key: cord-0839804-oh4qi54k authors: Meleti, Marco; Cassi, Diana; Bueno, Luis; Bologna‐Molina, Ronell title: Covid‐19 diffusion and its impact on dental practice in distant countries with similar ethnic background date: 2020-05-26 journal: Oral Dis DOI: 10.1111/odi.13438 sha: 24e2d01c32ccf76c1ee5ac7569e9b85ae79fdd83 doc_id: 839804 cord_uid: oh4qi54k Epidemiology of Covid‐19 and diffusion patterns of the novel coronavirus (SARS – CoV – 2) are still poorly understood, as they differ substantially among countries and even in neighboring regions within the same country. It is not clear if differences in viral spreading depends on population age, genetic influences, specific environmental factors (e.g. season of the year), socioeconomic conditions or a combination of these. Some Authors hypothesized that differences in models of SARS – CoV – 2 diffusion may be explained also on the basis of ethnic influences (Pareek, Bangash, Pareek, Pan, Sze, Minhas, Hanif, Khunti, 2020). Under such perspective, it seems rational to compare the Italian experience to that of Uruguay. Epidemiology of Covid-19 and diffusion patterns of the novel coronavirus (SARS -CoV -2) are still poorly understood, as they differ substantially among countries and even in neighboring regions within the same country. It is not clear if differences in viral spreading depends on population age, genetic influences, specific environmental factors (e.g. season of the year), socioeconomic conditions or a combination of these. Some Authors hypothesized that differences in models of SARS -CoV -2 diffusion may be explained also on the basis of ethnic influences (Pareek, Bangash, Pareek, Pan, Sze, Minhas, Hanif, Khunti, 2020) . Under such perspective, it seems rational to compare the Italian experience to that of Uruguay. These two countries have completely different geographical and socioeconomic conditions but they share similar ethnic background. In fact, about 40% of population of Uruguay has some degree of Italian ancestry, particularly deriving from Piedmont, Veneto and Lombardy, which are among the Italian regions with highest prevalence of Covid-19. Diffusion of SARS -Cov -2 in Italy and impact on dental practice It is still debated when the novel coronavirus started to actively circulate in Italy (Zehender et al, 2020 ). The first two cases (a couple of Chinese travelers from the Hubei region arrived in Italy on January 23 rd ) which were thought to be "isolated" cases were confirmed on January 31 st 2020 In the following 2 months, Italy faced the most tremendous socioeconomic and health crisis since World War II. According to the Civil Protection (the Italian surveillance system for the novel This article is protected by copyright. All rights reserved coronavirus outbreak), as of May 7 th , 215.858 persons in Italy were infected and 29.981 patients died for Covid-19 (mortality rate: 13.88%) (Italian Civil Protection, 2020). The impact on the public health system has been dramatic, with 4.068 patients in intensive care units and 28.748 patients allocated in other departments, at the moment of highest emergency (April 4) (Europost, 2020). All in all, after only 44 days from the diagnosis of "case 1", 32.816 patients were hospitalized for Covid-19 causing an amount of health needs which could barely be sustained, in some regions (Italian Civil Protection, 2020). Very surprisingly, not all Italian regions were affected by the SARS-CoV-2 diffusion in the same way, the northern part (Lombardy, Emilia-Romagna, Veneto and Piedmont) being more affected. Both private and public dental activities were profoundly affected by the outbreak. On one side, the lockdown measures and the diffuse fear of infection prevented most patients from seeking dental cares. On the other hand, guidelines developed by national dental associations suggested to strictly limit dental activities to emergency cares (e.g. abscesses, acute pain etc.) encouraging management via telemedicine (Izzetti, Nisi, Gabriele, Graziani, 2020) . Also, measures for preventing SARS -CoV -2 spreading (e.g. use of specific DPI, spatial and time distancing between patients etc.) were recommended to be strongly implemented, as dental settings were classified among places at higher risk of viral diffusion, because of procedures generating aerosols and droplets. This article is protected by copyright. All rights reserved The convergence of these factors led to a previously unfaced, radical crisis in the dental field. A confidential survey performed by one of the Authors on 10 dental private practices in the Province of Parma, highlighted a dramatically low number of accesses (average of 3 per month). It is worthy to mention that, in specific regions (e.g. Emilia Romagna), most dentists working for the public health system were employed in the management of patients with mild manifestations of Covid-19, through various activities such as performing oropharyngeal and nasal swabs and/or telephone surveillance. A possible short-term effect of the outbreak, strictly related to the lockdown period, specifically concerns oral medicine. It is highly probable that patients with chronic inflammations, potentially malignant disorders and undiagnosed malignant lesions of the oral mucosa will receive a somewhat late diagnosis, which can profoundly impact on treatment. On March 14 th the country was declared in "Phase 2: risk of spread" and by presidential decree, all activities in schools and in the University of the Republic (the only public Uruguayan University) as well as all aggregation activities, were suspended by presidential decree. (Uruguayan National Emergency System, 2020). On March 15th the health authorities confirmed This article is protected by copyright. All rights reserved the beginning of "Phase 3: Multisectoral Coordinated Response". In addition, all passengers on flights arriving from risk areas had to complete forms for their mandatory 14 days isolation and subsequent control. On March 20 th all flights from Europe were suspended. On March 24 th borders were closed for foreign citizens (Uruguayan National Emergency System, 2020). As of May 7 th , 673 people were confirmed to be infected by SARS -CoV -2 and 17 patients died for Covid-19 (mortality rate: 2,53%).(Uruguayan National Emergency System, 2020). With regard to professional dental practice, at present, only emergency cares are provided. Basically, the protocol consists of recording anamnesis by telephone and, in case of need, to prescribe analgesics, antibiotics and/or anti-inflammatories. On the other hand, when it is not possible to manage cases by phone, patients are treated in a dental setting, following specific In Uruguay, the entire population has health coverage either in public or private hospitals. Cases of dental emergencies are referred to these hospitals. References. Ethnicity and COVID-19: an urgent public health research priority Le liste di bordo per lo studio dell'emigrazione italiana verso le Americhe: il ruolo della famiglia nelle migrazioni transoceaniche», Bollettino di demografia storica Genomic characterization and phylogenetic analysis of SARS-COV-2 in Italy Genomic epidemiology of novel coronavirus -Global subsampling. Online The first two cases of 2019-nCoV in Italy: Where they come from An account of the first hours of the Covid-19 epidemic at the Nephrology Unit in Lodi (Lombardy) Online May 9 Accepted Article This article is protected by copyright. All rights reserved COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy Available at: Resultados del Censo de Población Online