A Message for CDA Corporate Member Provincial Dental Associations

Below is a snapshot of the Canadian Dental Association’s (CDA) pandemic work for the week ending April 24, 2020.

Advocacy Updates

New! Federal funding information on CDA website now more specific to dental practice models:CDA has partnered with MNP and the Canadian Medical Association to share and personalize federal funding program information that is more specific to certain business models. Corporate Member provincial dental associations (PDAs) are encouraged to promote the following new federal funding pages on the CDA website to dentists, including:

• For Dental Professional Corporations or Self-Employed Dentists
• For Cost Sharing Arrangements (Unincorporated Association)
• For Partnerships

Highlights:

• Canada Emergency Response Benefit (CERB): The eligibility criteria for CERB allow individuals to earn up to $1,000 per month while receiving the benefit. To apply, a portal will be available on April 27, 2020, with funds being dispersed the week of May 4, 2020.
• Canada Emergency Business Account (CEBA): The payroll aspects of eligibility requirements have been adjusted on both the low and high ends. It shifted the range to a $20,000 minimum and a $1,500,000 maximum in wages (from the previous $50,000 to $1,000,000 payroll range).
• Canada Emergency Wage Subsidy (CEWS) opens on Monday, April 27, 2020. CEWS is a three-month measure that will cover a significant portion of salaries for qualified businesses. The Government will pay 75% of the first $58,700 that an employee earns, which equates to a subsidy of $847 per week per employee. The subsidy is retroactive to March 15, 2020, and available through June 20, 2020. Funds will begin to be dispersed in the week of May 4, 2020. Note that dental office employees do not have to be actively working to be eligible for the wage subsidy. Hygienists, assistants and front office staff working outside the clinic can be proactive, maintain relationships with clients, and help to ensure a successful transition to re-opening the office. View this document for further details, including a list of possible tasks to help to ensure a successful transition to re-opening the dental office.

Updated! Emergency Commercial Rent Assistance (CECRA): Last week, the Prime Minister announced the intent to launch CECRA for small businesses which aims to lower rent for small businesses that have been affected by COVID-19. Some preliminary details about the program include the following, and the Federal Economic Response Plan section of the CDA website will be updated with this information, as soon as feasible.

• CECRA will provide forgivable loans to qualifying commercial property owners to cover 50% of three monthly rent payments that are payable by eligible small business tenants who are experiencing financial hardship during April, May and June.
• The loans will be forgiven if the mortgaged property owner agrees to reduce the eligible small business tenants’ rent by at least 75% for the three corresponding months under a rent forgiveness agreement, which will include a term not to evict the tenant while the agreement is in place. The small business tenant would cover the remainder, up to 25% of the rent.
• Impacted small business tenants are businesses paying less than $50,000 per month in rent and who have temporarily ceased operations or have experienced at least a 70% drop in pre-COVID-19 revenues. This support will also be available to non-profit and charitable organizations.

The Canada Mortgage and Housing Corporation will administer and deliver the CECRA, a collaboration between the federal government and provincial and territorial governments, which are responsible for property owner-tenant relationships.

It is expected that CECRA will be operational by mid-May, with commercial property owners lowering the rents of their small business tenant’s payable for the months of April and May, retroactively, and for June.

Other Important Updates

New! Establishment of CDA Task Force and Working Group:

CDA is working on what going back to practising dentistry would look like in Canada. A national Return to Practice Task Force (“Task Force”) has been established, which has representation from each of CDA’s Corporate Member PDAs. The CDA Task Force is responsible for assessing how the COVID-19 situation is evolving across Canada, and will examine and recommend options for dentists and their teams to return to work safely and productively. The Task Force will be co-chaired by Dr. Jim Armstrong and Dr. Aaron Burry.

Furthermore, information is actively being gathered and CDA is in communication with many other national dental associations to learn about their approaches. CDA is monitoring the situation closely, and any pertinent information from internationally-based associations will become part of the Task Force’s ongoing work.

Infection Control Working Group: This Working Group will be responsible for collecting and assessing information on infection protection and control to support returning to practice. The Working Group will present reports to the CDA Return to Practice Task Force, and will be chaired by Dr. Aaron Burry. Other members include Dr. Jim Armstrong, Dr. Richard Holden and Col Jean-Pierre Picard, along with Dr. Benoit Soucy as the lead CDA staff resource, with support from Costa Papadopoulos, CDA Manager, Health Policy and Information.

Terms of Reference for each for these two groups have been adopted and a meeting schedule has been established. CDA will report any important outcomes resulting from these groups.

Point of Care Tests (Rapid Testing):

More information is becoming available to better understand the potential for COVID-19 on-site testing. There are primarily two types of tests, each with its own strengths and limitations, including:

1. tests that attempt to detect the presence of the virus; and
2. tests that attempt to detect the body’s immune reaction to the virus.

The tests that are attempting to detect the presence of the virus are a greater predictor of the infectivity of the patient. However, these tests are sensitive to the technique used for collection since the virus is not evenly distributed through the body, which could potentially lead to false negatives.

The tests that attempt to detect the body’s reaction to the virus is able to confirm whether an individual has had COVID-19 and if immunity has been developed, but it will not confirm if the person is still infectious.

As the tests move from the lab-tested environment to real-world environments, inherent problems exist in terms of the tests not being 100% accurate. The FDA typically does not approve products unless they predict 100%, all of the time, negative. However, there are tests that have a certain degree of error for false positives, which are often upwards of 5%. For dentistry, tests with this degree of false positive rates would have tremendous implications if, for example, 5/100 times patients are being told that they are COVID-19 positive, when in fact they are not. CDA continues to watch testing for COVID-19 closely and will report any updates as they become available.

Learn more about tests and testing for COVID-19 by watching the University of Buffalo, School of Dental Medicine’s video, featuring Michael Glick’s, former editor of the Journal of the American Dental Association. This video has also been added to CDA’s COVID-19 Repository for future reference.

Teledentistry:

CDA continues to work to facilitate using code 05200 for teledentistry, and is assisting provinces to implement the code across Canada.

With regards to adjudicating claims, insurance companies have begun adding 05200 to plans, or are mapping it to codes that are already covered. CDA is receiving an increase in anecdotal reports across Canada confirming that claims are being reimbursed.

Earlier this week, the BC First Nations Health Authority has started to cover code 05200. CDA is also in contact with the Non-Insured Health Benefits (NIHB) program to cover this code for eligible First Nations and Inuit clients across Canada.

Personal Protective Equipment (PPE):

• PPE Procurement: CDA remains in contact with the Chief Public Health Officer of Canada with regards to the availability of PPE. Work by the Federal Government of Canada continues to procure more PPE. The availability of PPE will be made easier through a website that is under development, managed by the Government of Canada. The website will identify the types of available PPE, the location and the quantity. Federal supplies are being delivered directly to the provinces for distribution.
  
  Tip: Individuals/organizations seeking to obtain PPE should contact their provincial Chief Medical Officer for information, highlighting more specifically why/where there is a need for PPE to help strengthen the case to get access to stockpile supplies.
  
  
• Mask sterilization and reuse: Health Canada has approved technology for reconditioning N-95 masks. The technology requires an industrialized sterilizer and is being made available to hospitals. This technology will help alleviate some pressure on the PPE supply, thereby allowing other sectors to have a better chance at accessing available PPE.
  
  
• Guidance for IPAC Procedures: The Public Health Agency of Canada (PHAC) is working on guidance for infection prevention and control (IPAC) procedures for acute care, intensive care community-based care and home care. CDA is monitoring this closely for any applicability to dentistry, and will share updates with Corporate Member PDAs as soon as new information becomes available.
  
  
• Strategies to recuperate costs for PPE through insurance: If a Corporate Member PDA has a desire to increase fees to help cover the costs for PPE, one option is to look at increasing fee guides. This process will likely involve insurance companies examining their reimbursement schedule and communicating to plan sponsors to determine whether their contributions could be increased. The alternative strategy is to initiate discussions with provincial governments about the potential of covering some costs.

CDA Help Desk:

CDA’s Help Desk is available to assist dentists and dental office employees on how to navigate and access federal government support programs.

On average, the Help Desk receives about 10 calls per day. Calls are answered within two minutes, and last approximately five minutes in length. Ontario-based dentists continue to be redirected to ODA for information and services.

Help on navigating the federal funding programs is only a quick call away. Corporate Member PDAs are encouraged to promote CDA’s Help Desk service to dentists: 1-866-232-0385, M-F, 7:30 A.M. – 8:00 p.m. EDT.

Knowledge and Information Broker:

CDA Oasis is CDA’s primary channel of communication for delivering urgent information to the dental community during the COVID-19 pandemic.

CDA Oasis produces a series of video interviews with members of the CDA Board, CDA’s COVID-19 Team, and other relevant guests. The following five videos were published this week:

• The Impact of Covid-19 on Dental Departments in Toronto-Area Hospitals: Dr. Michael Glogauer talks about the impact of COVID-19 on hospital dental departments. Dr. Glogauer walks through his experience in managing patients during the pandemic crisis and explains that for some patients, elective procedures are still essential. (April 24)
• Triaging Pediatric Dental Emergencies During COVID-19: Dr. Reza Nouri presents his thoughts on triaging pediatric dental emergencies during Covid-19. He offers practical advice on how to manage your practice at this time, and walks us through a number of case studies to help us better understand what requires emergency attention and what does not. (April 23)
• The Impact of Covid-19 on Dental Practice Sales: Dr. Bernie Dolansky talks about the dental practice resale market and reassures dentists that, although deals are not currently closing, buyers are still active in the market and there is every reason to believe that values will withstand the COVID-19 crisis, just as they have withstood other crises in the past. (April 23)
• COVID-19: A Message of Hope from Dr. Gerhard Seeberger, President FDI: Dr. Gerhard Seeberger talks about the COVID-19 response effort across Italy and the impact it has had on the dental profession. (April 17)
• Dealing with COVID-19 in the Dental Department of the Montreal Jewish Hospital: In this thorough and insightful interview, Dr. Mel Schwartz takes us from triage to treatment and beyond, outlining how all dentists in the community must be part of the effort to provide an emergency service in what is an extraordinarily difficult time. (April 16)

CDA Oasis also hosted a webinar for the New Brunswick Dental Society about preparedness to return to practice.

This week’s CDA Oasis Bulletin collated relevant and timely “news that you can use” related to COVID-19.

CDA Essentials magazine is continuing its content creation and production process. Issue 2 of the magazine is available to read online. Issue 3 of the magazine is scheduled to be completed in May 2020.

Mental Health and Wellness:

Maintaining good mental health and wellness continues to be a priority. CDA is actively promoting available mental health and wellness support through CDSPI’s Members’ Assistance Program (MAP) via social media, its Help Desk service, and on its website. MAP can be accessed by calling 1.844.578.4040 or visiting www.workhealthlife.com. CDA is monitoring the volume of inquires about CDSPI’s MAP program and will report any significant uptake in the program to Corporate Member PDAs.

Additionally, one new wellness post has been featured in the Mental Health Corner of CDA Oasis:

• Your Emotional Wellbeing – Routines & Techniques
  Dr. Janet Leith talks about her experience with burnout and how, having tried many solutions in the past, she has finally found a better place by focusing on her own personal development.(April 17)

A growing list of other available mental health and wellness resources is available in CDA’s COVID-19 Repository. PDAs are encouraged to access the information and share resources, as deemed appropriate.

Reminder: Phishing Warning

There are a range of COVID-19-related phishing scams going out to dental offices. These scams tempt users:

• to buy face masks and other personal protective equipment;
• with phony medical cures; and/or
• to give up personal bank or government login credentials to access federal funds as part of Canada's COVID-19 Federal Economic Response Plan.

Please be vigilant when opening or responding to emails. Make sure you only open emails from known sources. It’s smart to avoid advertisements seeking to take advantage of the impacts of the COVID-19 pandemic.

Here are some tips to help spot phishing email:

1. Beware of online requests for personal information: A coronavirus-themed email that seeks personal information, such as your Social Insurance Number or login information, is a phishing scam. Legitimate government agencies will never for this information. Do not respond to the email with your personal data.
2. Check all links: You can inspect a link by hovering your mouse over the URL to see where it leads. Sometimes, it’s obvious that the web address is not legitimate. Keep in mind that phishers can create links that closely resemble legitimate addresses. Delete the email.
3. Watch for spelling and grammatical mistakes: If an email includes spelling, punctuation and grammar errors, it’s likely a sign that you’ve received a phishing email. Delete the email.
4. Look for generic greetings: Phishing emails are unlikely to use your name. Greetings like “Dear sir or madam” signal that an email is not legitimate. Delete the email.
5. Avoid emails that insist you act now: Phishing emails often try to create a sense of urgency or demand immediate action. The goal is to get you to click on a link and provide personal information immediately. Delete the email.

CDA COVID-19 Repository at a Glance:

New resources added!

CDA serves as a COVID-19 Repository for Corporate Member PDAs by collecting advice and available COVID-19 resources from external organizations and any sources that PDAs wish to share. The information is placed in the Repository and is exclusively available for use by the PDAs, for onward transmission to their respective dentist members, as deemed appropriate.

For quick reference, the following materials have been added to the Repository this week. For the complete resource listing, please log in to view them all. Login details on how to access the Repository are below.

Dental Schools, Research, Journal Articles and Continuing Education:

• John Hopkins Bloomberg School of Public Health: A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US (Center for Health Security)
• Research Canada: News Release: Research Canada welcomes $1.1 billion investment for national medical and research strategy to address COVID-19
• University of Buffalo: School of Dental Medicine - Michael Glick’s 23-minute video on Tests and Testing for COVID-19
• World Health Organization Collaborating Centre (WHOCC) for the Research and Training in Preventive Dentistry: COVID-19 and dental practice: What has been done in China? WHOCC CHN26 has collected anti-COVID-19 experience and knowledge in dental settings in China and to share with global colleagues in this critical time, hope to provide technical advices on the disease prevention and control in dental settings. (April 11)

Federal Government Resources:

• Office of the Prime Minister: News Release - Prime Minister announces new support for COVID-19 medical research and vaccine development (April 23)

Financial and Tax Resources:

• Milliman: The whitepaper, COVID-19 - Impact to dental utilization, explores potential effects of the COVID-19 pandemic on the dental industry, considering changes in utilization of dental services that could result from the pandemic and its containment efforts as well as the economic ramifications that are already starting to occur and may last for some time.

Mental Health and Wellness Resources:

• Canadian Dental Association:
• Your Emotional Wellbeing – Routines & Techniques
  Dr. Janet Leith talks about her experience with burnout and how, having tried many solutions in the past, she has finally found a better place by focusing on her own personal development. (April 17)
• Your wellbeing – Tips for Working Remotely. In his video presentation Tips on Working Remotely, Ralph Schirg, an organizational psychologist from Minneapolis, discusses the challenges of working from home. (Morneau Shepell’s resource available through the CDSPI MAP program) (April 16)
• Taking Care of You During the Pandemic! A look at the emotional challenges of living in a time of pandemic, and what can one do to cope better with this new reality. (This is an adapted text from the Morneau Shepell’s resource available through the CDSPI MAP program) (April 14)
• Morneau Shepell
• Introduction to working remotely (Webinar) in response to COVID-19 work from home protocols.
• Boosting team morale when remote working during COVID-19
• Tips: Managing Family Dynamics during COVID-19
• Tips: Maintaining your mental well-being if you are a health care worker during the COVID-19 pandemic

National and International Dental Association Resources:

• American Dental Association:
• Interim Mask and Face Shield Guidelines (April 18)
• Understanding Mask Types (April 17)
• Canadian Dental Association:
• CDA details about Canada Emergency Wage Subsidy, including and a list of possible tasks to help to ensure a successful transition to re-opening the dental office. (Word doc.)
• Webinar notes (Word doc.): Facts Not Fear - Discover what people are really thinking about the dental industry once the world awakens. A CDA staff member took notes during a presentation from a marketing firm (www.bigbuzzinc.com) and the Pacific Coast Society of Orthodontics. (April 21)
• CDA Oasis Discussions
• The Impact of Covid-19 on Dental Departments in Toronto-Area Hospitals: Dr. Michael Glogauer talks about the impact of COVID-19 on hospital dental departments. Dr. Glogauer walks through his experience in managing patients during the pandemic crisis and explains that for some patients, elective procedures are still essential. (April 24)
• Triaging Pediatric Dental Emergencies During COVID-19: Dr. Reza Nouri presents his thoughts on triaging pediatric dental emergencies during Covid-19. He offers practical advice on how to manage your practice at this time, and walks us through a number of case studies to help us better understand what requires emergency attention and what does not. (April 23)
• The Impact of Covid-19 on Dental Practice Sales: Dr. Bernie Dolansky talks about the dental practice resale market and reassures dentists that, although deals are not currently closing, buyers are still active in the market and there is every reason to believe that values will withstand the COVID-19 crisis, just as they have withstood other crises in the past. (April 23)
• Answering Your Questions about The TripleGuardTM Insurance Pandemic Coverage: In this video, Ed Dermit, President of CDSPI, speaks with Dr. John O'Keefe about the ongoing insurance coverage situation, and provides clarity on who is currently covered and what to expect when making a claim. (April 17)
• COVID-19: A Message of Hope from Dr. Gerhard Seeberger, President FDI: Dr. Gerhard Seeberger talks about the COVID-19 response effort across Italy and the impact it has had on the dental profession. (April 17)
• Dealing with COVID-19 in the Dental Department of the Montreal Jewish Hospital: In this thorough and insightful interview, Dr. Mel Schwartz takes us from triage to treatment and beyond, outlining how all dentists in the community must be part of the effort to provide an emergency service in what is an extraordinarily difficult time. (April 16)
• COVID-19: How Important is Point-of-Care Testing?: This video features CDA's Dr. Burry who explains why there is such an interest in point-of-care testing and how it differs from laboratory testing. He also talks about the costs and what the Canadian provinces are currently doing about the provision of point-of-care testing. (April 15)
• Dental Care During and After the Pandemic: Dr. Burry discusses how the dental practice has changed during the pandemic. He talks about how COVID-19 protocols are affecting his daily practice, and the challenges of dealing with a more de-personalized experience for the patient. (April 15)

Provincial Dental Association/Regulatory Body Resources:

• RCDSO: Guidance on emergency and urgent care during COVID-19 (updated April 24)

Access to COVID-19 Repository: PDA Executive Directors and CDA Board Members have access to the CDA COVID-19 Repository via the CDA Board Resource Website.

New! This week, based on requests, CDA has now expanded access to include the Corporate Member Presidents, as well as anyone else in a Corporate Member PDA who could benefit from the Repository resources.

The link to access the CDA COVID-19 Repository: https://boardresources.ca/covid/.

Log-in: PDA Executive Directors, CDA Board Members and Corporate Member Presidents can use their existing CDA Board Resources login credentials to access the COVID-19 Repository.

New! If you have trouble logging in, or require a login for someone in your organization who would like access, please email Dean Smith, CDA Manager of Information Technology, dsmith@cda-adc.ca.

Share: To include your organization’s resources in the COVID-19 Repository, please email Zelda Burt, CDA Communications Manager, zburt@cda-adc.ca.

The CDA COVID-19 Response Team works diligently on a range of fronts to help minimize and mitigate the impacts of COVID-19 on the dental profession. CDA is working to address scientific, clinical, economic and business-related matters impacting dentistry, including efforts to increase awareness about the mental health and wellness of dentists, their families and dental office employees during these challenging times. CDA will communicate regular updates as new information becomes available.