Year : 2022 | Volume
: 16 | Issue : 1 | Page : 1--2
COVID-19 pandemic: 2022 and beyond, perspectives and reflections
Coorg Institute of Dental Sciences, Virajpet, Karnataka; Max Healthcare, New Delhi, India
Coorg Institute of Dental Sciences, Pune, Maharashtra, India. Max Healthcare, New Delhi
|How to cite this article:|
Kalha A. COVID-19 pandemic: 2022 and beyond, perspectives and reflections.J Dent Def Sect. 2022;16:1-2
|How to cite this URL:|
Kalha A. COVID-19 pandemic: 2022 and beyond, perspectives and reflections. J Dent Def Sect. [serial online] 2022 [cited 2022 Jun 30 ];16:1-2
Available from: http://www.journaldds.org/text.asp?2022/16/1/1/342653
Emergency or disaster management planning uses a four-phase disaster cycle, often with the intent of breaking down a situation, analyzing it, and then creating a cogent response. The four phases of disaster management are mitigation, preparedness, response, and recovery. The beginning of the 3rd year of the pandemic brings us into a serious introspection about where we stand as a fresh wave of infections gathers momentum globally and new variants create a fresh fear and anxiety.
Unfortunately, as we enter 2022, we are still in the emergency part of the cycle with no predictions regarding mitigation or recovery. Fatigue sets in from a constant state of preparedness and the sheer exhaustion finds us in a situation that this is something to be managed, factored into day-to-day existence. It will take innovation, leadership, situational awareness, resilience, and learning to manage the way forward, especially for the Armed Forces. Military commanders are trained to deal with dynamic situations but with a learning contrived from experience and precedents. This pandemic challenges all aspects of preparedness and mitigation with no known precedents.
Three years into the pandemic, some introspection is necessary. Was it a black swan event, catastrophic, completely unpredictable with radical outcomes? The reality is that it was predictable, an event on the sidelines waiting to happen. In an article published on January 26th, 2020, when the virus was still confined to China, Nicholas Nassim Talib, Joseph Norman, and Yaneer Bar-Yam cautioned the world and suggested nipping it in the bud. Their anxiety was fueled by the fact that due to increased connectivity, the spread of the virus would be nonlinear, an output disproportionate to inputs. the structure and growth of the virus are owing to unknown and unknowable inputs such as incubation period in humans and random mutations. The rapid spread of the virus would be a convergence of eccentric inputs such as wet markets, air travel, and networked human connections. Some lessons are still unlearnt by the world as vaccine inequity leads to mutations and the emergence of strains. Africa is the crucible for mutations with a 7% vaccination record and first-world nations stockpile and destroy vaccines rather than share it. An event of such catastrophic dimensions was predicted and even anticipated and yet when it happened, the world was unprepared.
Dentistry, Oral Health, and a Tryst with COVID-19
Needless to say, in retrospect is that dentistry took a big hit and what came to the surface was the glaring chasm in health-care thinking where the entire profession was equated to a set of procedures and skills, essential but inconsequential when faced with a pandemic and all the advisories by regulating, statutory, and advisory bodies recommended a complete shutdown. The entire ambit of oral disease and well-being was relegated to an indiscriminate use of broad-spectrum antibiotics, anti-inflammatories, and analgesics with scant regard to the consequences.
Military dentistry scored in this aspect as shutting down was not an option but providing interventional care was a mandate. As a profession, a negative impact whether economic or in stature was perceptible with lingering effects and consequences. The fact that the dental professional with foundational training in medicine, surgery, anesthesia, and basic health sciences could be used to amplify the beleaguered health-care workers and act as a force multiplier was evidenced by the contributions of the Armed Forces Dental Services in manning and running several COVID care facilities. Defining a correlation between oral health and COVID-19 is slow, tedious work as always with a public health initiative. It's about the investigation, evidence, statistics, and correlation but more than that defining a value for such outcomes and work is a challenge, especially where the mainstream health care was completely prepossessed with the intensive care unit (ICU) and intensive care of severe disease manifestation.
As the pandemic progressed, some facts began to slowly emerge; Severe COVID-19 illness started to correlate with age, obesity, diabetes, hypertension, and smoking-all factors related to periodontal disease so perhaps both were outcomes of poor overall health and oral health. The second clue, COVID-19 was related to cytokine storms, inflammatory molecules released in excess by the immune system, a phenomenon similar to periodontal disease, and loss of taste suggested an oral connection. A clinically significant correlation began to emerge between periodontal disease, COVID-19 severity, and mortality. The virus replication has been found in salivary glands, even periodontal tissues, and the mucous membrane of the mouth.
The researchers had seen in their respective RNA sequencing data sets that cell in the oral cavity expressed the proteins angiotensin-converting enzyme 2 and TMPRSS2 – both of which are needed by severe acute respiratory syndrome-coronavirus-2 to enter and infect host cells. Confirmation that the mouth was susceptible to infections was also associated with the finding that loss of taste and smell was associated with a higher viral load in saliva and could infect even if the patient was asymptomatic.
Nature published a very relevant article on collaborative research which revealed that those with COVID-19 and gum disease were 3.5 times more likely to be admitted to an ICU than those without gum disease. They were 4.5 times more likely to be put on a ventilator and 8.8 times more likely to die. The team also looked at the biomarkers in COVID-19 patients and found them to be significantly higher in those with poor oral health. A learning much later into the pandemic showed that oral health status correlated with both morbidity and mortality due to COVID-19 disease and that poor oral health correlated with increased C-reactive protein (CRP) in the 1st week of infection, influencing the course of the disease. Inflammatory markers such as CRP, D-dimer, and white cell counts were significantly elevated with patients with Stage 2, 3, 4, or periodontitis than those without. The possibility of a vascular ingress of the virus through the oral tissues was proposed by researchers.
The pandemic has redefined a new normal, and the basic tenets of human interaction, social interaction, the workplace have all been redefined. Do we redefine dentistry and oral health? Entropy pervades all systems and has dentistry been decaying at a steady even though imperceptible rate? The close correlation of the COVID-19 disease and oral disease and health is well defined; we struggle with the sequelae of mucormycosis and yet oral health and disease do not find a relevant position in the overall ambit of health care. Industry-driven trends have led to a projected image of being relegated to a cosmetic or esthetic service rendered by skills, appliances, and techniques rather than by knowledge and depth of understanding of human health and disease.
The sequestration of dental colleges from medical institutions has led to a steady loss of interest and training, exposure to basic sciences, general human pathology, pharmacology, medicine, surgery, and critical care. The foundation of oral medicine, diagnostics, public health dentistry, critical thinking, evidence, and analytics will be the way forward. This becomes even more relevant in the military environment. Training of dental personnel in disaster management, a role beyond dentistry, will require a rethink on training and bridging courses between the gaps in knowledge in the present ecosystem and that required in the post pandemic world. The Armed Forces Dental Services find themselves in this unique position of redefining military dentistry and training. The need to maintain critical force levels in operational readiness takes precedence over all else. Would public health dentistry issue guidelines for future troop accommodations, preventive measures in the field, and a greater focus on oral health and its preventive maintenance.
The pandemic may become endemic as predicted but the virus will continue to be a challenge, and this may not yet be the only challenge to humankind. There is a need to rise to a new call and redefine our profession.
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Conflicts of interest
There are no conflicts of interest.