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 17, 2020.

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

Worldwide: As of July 14, 2020, there have been over 13.2 million infections worldwide with an approximate 27% increase in cases just in the past two weeks. The United States (U.S), Brazil and Russia account for most of the increase. The U.S. is leading the world in the number of case growth, while other European countries, such as Canada, shows very low new case growth. Australia and Japan are currently experiencing clusters in community spread.

Canada: Canada saw approximately 4,000 new cases added over the last two weeks, which equates to a 2% weekly increase. Other key points include:

• Ontario: Ontario’s daily cases have been consistently below 150 cases per day for several days. The Golden Horseshoe (area around Lake Ontario including Toronto) and Southwestern Ontario regions will remain in Stage 2 opening, whereas the rest of Ontario is moving into Stage 3.
• Positive Test Rates: An indicator of community spread is the rate of positive testing vs. all tests performed. In Ontario for example, during the peak of new cases, the level of positive tests has been between 2% to 3% of over 20 thousand daily tests performed. At present, the positive test rate is less than 1% (a positive return test rate of 1 out of 200 or less).
• Death Rate: The death rate from all infections remains around 8%. New deaths represent less than 1% of total cases per week, and is largely attributed to outbreaks in health care settings particularly long-term care facilities.
• Trends:
  • Despite significant lower daily reported case reductions for several weeks, cluster outbreaks, a concentration of infections in the same area associated with a sentinel case, are now occurring in Alberta, Saskatchewan and British Columbia and Prince Edward Island. These outbreaks have contributed to a general shift in the pattern of new case growth in Canada, and are primarily related to individuals traveling to and from various regions. There is growing concern about resurgence of community spread in Quebec that is directly linked to the reopening of bars and private indoor gatherings of more than 10 people. Testing results show a return to the 3% positive test results seen in June during the peak. An additional concern has been a significant decrease in the level of testing being done.
  • There is an ongoing debate within public health circles that a greater emphasis be placed on more rapid cluster management rather than attempting to eliminate the virus completely through greater restrictions. As a result, impacted areas may start to see more rapid reclosures due to cluster outbreaks. An overall strategy is to make masks mandatory in many jurisdictions in public places.
  • There has been a shift with majority of individuals returning positive tests being under the age of 40.

USA: The U.S. has increased its overall cases by nearly 30% over the past two weeks. The number of cases will now exceed 3.5 million. Other key points include:

• Positive Test Rates: The U.S. is currently experiencing a significant community spread, with a high proportion of positive test results. The general situation is deteriorating. Arizona is reporting a 1 in 4 positive test rate last week, while Florida is returning a 1 in 6 positive test rate.
• Death Rate: The percentage of all deaths in a one- or two-week period is an indication of the severity of the local epidemic. Over the past two weeks, the percentage of individuals to pass away from COVID-19 to date has increased dramatically. These states reported the following percentage of all deaths from COVID in the past two weeks:
  • Arizona: 40%
  • Florida: 24.2%
  • Nevada: 10.4%
  • Utah: 32%
• Trend: A recent trend saw more young people being infected compared to earlier times of the U.S. epidemic, which affected older Americans. This meant a temporary lower death rate and hospital admissions in the short term. However, this trend has been leading to greater community spread and an increase in complications, more hospitalizations and an increase in deaths. These issues are anticipated to only further increase over the coming weeks.

Government of Canada and Public Health Circles:
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 remains concerned about the trends in the U.S. and has been sending warnings and reminders to remain vigilant to help protect individuals against contracting COVID-19.

There is a general trend of local regulations requiring the wearing of masks in indoor spaces, as well as increased measures being reintroduced particularly for bars and restaurants as a result of cluster outbreaks (i.e. reduced hours and spacing of tables etc.).

Important! 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.

1. Dental offices within cluster outbreak areas should be extra cautious. Cluster outbreaks could be related to a specific facility in their respective area, such as a hospital or processing plant. These outbreaks need to be taken into consideration when dental offices screen/pre-screen individuals to help minimize the risk of the spread of infection.
2. Generally, 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. Dental office staff should be 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.
   • Critical! Respect the need to socially distance in lunchrooms, sterilization rooms, and other common areas to avoid the spread of the virus.

Advocacy:

New! Significant Changes Proposed by Government to Wage Subsidy:
On Friday, July 17, 2020, Finance Minister, Bill Morneau, unveiled changes to the Federal Government's wage subsidy program that will extend the program until the end of the year, and allow more businesses to qualify for it.

Proposed changes will see the wage subsidy accessible to employers with a revenue decline of less than 30%, and will provide a gradually decreasing base subsidy to all qualifying employers. The intent is to allow employers with less than a 30% revenue loss to keep and bring back workers, while also ensuring those who have previously benefited could still qualify, even if their revenues recover and no longer meet the 30% revenue decline threshold.

A top-up subsidy of up to an additional 25% for employers that have been most adversely affected by the pandemic will be made available. Employers that have experienced a 3-month average revenue drop of more than 50% will be eligible for this additional top up. More details to follow.

To implement the measures included in today’s announcement, new legislation will be introduced to Parliament. The legislative proposals have already been shared with Opposition Parties.

New! Safe Restart Program Agreement Announced:
On Thursday, July 16, 2020, the Federal Government announced a federal investment of more than $19 billion to help provinces and territories safely restart their economies and prepare for possible future waves of the virus.

This program will help address key priorities, as agreed upon by the Federal Government and the provinces, for the safe restart of Canada’s economy over the next six to eight months. This includes measures to increase testing and contact tracing, and support for the capacity of health care systems, including services for people facing mental health challenges.

Importantly, this new program will also assist with the procurement of personal protective equipment (PPE). The Government of Canada will commit $4.5 billion to purchase PPE for national use and commit $3 billion to provinces and territories for PPE investments.

Additionally, it includes commitments to help Canadian workers during this challenging time, such as aiding in the availability of safe child care to help parents returning to work, and a temporary income support program to provide 10 days of leave to those who do not have paid sick leave.

To access the funding, provinces will subsequently need to outline how they intend to use these funds.

New! Canada Emergency Wage Subsidy (CEWS) Extended:
On Tuesday, July 14, 2020, the Federal Government announced that the CEWS has been extended to December 31, 2020. The extension will help provide greater certainty and support to businesses as the economy restarts. This is a positive update since CDA has asked for an extension previously. However, the qualification criteria for CEWS will change. CDA has begun asking for the revenue qualifiers to be reviewed.

Reminders:

• Funds Allocated for EI: The Federal Government has indicated that an extra $10 Billion will be allocated for Employment Insurance in the coming fiscal year. This would suggest that the Canada Emergency Response Benefit (CERB) will sunset as currently planned at the end of August, and that those who are still on the CERB at that time will be transferred back to the EI system.
• Pre-Budget Consultations 2020: The Standing Committee on Finance will commence the annual pre-budget consultation process. The theme of this year’s consultations is “economic restart and recovery.” An aspect CDA may include in its brief surrounds expanding the Canada Student Loan Forgiveness Program to include dentists. Currently, the Program is only available for medical doctors and nurses. The Program offers a level of loan forgiveness if individuals provide services in northern and remote communities. The deadline for briefs is August 7, 2020. CDA will circulate a brief for discussion soon.

CDA will continue to track any further developments or announcements and report updates as information becomes available.

Update: TripleGuard^TM Insurance Pandemic Coverage

CDSPI reported that approximately 100 pandemic claims remain open at this point in time. Claimants have been advised by AVIVA what information is required in order to move the claims ahead. 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 provincial dental associations (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.

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.

Personal Protective Equipment (PPE):

New! PPE Labeling Issue: Why Government Procured PPE labeled “not for medical use” are available for medical use in Canada

In response to international criticism concerning medical supplies and PPE exported from China, the Government of China introduced a series of measures to control the quality of exported PPE. A joint declaration must be signed by both the exporter and the importer (i.e. Government of Canada) of PPE before the product can leave China, as well as new labelling requirements for select products.

Upon careful inspection, PPE sourced from China that meets the Government of Canada’s specifications will be labelled by the Public Health Agency of Canada (PHAC) on the outer shipping boxes, confirming quality and stating that it is suitable for use in healthcare settings.

Organizations/individuals receiving government procured PPE should be aware that Chinese labels are intended to protect the reputation of the Chinese industry.

To maintain the integrity of the PPE packaging, PHAC will not remove labels inserted inside individual product boxes that are in Simplified Chinese indicated that the product is ‘not for medical use.’ The process of removing these inserts would cause significant delays in the distribution, and in some cases, destroy the integrity of packaging.

Read PHAC’s full mitigation strategy on PPE Shipments from China here.

New! CDC Report and General Implications for Public Health Practice: Consistent and correct use of cloth face coverings is recommended to reduce the spread of COVID-19

The Centers for Disease Control and Prevention (CDC) released a report, indicating that among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported. Among 67 clients tested for COVID-19, all test results were negative. Adherence to the community’s and company’s face-covering policy likely mitigated spread of COVID-19.

The implications for public health practice are that as stay-at-home orders are being lifted, professional and social interactions in the community will present more opportunities for the spread of COVID-19. As such, broader implementation of face covering policies could mitigate the spread of infection among the general population.

Dentists who are concerned about the spread of infection in common areas within the dental office could consider key takeaways from this study:

• Consistent and correct use of face coverings, when appropriate, is an important tool for minimizing spread of COVID-19 from pre-symptomatic, asymptomatic, and symptomatic persons.
• Consider updating workplace policies to include the use of face coverings, when appropriate, for employees and patients, in addition to daily monitoring of signs and symptoms of employees, procedures for screening employees who arrive with or develop symptoms at work,
• Post messages to inform and educate employees and patients of the use of face coverings.

New! Scams Targeting Dental Offices

Fraudulent Dental Supply Orders Being Placed or Rerouted
The Dental Industry Association of Canada has been notified by some of its members regarding the following scams involving dental supply orders. Two types of scenarios have been occurring in British Columbia and Ontario, and may also be happening in other provinces. The Canadian Anti-Fraud Centre (CAFC) has been made aware of this matter.

“Scenario A”
A person posing as a Dentist/Dental Assistant etc. from a legitimate dental office places an order with a distributor who then processes the order and has it shipped to the legitimate dental office address. The fraudsters then pose as representatives from the distributor, contacts the legitimate dental office and advises these products were shipped in error and they will be sending a courier company to pick them up to which they are then re-routed to a hotel, warehouse etc.

“Scenario B”
The fraudster poses as an employee of the distributor and asks the courier company to re-direct legitimate orders from the distributor to a new address.

What to do:

• Dental offices should be vigilant of unauthorized purchases or suspicious requests to return or reroute packages.
• Dental offices should implement standard procedures when ordering/accepting any deliveries to make sure these deliveries are legitimate. If a dental office didn’t order the package, do not accept it, regardless of what the sender says.
• Be aware of calls related to orders that your office is not aware of.

FedEx Scam: Shipping Charges to BAHRAIN:

CAFC advised CDA that dental offices should be on the lookout for unsolicited packages arriving via FedEx claiming to contain PPE and other items such as equipment (monitors) to offices. These deliveries are part of a scheme that results in offices being charged for the subsequent delivery of these products to BAHRAIN.

What to do: Do not accept these packages at the time of delivery. Refuse and return the packages to the sender. This prevents dental offices from being held responsible for the unsuspected shipping charges.

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 subject matter experts. The following video was published this week:

• The Science of COVID-19 - Evidence + Facts:
  In this in-depth interview, Dr. Jason Kindrachuk outlines what we know about the virus, based on the evidence so far. He gives his expert insight into its modes of transmission, including contact and aerosol transmissions, explains the difference between a resurgence and a second wave, and offers his thoughts on hopes for a vaccine. (July 13, 2020)

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

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:

Reminder: Mental health and wellness support is available through CDSPI’s Members’ Assistance Program (MAP). If you need help, reach out by calling 1.844.578.4040 or visit www.workhealthlife.com

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:

• COVID-19 Economic Impact poll results: HPI COVID-19: Economic Impact on Dental Practices Week of June 29 (July 13, 2020)
• Webinar: HPI’s Chief Economist, Marko Vujicic, discusses the new poll results. (July 13, 2020) Topics include:
  • The latest data from the biweekly poll’s core questions, including patient and collection volumes.
  • PPE availability at dental practices.
  • Staffing levels in dental offices.
  • BLS data on employment in dental offices in June.
  • How COVID-19 has impacted practices’ hours of operation and patient capacity.
  • How data from the 27 “early opener” states suggest a patient volume plateau may be near.

International Resources:

American Dental Association:

• Toolkit: Patient Return: What to Expect After COVID-19. ADA’s suite of communication tools to help dentists and their teams illustrate what patients can expect before, during and after their visit. The toolkit includes a visual guide, extensive FAQ, Facebook posts, email templates, text message templates and in-office signage. (July 13, 2020) Log in to view.

World Health Organization

• Scientific Brief: Transmission of SARS-CoV-2: implications for infection prevention precautions (July 9, 2020)

National Resources:

Canadian Dental Association

• The Science of COVID-19 - Evidence + Facts:
  In this in-depth interview, Dr. Jason Kindrachuk outlines what we know about the virus, based on the evidence so far. He gives his expert insight into its modes of transmission, including contact and aerosol transmissions, explains the difference between a resurgence and a second wave, and offers his thoughts on hopes for a vaccine. (July 13, 2020)

Public Health Agency of Canada (PHAC)

• Mitigation Strategy: PPE Shipments from China (July 13, 2020): In this document, PHAC explains why some PPE labeled “not for medical use” by China are made available for medical use in Canada.

Provincial Dental Association / Regulatory Body Resources:

British Columbia Dental Association

• BCDA COVID-19 Member Update (July 16, 2020): BCDA Census – Check Your Spam!; Upcoming Webinars; RCMP Verification Identity; The Dentist Wellness Program (DWP) is Here for You; and Reminder: BCDA Member Discounts
• COVID-19 Member Update (July 14, 2020): Canada Emergency Wage Subsidy (CEWS) Extended to December; BCDA Census Survey – Help Us Help You; Dentist Wellness Program Peer Support Session; and Canadian Dental Association (CDA) Weekly Update
• July 7, 2020 Member Update: CECRA Program for Dentists with TripleGuard^TM Insurance Policies; Small Business BC Non-Medical PPE Marketplace; Canadian Dental Association (CDA) News Release; Dentist Wellness Program Peer Support Session; and Canadian Dental Association (CDA) Weekly Update.

Dental Association of PEI

• Update from Covid-19 Task Force (July 15, 2020)

Newfoundland & Labrador Dental Association

• NLDA COVID-19 Update (July 15, 2020): The Gathering Place Dental Clinic is preparing to open it's doors; NLDA Member Surveys; CDA-NLDA Social Media Campaign; Mental Health and Wellness; Atlantic Bubble and Self-Isolation; and more.

Nova Scotia Dental Association:

• NSDA News Brief - NSDA President’s Message to Members #17 (July 17, 2020): NSDA has decided to move these messages from bi-weekly to on an “as-needed” basis going forward as offices have now returned to providing routine dental care and the current situation with COVID-19 in Nova Scotia has stabilized. Read more for details on Government Support, Return to Practice and What Comes Next.
• NSDA News Brief (July 10, 2020): Interested in a role with the Provincial Dental Board of Nova Scotia? Updated Return-to-Practice Office Manual, Thinking of hosting an NSCC Dental Assisting Student in your office this autumn? And More.

Ontario Dental Association

• Your Weekly COVID-19 Update (July 15, 2020): ODA Secures Alternative Option for Respirators; Ontario Moves to Stage 3 – Stay Safe and Remain Vigilant; Government Dental Programs and PPE; New Virtual ASM20 Advocacy Session; CDA Launches Public Campaign; and CDA Update
• Update on Chief Medical Officer Memo (July 9, 2020): ODA Asks for Clear Guidance and Collaboration

Royal College of Dental Surgeons of Ontario (RCDSO)

• COVID-19 Update (July 16, 2020): AGP and PPE in the dental office

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.