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COVID-19 Update Best Practices

Dr. Barry Howell, Chair of the ISDS COVID Task force, shares his most recent COVID-19 Update to assist members with best practices.

COVID UPDATE –

1) ADA poll shows that 97% of consumers are ready to go back or have gone back to the dental offices. The Last ISDS poll from June 3 showed that 93% of dentists were vaccinated while the CDC reports that 59.3% of the population 12 y/o and older are fully vaccinated.

2) According to the IDPH – Illinois remains in Phase 5.  The CDC Guidance for Dental Settings and the Illinois Dept. of Public Health and the IDPH Revised Interim Guidance: Provision for Routine Oral and Dental Care documents remain essentially unchanged since September 2020.  All individuals including those fully vaccinated, must wear a mask in (health care) dental settings.  They still continue to recommend the screening of patients and staff for COVID symptoms, regardless of vaccination status.  Taking a daily temperature of both patients and staff, questioning any breathing issues, sore throat, muscle aches, vomiting, diarrhea, loss of taste or smell should all be part of the pre-appointment questions.

3) Research shows that the rate of COVID-19 in a population seeking oral healthcare reflects the community positivity rate.  Asymptomatic or presymptomatic patients pose a risk to providers, staff and other patients.

4) When patients are present, keep masks on at all times for everyone in the office, staff and patients, regardless of vaccination status.

5) When patients are present, social distancing should still be observed.  Only have as many patients in the reception area that will accommodate a minimum of 6’ of separation.

6) When it comes to handshaking – the ADA and CDC suggest using your best judgement.

7) In regards to staff in the office:

a) OSHA requires a Hazard Assessments in the Dental Practice.  Practices must have a safety plan for a possible exposure to COVID-19.  The ADA’s return to work guidance toolkit has been updated to include a hazard assessment and can be downloaded from the ADA website.

b) Continue temperature and health screening daily, regardless of vaccination status of staff and patients

c) Any unvaccinated staff must observe all precautions – mask, social distance, etc. at all times.  Even when there are no patients present.

d) Fully vaccinated staff can dine together in the break room or be closer than 6’ without masks

e) In-person staff meetings in the office of fully vaccinated employees can also be conducted without masks as long as there are no others present

f) Keep up the high level of PPE – treat every patient as if they could be a carrier

g) While OSHA has held that facilities such as hospitals and nursing homes have been required to install substantial infection controls such as rerouting ventilation systems and other capital improvements, dental practices are still exempt due to the exceptionally low infection rate in dental offices.  However, many offices installed HEPA air filtration units in their operatorys last year.  If you did, it’s time to change your filters. 

8) There are still surges in COVID cases.  It’s important that you know your local rate of risk:  the IDPH website updates their demographics of COVID cases for each county, also the local level of population in the county that’s been vaccinated.  You can also get reports of positive cases in your community.  The higher the number of positive COVID cases in your community, the higher the chance your patient might have COVID.

 

New CDC Recommendations continue with the same language as in previous updates with a few exceptions:

  1. The update for dental offices removes the language to avoid aerosol-generating procedures for all patients regardless of COVID status.

The new language states to avoid aerosol procedures only in patients suspected or confirmed as COVID possible.  If you have to use aerosol producing equipment for suspected COVID positive patients, there are specific recommendations on how to do it.  All other patients can safely be treated with aerosol producing equipment.

Breakthrough Infections and the Delta Coronavirus Variant

  1. No vaccine is 100% effective:

    Dr. Salk’s polio vaccine was 80-90% in disease prevention.  The measles vaccine give today is 94% effective.  The Pfizer and Moderna COVID vaccinations are 95% effective.

  2. The virus keeps mutating. The CDC validates that 83% of all new infections are the Delta Variant.  It’s considered more contagious than the common cold, than small pox, Ebola, SARS or MERS.  Breakthrough infections occur in people who have been vaccinated, but are less likely to cause hospitalization to those exposed than those who have not been vaccinated.

  3. According to the CDC, through July, there were just over 6000 breakthrough infections in the US out of more than 163 million fully vaccinated individuals.  That’s less than .004% breakthrough and less than .001% mortality.  Another way of looking at it is that 99.99% of vaccinated individuals are protected from a breakthrough event.        

Long COVID as a Disability

  1. Long COVID describes people who contract COVID and present with a range of new or ongoing symptoms that can last for weeks or months after infection with the virus has cleared their body.  These symptoms can continue or worsen with physical or mental activity.
  2. The Dept. of Health and Human Services has determined that Long COVID can be a disability under the American Disabilities Act.
  3. Those employees who are diagnosed with Long COVID will be entitled to “reasonable modifications” in the employment status which could include modifications in their job description, hours of work or any physical activity required.

COVID, OSHA and the Dental Office

A hazard assessment is required under OSHA and dental practices must have a written safety plan in place for COVID related exposure control.

The ADA has created a document to address COVID and the OSHA requirement in the Return to Work Interim Guidance Toolkit, that can be downloaded from the ADA website.

The ADA has also recently revised the Update to Office Procedures During COVID-19 to keep with the current recommendations – but nothing has substantially changed.

 

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