Discussion | Noma disease occurs in the setting of chronic malnutrition and poverty. Delay in care serves as an alternative metric to evaluate noma disease burden when few other data exist. Delay in care reflects disease incidence, prevalence, and the ability of existing surgical care systems to offer treatment; however, this metric is unable to substratify these data.In northern Nigeria, which lies within the noma belt, we identified a delay of 14.5 years between the onset of acute noma disease and surgical treatment in a recent cohort of patients with noma. This prolonged delay is consistent with the known burden of disease. Further methods of evaluating the noma disease burden should be explored to better understand and eventually treat the disease.

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The global pandemic resulting from the coronavirus disease of 2019 (COVID-19) outbreak has caused significant limitations in the public's access to routine dental and medical care. The availability of appointments at private medical and dental practices, especially on the East Coast, have been severely curtailed as practices have shut their doors and laid off workers in response to stay-at-home orders and reduced clinical volume. 1 Even larger academic practices have been forced to close for all but the most severe emergencies. 2,3 Despite this, routine dental issues have continued to occur. Data from Google Trends have shown that although United States searches for ' 'dentist appointment' ' are at a 1year low, searches for ' 'dental emergency'' are at a 1year high (Fig 1A). This has also coincided with a massive spike in interest for the terms ' 'COVID-19' ' and ' 'stay at home,' ' and the growing awareness of COVID-19 in the United States (Fig 1B). However, routine dental conditions can rapidly evolve into emergencies if not promptly treated, and these data suggest that although patients have been decreasingly searching for dental appointments, they have been increasingly

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