The effect of COVID-19 pandemic on oral medicine services in a tertiary referral center.

Toward the end of February 2020 (23/2/2020), the first case of COVID‐19 was diagnosed in Israel (Israeli Ministry of Health, 2020, 2020). Since then, the number of COVID‐19 patients has been rising, standing now on approx. 16,000 confirmed cases. As the new situation developed, the Sheba Medical Center acted quickly in order to upgrade its capacity in accordance with data coming from China. The Oral Medicine Unit was instructed to adjust its activities according to the accumulating data and the Israeli Ministry of Health (MoH) regulations which were updated periodically. As of March 17, 2020, the MoH halted all elective dental treatments across the country (Israeli Ministry of Health, 2020, 2020).

According to Sheba Medical Center policy (effective since March 17), all clinical departments divided their staff into three working teams (capsules) in order to avoid cross‐infection of an entire department. The teams did not have any overlap, and important patient updates were made via phone call or email. In addition, staff members that were not involved in providing urgent care (e.g., dental hygienists and orthodontists) and staff over 60 years of age had the opportunity to stay home or serve on different roles according to the medical center's current needs. As a result, our unit functioned with less than one‐third of its personnel each working day present at the clinic to deal with emergencies. Soon after, we have introduced a telemedicine service using a designated secured system (Datos Health, Ramat Gan, Israel) with the first patient seen on March 23. Our Oral Medicine Unit services include both oral medicine (mucosal diseases, salivary glands dysfunction, and orofacial pain) and dental care for medically compromised patients and patients with special needs at all ages (including dental treatment under sedation and general anesthesia). Therefore, the vast majority of our patients were considered to be at a high risk for COVID‐19 severe morbidity and mortality.

The present paper aims to report the dynamics of our activities during the first phase of the COVID‐19 pandemic in Israel and to assess the benefit of telemedicine under the current circumstances.

During the first phase of the pandemic (starting from mid‐February till April 23), 831 patients were treated at the Oral Medicine Unit in Sheba Medical Center, Tel Hashomer, Israel. Due to the MoH regulations, which halted all elective dental activity as of March 17, only 194 patients were seen during the following 5 weeks (Israeli Ministry of Health, 2020, 2020). 77.3 percent of the visits were related to dental emergencies, while 22.5 percent were urgent oral cavity diseases (e.g., oral cancer, symptomatic osteonecrosis of the jaw, and severe oral ulcerations). Treatment was conducted in accordance with the ADA guidelines for minimizing the risk of COVID‐19 transmission (American Dental Association, 2020).

There was a gradual decline in patient's attendance during the last 2 weeks of February that can be explained by patients refraining from coming to their appointments in order to avoid the risk of infection (Figure 1). During the first 2 weeks of March, an additional decline can be observed, this time steeper. This decline can be explained by the MoH regulations prohibiting elective procedures, in order to protect both patients at risk and staff.

Figure 1

Total number of patient visits (per week) between February 16 and April 23

Specifically, there was a dramatic reduction in patient attendance to dental care as well as to periodontal maintenance. There was also a decrease in patient attendance to the oral disease clinic. However, this decrease was gradually compensated with the growing telemedicine service. It is worth mentioning that dental treatment under GA or sedation has decreased to 11 patients in March and only 3 patients in April, compared with a monthly average of 21.25 patients in 2019.

Interestingly, following 4 weeks of minimal activity, an increase in patient flow was noticed, probably because of increasing demand for urgent dental treatment. Despite the rising number of active COVID‐19 patients and related deaths during that period, patients decided to leave home and attend the clinic.

The introduction of telemedicine service was found to be very beneficial especially in terms of patients' triage. Patients turned to the telemedicine modality for several reasons including oral lesions, dental pain, orofacial pain, and osteonecrosis of the jaws. 88.3 percent of the patients who used telemedicine did not need immediate intervention forcing them to leave home and attend our clinic, as most of our patients are at high risk.

In conclusion, the significant decline in patient's attendance and the rising costs of PPE pose a dramatic challenge for the financial stability of oral medicine/dental services in most medical centers worldwide. It is obvious that halting oral and dental care services for a period longer than several weeks is not practical and may impact significantly on patients' quality of life. Effective telemedicine service can be beneficial for both patients and organizations at such difficult times.

AUTHOR CONTRIBUTION

Marina Umansky Sommer: Conceptualization; Data curation; Investigation; Visualization; Writing‐original draft; Writing‐review & editing. Tzippy Davidovitch: Conceptualization; Data curation; Investigation; Visualization; Writing‐original draft; Writing‐review & editing. Ori Platner: Investigation; Writing‐review & editing. Asya Inerman: Investigation; Writing‐review & editing. Noam Yarom: Conceptualization; Data curation; Investigation; Visualization; Writing‐original draft; Writing‐review & editing.