Risk for dental healthcare professionals during the COVID-19 global pandemic: An evidence-based assessment
Risk for dental healthcare professionals during the COVID-19 global pandemic: An evidence-based assessment
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DOI：
10.1016/j.jdent.2020.103434
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发表时间：
2020-10-01
影响因子：
4.4
通讯作者：
Eliav, Eli
中科院分区：
文献类型：
--
作者：
Ren, Yanfang;Feng, Changyong;Eliav, Eli
目标：在 COVID-19 大流行期间，牙科保健专业人员 (DHP) 的焦虑加剧，源于个人防护装备 (PPE) 对抗牙科气溶胶的有效性和无症状患者的风险水平的不确定性。我们的目标是根据现有的科学证据评估 DHP 在大流行期间提供牙科护理的风险。方法：我们回顾了最佳可用证据，并根据以下基本参数估计了 COVID-19 大流行期间 DHP 的年化风险 (p = d(a)s(1 -1-p(o)p(1) (1-e)(yn))：p(o)，当地人口中无症状患者的患病率；p(1)，DHP 的概率被无症状患者感染；e，PPE 的有效性；s，被无症状患者感染后出现症状的概率；d(a)，a 组患者每天就诊的患者人数；y，每年工作的天数。在大流行高峰期，美国一个中等城市中，出现症状并死于感染的人数估计为 1:13,000 (0.008%)。当当地社区无症状病例的流行率较低时，70 岁以下 DHP 的风险可以忽略不计。结论：根据有关 PPE 有效性和流行率的现有证据，牙科诊所中 COVID-19 传播的风险非常低。无症状患者的面罩和术前口腔冲洗可能会进一步降低风险。临床意义：DHP 应遵循预约前方案和牙科治疗期间个人防护装备使用指南，以保持较低风险。
Objectives: Heightened anxiety among dental healthcare professionals (DHPs) during the COVID-19 pandemic stems from uncertainties about the effectiveness of personal protective equipment (PPE) against dental aerosols and risk levels of asymptomatic patients. Our objective was to assess the risks for DHPs providing dental care during the pandemic based on available scientific evidence.Methods: We reviewed the best available evidence and estimated the annualized risk (p = d(a)s(1 -1-p(o)p(1) (1-e)(yn)) for a DHP during the COVID-19 pandemic based on the following basic parameters: p(o), the prevalence of asymptomatic patients in the local population; p(1), the probability that a DHP gets infected by an asymptomatic patient; e, the effectiveness of the PPE; s, the probability of becoming symptomatic after getting infected from asymptomatic patient; d(a), the probability of dying from the disease in age group a; n, number of patients seen per day; and y, number of days worked per year.Results: With the assumption that DHPs work fulltime and wear a N95 mask, the annualized probability for a DHP to acquire COVID-19 infection in a dental office, become symptomatic, and die from the infection is estimated at 1:13,000 (0.008 %) in a medium sized city in the US at the peak of the pandemic. The risk estimate is highly age-dependent. Risk to DHPs under the age of 70 is negligible when prevalence of asymptomatic cases is low in the local community.Conclusions: Risk of COVID-19 transmission in dental office is very low based on available evidence on effectiveness of PPE and prevalence of asymptomatic patients. Face shields and pre-procedure oral rinses may further reduce the risks.Clinical significance: DHPs should follow guidelines on pre-appointment protocols and on PPE use during dental treatments to keep the risk low.