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 24, 2020.

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

Worldwide: As of July 21, 2020, there have been over 14.8 million infections worldwide with an approximate 12% increase in new cases just in one week. 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. European countries are maintaining constant with few new infections, while Canada is showing low new case growth. Australia and Japan are continuing to experience clusters of community spread.

Canada: Canada saw approximately 3,000 new cases added this week, which equates to a 2.7% increase, higher than the previous week because of new cluster infections in various provinces. Other key points include:

• Ontario: Ontario’s daily cases have been consistently below 150 cases per day for several days, with this week showing the largest new cases at 135 - the highest new case number since June 15, 2020. The Peel and Southwestern Ontario regions will remain in Stage 2 opening, whereas the rest of Ontario is now 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 20,000 daily tests performed. At present, the positive test rate is negligible (a positive return test rate well below 1 out of 200 or less) and an indicator that like the rest of the country there is no indication of community spread at present.
• 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 reported in Alberta, Saskatchewan, Ontario, Quebec and British Columbia. 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 and growth in private house parties that increased around the July 1^st holiday.
  • Public health response has shifted with a greater emphasis being placed on more rapid cluster management rather than attempting to eliminate the virus completely through greater restrictions. As a result, impacted areas may see more targeted rapid re-closures due to cluster outbreaks. In order to simulate a form of herd immunity, the wearing of masks is now 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 last week to being under 30 this week.

USA: The U.S. has increased its overall cases by nearly 27% this week (30% for the previous two weeks) and daily case rates doubled this week, demonstrating that the situation is worsening. The number of cases will exceed 4 million. Other key points include:

• Positive Test Rates: The U.S. is currently experiencing significant community spread, with a high proportion of positive test results. The general situation continues to deteriorate with day or day total cases increasing. Arizona is reporting a 1 in 4 positive test rate last week, while Florida is returning a 1 in 6 positive test rate.
• Seven-day Average: April New Cases vs. July New Cases: In April, U.S. cases peaked at a 7-day running average of 31,700 cases and declined to less than 20,ooo cases per 7-day average by June 3, 2020. Following a steady increased and resurgence later in the month, as of July 21, the 7-day average new cases exceeds 66,432 - or more than double the number of daily cases seen at the height of initial outbreak.
• Seven-day Average: April New Deaths vs. July New Deaths: On April 16, 2020, the U.S. peaked its 7-day average of 2,228 deaths per day and saw a steady decline until July 4 when it reached 474 average deaths in a 7-day period. It then increased steadily to the current 7-day average of 786 deaths per day as of July 21.
• Trend: A current trend continues with young people being infected compared to the late March and April timeframe, which affected primarily older Americans. This has meant a temporary lower death rate and hospital admissions in the short term. However, there is growing community spread and an increase in complications, hospitalizations and an increase in daily deaths (which exceeded 1,000 per day July 22) that is taxing the ability of the health care system to respond in most parts of the country other than the Northeast. These trends are anticipated to continue and raise additional concerns when coupled with the return-to-school plans in place for later in August and early September.

Government of Canada and Public Health Circles:
The Government of Canada continues to prepare for and is concerned about a potential resurgence. Personal protective equipment (PPE) continues to be stockpiled. There are ongoing strains on the availability and supply of PPE.

The Public Health Agency of Canada’s (PHAC) response to the pandemic succeeded in flattening the outbreak and Canada has done well in minimizing infection and deaths. The focus now is the long-term management of cluster outbreaks given the inability to date to eradicate the virus completely through stringent lockdown measures. PHAC continues to remind Canadians remain vigilant to help protect individuals against contracting COVID-19.

Public Health Officers are concerned about the new patterns of infection that are increasingly associated with younger individuals who are “letting their guard down,” raising the risk of a return to community spread. More jurisdictions are introducing requirements to wearing masks in indoor spaces, as well as increased measures, particularly for bars and restaurants, as a result of cluster outbreaks (i.e. reduced hours, increased spacing of tables, requirements to wear masks until seated 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. The current pattern suggests an increasing number of these clusters surround individuals under 30 years of age. Cluster outbreaks can be related to a specific indoor 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 washrooms¹. This remains a significant concern. Dental office staff should be reminded of the following:
   • Do not let your guard down.
   • Staff should wear masks at all times while in the office. Given the increased pressure on the supply of all types of medical grade masks, a personal cloth mask that is washed daily is a good alternative when staff are not performing clinical duties, are on breaks, or when entering/leaving the office.
   • 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.

¹ This information is based on case reports from Ontario and Quebec, and in particular, within long-term care and hospital settings. In these settings, the routine wearing of masks was not part of protocols, and staff-to-staff infections were common based on the contact tracing and follow-up. Early reports from China confirm similar findings.

Advocacy:

Updated! Significant Changes Proposed by Government to Wage Subsidy: On Friday, July 17, 2020, Finance Minister, Bill Morneau, unveiled changes to the Canada Emergency Wage Subsidy program (CEWS) that will extend the program until the end of the year, and allow more businesses to qualify for CEWS.

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.

CDA is currently working to develop top-level guidance on the revamped program. Given the specificity of the program to each particular business, and some of the complexity of the “sliding scale” nature of the new subsidy, it is highly recommended that accounting and finance professionals are engaged to help individual practices and businesses navigate the new rules.

To implement the measures, legislation was passed this week in Parliament, and will be dealt with in the Senate next week. The new program’s application process will launch once the legislation has Royal assent.

Reminder: Pre-Budget Consultations 2021: 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.” The deadline for briefs is August 7, 2020. CDA will circulate a brief for discussion soon.

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.

COVID-19 Laboratory Testing and Product Recalls by Health Canada:

Update! COVID-19 Testing: On June 22, the Public Health Agency of Canada (PHAC) and the Association of Medical Microbiology and Infectious Disease Canada presented a joint update, Challenges in COVID-19 Laboratory Testing.

The information demonstrates that it can take up to two weeks for immunoglobulins (i.e. antibodies) to reach detectable levels, and therefore, serological tests are not appropriate diagnostic tests and should not be used for point-of-care testing. Molecular tests appear more promising; however, the interpretation of negative results continues to be a challenge because the rate of false negatives is not well defined at this point in time.

It seems unlikely that point-of-care tests, suitable for identifying individuals who are not at risk of transmitting COVID-19, will become available in the near future.

New! Recall of certain hand sanitizers that may pose health risks: On July 17, 2020 and July 21, 2020, Health Canada issued advisories, recalling certain hand sanitizers from the market because they contain ingredients that are not acceptable for use in hand sanitizers in Canada. Please read the full advisories to obtain lists of affected products.

What to Do:

• Stop using the products listed in the advisories and may pose a risk to health. Please follow municipal or regional guidelines on how to dispose of chemicals and other hazardous waste. You may also return the product to your local pharmacy for proper disposal.
• Consult your health care professional if you have used these products and have health concerns.
• To help limit the spread of COVID-19, wash your hands often with soap and water for at least 20 seconds. Use alcohol-based hand sanitizers if soap and water are not available.
• Use hand sanitizers that have been authorized for sale in Canada. These products can be found on the list of hand sanitizers that meet Health Canada’s requirements.
• Consult the list of hand sanitizers authorized or registered in other jurisdictions that may not display an NPN or DIN but have been accepted for use in Canada during the COVID-19 pandemic. The list of accepted products can be found here.
• Report any health product adverse events or complaints to Health Canada.

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:

• How Is Your Return to Practice Going?:
  Dr. Bill Abbott shares his experience of the COVID-19 lockdown and his return to practice. He presents in detail the return-to-work protocols established successfully in his office. He walks through the patient's journey, office infrastructure; and considers next steps for dentistry in the post COVID-19 era. (July 21, 2020)
• How Can You Stay Hydrated With All the Protective Equipment?:
  Research in high performance athletes shows that with the loss of as little as 1% of body weight in moisture, mental focus, reaction time and executive function are all significantly diminished. In this interview, Dr. Uche Odiatu talks about staying hydrated through a busy shift at the dental office. (July 20, 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.

New! CDA’s Return to the Office Plan:

At CDA, our priority is to keep our employees and their families healthy, especially in the midst of the COVID-19 pandemic.

CDA abides by governmental guidelines as we strive to balance public health concerns with the needs of our business. CDA has developed a COVID-19 Return to the Office Plan for its employees, which details how the organization plans to reopen its Ottawa-based office.

Since the outbreak of the COVID-19 pandemic, CDA staff have been working remotely. CDA’s plan is to continue remote work until January 2021, at which point an evaluation will be completed to determine the safety of a full return to the office.

It is business as usual for CDA while its staff works remotely. CDA will continue to monitor public health advisories and update its COVID-19 Return to the Office Plan accordingly, keeping Corporate Member PDAs and CDA Stakeholder Groups informed of any further changes.

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 visit www.workhealthlife.com

New! The following wellness post was featured in the Mental Health Corner of CDA Oasis:

• Feeling Overwhelmed? Ways to Cope:
  In this insightful discussion with Dr. John O'Keefe, Dr. Sally Safa addresses the issue of overwhelm. But what is overwhelm and why are dentists especially prone to it? And what strategies can we adopt to cope better and lead happier, healthier lives at work and at home? (July 22, 2020)

Podcast Series: Carrying On. Mental Health Strategies for COVID-19 - As a country, we face a changing world and higher stakes than ever before. The way we respond to challenges today will define the Canada of tomorrow. The Conference Board of Canada’s Chief of Research, Workplace Productivity, Dr. Bill Howatt, shares strategies to support mental health through COVID-19.

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.

International Resources:

World Health Organization

• Disability considerations during the covid-19 outbreak. Establishing COVID-19 triage stations at healthcare facilities: Key instructions and tips. The purpose of this document is to provide guidance on how to rapidly establish a triage area at a healthcare facility (HCF). The intended users of this document are healthcare officials/personnel who are responsible for case management (CM) and infection prevention and control (IPC) at the facility. Ideally, regardless of the type of facility, each entry point into the HCF should have a triage station, where patients will be screened for COVID-19. (July 23, 2020)

National Resources:

Canadian Dental Association

• CDA’s COVID-19 Return to the Office Plan (July 15, 2020)
• How Is Your Return to Practice Going?: Dr. Bill Abbott shares his experience of the COVID-19 lockdown and his return to practice. He presents in detail the return-to-work protocols established successfully in his office. He walks through the patient's journey, office infrastructure; and considers next steps for dentistry in the post COVID-19 era. (July 21, 2020)
• How Can You Stay Hydrated With All the Protective Equipment?: Research in high performance athletes shows that with the loss of as little as 1% of body weight in moisture, mental focus, reaction time and executive function are all significantly diminished. In this interview, Dr. Uche Odiatu talks about staying hydrated through a busy shift at the dental office. (July 20, 2020)

The Conference Board of Canada

• Podcast. Norman Amundson on and career paths: As the pandemic spread around the world, normal life shut down to shelter people. In its wake, millions were left unemployed. As regions start to relax their restrictions, many people are returning to their jobs or have found new ones. But many are still looking. On this episode of Bright Future, UBC professor emeritus, advocates for hope during this emotional roller coaster. Listen as Norman Amundson shares tips for dealing with a layoff.

Mental Health and Wellness Resources:

Canadian Dental Association:

• Feeling Overwhelmed? Ways to Cope:
  In this insightful discussion with Dr. John O'Keefe, Dr. Sally Safa addresses the issue of overwhelm. But what is overwhelm and why are dentists especially prone to it? And what strategies can we adopt to cope better and lead happier, healthier lives at work and at home? (July 22, 2020)

Conference Board of Canada

• Pandemic Pulse Check: COVID-19’s Impact on Canadians’ Mental Health (July 17, 2020)

Provincial Dental Association / Regulatory Body Resources:

British Columbia Dental Association

• BCDA COVID-19 Member Update: Save the Date! Upcoming BCDA Webinar; Monthly BCDA Survey - Round Two Coming Soon; and Media of Interest (July 23, 2020)
• BCDA COVID-19 Member Update (July 21, 2020): Proposed Changes to Canadian Emergency Wage Subsidy Program (CEWS); New BC Access Grant for Students; BCDA and BCDHA Seek Clarification on Oral Health Colleges' Guidelines; Canadian Dental Association (CDA) Weekly Update; Dentist Wellness Program (DWP) Peer Support Session; BC Oral Biopsy Service – iOBS Account Registration; and RCMP Historical Verification of Identity

New Brunswick Dental Society

• 2021 Suggested Fee Guide (July 23, 2020)
• COVID-19 Situational Report week ending July 17, 2020: A weekly summary from the Canadian Dental Association regarding COVID-19 (July 21, 2020)
• COVID-19 Protocol Changes (July 17, 2020)

Newfoundland & Labrador Dental Association

• NLDA COVID-19 UPDATE (July 23, 2020): CDA Situation Report; The Gathering Place Dental Clinic; NLDA Member Surveys; Mental Health and Wellness; and more.

Ontario Dental Association

• Weekly COVID-19 Update (July 22, 2020): Return-to-Practice Guidance: What You Can Do; Time Running Out on July SteriPro Offer; Most of Ontario in Stage 3 of Reopening; Safe Direct PPE Labelling; Beware of Dental Supply Order Scams; ODA in the News; Reminder for New Virtual ASM20 Advocacy Session; More Federal Support for Canadian Employers; CDA Update; and more.

Royal College of Dental Surgeons of Ontario (RCDSO)

• COVID-19 Update – Screening Health Care Workers (July 23, 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.