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 July 3, 2020.

This Week’s Fast Facts: COVID-19 Situational Report

Worldwide: Currently, there are more than 11 million cases worldwide. This represents a 28% increase from recent averages, or an increase of nearly 15% per week.

USA: In the United States (U.S.), the number of cases increased by 26%, and will reach nearly 3 million cases over the coming days. There is a very concerning surge in positive tests (over 50K daily and rising), meaning case growth again exceeded 13% while most western countries have had minimal new case growth. A current trend sees more young people being infected compared to earlier times of the U.S. epidemic, which affected older Americans. This means a lower death rate and hospital admissions in the short term, but greater community spread and increased trend of complications, hospitalizations and deaths that are anticipated to increase continuously in the coming weeks. The death rate for all infections in the U.S. represents 5.4% of cases, which is down slightly to 4.8% based on new infections.

Individual States: Some states continue to report record number of single-day cases. Spikes are associated with decreased compliance with public health social distancing recommendations, and more infections following group gatherings. A few examples include:

• In South Carolina, 17.5% of all individuals who have died to date in the U.S. from COVID-19 occurred in the past two weeks. The caseload has reached an average of 192% of new cases per day.
• In Arizona, 38.1% of all individuals who have died to date in the U.S. from COVID-19 occurred in the past two weeks. This state’s caseload has reached an average of 244.7% of new cases per day.
• In Florida, 15 of all individuals who have died to date in the U.S. from COVID-19 occurred in the past two weeks, and the state is reaching an average of 376% of new cases per day.
• Nevada has seen 14.7 of all individuals who have died to date in the U.S. from COVID-19 occurred in the past two weeks, and has an average of 255.7% of new cases per day.
• Utah has seen 32.5% of all individuals who have died to date in the U.S. from COVID-19 occurred in the past two weeks, and has an average of 162% of new cases per day.

Canada: Canada saw approximately 4,000 new cases added compared to 13,000 in the previous two weeks. This is an approximate 2% of case growth per week, which is positive news and more manageable compared to the U.S. The death rate of all infections remains 8.2%, with new deaths representing far less than 1% of total cases per week which is largely attributed to outbreaks in health care settings, long-term care facilities, food processing plants, etc. with Alberta, British Columbia, Manitoba, Saskatchewan, Ontario and Quebec still experiencing limited new cases and/or outbreaks. Many provinces saw new deaths this week, with Quebec representing 64% of all COVID-related deaths and Ontario 31%.

Individual Provinces:

• Alberta: 8.2% of new case growth over the past two weeks
• British Columbia: 5.8% of new case growth over the past two weeks
• Manitoba: 10% of new case growth over the past two weeks
• Ontario: Testing in Ontario was initially returning positive infection rates of 2-3%. Now testing over 30,000 people per day, Ontario is returning a rate of less than 1%, which represents a decline of 0.5%. Ontario has seen an average of 3.3 % of new case growth over the past two weeks.
• Quebec: 1.8% of new case growth over the past two weeks.
• Saskatchewan: 14% of new case growth over the past two weeks

Government of Canada: The Government of Canada continues to prepare for a second wave this Fall, and is stockpiling personal protective equipment (PPE). The Public Health Agency of Canada’s (PHAC) response to the pandemic has moved from a crisis response to one of long-term management. PHAC is concerned about the trends in the U.S. and has been sending warnings and reminders for individual to remain vigilant to help protect themselves against contracting COVID-19.

Reminder! Dental Profession to Remain Vigilant
CDA reminds the dental profession that there needs to be continued vigilance regarding the screening and pre-screening of patients.

In general, outbreaks and case transmission to date among health care personnel are associated with common areas, such as lunchrooms or washrooms. This remains a significant concern. Individuals are reminded of the following:

• Do not let your guard down.
• Continue to take all necessary precautions, including disinfecting common area surfaces, such as counters, door handles, faucets, sinks and toilets.
• Clean hands frequently.
• Respect the need to socially distance to avoid the spread of the virus.

Advocacy:

Update! Canada Emergency Commercial Rent Assistance (CECRA) Program for Dentists with TripleGuard^TM Insurance Policies

On June 30, 2020, the Federal Government announced important changes to the CECRA program.

Importantly for dental offices, the government is removing the claw-back of insurance proceeds and provincial rent supports from the CECRA forgivable loan amount for both existing and new applicants. This means that dental offices that were deemed ineligible for CECRA because of their TripleGuardTM pandemic insurance will be reassessed. Existing applicants who are affected will be notified and will have any previously clawed-back amounts restored to their forgivable loan.

The CECRA will also be extended by one month, to cover eligible small business rents for July.

CDA has been lobbying for these specific changes and others to the CECRA to help make the program more accessible to dental offices. We will continue to monitor the program, and encourage dentists to share any challenges they may face in the coming weeks.

Update: TripleGuard^TM Insurance Pandemic Coverage

CDSPI reported that most of the pandemic claims have been settled by AVIVA. For the latest news and updates, please visit the CDSPI website.

CDA’s Return to Practice Task Force (The Task Force):

The Task Force includes representatives from all Corporate Member PDAs. The Task Force meets bi-weekly to discuss deliverables for:

1. information exchange on return-to-practice status across the country;
2. strategies for obtaining and securing PPEs; and
3. communications to the public on dentists returning to practice.

Coming July 7! News Release and Social Media Campaign: Taking Care of your Oral Health, Your Dentist is Ready to See You

To encourage the public to see their dentist, to get back to oral health, and to restart routine care as soon as possible, CDA will issue a news release on Tuesday, July 7, 2020 between 9-10 a.m. EST. This release is supported by a social media campaign which consists of nine posts and a range of graphics. For maximum impact, Corporate Member PDAs have been provided with the bilingual messaging. The materials can be customized, liked and shared among the public and dentists, as deemed appropriate.

Upcoming: Tips on Extending the Life of PPE
To assist the Task Force in its work, CDA Oasis is in the process of putting together a video series with dentists from across the country related to their experiences in return to practice; tips on how to extend the life of PPE in their part of the country; and stories of small companies helping dentists to be creative in managing the PPE shortage. The series also explores dentists' return to practice processes; collaboration efforts; how they prepared their staff; and patient communications. Interviews shows that patients are eagerly looking to return to their dental home for regular care, and while it was difficult to return to practice initially, it is becoming easier with experience and time to adjust to the new normal. CDA Oasis has over 16 dentists lined up to be interviewed, with 12 already completed. Another 10 requests have been received; the recruiting process is continuing. Should Corporate Member PDAs have a dentist in mind to be interviewed for this series, please forward details to Dr. Chiraz Guessaier. Stay tuned for more information.

Reminder: The Task Force continues to review and prioritize its list of deliverables. Any specific expectations or special requests of the Task Force should be fed forward by Corporate Member PDAs to their PDA member Task Force representative.

Update:CDA’s Infection Control Working Group

This Working Group is responsible for collecting and assessing information on infection protection and control to support the Return to Practice Task Force. The Working Group will meet regularly until its tasks are completed. The Working Group has organized their work into four key areas, including:

1. minimizing the emission of infectant particles;
2. controlling infectant particles’ dispersion to other surrounding areas;
3. protecting staff and patients in the dental office, including PPE requirements; and
4. contamination and disinfection protocols.

On June 25, the Working Group met with Dr. Kenneth Kindrachuk from the University of Manitoba, Canada Research Chair in Molecular Pathogenesis of Emerging and Re-Emerging Viruses. Dr. Kindrachuk updated the Working Group on his work and how it could impact recommendations regarding infection control procedures during the COVID-19 pandemic, including whether N-95 masks are needed or if surgical masks with a face shield provide the necessary protection. To follow-up on this meeting, CDA Oasis will record an interview with Dr. Kindrachuk which will be made available as soon as possible.

The Working Group continues to monitor the bi-weekly updates of the Office of the Chief Public Health Officer of Canada (OCPHO). This week, the OCPHO update focused on COVID-19 modeling and how it is used to inform decisions to alter public health measures while controlling the epidemic. The OCPHO continues its work on the evaluation in the impact of COVID-19 on health care workers. Unfortunately, the scarcity of data is preventing the inclusion of dentists in the report prepared to date.

Personal Protective Equipment (PPE):

Update: Federal Government Initiatives on Preparing for a Second Wave of COVID-19
In preparation for a potential second wave of COVID infections in the Fall, the Public Health Agency of Canada (PHAC) has launched an initiative to estimate the PPE needs of different occupational groups. CDA participated in a meeting convened to validate the assumptions made by PHAC, along with representatives from CDRAF, CDHA, CDAA and of the Office of the Chief Dental Officer of Canada. The meeting showed that PHAC was severely underestimating the needs of dentistry and needed to go back to the drawing board using estimates that would approximately double their original assumptions. Once completed, this research will be used, among other things, to estimate the need for the production of PPE in Canada.

New! Excess PPE Research:
Science-based evidence continues to get stronger on the use of excess PPE and its disadvantages, such as lowering oxygen levels or creating a false sense of protection against COVID-19. CDA is monitoring the ongoing debate and science-based research closely to help inform protocols as the dental profession moves forward in returning to full operation.

Update: U.S. vs. Canadian PPE Stock
It continues to be difficult for Canada to secure PPE from suppliers in the U.S. because these products are not allowed to be exported to Canada. Hospitals and other health care facilities in the U.S. have priority to deal with the current surge of cases in many States and to rebuild their stocks in efforts to be more prepared for a potential second wave of COVID-19 in the Fall. Based on the current COVID-19 situational report in some States, Canada will likely not see any significant amount of PPE production come out from the U.S. in the foreseeable future.

Update: Predicted Glove Shortages
CDA anticipates that the next PPE shortages will be for gloves. Due to the historical reliance on latex gloves, most glove producers are located in Asia where latex trees grow. Since the distribution of gloves is more diversified, Canada should not suffer the same type of supply chain issues as it did with gloves when China was shut down as a result of the pandemic. However, the supply chain will be impacted due to the increase in demand worldwide - not necessarily from the health care sector, but other areas such as the food and service industries who now use more gloves than before. CDA will report new information as it becomes available.

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.

Reminder! CDA Essentials Issue 4 is available online. Content specific to COVID-19 includes the President’s Column, CDA at Work, N95 Respirators Guide, Your COVID-19 Questions Answered, Using Teledentistry to Reach Patients, Helping the Community in the Early Days, and Supporting Dentists During the Pandemic. Read these articles and more.

Mental Health and Wellness:

With the COVID-19 pandemic placing significant strain on individuals and families across the country, it’s more important than ever to safeguard your mental health and overall wellness.

CDA continues to actively promote 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

The Mental Health Commission of Canada (MHCC) offers credible information and resources about maintaining mental health during this difficult time.

Visit the MHCC’s Resource Hub to find out what’s new, review mental health resources in response to COVID-19 (tip sheets; posters; webinars), get links to provincial mental health resources and workplace resources, and more.

CDA Help Desk:

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

For assistance, please call 1-866-232-0385, M-F, 7:30 A.M. – 8:00 p.m. EDT.

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 Resources

American Dental Association:

• Webinar: COVID-19 Economic Impact: The Dental Care Rebound - What the Data for the Week of June 15th Tells Us. (June 30, 2020) Topics covered in this webinar includes
  • The latest data from the biweekly poll’s core questions, including patient and collection volumes.
  • PPE availability at dental practices.
  • Average number of dentists and non-dentist staff currently employed per practice.
  • An update on practices in the 27 “early-opener” states.
  • Updated projections on U.S. dental care spending for 2020 and 2021.
• Research Brief: Modeling the Impact of COVID-19 on U.S. Dental Spending — June 2020 Update (June 30, 2020)
• Complete results from the ADA Health Policy Institute’s polling on how COVID-19 is affecting dental practices – Week of Jun 15 results (June 30, 2020)

Statistics Canada

• Payroll employment, earnings and hours, April 2020 (June 25, 2020)

International Resources:

FDI World Dental Federation

• News Release: Oral health and access to care under siege during COVID-19 pandemic (June 29, 2020)

Provincial Dental Association / Regulatory Body Resources:

British Columbia Dental Association

• June 30, 2020 Member Update: BCDA COVID-19 Member Updates; Associate Dentists Canada Emergency Commercial Rent Assistance (CECRA) Update; Dentist Wellness Program Peer Support Session - No Meeting July 1; and more.
• June 25, 2020 Member Update: Temporary Layoff Period Extended; Dentist Wellness Program Support Session; and more.

Newfoundland & Labrador Dental Association

• NLDA COVID-19 Update: Upcoming CDA-NLDA Social Media campaign; Update on Mental health and wellness; media updates and more. (July 2, 2020)

Nova Scotia Dental Association:

• President's Message #16 for COVID-19 update: Government support; return to practice; pandemic insurance; what comes next; and more. (July 2, 2020)
• NSDA News Brief: June/July issue of Nova Scotia Dentist magazine, NSCC Dental Assisting Students work term placements webinar for NSDA members, Reminder for Business Reopening and Support Grant Program deadline (June 29, 2020)
• NSDA News Brief: NSCC Dental Assisting Students, No-Cost Access to Provincial PPE Supplies, NSDA Supply Hub Announcement, And More. (June 25, 2020)

Ontario Dental Association

• Your Weekly COVID-19 Update: Return-to-Practice Toolkit Updated; Update on Guidance for Dentists and for Dental Hygienists; Joint Statement: ODHA and ODA Discuss Shared Concern; Most of Ontario Moves to Stage 2 of Reopening; N95 Mask Fit-Testing; and the CDA COVID-19 update. (June 30, 2020)

Access to COVID-19 Repository: PDA Executive Directors, Corporate Member Presidents and select staff, and CDA Board Members have access to the CDA COVID-19 Repository via the CDA Board Resource Website.

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

Log-in: Please use your existing CDA Board Resources login credentials to access the COVID-19 Repository.

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.