ANALISIS FAKTOR - FAKTOR TRANSMISI LOKAL COVID-19 DI PRAKTEK DOKTER GIGI

The city of Wuhan is the city where the COVID-19 virus has been detected for the first time . This virus originates from the subfamily Orthocoronavirinae and has four genera, namely: (β-COV) β-coronavirus, (α- cov) α-coronavirus , (δ-COV) δ-coronavirus, and (γ-COV) γcoronavirus (Li et al., 2020). Transmission in a dentist's practice is very likely due to inhalation of Aerosols or droplets containing viruses. To prevent transmission in the dentist's practice, actions such as a dental doctor using PPE level 3, hand sanitizers are placed in each room to wait, Patients who come are required to wear a mask and check body temperature. The aim of the literature study on COVID-19 ini to find out about the outbreak and prevention of COVID-19 at the Dentist's Office . The conclusion of the literature study is that the cause of COVID-19 is SARS-COV2 which shows that the RNA virus has a sample (sheath) and is also a species of the genus β-COV2. This virus has a diameter varies between 60-140 nm. The entry of the virus into the host body pitch hanging to the ability of ACE2 binds to the virus , wherein the receptor from the membrane extracellular expressed in epithelial cells. (β-COV) β-coronavirus, (α-cov )α-coronavirus ,(δ-COV) δ-coronavirus ,dan (γ-COV) γcoronavirus (Li et al., 2020). Penularan di Praktek Dokter Gigi sangat mungkin terjadi akibat terhirupnya Aerosol atau Droplet yang mengandung virus. Untuk mencegah terjadinya penularan di praktek dokter gigi dilakukan tindakan seperti dokter gigi menggunakan APD level 3, hand sanitizer diletakkan disetiap ruangan untuk tunggu, Pasien yang datang diwajibkan menggunakan maskernya serta mengecek suhu tubuh. Tujuan dari studi literatur mengenai COVID-19 ini untuk mengetahui penjangkitan serta pencegahan COVID-19 di Praktek Dokter Gigi. Kesimpulan studi literatur yaitu penyebab COVID-19 adalah SARS-COV2 yang menunjukkan virus RNA memiliki sample (selubung) dan juga merupakan spesies dari genus β-COV. virus ini memiliki diameter bervariasi antara 60-140 nm. Masuknya virus ke dalam tubuh inang tergantung kepada kemampuan ACE2 berikatan dengan virus, dimana reseptor dari membran ekstra selular diekspresikan di sel epitel.


INTRODUCTION Background
In 2019, in December, the world was shaken by a staggering number of serious infections of unknown cause. The World Health Organization (WHO) received a report at the end of 2019 from China that it was found in Hubei province, precisely in the city of Wuhan, China, there were 44 pneumonia sufferers. At first it was thought that there was a market that traded marine animals, river fish and various other animals. The identified and the genetic code was obtained on January 10, 2020 (Hendayani et al., All, 2020).
spreading very rapidly throughout the country. The COVID-19 outbreak was declared by WHO in 2020, in March (WHO, 2020) . The first COVID-19 pandemic in Indonesia was declared 2 Maret 2020. The number of confirmed cases was 64,958 and the number of deaths was

144
The COVID-19 virus has a huge impact on various medical industries, including dentists, because it is very easy to contract various diseases that can be transmitted and are exposed to saliva and blood (Laheij et al., 2020).
At 6 A pril 2020 based on data released

History of Covid and Its Spread
On December 1, 2019, P rovincial Hubei, China precision in wuhan city beginning COVID-19 was detected while Indonesia was detected beginning March 2, 2020 when two people confirmed infected with transmission by someone from Japan.
Using the 2019-nCOV genome isolated from infected patients in Wuhan, a study was carried out to determine the pathogen causing the outbreak in Wuhan. Corona virus is an RNA virus that has a particle size of 60-140 nm ( Meng et all., 2020) At the end of January , in 2020 this direct 2020) and Disaster Management Agency (BN P B ) appeal to all dentists to temporarily stop their services because they are very likely to be infected with COVID-19 , but for emergencies it is still handled. It is estimated that the dentist has not practiced the drug for 4 months for COVID-19.

Problem Formulation
How to analyze local transmission of COVID-19 in a dentist's office.

General Purpose
Knowing the cause of the local transmission of COVID-19 that occurs in the practice of dentists .

Special Purpose
When various cases prove pandemic d itularkan from person to person, doctors and medical personnel dealing with patients who were treated without a history of going to the market that has been closed, resulting pandemic threat increases (Handy et al., 2020).
The corona virus is a new epidemic that is spreading rapidly and no cure has been found, a lot of information cannot be obtained through social media, and not everyone can trust this information, and it creates a stigma for people related to COVID-19.
human-to-human transmission soared up to 2000 cases of contracting COVID-19 in one day. Corona virus was unveiled WHO became the name of the outbreak extends across the surface of the earth, on February 11th, 2020 (Handy et al l ., 1. This is to determine the analysis of local transmission factors for COVID-19 in a dentist's practice.
2. To prevent the occurrence of local transmission factors in dentist practice.
As a new disease that is spreading rapidly, there is no cure, and a lot of information cannot be obtained through social media, and not everyone can trust the information, which embarrasses those associated with COVID-19. Therefore , the review aims to provide the initial signs of COVID-19 are unclear, fever occurs , coughs heal spontaneously or become short of breath, and inflammation of the lungs that causes acute respiratory distress syndrome (ARDS), blood clotting disorders, decreased kidney function, decreased organ function (Chen et al. , all ., 2020).
Corona viruses are zoonotic in nature which can be transmitted from animals to humans but some evidence has been found that transmission between humans through droplets.
Various kinds of transmission of infection in the doctor's practice, such as saliva, hands, respiratory secretions, particles or dust used for burial , blood splashes, clothes and hair as well as dental tools and other equipment.

Social Impact of Covid
As a result, there has been an increase in reports of people who are positive for Covid-19, especially those from areas affected by the outbreak. The impact appears the following community stigma encourages people not to tell the disease, to avoid discrimination, prevents people from seeking treatment when they feel symptoms, prevents people from developing healthy behaviors and leads to more serious health problems, prolonged transmission and difficulty controlling the spread of the virus outbreak. this corona.
As far as COVID-19 is concerned, a growing number of reports are showing that people in areas affected by the epidemic are being stigmatized by the public. In Indonesia, the stigma arises because social behavior, namely: isolation of survivors / patients who had recovered from Covid-19 because it is believed to give the pen a snake 's disease, rejection and isolation of people who moved from one place to another, isolation Ras particular, for their assuming being a virus carrier, isolating medical personnel / health workers because they work in a hospital , this is believed to be able to spread the corona virus.

Effects of Local Covid Transmission in Dentist Practices
Dentists belonging to the category of professionals can be at risk of spreading the virus. The assessment is based on the possible spread of behavior known or suspected to contain the virus that causes COVID-19.
The outbreak has affected health workers, including oral and dental therapists or dentists and dental nurses . prone work with various infections due to frequent contact with saliva and blood (Laheij et al., 2012).
The virus that causes COVID-1 9, SARS-COV-2, could have spread to dental practice, due to inhalation of aerosols and droplets containing microbes and direct contact through mucous membranes, oral fluids , equipment and exposure to microbes (Chen et al. al l ., 2020).
During the COVID-19 pandemic, patient treatment and action is needed to prevent hospital infections. P asien to enter the clinic is limited to prevent transmission of the virus between patients (Lai et al., 2020).
The Indonesian Dental Association (PDGI) and the Association of Indonesian Dental and Dental Hospitals (ARSGMPI) have published manuals for dentists "New Normal" and "Guidelines for Practical Management of Dental and Oral Hospitals " as basic guidelines for dentists to perform dental care. .

Virus Checking Process
The checks carried out to detect the disease COVID-19, M etode RRT-PCR test swab (swab) throat, bronchoalveolar lavage is used, and a CT scan of the chest is a test Diagnovision sticks for viruses corona in order to get a picture of normal to abnormal y aitu: fluid buildup , inflammation pleurisy and pneumonia other features (Guan et al l ., 2020).

Precautions in Dentist's Practice
The California Dental Association (CDC ) recommends using grade 3 PPE , including an N95 mask , gown, sterile gloves , safety cap, and protective shoes. When they want to take steps that can cause aerosols (Peng et all., 2020) .
The first level is the use of surgical masks, headgear, white coats, face masks or goggles and latex gloves or nitrile completely disposable to provide standards for the protection of the clinic staff. The second level is used to provide protection for doctors like a gown. At the same time, the third level is for following up on patients with suspected or diagnosed COVID-19. PPE level 3 uses protective clothing ( hazmat ).

Characteristics of the SARS-COV-2 virus
Quoting from the dentist book "New Normal Era" published on July 2 020, the SARS-COV-2 virus describes a positive RNA virus that comes from the Ortho coronavirinae subfamily of the Coronavirus family (Similar to the results obtained by ZHU et al. . 2020). The orthocoronavirinae subfamily of Nidovirales has four consecutive genera, consisting of α-coronavirus (α-cov), βcoronavirus (β-COV), γ-coronavirus (γ-COV) and δ-coronavirus (δ-COV) (Li et al., 2020). Among the four genera, SARS-COV-2 is a type of β-COV-2. Microbials that can be isolated into mammals are shown in Figure 1: Quoted from the KEMENDAGRI-Prevent-Covid19 book as well as the dentist's handbook below normal, there is a new suitability regarding virus spawning or transmission as below.

Transmission or Transmission of Viruses
The World Health Organization (WHO), follows:

Figure 3.2 Virus Transmission Transmission
Transmission of virus transmission, Illustration of splash distance, droplets and aerosol particles (Froum and Strange, illustration modified in 2020).
A dentist guidebook in the new normal era, the results of research by Rahmi Amitha et al. (2020) is the same as the results of Ira Lia Sari's (2020) research on the SARS-COV-2 prevention literature, which shows that the method of laying the SARS-COV-2 virus includes:

Spalatter
The SARS-COV-2 virus can transmit while speaking, which secretes droplets of fluid from between humans. Splatters are ballistic in that they apply a certain amount of force from one location to another . P articles are very large of droplets in the air, can stay in the air for a short time, and can reach an area of less than 1 m (Harrel et al., 2004).

Droplet
The droplets can be referred to as melted droplets. The water droplets move a maximum of 1.5 m, the water droplets will gradually shrink and remain in the air. D nature reach someone (radius of 1-1.5 m) and s eseorang with symptoms MOHA-Covid19 guidebook which states that usually polymorphs with a diameter of 60-140 and COVID-19 belong to Flor eliptic. MERS-COV and SARS-COV are genetically very different. Current research shows that homology exists between the two, namely that the COVID-19 DNA characteristic of having the corona virus the Center for Disease Control and Prevention and the Ministry of Health has proven that respiratory infections can spread based on particle size, namely the spread of particles> 50μ (Harrel et al., 2004). The droplets are larger than 10μ and the aerosol particles are 0.3-10μ. The Center for Disease Control and Prevention (CDC), WHO also acknowledges that these three forms of transmission are the modes of transmission of the SARS-COV-2 virus (WHO, 2014). The distribution diagrams of splashes, droplets and aerosols are shown in Figure  2 as term comparable by bioa erosols or water particles small . Aerosols are formed by solid or liquid particles, which expand in the air and are able to stay alive (Wang et al ., 2020) Microbial y ang guess ndung in aerosol products capable of spreading throughout the coughing , sneezing, talking, breathing difficulties ( Olsen et pernafasa an bebicara, shape or sneeze, droplets of water will spread through the nose, mouth or eyes (may be exposed to SARS-CoV-2 Organ virus).

Aerosols have a
Clinical Characteristics a l l., 2003) .
Aerosol particles take maximum steps, witha transverse rangeof approximately 1m. In the aerosol particle ameter, it is usually 0.3-10μ, particles with a size of 1-10μ can stay in the air for 3 hours, this was done from various other studies (from and odd, 2020). As shown in Table 3.1, the SARS-COV virus can survive at room temperature and on the surface of the substance (KAMPF et al., 2020).

Patient Under Supervision (PDP)
A person with an acute respiratory aerosol droplets.

Epidemiological Characteristics
The Case Fatalitiy Rate (CVR) depends on the availability of medical services, the age and health problems of the population, and the number of diagnosed cases. Studies show that by January 2020, the mortality rate will be between 2% and 3%. The World Health Organization concludes that in Hubei Province alone, the case fatality rate is around 3% and 2% as of February 2020. WHO estimates that the average infection to death ratio (IVR, mortality rate of infected persons) is in the range of 0.8% -0.9%. namely:

PREVENTION IN DENTAL PRACTICE
a. A person who experiences cough, sore throat, runny nose, fever and respiratory problems . In the last 14 days before the onset of symptoms, no one found another cause based on a convincing clinical picture, but reported travel history from country or region b. People who are characterized by respiratory illness (cough, sore throat, and runny nose) have had direct contact with a confirmed COVID-19 case and have a history of exposure within the past 14 days and before the onset of symptoms. aerosol concentration in the room is relatively closed. Aerosols can be contracted if the person comes in direct contact with the patient. Transmission can occur to patients via infection, namely (≥38 ° C); fever: followed by respiratory symptoms such as: mild to severe pneumonia, runny nose, sore throat, shortness of breath and cough . The CDC report shows that the clinical manifestations of the disease are divided into three parts according to their severity,

Dental Procedures Produce Aerosols and Droplets
Dental Procedures that Produce Aerosols and Droplets greatly trigger transmission in dentistry, including :

Prevention of Medical Staff and Patients
Therefore, it is necessary to prevent medical personnel and patients from spreading the corona virus as follows: The medic takes off the outer gloves, gown and wears an alcohol-based hand rub to rinse the gloves . Doctors educate and treat patients. Caregiver nurses (executive clinic) disinfect dental tools, equipment.
a. When the patient arrives at the clinic, the patient wears a mask and asks him to clean his hands using an alcohol-based hand rub then take anamnesis of symptoms, history and signs of the epdemiology of COVID-19. The results are written on the CPPT. The conclusion is written on the CPPT. b. Patients are taken to the emergency room if they have signs, symptoms and also a history of the epidemiology of COVID-19 c. A complaint history is carried out if there are no signs, symptoms and epdemiological history of COVID-19 d. When an oral will dperiksa, the first patients are required to wear an apron, m elepas mask, then 0.5% -1% hydrogen peroxide is used to rinse in 1 minute duration. Povidone iodine can also be used (1%) to rinse your mouth for 15 minutes to 1 minute . e. Before taking action, please obtain patient consent f. Dental care that requires an aerosol effect is carried out in a special aerosol room . g. He did four handed in dental care. h. During operation, infection control must be carried out by the operator to avoid sharp objects that can cause injury and any sharp tools to be disposed of must be considered . i. The action is complete, ask the patient to rinse again then wear a mask and remove the apron he used earlier.
1. COVID-19 caused by SARS-COV2 SARS-COV2 is an RNA virus with a sample (sheath) and is also the β-COV2 type. 2. The size of the virus particles varies between 60-140 nm in diameter. 3. The ability of the virus to enter the host depends on the ability of the virus to bind to ACE2, and the outer membrane receptors expressed on ACE2 epithelial cells. 4. In the dentist's office, the spread COVID-19 occurs by inhaling aerosols or droplets that contain the virus and contact it directly to the fluid in the mouth, mucous membranes, as well as the equipment affected by the virus .