key: cord-0895122-dn7iuzq1
authors: Abreu Alves, Fabio; Saunders, Deborah; Sandhu, Shaiba; Xu, Yuanming; Felix de Mendonça, Nathalia; Simon Treister, Nathaniel
title: Implication of COVID‐19 in oral oncology practices in Brazil, Canada and the United States
date: 2020-06-17
journal: Oral Dis
DOI: 10.1111/odi.13493
sha: 24f54a627ad49181e14983f83c0203bbd30791d3
doc_id: 895122
cord_uid: dn7iuzq1

The newly emerged Coronavirus disease 2019 (COVID‐19) is an infectious disease that has spread rapidly throughout the world. The most common signs and symptoms are fever, dry cough and shortness of breath which can progress to severe viral pneumonia and multi‐organ failure in susceptive patients (Chen et al. 2020, Wang et al. 2020). Droplet transmission and person‐person transmission appear to be the main route of transmission of COVID‐19, however asymptomatic patients are also carriers of the virus (Rothe et al. 2020).

The newly emerged Coronavirus disease 2019 is an infectious disease that has spread rapidly throughout the world. The most common signs and symptoms are fever, dry cough and shortness of breath which can progress to severe viral pneumonia and multi-organ failure in susceptive patients (Chen et al. 2020 . Droplet transmission and person-person transmission appear to be the main route of transmission of COVID-19, however asymptomatic patients are also carriers of the virus (Rothe et al. 2020) .

Patients who are under medical care for chronic diseases and without urgent concerns or complications have generally been encouraged to stay at home during this time (we must note that this is a rapidly evolving situation, and at the time of submission of this manuscript there has been some loosening of restrictions at some centers). However, many patients who are undergoing oncological treatment (OT) require regular office visits in order to receive care and to be evaluated for treatment-emergent side effects. Oral Medicine specialists play an important role in mitigating oral side effects and ensuring that cancer patients are able to maintain adequate oral health and function, as well maintaining their scheduled treatment without interruption. Some cancer patients require emergent dental care prior to initiation of cancer therapy to reduce the risk of complications that could lead to delays in the commencement of OT. (Brennan et al. 2017 , Lalla et al. 2017 . 

This article is protected by copyright. All rights reserved Forced quarantine of cancer patients, caregivers, and health professionals may result in undesirable delays of cancer treatment and exacerbation of oral side effects, which can worsen the disease prognosis (Werner, Carey, Albergotti, Lukens, Brody 2020). During the pandemic period, there has been a substantial decrease in patient visits. Our three centers provided a total of 3,154 oral medicine-related patient visits during the 6 weeks prior to stay-at-home orders, and 1,531 in the following 6 weeks (reduction of 51.5%) (Table 1, Figure 1 ). Patients who are in active OT have for the most part experienced only minor changes in their visits or treatment protocols (e.g. use of oral chemotherapy rather than an infusion to limit time at the cancer center). However, patients who were not under active OT were encouraged to stay at home and their visits or dental procedures were postponed when possible. Virtual visits adopted by the centers represented only 1.4% of the total visits before quarantine (and only at one center), and it has increased to 17.3% during the stay-at-home period (Table 1, Figure 1 ). Virtual visits have greatly facilitated the provision of oral medicine care and support for both established and new consultations, allowing for effective triage of potentially urgent cases problems requiring immediate clinical attention ( Figure 2 ). Telemedicine/dentistry or telehealth has been used to facilitate patient-professional communication and has been widely and effectively incorporated into oncology care (Villa, Sankar, Shiboski 2020; Schrag, Hershman, Basch 2020) .

A finding that was noted early in the pandemic for all centers was that some symptomatic oncology patients complaining of classic oral complications (e.g. xerostomia, mucositis, taste changes) would also screen positive for the signs and symptoms of COVID-19 (e.g. due to reporting a dry cough, related to xerostomia). Our centers have adopted measures for minimizing the risk of COVID-19 transmission between patients and health professionals. Screen positive patients are isolated prior to assessment and in some cases swabbed for COVID-19. With these measures, the more limited operations have been safe and efficient and there have not been outbreaks of cases among patients or staff.

In summary, our group has demonstrated various strategies, often coordinated at the institutional level, to maintain essential oral/dental care for cancer patients during the COVID-19 pandemic.

We anticipate that there will be many lessons learned from this experience that will have the potential to improve access to oral medicine care for cancer patients in the future.

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This article is protected by copyright. All rights reserved Antibiotics and analgesics were prescribed, and the patient was scheduled for a virtual visit in 3 days. During the virtual visit, right facial swelling was noted and the patient reported no improvement, and now with painful spasms. The patient was immediately scheduled for an outpatient visit and panoramic radiograph demonstrated pathologic fracture of the mandible. The patient was seen urgently by a surgeon who prioritized the case as level 1 given operating room

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