Health Organization Global Research Articles

Perspectives on Repurposed Drugs Based on Globally Accepted Therapeutic Guidelines to Combat SARS-CoV-2 Infection.

A beta coronavirus was identified in Wuhan, China, in December 2019 and was named severe acute respiratory syndrome coronavirus-2. It spread globally at a rapid rate and killed innumerable people. The SARS-CoV-2 infection, also called coronavirus disease 2019, was declared a pandemic by WHO on March 11, 2020. The increasing number of SARS-CoV-2 related deaths is due to a number of reasons. A few antiviral, antimicrobial, and immune-based drugs have been repurposed for treatment as well as improvement of patient prognosis. These drugs are currently being studied in clinical trials conducted by the World Health Organization (WHO), National Institutes of Health (NIH), and other global health organizations to identify the agents that produce maximum positive patient outcomes and reduction in mortality rate. The aim of this article is to discuss the safety and efficacy of the repurposed drugs in SARS-CoV-2 infection based on currently available clinical evidence and to emphasize the importance of caution required whilst employing the international therapeutic guidelines. Also highlighted in this article are certain specific comorbid conditions, that either involve treatment with the repurposed drugs or have a direct impact of the virus in patients owing to their vulnerability.

Setting the stage for a Global Programme to Eliminate Lymphatic Filariasis: the first 125 years (1875-2000).

The development of the World Health Organization's Global Programme to Eliminate Lymphatic Filariasis (GPELF) can be interpreted through many different lenses—e.g. one focusing on the health or economic plight of affected individuals and populations, another tracking the individuals and organizations responsible for building the programme or, as in this review, one identifying each of the critical requirements and specific hurdles that need to be addressed in order to successfully construct the programme. For almost 75 y after the life cycle of LF was first described, the principal tool for countering it was vector control. Discovery that diethylcarbamazine (and later ivermectin and albendazole) could effectively treat affected and at-risk populations, along with the availability of a simple, field-based diagnostic test to monitor programme progress, provided the essential tools for LF elimination. Recognition of this potential by the global health community (including the World Health Assembly) led two pharmaceutical companies (GlaxoSmithKline and MSD (Merck & Co. Inc., Kenilworth, NJ, USA) to make enormous, unprecedented donations of albendazole and ivermectin to achieve this goal. Additional resource support from the public and private sectors and from health ministries in the 80 LF-endemic countries led to the creation of a Global Alliance to Eliminate LF, which launched the GPELF in 2000, just 125 y after the LF life cycle was first described.

Evolution of the monitoring and evaluation strategies to support the World Health Organization's Global Programme to Eliminate Lymphatic Filariasis.

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) was established with the ambitious goal of eliminating LF as a public health problem. The remarkable success of the GPELF over the past 2 decades in carrying out its principal strategy of scaling up and scaling down mass drug administration has relied first on the development of a rigorous monitoring and evaluation (M&E) framework and then the willingness of the World Health Organization and its community of partners to modify this framework in response to the practical experiences of national programmes. This flexibility was facilitated by the strong partnership that developed among researchers, LF programme managers and donors willing to support the necessary research agenda. This brief review summarizes the historical evolution of the GPELF M&E strategies and highlights current research needed to achieve the elimination goal.

PCN186 A Comparison of Breast Cancer Burden in 120 Countries (2008-2017)

Breast cancer is the cancer with the highest incidence in women in many countries. The purpose of this study is to explore the influencing factors of various national levels that affect the burden of breast cancer disease in countries around the world. We also generate strategic policy recommendations based on the research results to reduce the burden of breast cancer disease in the country. This study used the incidence and mortality of breast cancer in women as a measure of disease burden. The data comes from the statistical data of the World Health Organization's Global Disease Burden system from 2008 to 2017. We used the generalized linear mixed model statistical method to analyze the four types of country-level factors that affect women’s breast cancer incidence and mortality. The study found that, after adjusting for other factors, the country’s mean of total cholesterol, average body mass index, average annual alcohol consumption, smoking percentage, average life expectancy, years of education, GDP per capita, and total female population and the annual average temperature were significantly positively correlated with the incidence of breast cancer in women. The mean systolic blood pressure and the prevalence of high fasting blood glucose were significantly negatively correlated with the incidence of breast cancer in women. In terms of mortality, the country’s average systolic blood pressure, average total cholesterol, average annual alcohol consumption, smoking percentage, average remaining life, years of education, and average annual temperature are significantly positively correlated with the incidence of female breast cancer. This study found that the higher the average total cholesterol, the higher the average annual alcohol consumption, the higher the smoking rate, and the higher the average temperature, the higher the incidence and mortality of breast cancer among women.

Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study

SummaryBackgroundStrengthening the capacity of midwives to deliver high-quality maternal and newborn health services has been highlighted as a priority by global health organisations. To support low-income and middle-income countries (LMICs) in their decisions about investments in health, we aimed to estimate the potential impact of midwives on reducing maternal and neonatal deaths and stillbirths under several intervention coverage scenarios.MethodsFor this modelling study, we used the Lives Saved Tool to estimate the number of deaths that would be averted by 2035, if coverage of health interventions that can be delivered by professional midwives were scaled up in 88 countries that account for the vast majority of the world's maternal and neonatal deaths and stillbirths. We used four scenarios to assess the effects of increasing the coverage of midwife-delivered interventions by a modest amount (10% every 5 years), a substantial amount (25% every 5 years), and the amount needed to reach universal coverage of these interventions (ie, to 95%); and the effects of coverage attrition (a 2% decrease every 5 years). We grouped countries in three equal-sized groups according to their Human Development Index. Group A included the 30 countries with the lowest HDI, group B included 29 low-to-medium HDI countries, and group C included 29 medium-to-high HDI countries.FindingsWe estimated that, relative to current coverage, a substantial increase in coverage of midwife-delivered interventions could avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths, equating to 2·2 million deaths averted per year by 2035. Even a modest increase in coverage of midwife-delivered interventions could avert 22% of maternal deaths, 23% of neonatal deaths, and 14% of stillbirths, equating to 1·3 million deaths averted per year by 2035. Relative to current coverage, universal coverage of midwife-delivered interventions would avert 67% of maternal deaths, 64% of neonatal deaths, and 65% of stillbirths, allowing 4·3 million lives to be saved annually by 2035. These deaths averted would be particularly concentrated in the group B countries, which currently account for a large proportion of the world's population and have high mortality rates compared with group C.InterpretationMidwives can help to substantially reduce maternal and neonatal mortality and stillbirths in LMICs. However, to realise this potential, midwives need to have skills and competencies in line with recommendations from the International Confederation of Midwives, to be part of a team of sufficient size and skill, and to work in an enabling environment. Our study highlights the potential of midwives but there are many challenges to the achievement of this potential. If increased coverage of midwife-delivered interventions can be achieved, health systems will be better able to provide effective coverage of essential sexual, reproductive, maternal, newborn, and adolescent health interventions.FundingNew Venture Fund.

Infodemiology of solid organ transplantation: relationship to the Global Observatory on Donation and Transplantation data.

Although transplantation medicine has been continuously improving, its impact on the general population needs to be evaluated. This study describes the global community interest in solid organ transplantation (SOT) using Google Trends, comparing relative search volumes (RSVs) and data from the World Health Organization (WHO) Global Observatory on Donation and Transplantation (GODT) regarding SOT activity all around the world. The online interest for the search terms "kidney transplantation", "liver transplantation", "heart transplantation" and "lung transplantation" was measured, evaluating RSVs and the number of worldwide SOT recorded in the GODT website from 2008 to 2018. The mean values of RSVs were 51.7±16.8 for liver transplantation, 39.8±9.6 for kidney transplantation, 22.4±7.4 for heart transplantation and 15.4±5.2 for lung transplantation, and these values gradually reduced during the study period. Anglo Saxon countries had the highest interest for SOT, and the mean values of RSVs per year and annual numbers of SOT were inversely correlated. Despite the apparent interest and awareness, we found that public interest in SOT is decreasing. Access to information is crucial for improving understanding of transplantation and motivation to donate. Health care professionals could take advantage by using the internet, and evaluation of RSVs could represent valuable feedback.

A Study of Policies and Guidelines for Collecting, Processing, and Storing Coronavirus Disease 2019 Patient Biospecimens for Biobanking and Research.

Biobanking has been playing a crucial role in the development of new vaccines, drugs, biotechnology, and therapeutics for the prevention and treatment of a wide range of human diseases. This puts biobanks at the forefront of responding to the ongoing worldwide outbreak of the severe pandemic, coronavirus disease 2019 (COVID-19). The leading public health institutions around the world have developed and established interim policies and guidelines for researchers and biobank staff to handle the infectious biospecimens safely and adequately from COVID-19 patients. A study of these important and complementary policies and guidelines is conducted in this study. It should be emphasized that the COVID-19 biospecimens must be collected, processed, and preserved by trained personnel equipped with right personal protective equipment to prevent the transmission of the coronavirus and ensure the specimen quality for testing and research. Six of the leading global public health organizations or institutions included in this study are the World Health Organization, the Pan American Health Organization, the U.S. Centers for Disease Control and Prevention, the Public Health England, the U.S. Food and Drug Administration, and the Office of Research at the University of California, San Francisco. In conclusion, following the recommended guidance and policies with extreme precautions is essential to ensure the quality of the collected COVID-19 biospecimens and accuracy of the conducted research or treatment, and prevent any possible transmission. Efforts from cryobiologist and biobanking engineers to optimize the protocol of COVID-19 biospecimen cryopreservation and develop the user-friendly and cost-effective devices are urgently required to meet the urgent and increased needs in the specimen biobanking and transportation.

THE INTERNATIONAL GOVERNMENT ORGANIZATIONS ROLE IN GLOBAL HEALTH

International government organizations with a global outreach are working on global health issues to achieve the objective of Health for All. The key actors in global health working on global health problems are the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) (Johnson, Stotskopt, & Shi, 2018). These international organizations participate in generating and sharing knowledge, engage in advocacy,provide global funds for health efforts. Our paper will analyze the structure, goals, and processes of global health organizations, UNESCO and UNAIDS.

Multispecies Evaluation of a Long-Acting Tenofovir Alafenamide Subdermal Implant for HIV Prophylaxis.

New HIV-1 infection rates far outpace the targets set by global health organizations, despite important progress in curbing the progression of the epidemic. Long-acting (LA) formulations delivering antiretroviral (ARV) agents for HIV-1 pre-exposure prophylaxis (PrEP) hold significant promise, potentially facilitating adherence due to reduced dosing frequency compared to oral regimens. We have developed a subdermal implant delivering the potent ARV drug tenofovir alafenamide that could provide protection from HIV-1 infection for 6 months, or longer. Implants from the same lot were investigated in mice and sheep for local safety and pharmacokinetics (PKs). Ours is the first report using these animal models to evaluate subdermal implants for HIV-1 PrEP. The devices appeared safe, and the plasma PKs as well as the drug and metabolite concentrations in dermal tissue adjacent to the implants were studied and contrasted in two models spanning the extremes of the body weight spectrum. Drug and drug metabolite concentrations in dermal tissue are key in assessing local exposure and any toxicity related to the active agent. Based on our analysis, both animal models were shown to hold significant promise in LA product development.

Vaccine Procurement Contracts for Developing Countries

In recent years, several Global Health Organizations (GHOs) have experimented with market‐based procurement contracts to encourage pharmaceutical companies to bring late‐stage vaccines to developing‐country markets. Pharmaceutical companies often find such markets financially unattractive because the opportunity cost of capacity commitment is high, developing countries have limited ability to pay, and demand is uncertain. A contract design recently implemented by one GHO offers the manufacturer a per‐dose sales subsidy, which is paid by the GHO, on top of the base price paid by developing countries. The subsidy is required because the base price is not enough, by itself, to induce the manufacturer to commit capacity for developing‐country markets. A natural question that arises in this context is whether, within a fixed budget, alternate contract designs lead to higher capacity commitment. This study proposes and analyzes three contract designs that include the current practice and two alternatives inspired by contracts studied in the operations management literature. It also considers two types of budget constraints that may arise in practice and quantifies the impact of each type of budget constraint on the manufacturer’s capacity commitment. We show that the best contract design depends on the size of the budget, and that GHOs can increase capacity commitment (over the contract design used in practice) by choosing the budget‐appropriate contract design and optimal parameters for the chosen design.

Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels.

ObjectivesSerum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C.MethodsThis prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL.ResultsMean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively).ConclusionDiagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.

Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer

We evaluated global and regional burdens of, risk factors for, and epidemiologic trends in pancreatic cancer among groups of different sexes and ages. We used data from the GLOBOCAN database to estimate pancreatic cancer incidence and mortality in 184 countries. We examined the association between lifestyle and metabolic risk factors, extracted from the World Health Organization Global Health Observatory database, and pancreatic cancer incidence and mortality by univariable and multivariable linear regression. We retrieved country-specific age-standardized rates (ASRs) of incidence and mortalities from cancer registries from 48 countries through 2017 for trend analysis by joinpoint regression analysis. The highest incidence and mortality of pancreatic cancer were in regions with very high (ASRs, 7.7 and 4.9) and high human development indexes (ASRs, 6.9 and 4.6) in 2018. Countries with higher incidence and mortality were more likely to have higher prevalence of smoking, alcohol drinking, physical inactivity, obesity, hypertension, and high cholesterol. From 2008 to 2017, 2007 to 2016, or 2003 to 2012, depending on the availability of the data, there were increases in incidence among men and women in 14 (average annual percent changes [AAPCs], 8.85 to 0.41) and 17 (AAPCs, 6.04 to 0.87) countries, respectively. For mortality, the increase was observed in 8 (AAPCs, 4.20 to 0.55) countries among men and 14 (AAPCs, 5.83 to 0.78) countries among women. Although the incidence increased in 18 countries (AAPCs, 7.83 to 0.91) among individuals 50 years or older, an increasing trend in pancreatic cancer was also identified among individuals younger than 50 years and 40 years in 8 (AAPCs, 8.75 to 2.82) and 4 (AAPCs, 11.07 to 8.31) countries, respectively. In an analysis of data from 48 countries, we found increasing incidence and mortality trends in pancreatic cancer, especially among women and populations 50 years or older, but also among younger individuals. More preventive efforts are recommended for these populations.

RESEARCH OF HYDROPHILIC GLOBULES CONTAINING A LACTIC ACID-CHITOSAN COMPLEX

Gynecological scientific journals report that traditional therapeutic regimens used to treat vaginal inflammation recommended by global treatment centers and health organizations are not producing satisfactory results. Insufficient duration of the drug’s contact with vaginal mucosa does not provide adequate pH conditioning the physiological biocenosis of the organ. The conducted research and obtained positive results encourage further research possibilities in the field of optimization of pharmaceutical properties of the examined gynecological preparations. Assuming the above assumptions tested impact of polyvinylpyrrolidone K-15, polyvinylpyrrolidone K-30 and polyvinylpyrrolidone K-90 in the properties of the globules. The study was prepared formulations with different pH and rheological properties. The device simulating the conditions in the vagina, studied the adhesion and movement of the gel on the mucosa of the organ. Globules after application of the apparatus simulates the natural conditions in the gel passes and cover the surface. A wide range of pH of the gels allows the selection of the optimum formulation

Important Aspects of Human Behavior in Road Traffic Accidents

AbstractWorldwide road traffic accidents have been increasing. Human behaviors and environmental factors are often responsible for such events. This being a serious public health concern, public health interventions are needed to minimize the rate of road traffic accidents. We aimed to identify broader human behaviors, sociodemographic factors, and environmental factors associated with the risk of road traffic accidents. We searched for the relevant studies in electronic database including PubMed, Cochrane, Web of Science, Google Scholar, and World Health Organization global health library. In addition, a manual search was also performed. Findings from scientific literature were presented in a summative form. Young age, male gender, speed, influence of substance, use of mobile phone, driving experience, temperament, attitude, aggression, stress, anxiety, emotionality, fatigue, lack of sleep, and road conditions were found closely associated with a risk of road traffic accidents. Despite having substantial driving training and ability to handling motor vehicles, professional drivers such as bus and taxi drivers are very vulnerable to road traffic accidents. This study reports that the increasing prevalence of road traffic accidents can be addressed significantly by applying behavior change theories. The health belief model was found useful in promoting safer driving.

Health labour markets: an overview of some human factors that influence demand and supply

Abstract Background The global demand for health workers is expected to double by 2030 and it is estimated that if need is taken into account, there will be a deficit as high as 18 million according to the World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030. Combined with inequities in the access to qualified health workers, this impedes progress towards the achievement of universal health coverage, global health security and the SDGs. This paper addresses health labour market deficiencies. It aims to provide guidance for a comprehensive analysis of health labour market dynamics, including the political and social factors that, in addition to economic ones influence the behaviour of health workers and of employers. Methods This paper uses the material of the WHO Health Labour Market Analysis Guidebook, which is based on the most recent literature on the demand and supply of health workers and on factors that affect them. It also draws from empirical analysis conducted recently by WHO in four regions of the world. Results On the supply side, the paper illustrates how social norms, such as those related to gender, influence the decision to become a health professional, the choice of a specialty, the choice of a practice location, and labour market participation. As to demand, examples are given of how professional interest groups' political actions (councils, trade unions) influence the division of tasks and which types of jobs will be offered. Conclusions The analysis of the dynamics of health labour markets must include human factors to achieve a better understanding of the forces that drive health worker shortages and surpluses, skills-mix and geographical imbalances, and suboptimal performance and to develop effective policies to address these issues.

Legal agreements: barriers and enablers to global equitable COVID-19 vaccine access

Law can serve as both an enabler and a barrier to global health, equity, and justice.1 The impact of legal determinants of health on the COVID-19 pandemic is evident where law is being used as a mechanism to enable or prevent global equitable access to COVID-19 vaccines. Barriers to equitable access are partly driven by vaccine nationalism2 with governments seeking to use law to secure priority access to future vaccines through Advance Purchase Agreements (APAs) with vaccine manufacturers. These bilateral legal agreements can be in a nation's interest, but given the uncertain success of individual COVID-19 vaccine candidates and the global spread of SARS-CoV-2, APAs are a gamble and erode collaboration between countries. Importantly, such bilateral legal agreements are likely to contribute to inequities and potentially extend the pandemic's time frame. By contrast, multilateral legal agreements could be the path back to global health security and justice by re-establishing norms of international solidarity, committing to global equitable vaccine access initiatives, and laying a foundation for a post-pandemic era built on multilateralism and cooperation.

Improving uptake of hepatitis B and hepatitis C testing in South Asian migrants in community and faith settings using educational interventions—A prospective descriptive study

BackgroundChronic viral hepatitis (CVH) is a leading contributor to the UK liver disease epidemic, with global migration from high prevalence areas (e.g., South Asia). Despite international guidance for testing high-risk groups in line with elimination targets, there is no consensus on how to achieve this. The objectives of this study were to assess the following: (1) the feasibility of recruiting South Asian migrants to view an educational film on CVH, (2) the effectiveness of the film in promoting testing and increasing knowledge of CVH, and (3) the methodological issues relevant to scale-up to a randomized controlled trial. MethodsSouth Asian migrants were recruited to view the film (intervention) in community venues (primary care, religious, community), with dried blood spot CVH testing offered immediately afterwards. Pre/post-film questionnaires assessed the effectiveness of the intervention. ResultsTwo hundred and nineteen first-generation migrants ≥18 years of age (53% female) were recruited to view the film at the following sites: religious, n = 112 (51%), community n = 98 (45%), and primary care, n = 9 (4%). One hundred and eighty-four (84%) underwent CVH testing; hepatitis B core antibody or hepatitis C antibody positivity demonstrated exposure in 8.5%. Pre-intervention (n = 173, 79%) and post-intervention (n = 154, 70%) questionnaires were completed. ConclusionsThis study demonstrated the feasibility of recruiting first-generation migrants to view a community-based educational film promoting CVH testing in this higher risk group, confirming the value of developing interventions to facilitate the global World Health Organization plan for targeted case finding and elimination, and a future randomized controlled trial. We highlight the importance of culturally relevant interventions including faith and culturally sensitive settings, which appear to minimize logistical issues and effectively engage minority groups, allowing ease of access to individuals ‘at risk’.

Socioeconomic Factors Associated With Liver-Related Mortality From 1985 to 2015 in 36 Developed Countries

There is increasing disparity in liver-related mortality worldwide. Although there are many biologic and lifestyle risk factors for liver-related mortality, the effects of inequalities in social and economic determinants of health have received little attention. We investigated changes in liver-related mortality from 1985 through 2015 in 36 countries, using 4 international health and economic databases, and searched for socioeconomic factors that might influence these trends. We collected information on sex- and country-specific liver-related mortality from countries with designated high-usability data from the World Health Organization mortality database. We obtained data on alcohol consumption per capita, the percentage of adults with a body mass index greater than 30 kg/m2, health expenditure per capita, gross domestic product per capita, Gini index, national unemployment estimates, and diabetes prevalence from the World Health Organization global health observatory data repository, the World Bank database, and the International Diabetes Federation. We examined changes in mortality using Joinpoint regression analysis. Univariate analysis and a mixed-effects linear model were used to identify factors associated with liver-related mortality. From 1985 to 2015, the mean liver-related deaths per 100,000 persons increased in men from 23.8 to 26.1, and in women from 9.7 to 11.9. Increased liver-related mortality was associated with male sex, a high level of alcohol consumption, obesity, and indicators of national wealth and government health expenditure gross domestic product or government expenditure on health. In addition to established risk factors for liver mortality, this study identified addressable economic factors associated with liver-related mortality trends. Health care professionals and policy makers may wish to consider these factors to reduce liver-related mortality.

Development of a potent Zika virus vaccine using self-amplifying messenger RNA.

Zika virus (ZIKV) is the cause of a pandemic associated with microcephaly in newborns and Guillain-Barre syndrome in adults. Currently, there are no available treatments or vaccines for ZIKV, and the development of a safe and effective vaccine is a high priority for many global health organizations. We describe the development of ZIKV vaccine candidates using the self-amplifying messenger RNA (SAM) platform technology delivered by cationic nanoemulsion (CNE) that allows bedside mixing and is particularly useful for rapid responses to pandemic outbreaks. Two immunizations of either of the two lead SAM (CNE) vaccine candidates elicited potent neutralizing antibody responses to ZIKV in mice and nonhuman primates. Both SAM (CNE) vaccines protected these animals from ZIKV challenge, with one candidate providing complete protection against ZIKV infection in nonhuman primates. The data provide a preclinical proof of concept that a SAM (CNE) vaccine candidate can rapidly elicit protective immunity against ZIKV.

Strategic Preparation for Dental Care Delivery during COVID-19 Transition-An Update

As we all look forward to phasing towards the new normal, COVID-19 has certainly changed the way we would be practicing dentistry. As the global health organizations are working relentlessly laying down guidelines to control the transmission, the dental team should effectively integrate these guidelines to establish safe practices considering the scarcity of available armamentarium. As we cautiously move from treating emergencies to regular care, it would be important to modify and reorganize our existing offices to best contain and prevent cross contaminations of the novel corona virus. Incorporating teledentistry wherever possible, careful management of personal protective equipment, employing strategies for extended use, re use and decontamination of respirators, improvising disinfection protocols will enable us to effectively surmount the existing scarcities and provide quality care. Also it is important that each and every one of the dental team have clear guidelines on how to manage patients with different COVID experiences. These experiences may range from COVID screening to dealing with patients who have active infection or patients who have resolved COVID infection when presented for dental care, and if situations arise, the team should be prepared for self quarantine. It is crucial to be in collaboration with local and state health departments to better understand local disease transmission rates and follow guidelines until we receive evidence based data.