DISCUSSION

The present public health crisis due to COVID-19 has triggered intense fear, anxiety, and stress challenging the psychological well-being among various groups. ^{Reference Grover, Dua and Sahoo9} With lack of sufficient literature determining fear of coronavirus among dentists, and to provide an insight into fear and anxiety toward COVID-19, the present study was undertaken. Due to lack of a standardized questionnaire, one by Ahmed et al., which was simple, comprehensive, practical, objective, and with a good validity (0.74), was used in the present study. ^{Reference Ahmed, Jouhar and Ahmed10} Although an attempt was made to include all the age strata, our study did not have any respondents older than 60, which could be due to the methodology of data collection (the phone-based application WhatsApp).

Dentists account for one of the groups of health-care workers most susceptible to this disease, as established by the evidence of transmission of virus through fomites, aerosols, and droplets. ^{Reference Peng, Xu and Li11-Reference Gamio13} The viral load of SARS-CoV2 in human saliva, which was proven to be very high along with transmission even by asymptomatic carriers, places dentists into high-risk group. ^{Reference Peng, Xu and Li11,Reference Meng, Hua and Bian12} The psychological well-being of dentists may be affected and may manifest as fear of getting infected from co-workers or patients with elevated levels of anxiety when providing treatment. The same is supported by the findings of our study, wherein 80% of dentists reported positively to Q1 and 2. Likewise, in a global study that assessed anxiety and fear of dentists across 30 countries, around 90% of the respondents reported fear of getting infected from patients or co-workers. ^{Reference Ahmed, Jouhar and Ahmed10}

The present survey was conducted from May 9, 2020, to May 11, 2020, where the number of COVID-19 positive cases were steadily increasing both at national and state level. ^14,15 This has also affected dental practices, with 60% of our surveyed population favoring closure of practices until the number of cases start declining, indirectly signifying fear and anxiety among them.

One of the easiest and most recommended methods for reducing the transmission of the virus is practicing physical distancing. However, dental practice involves close contact with patients during routine treatments. Hence, 60% of the respondents felt nervous while talking to patients in close vicinity.

Around 90% of our study population feared carrying infection back home. The ability of the virus to thrive on inanimate surfaces for hours to days with a long incubation period makes it easy for transmission and cross-infection. ^{Reference van Doremalen, Bushmaker and Morris16} This could significantly contribute to infection being carried back home and a major cause of fear among dentists as reported in a similar study, wherein 92% of dentists surveyed across 30 countries reported fear of carrying infection back home. ^{Reference Ahmed, Jouhar and Ahmed10}

The Ministry of Health, Medical, & Family Welfare, Government of Telangana established quarantine and isolation facilities for management of suspected and infected patients. Confusion, fear, and anxiety due to isolation and quarantine has been reported in the literature. ^{Reference Brooks, Webster and Smith6} The apprehension of getting quarantined thus affects the entire family, which has been noted in the present study with more than 50% of the respondents reporting the fear of quarantine (Q6).

Although in India, the burden of COVID-19 treatment is borne by the Government, the anticipated burden of postrecovery complications could be a factor in influencing the high level of fear of respondents to Q7 in the present study. A pronounced fear of cost of treatment when infected was noted in BDS than MDS respondents (P = 0.035), as it could negatively affect their prime source of income.

Greater mortality rates associated with COVID-19 is 1 of the most significant factors for fear among different sections of the population, with females susceptible to greater levels of stress and anxiety. ^{Reference Lim17-Reference Doshi, Karunakar and Sukhabogi19} In our study, females had greater fear of dying due to COVID-19 compared to male counterparts (P = 0.045), which could be attributed to the traditional family system still followed in India, with females as the primary care providers for households, increasing their responsibility and, thus, fear of the entire family being susceptible to consequences of COVID-19 infection. Approximately 84% of the study population had a positive attitude regarding development of a COVID-19 vaccine that could also play a vital role in controlling the pandemic.

Irrespective of the age, gender, qualification, type of practice, and years in practice, the levels of fear reported in the present study was high, similar to several studies reported in the literature. ^{Reference Ahmed, Jouhar and Ahmed10,Reference Lim17,Reference Sakib, Bhuiyan and Hossain20,Reference Soraci, Ferrari and Abbiati21} Overall, based on the mean fear score (6.57 ± 2.07), our study population presented a high level of fear. The augmented fear could be attributed to the probability of direct and close interaction when treating COVID-19 positive patients and a knowledge of the disease and mortality associated with the contagion. Respondents between 41 and 60 y of age exhibited high fear scores, with a mean of 6.70 ± 2.01, which depicts the fear of productive, potent, thriving practitioners, who are primarily involved in providing the necessities of life to their families. Dentists with individual practices recorded a high mean fear score (6.70 ± 2.06), which could be an effect of following the stringent guidelines and protocols issued by regulatory bodies. ^22-25 Nevertheless, those with practices affiliated with hospitals may have better support systems and facilities.

The present study, being an online survey done in a very short period of time, could not establish a cause-and-effect relationship. It being a self-reported one, the probability of social desirability bias cannot be eliminated. The results of the present study have to be carefully interpreted and cannot be generalized, as they pertain to the state of Telangana only.