206 healthcare workers at emergency wards, infectious wards, and intensive care units. The control group consisted of 235 healthcare workers working in wards other than those where individuals from the study group worked. Regression adjusted by age, gender, the occurrence of hypertension, diabetes mellitus, dyslipidemia, asthma, autoimmune diseases, and cigarette smoking showed the elevated risk of anxiety on the Generalized Anxiety Disorder (GAD-7) scale (OR = 1.934; p < 0.001), depression on the Patient Health Questionnaire (PHQ-9) scale (OR = 2.623; p < 0.001), and sleep disorders on the Insomnia Severity Index (ISI) scale (OR = 3.078; p < 0.001). Our study showed that healthcare workers who are exposed to SARS-CoV-2-infected patients at emergency wards, infectious wards, and intensive care units are at a much higher risk of showing symptoms of anxiety, depression, and sleep disorders than healthcare workers working in other wards. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

6 pages, 703 KiB

Open AccessArticle

Excess Deaths and Hospital Admissions for COVID-19 Due to a Late Implementation of the Lockdown in Italy

by Raffaele Palladino, Jordy Bollon, Luca Ragazzoni and Francesco Barone-Adesi

Int. J. Environ. Res. Public Health 2020, 17(16), 5644; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165644 - 05 Aug 2020

Cited by 26 | Viewed by 3535

Abstract

In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%) reduction, respectively. We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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12 pages, 314 KiB

Open AccessArticle

COVID-19 Outbreak in North Italy: An Overview on Dentistry. A Questionnaire Survey

by Maria Grazia Cagetti, Jean Louis Cairoli, Andrea Senna and Guglielmo Campus

Int. J. Environ. Res. Public Health 2020, 17(11), 3835; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17113835 - 28 May 2020

Cited by 101 | Viewed by 9905

Abstract

This survey assessed the symptoms/signs, protective measures, awareness, and perception levels regarding COVID-19 among dentists in Lombardy, Italy. Moreover, an analysis of the answers gathered in areas with different prevalence of the disease was carried out. All Lombardy’s dentists were sent an online ad hoc questionnaire. The questionnaire was divided into four domains: personal data, precautionary measures (before patient arrival; in the waiting room; in the operating room), awareness, and perception. Three thousand five hundred ninety-nine questionnaires were analyzed. Five hundred two (14.43%) participants had suffered one or more symptoms referable to COVID-19. Thirty-one subjects were positive to the virus SARS-CoV-2 and 16 subjects developed the disease. Only a small number of dentists (n = 72, 2.00%) were confident of avoiding infection; dentists working in low COVID-19 prevalence areas were more confident than those working in the Milan area and high prevalence area (61.24%, 61.23%, and 64.29%, p < 0.01 respectively). The level of awareness was statistically significantly higher (p < 0.01) in the Milan area (71.82%) than in the other areas. This survey demonstrated that dentists in the COVID-19 highest prevalence area, albeit reported to have more symptoms/signs than the rest of the sample, were the ones who adopted several precautionary measures less frequently and were the more confident of avoiding infection. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

Review

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12 pages, 440 KiB

Open AccessReview

COVID-19 and Dentistry: Prevention in Dental Practice, a Literature Review

by Federico Alcide Villani, Riccardo Aiuto, Luigi Paglia and Dino Re

Int. J. Environ. Res. Public Health 2020, 17(12), 4609; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124609 - 26 Jun 2020

Cited by 76 | Viewed by 14971

Abstract

SARS-CoV-2 is a member of the family of coronaviruses. The first cases were recorded in Wuhan, China, between December 2019 and January 2020. Italy is one of the most affected countries in Europe. COVID-19 is a new challenge in modern dentistry. New guidelines are required in dental clinics to avoid contagion caused by cross-infections. A narrative review was performed using both primary sources, such as scientific articles and secondary ones, such as bibliographic indexes, web pages, and databases. The main search engines were PubMed, SciELO, and Google Scholar. Twelve articles were selected to develop the bibliographic review by applying pre-established inclusion and exclusion criteria. Precautionary measures should be applied to control COVID-19 in clinical practice. Several authors have highlighted the importance of telephone triage and/or clinic questionnaires, body temperature measurement, usage of personal protective equipment, surface disinfection with ethanol between 62% and 71%, high-speed instruments equipped with an anti-retraction system, four-handed work, and large-volume cannulas for aspiration. Clinically, the use of a rubber dam is essential. FFP2 (or N95) and FFP3 respirators, if compared to surgical masks, provide greater protection for health workers against viral respiratory infections. Further accurate studies are needed to confirm this. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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Other

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8 pages, 974 KiB

Open AccessProject Report

Study Protocol for an Online Questionnaire Survey on Symptoms/Signs, Protective Measures, Level of Awareness and Perception Regarding COVID-19 Outbreak among Dentists. A Global Survey

by Guglielmo Campus, Marcela Diaz-Betancourt, Maria Grazia Cagetti, Joana C. Carvalho, Thiago S. Carvalho, Javier F. Cortés-Martinicorena, James Deschner, Gail V. A. Douglas, Rodrigo A. Giacaman, Vita Machiulskiene, David J. Manton, Daniela P. Raggio, Francisco Ramos-Gomez, Ruxandra Sava-Rosianu, Natalia S. Morozova, Gianrico Spagnuolo, Ana Vukovic, Thomas G. Wolf and on behalf of the COVIDental Collaboration Group

Int. J. Environ. Res. Public Health 2020, 17(15), 5598; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155598 - 03 Aug 2020

Cited by 47 | Viewed by 12151

Abstract

The Centres for Disease Control and Prevention and the World Health Organization have developed preparedness and prevention checklists for healthcare professionals regarding the containment of COVID-19. The aim of the present protocol is to evaluate the impact of the COVID-19 outbreak among dentists in different countries where various prevalence of the epidemic has been reported. Several research groups around the world were contacted by the central management team. The online anonymous survey will be conducted on a convenience sample of dentists working both in national health systems and in private or public clinics. In each country/area, a high (~5–20%) proportion of dentists working there will be invited to participate. The questionnaire, developed and standardized previously in Italy, has four domains: (1) personal data; (2) symptoms/signs relative to COVID-19; (3) working conditions and PPE (personal protective equipment) adopted after the infection’s outbreak; (4) knowledge and self-perceived risk of infection. The methodology of this international survey will include translation, pilot testing, and semantic adjustment of the questionnaire. The data will be entered on an Excel spreadsheet and quality checked. Completely anonymous data analyses will be performed by the central management team. This survey will give an insight into the dental profession during COVID-19 pandemic globally. Full article

(This article belongs to the Special Issue COVID-19: A Public Health Approach for Health Professionals)

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