CORONAVIRUS, COVID 19 PANDEMIC AND DENTAL CARE- 5
The outbreak of Coronavirus disease (COVID-19) is by a new strain of Coronavirus called Novel Coronavirus, also named Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) identified in December 2019 and not caused any disease in human beings before. Common symptoms are cough, fever, loss of taste, loss of smell and, shortness of breath. On 30 th January 2020 World Health Organization (WHO) announced the current COVID-19 outbreak a Public Health Emergency of International Concern and on March 11 th declared it as a pandemic.
The virus spreads from person to person when in close contact, most often via small droplets produced by coughing, sneezing, and talking. As Dentists work very close to the mouth and throat of patients and some dental procedures generate small droplets called micro aerosols from patient’s mouth, it is very difficult to minimize the chance of getting infected by the novel coronavirus, despite using best practices and protective clothing to minimize cross-
Diagnosis and Treatment of COVID 19
2. COVID Tests
The COVID-19 diagnosis is mainly based on the epidemiological details such as travel history to or residency in an infected area within two weeks of the onset of symptoms, laboratory tests, clinical signs and symptoms, and imaging results. The outcome of a single negative test does not mean a suspected patient is not infected. The WHO has stated that education, isolation, prevention, controlling the transmission, and treatment of infected persons are the critical steps in controlling COVID-19.
2. COVID Tests
COVID tests are mainly diagnostic tests and antibody tests. A diagnostic test shows the active coronavirus infection. A diagnostic test is classified again into an antigen test and molecular test. The antigen test detects specific protein on the surface of the virus and the test is less sensitive but more specific. So, more chance of false-negative results, and the false-positiveresult is unlikely. Molecular tests, such as Real-Time Polymerase Chain Reaction (RT-PCR),
Nucleic Acid Amplification Test (NAAT), and Loop-Mediated Isothermal Amplification (LAMP) tests, detect the virus’s genetic material. These tests are more sensitive, more accurate, and reliable. Antigen test and LAMP test are rapid tests taking less than 30 minutes for the results,
NAAT results within 60 minutes and RT PCR may take 12 hours or more. An antibody test is a serological test designed to detect whether the person has developed antibodies to COVID- 19. Antibodies are made by the immune system in response to a threat such as viruses. The antibody which appears first during infection is IgM and it begins to rise after 1 week of the initial infection, while the IgG appears later usually after14 days, and may last for 6 months or more. The presence of Ig M indicates active infection and IgG alone in theblood shows the patient is recovered. Rapid antibody test takes only 10- 15 minutes for theresult. An Enzyme-Linked Immunosorbent Assay (ELISA) is a biochemical technique that can detect antigens or antibodies.
Studies shows, the conventional radiographs such as chest X-ray have no diagnostic value in the early stages of the infection. But CT scans may present some findings even before theonset of symptoms. Bilateral patchy shadows or multilobar ground-glass radiopacities with ill- defined margins is the typical feature of the CT in COVID-19 positive cases.
Along with the preventive measures like use of mask, use of sanitizers and social distancing, need to practice healthy lifestyles like maintaining of regular sleep for six to eight hours, stay hydrated by drinking at least 2 to 3 liters of water per day, manage anxiety and stress, do regular exercise, eat balanced diet including carbohydrate, minerals, and vitamins mainly A, D, and C. Also habits like smoking and alcohol consumption need to be stopped as smoking
aggravates respiratory distress and alcoholism alter stomach epithelium, absorption of nutrients, and causes dehydration. Classify the patients to asymptomatic, mild, moderate, severe, or critical based on the clinical presentation.
Asymptomatic cases are at home in quarantine for a minimum of 14 days, symptomatic treatment for mild and moderate cases, fever can be treated with paracetamol 500mg or 650mg, ORS for diarrhea, and steam inhalation for runny nose. If the patient develops difficulty in breathing, persistent chest pain, confusion, or bluish discoloration of face and lips considers it as severe or critical and seek emergency medical intervention. Strategies tried so far for the
treatment of COVID- 19 are, drugs such as Hydroxychloroquine and Azithromycin, Convalescent plasma, Steroids like Dexamethasone, and Hydrocortisone, antiviral Remdesivir, and adjuvant therapy with Vitamin D and C. Vaccine is still in different stages of development.
Researchers are trying to develop a vaccine by making use of an inactive virus, non-replicating viral vector, recombinant protein, and so on. Few vaccines are under trial.
Silent hypoxia can be monitored by Pulse oximetry technology and oximeters are small non-invasive devices that show immediate readings of blood oxygen levels by clipping the device on the index finger of patients. If the reading is less than 95, the oxygen saturation in the blood is low and needs emergency medical consultation. Once the test is positive for IgG antibodies, the patient is recovered from COVID-19 and can donate plasma for convalescent plasma therapy to those who are critically ill.
At this time, the strategy towards COVID-19 is to control the infection source by preventing theinfection and controlling measures to minimize the transmission risk, and to provide early detection, quarantining, and assistance to infected patients.