key: cord-0931561-so42rcgr authors: Kinariwala, Niraj; Perera Samaranayake, Lakshman; Perera, Irosha; Patel, Zeal title: Concerns and Fears of Indian Dentists on Professional Practice During the Coronavirus Disease‐2019 (COVID‐19) Pandemic date: 2020-06-07 journal: Oral Dis DOI: 10.1111/odi.13459 sha: 49db6afde2395cdaca214a4d19025ad5b5878742 doc_id: 931561 cord_uid: so42rcgr The Coronavirus disease‐2019 (COVID‐19) pandemic, due to the Severe Acute Respiratory Syndrome Virus 2 (SARS‐CoV‐2) was declared a public health emergency of international concern by the World Health Organization on 30(th) of January 2020 (World Health Organization, 2020). The first case of COVID‐19 was reported in India on the same day, and at the time of writing, on 20(th) May 2020, India has reported over 106,000 patients, with over 3,300 related deaths. The country is under a state of lockdown since 25(th) March, 2020, and over 600 health care providers have been infected. The Coronavirus disease-2019 pandemic, due to the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) was declared a public health emergency of international concern by the World Health Organization on 30 th of January 2020 (World Health Organization, 2020) . The first case of COVID-19 was reported in India on the same day, and at the time of writing, on 20 th May 2020, India has reported over 106,000 patients, with over 3,300 related deaths. The country is under a state of lockdown since 25 th March, 2020, and over 600 health care providers have been infected. Earlier epidemics such as the severe acute respiratory syndrome (SARS) has shown the susceptibility of health care providers, including dental care workers, to the risk of possible infection, and the consequential psychological toll on these workers (Schwartz, King & Yen, 2020; Wu, Fang, Guan et al. 2009 ). Indeed, a recent report from Indonesia indicates that dentists have died from COVID-19 (Booth, 2020) , although it is unclear whether the infection transmission occurred due to occupational exposure. Dental care workers are, therefore, likely to be concerned about the post-pandemic delivery of professional services, and there is a need to assess their psychological profile in terms of their preparedness for resuming dental practice in the face of the unprecedented pandemic. Hence, we conducted the current questionnaire survey to fulfil the latter objective. A cross-sectional, on-line questionnaire survey, (approved by the Research Unit, Karnavati School of Dentistry, Karnavati University, India) was conducted from 3 rd May, to 5 th May, 2020. The target group comprised dentists in the private, single-handed practices, group practices and academic institutes, regardless of their specialization. The questionnaire which was developed in English based on guidelines of Centre for Disease Control (CDC), Ministry of Health and Family Welfare of the Government of India, and the Dental Council of India (DCI) assessed the dentists' preparedness, concerns and fears related to dental practice during and the post COVID-19 era. The participants were recruited from a Facebook group, Endohaveli: a diverse group of over 52,000 Indian dental professionals. Statistical analyses were conducted using SPSS-21.0 (IBM Corp., Armonk, NY., USA). A total of 403 responses were received out of 1200 questionnaires forwarded, on-line to a random sample of dentists practicing throughout India. The response rate of 33.6%, was within the general acceptable degree for on-line survey responses (Funkhouser, Vellala, Baltuck et al, 2017) . The perceived preparedness and anxieties of dentists in the provision of patient care during the pandemic is shown in Table 1 . Given that personal protective equipment (PPE) for the dental team is an essential prerequisite for provision of dental care during the COVID-19 pandemic, it was surprising to note that a majority of the respondents (61.5%) have not purchased PPE, while N95 masks were not available to a similar This article is protected by copyright. All rights reserved proportion (55.8%). In this context it should be noted that Indian dentists are besieged by substandard, poor quality, and heavily overpriced PPE kits, and this may be one reason for the latter responses. Additionally, a significant proportion of dental clinics in India are not geared for ideal donning and doffing of PPE. Ebola virus outbreak has shown that improper doffing may lead to self-contamination and spread of infection (Suen, Guo & Tong, et al., 2018) . As for patient management concerns, a small majority of dentist (57.8%) perceived that they like to request COVID-19 test results from all patients prior to any aerosol generating treatment procedures, while two fifths (40.0%) of the respondents wished to request the test only from symptomatic patients. Although a large proportion of respondents wished to ascertain COVID-19 disease status of patients, during the post-pandemic period, this is an unrealistic expectation, especially in a developing country such as India. Hence scrupulous adherence to standard infection control measures including droplet precautions, appear to be the only practical method currently available to prevent SARS-CoV-2 transmission in the operatory. In the aftermath of the pandemic though aerosol generating procedures must be kept to a minimum, heeding the guidelines issued by the professional bodies (Jamal, Shah, Almarzooqi et al, 2020) . In this context, although India is currently under a country-wide lockdown, up to two-fifths of the respondents (22.8%) provided emergency treatment during this period. Although we did not question as to the reasons underlying such care provision, a recent study indicates increased global utilization of dental emergency services during COVID-19 pandemic (Guo, Zhou, Liu, &Tan, 2020) . The shape and form of `new normal,` post-pandemic care provision in health facilities is currently under discussion. Clearly, our data indicate that approximately one-half of the respondents (54.3%) were not confident, and about a third (35.7%) hesitant to commence their post-pandemic dental practices. The reasons for this appear to be either personal health, and/or financial considerations, as approximately one-half of the respondents (45.9%) were anxious of the risk of contracting SARS-CoV-2 infection via a patient, and roughly, a third (35.5%) were concerned of increased treatment costs due to additional infection control procedures. It is noteworthy that only one tenth of the respondents (10%) were confident/fairly confident of post-pandemic delivery of dental care (Table1). COVID-19 pandemic has led to an array of medico-legal and professional concerns for Indian dentists in terms of patient care provisions. Hence, the Indian government and the Dental Council of India (DCI) have promulgated guidelines on appropriate patient management principles during the pandemic. Interestingly, an overwhelming majority of dentists (87.8%) expect the government and the non-governmental organizations to further enact and enforce laws to safeguard professional obligations of dentists during, and after COVID-19 pandemic (Table 2) . However, a three-quarter of the responders (75.5%) appear to be worried about medico-Accepted Article legal consequences of post-pandemic dental care provision, and a one-quarter (27.5%) perceived themselves to be ill-equipped to follow guidelines so formulated by the government and DCI. Finally, we wished to ascertain whether the COVID-19 tracking mobile application introduced by the Indian government in April 2020, called Arogya Setu (literally, bridge for disease freeness) is used by the respondents. Approximately two thirds of the respondents (62 %) were users of this app, and were significantly better prepared, with modest concerns, than non-users in providing patient care (p=0.0001). In conclusion, Indian dental professionals, in general, seem inadequately prepared for provision of patient care either during or after COVID-19 pandemic, due to professional, and/or medico-legal concerns. However, the utility of Arogya setu mobile application emerged as a significant factor that may mitigate such concerns. Further, detailed surveys in large cohorts are required to elicit the full spectrum of such views amongst the dental professionals in India. Dentists in Indonesia are dying from COVID-19 Survey Methods to Optimize Response Rate in the National Dental Practice-Based Research Network. Evaluation & the Health Professions The impact of the COVID-19 epidemic on the utilization of emergency dental services Accepted Article This article is protected by copyright. All rights reserved Overview of Trans-National Recommendations for COVID-19 Transmission Control in Dental Care Settings Protecting health care workers during the COVID-19 coronavirus outbreak -Lessons from Taiwan's SARS response Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk We thank Dr Rahul Bisht for his help in data collection. We also thank all the dentists who made time in their busy schedules to complete the questionnaire.This study received no funds or financial support from any profit or not-for-profit organizations.The authors declare that they have no conflict of interest This article is protected by copyright. All rights reserved Main concern to commence the dental practice again Risk of getting infected by a COVID-19 patient 185 45.9Limited supply of PPE 75