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 May 8, 2020.

Advocacy Updates

Update! Canada Emergency Wage Subsidy to be extended: As part of his regular briefing on Friday morning, Prime Minister Justin Trudeau announced that the Canada Emergency Wage Subsidy (CEWS) will be extended beyond the planned end on June 6, 2020. Further details about the extension will be released next week. The request for an extension of the CEWS program was part of CDA’s presentation to the House of Commons’ Standing Committee on Finance last Friday. As of today, approximately 180,000 businesses across Canada have applied for the CEWS.

Now Available! Statistics Canada reveals the economic impact of COVID-19 through its Labour Force Survey, April 2020: On May 8, 2020, Statistics Canada revealed facts and figures about COVID-19’s impact on the Canadian economy. The base unemployment rate reached 13%, an increase of 5.2 percentage points in just one month. Moreover, the results for April, 2020 show that more than one-third (36.7%) of the potential labour force did not work or worked less than half of their usual hours, illustrating the continuing impact of the COVID-19 economic shutdown on the labour market.

The "recent labour underutilization rate" combines those who were unemployed; those who were not in the labour force, who wanted a job, but did not look for one; and those who were employed but worked less than half of their usual hours. In comparison, this rate was 11.3% in February.

Advocacy Tool and Tips! Letter and Tactics to reach Provincial Government Officials to Access PPE Stock: This week, CDA provided Corporate Member PDA Executive Directors with a sample letter to reach out to provincial officials with regards to accessing PPE from their stocks. Corporate Member PDAs are welcome to personalize, adapt and send the letter to the Minister of Health, the Chief Medical Officer, or the Dental Director in their respective province. CDA suggested the following tactics to bring further attention to the discussion:

1. Email the Health Minister and copy the Chief Medical Officer (CMO): Provincial health ministers have been deferential to CMOs throughout the COVID-19 crisis; however, the CMOs ultimately answer to the Provincial health minister. Getting the provincial minister or their staff to ask questions about this issue can help draw further attention to the matter.
2. Engage the Provincial Dental Director: Copy the dental director on your correspondence, and follow up directly. Let them know that it is important to raise the issue from within government.

Update! Emergency Commercial Rent Assistance (CECRA): CECRA aims to lower rent for small businesses that have been affected by COVID-19. It is anticipated that the CECRA program will be launched in the coming weeks. A number of commercial landlords have expressed their concerns about the program. One issue pertains to requiring a mortgage on the property in order to receive aid. CDA has raised this issue with the Federal government in recent weeks, and underlined the issue as part of its presentation to the Finance Committee. CDA will report any further updates about the Program as new information becomes available.

Reminders:

• View CDA President Presentation to Federal Finance Committee: Last week, Dr. James Armstrong, CDA President, addressed the House of Commons’ Standing Committee on Finance as part of its study regarding the Government of Canada’s response to the COVID-19 pandemic. Dr. Armstrong outlined the challenges that COVID-19 and the ensuing shutdown have posed for dentistry, and emphasized the need to support dental practices in the coming months. Other key recommendations included the need to extend the Canada Emergency Wage Subsidy, tax credits for practices that need to physically adapt to new guidelines, facilitated access to PPE, and support for extended health care benefits. View a copy of Dr. Armstrong’s opening written statement or the webcast presentation beginning at 16:22:40. He also answered questions at 17:26:40, and 17:47:47.
• Visit CDA’s website for federal funding program information that is specific to certain business models used in dentistry, including:
  • For Dental Professional Corporations or Self-Employed Dentists
  • For Cost Sharing Arrangements (Unincorporated Association)
  • For Partnerships

Other Important Updates

Personal Protective Equipment (PPE):

Ongoing! Discussions with Federal Government: CDA remains in discussion with the Public Health Agency of Canada (PHAC), and participates in bi-weekly updates with the Chief Medical Officer on the availability of PPEs. This week’s discussions surrounded clarifying a range of issues pertaining to masks, including the effectiveness of KN95 masks compared to N95. In summary, the standards used for the certification of KN95 and N95 masks are different but equivalent. The most important point to remember when looking at KN95 and N95 masks is that both come in a medical and a commercial version. The medical versions are tested and certified for fluid penetration, but the commercial version is not. The difference between a level 3 surgical mask and a N95 mask is not filtration but the fit. Proper fit prevents infiltration around the mask for N95 but not for level 3 surgical mask.

Update! Allocating PPE for Dentistry: Government-procured PPE stock continues to be distributed to health organizations from provincial governments. On May 6, 2020, CDA was invited along with the Chief Dental Officer, the Canadian Dental Regulatory Authorities Federation (CDRAF) to participate in a phone call with the Clinical Lead COVID-19 at the Public Health Agency of Canada (PHAC) about PPE allocation for dentistry. CDA underscored the reasons for fulfilling the need for PPE for the dental profession, which include keeping dental emergencies away from hospital ERs and minimizing the need for pharmacological management of dental conditions that are better handled surgically.

New! Logistic Advisory Committee Established: The Government of Canada has struck this Committee to look at the availability of PPE. Based on initial reports from the Committee, it seems that there are sufficient PPE supplies for hospitals and long-term care facilities across Canada, but shortages remain in community care settings, including medical and dental clinics.

New! Immunity Task Force Established: The Federal Government has struck this Task Force to coordinate nation-wide COVID-19 testing. The Task Force is specifically interested in COVID-19 tests that attempt to detect the body’s immune reaction to the virus, none of which have been approved for use in Canada to date. CDA will share more information as discussions of this Task Force progress. Watch a video to learn more about tests and testing for COVID-19 by the University of Buffalo, School of Dental Medicine.

Liability: Personal Procurement of PPE: There are reports of corporate dentistry organizations or unauthorized resellers procuring PPE directly for Canadian dentists in the global market. When an individual or an organization procures PPE directly, they become the importers of those products. This can be extremely risky as under Health Canada regulations, the importer of any class of medical device becomes responsible for all liabilities, including fraudulent or defective products should they cause harm to patients or staff. Corporate Member PDAs may wish to caution dentists about importing their own PPE, particularly masks, due to the risks involved.

Reminder: Mask Certification vs. Fraudulent Markings: As efforts to secure PPEs intensify, increasing numbers of counterfeit materials are being identified. Corporate Member PDAs are encouraged to remind dentists to carefully examine supplies procured from non-government stockpiles. Here is more information about how to identify a NIOSH-approved respirator, and additional tips for spotting counterfeit respirators.

CDA’s Return to Practice Task Force:

CDA’s newly established Return to Practice Task Force, which includes representatives from all Corporate Member PDAs, meets weekly to discuss deliverables for:

1. evidence-based treatment protocols and how to carry these out;
2. strategies for obtaining and securing PPEs; and
3. communications to the public on dentists returning to practice.

New! Return-to-Practice Office Manual Tool Coming Soon: The Return to Practice Task Force has drafted a Return-to-Practice Office Manual. The document consolidates considerations from around the world related to return to practice, and it serves as a tool for Corporate Member PDAs. A Word document format of the Manual can be modified by Corporate Member PDAs when developing their own specific provincial information for dentists. Since the roll-out of returning to practice is occurring at different stages across Canada, each province will have its own specific guidelines to follow. The Return-to-Practice Office Manual tool is expected to be available in the coming days. The document will continue to be updated as guidance and evidence-based findings become available to help guide recommendations.

Important! Avoid Unnecessary or Expensive Dental Office Purchases: This week, a Dental Industry Association of Canada (DIAC) representative met with the Return to Practice Task Force. There continues to be reports of some suppliers placing pressure on dentists to purchase expensive materials and equipment in preparation for returning to practice. CDA is advising against making major modifications to dental offices at this time, until more information about what will really be required becomes available. To help with the documentation of these issues presenting, please forward any examples of inappropriate vendor activity or advertisements to Dr. Benoit Soucy, CDA Director for Clinical and Scientific Affairs.

Reminder! Corporate Member PDAs who have specific expectations or special requests of the Return to Practice Task Force should feed comments forward to their PDA member representative.

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 every Thursday 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.

With the assistance of the CDA Committee on Clinical and Scientific Affairs, the Working Group is researching credible, science-based information in all four areas. It will be calling on external subject matter experts, as required.

Insurance Coverage and Claims:

New! Documentation of Care for Government Employees: The Treasury Board of Canada (TBC), the largest employer in Canada, contacted CDA to obtain more information regarding the types of accommodations that can be made to help minimize the impact that the interruption of the delivery of elective care is having on their employee benefit plan.

The TBC’s primary concern surrounds employees who are aging out of insurance plans or who have left employment. The TBC has sought clarification related to the types of information dentists could provide to the insurer that demonstrate that treatment had been started but was interrupted by the shut down of the delivery of non-urgent services.

Discussions also included initiatives which CDA’s Dental Benefits Committee would like to promote to insurance companies, such as the transfer of benefits from 2020 to 2021 and the coverage of temporary restorations, adjustments of frequency limits. CDA will report back any further correspondence with the TBC, as well any updates on this topic as new information becomes available.

Update: Covering Extra Costs for PPE: CDA has initiated discussions with CLHIA about claiming for the additional costs related to new enhanced PPE requirements. These discussions are essential in order to create an industry-wide approach. These claims will have to be made in a consistent manner across insurance companies. CDA will report further updates as discussions progress.

TripleGuard^TM Insurance Pandemic Coverage:

Reminder! Claims not yet submitted: Approximately 600 dentists across Canada have not submitted claims. CDSPI is following-up on this, but Corporate Member PDAs may wish to send a reminder to dentists that sub-pandemic coverage is activated when there is a provincial order in place by the government to shut down non-essential services. Note that this is not the date of any instruction from respective dental associations or colleges. The date of restrictions being lifted is in essence the cut-off date of claims. Here is more information about the claims process.

CDSPI advises that over 6,000 claims have been filed with Aviva. Claims continue to be processed with some being completed between 48 to 72 hours with appropriate financial information provided. There are delays in the processing of claims and additional communication from CDSPI to Corporate Member PDAs has been requested to assist in the communication with their member dentists. Additional updates are provided weekly by CDSPI with respect to the progress being made by Aviva.

CDSPI is also working to provide Corporate Member PDAs with additional information to convey to members dentists on how to expedite claims, and is planning to communicate an update to policy holders soon. CDA will share any updates as new information becomes available; however, please continue to check CDSPI’s website for new information on pandemic claims.

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 videos were published this week:

• What Changes Can We Expect Around Drug & Prescription Protocols?: When dental offices finally emerge from the COVID-19 pandemic, much will have changed. And though none of us has a crystal ball, it is clear that the future of dentistry is evolving before our eyes. So, what about pharmacological protocols? Will the way we prescribe drugs be radically changed? (May 5)
• Adapting Oral and Maxillofacial Services During the Pandemic: So, how have dental surgeons adapted their services in these unprecedented times? Dr. Marco Caminiti talks to Dr. John O’Keefe about some of the initiatives he has introduced to his practice. Dr. Caminiti explains that, though being part of the overall hospital environment has its benefits, considerable hurdles remain. (May 5)

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

CDA Essentials Issue 2 is available online. Issue 3 of the magazine will be ready for distribution shortly.

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.

New! Data on Mental Health: On May 7, 2020, Statistics Canada released data on how the COVID-19 pandemic has changed Canadians’ lives in a very short period of time. Given the disruption and stress, it may come as no surprise that the consumption of cannabis, alcohol and tobacco has increased for some. In particular, Canadians who rated their mental health as fair or poor were more likely to report increased use of these substances.

New! Funds Announced to Develop, Expand and Launch Virtual Care and Mental Health Tools: On May 3, 2020, the Prime Minister announced an investment of $240 million to develop, expand, and launch virtual care and mental health tools to support Canadians. A portion of the investment will support Wellness Together Canada, an online portal that provides Canadians with free resources, tools, and professional support services to help with wellness and resilience, as well as mental health and substance use. Wellness Together Canada offers the following at no cost to Canadians:

1. Wellness self-assessment and tracking.
2. Self-guided courses, apps, and other resources.
3. Group coaching and community of support.
4. Counselling by text or phone.

New! Three wellness posts have been featured in the Mental Health Corner of CDA Oasis:

• Your Wellbeing – Resilience During a Pandemic: Concern about the pandemic may intensify the effects of other stresses in our daily lives. This can impact your built-in physical stress response, which may leave you more vulnerable to the flu as well as other health risks. It is therefore important to take care of yourself and build your resilience. (May 4)
• Your Wellbeing - Accepting change is vital to your health and happiness: Some changes in our personal or work life can ask us so much from us that the impact can lead to depression or anxiety. However, proactive resilience building can make change less frightening and a more fulfilling prospect. Here are some building blocks for a resilient self that will help you be more flexible and prepared for change. (May 6)
• Your Wellbeing - Tips on Communicating in the Digital Age: Speaking with someone face-to-face is different than sending an email and a phone call is different than a text message. Different mediums are used at home and at work, bringing even more nuances into play. Here are some factors to consider when you are using and moving quickly between multiple forms of communication. (May 8)

Reminder! May 4 to 10, 2020 is Mental Health Week, a Canadian tradition where communities, schools and workplaces rally to celebrate, protect and promote mental health. A growing list of mental health and wellness resources is available in CDA’s COVID-19 Repository. Corporate Member PDAs are encouraged to access the information and share helpful mental health resources with dentists, as deemed appropriate.

CDA Help Desk:

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

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.

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.

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:

Cochrane Oral Health

• Recommendations for the re-opening of dental services: a rapid review of international sources: COVID-19 Dental Services Evidence Review (CoDER) Working Group (May 7)
• Key Messages on the rapid review

Statistics Canada:

• Labour Force Survey, April 2020 (May 8)
• Impacts of COVID-19 on Canadians: First results from crowdsourcing (April 23)

International Resources:

California Dental Association:

• Back to Practice Resources:
  • Preparing Your Practice: Includes a letter to employees; Two Weeks before Opening; Prepping for Dental Plan Payments; Supply Checklist; Employee Screening for COVID-19; EPA and CA Registered Disinfectants; Employee Protection from COVID-19; N95 Mask Fit Testing Requirements
  • Patient Care: Includes information on Masks and children during COVID-19; Patient Screening Form; When a Patient Reports COVID Symptoms; Patient Communications and Management
  • Practice Management: Includes a sample leave expansion/emergency paid sick leave policy; suspected or confirmed cases of COVID-19 in the workplace; Paycheck Protection Program Forgiveness tracker; an employer guide; employee leave request notice; documentation checklist, and more.
• Article (April 23): Be wary of counterfeit products marketed to dentists during the COVID-19 pandemic

(CDC) Centers for Disease Control and Prevention:

• Counterfeit Respirators / Misrepresentation of NIOSH-Approval (April 28)
• Additional Tips for Spotting Counterfeit Respirators (April 21)

Legal Resources:

Bloomberg Law

• Article (May 4): Ambitious Timeline for Vaccine Requires Companies to Accept Risks

National Resources:

Prime Minister’s Office

• News Release: Prime Minister announces virtual care and mental health tools for Canadians (May 3)

Canadian Dental Association:

• A summary update of Provincial Re-Opening Plans provided by TSA Temple Scott Associates Strategic Communications (May 7)
• Address by CDA President, Dr. James Armstrong, to the House of Commons’ Standing Committee on Finance as part of its study regarding the Government of Canada’s response to the COVID-19 pandemic (May 1)

CDA Oasis Discussions:

• What Changes Can We Expect Around Drug & Prescription Protocols?: When dental offices finally emerge from the COVID-19 pandemic, much will have changed. And though none of us has a crystal ball, it is clear that the future of dentistry is evolving before our eyes. So, what about pharmacological protocols? Will the way we prescribe drugs be radically changed? (May 5)
• Adapting Oral and Maxillofacial Services During the Pandemic: So, how have dental surgeons adapted their services in these unprecedented times? Dr. Marco Caminiti talks to Dr. John O’Keefe about some of the initiatives he has introduced to his practice. Dr. Caminiti explains that, though being part of the overall hospital environment has its benefits, considerable hurdles remain. (May 5)

Mental Health and Wellness Resources:

Canadian Dental Association:

• Your Wellbeing – Resilience During a Pandemic: Concern about the pandemic may intensify the effects of other stresses in our daily lives. This can impact your built-in physical stress response, which may leave you more vulnerable to the flu as well as other health risks. It is therefore important to take care of yourself and build your resilience. (May 4)
• Your Wellbeing - Accepting change is vital to your health and happiness: Some changes in our personal or work life can ask us so much from us that the impact can lead to depression or anxiety. However, proactive resilience building can make change less frightening and a more fulfilling prospect. Here are some building blocks for a resilient self that will help you be more flexible and prepared for change. (May 6)
• Your Wellbeing - Tips on Communicating in the Digital Age: Speaking with someone face-to-face is different than sending an email and a phone call is different than a text message. Different mediums are used at home and at work, bringing even more nuances into play. Here are some factors to consider when you are using and moving quickly between multiple forms of communication. (May 8)

HelpGuide

• Coronavirus Anxiety: Coping with Stress, Fear, and Worry

Manulife Canada

• Stronger Minds by BEACON is a free digital program for all Canadians to support your mental well-being through the COVID-19 crisis. Joint to get fresh resources will be added ongoing, in response to the evolving needs and interests expressed together by Stronger Minds participants, including:
  • Overcoming worry, fear and stress
  • Staying positive and hopeful
  • Dealing with isolation and loneliness
  • Parenting, maintaining motivation, getting better sleep
  • And much more.
• Sharing Humanity COVID-19 podcast: Helping Canadians stay mentally, physically and financially healthy during the COVID-19 pandemic.
• Podcast: Parenting while isolated and working from home
• Tips: Helping kids cope during the coronavirus
• How to start a new exercise program: Regular exercise has shown to boost immunity, reduce risk of illness, and support mental health. Five tips.

Provincial Dental Association / Regulatory Body Resources:

British Columbia Dental Association

• May 7, 2020 Member Update: Member article on COVID-19 and Mental Health; BC’s Restart Plan, and more
• May 6, 2020 Member Update: BC Government announcement; a summary of what BCDA is working on; and more.
• May 5, 2020 Member Update: New Harris & Co Article on Temporary Layoffs; RCMP verification of identity; BCDA Back to Work Task Force; and more.
• May 4, 2020 Member Update: BC Dentists Launch New P2P Tele-Dentistry App; Statistics Canada COVID-19 Survey; and more.
• May 1, 2020 Member Update: COVID-19 Staff Consent Form, and more.

Dental Association of PEI

• Webinars coming up (May 7): Office Protocols for opening on PEI; finances and survival for you and your practice with Prof. James Armstrong of the Sauder School of Business in BC; and more.
• Phase 2 Protocol Update (May 6): Changes were made to the patient entering the office as well as some additions to NON-AGP in the list. See Phase II 2 Protocol.
• PPE Ordering Update (May 6): Face shields, hand sanitizer and gowns
• DAPEI Update May 2: Dental Office Protocol for opening May 22, 2020. Supplementary documents include RCDSO Updated Guidance on Emergency and Urgent Care During COVID-19 Pandemic; COVID-19 Pandemic Emergency Dental Risk Acknowledgement by Patient; DAL COVID-19 Standard Operating Procedures Nova Scotia Satellite Dental Clinics (Apr 17); and DAPEI Return to Practice Protocols for Dental Practices on PEI Treatment of Emergencies – Non-AGP Dental Care May 22
• DAPEI Update May 1: Protocol for treating patients beginning May 22 and types of PPE to wear

New Brunswick Dental Society

• COVID19: Advisory Group Process (May 6)
• Video from Vitalité Health Network regarding donning and doffing of PPE
• Member Communication (May 1)

Newfoundland & Labrador Dental Association

• NLDA COVID-19 Update (May 5): Mental Health Week 2020; Pandemic Plan Update; CDSPI Pandemic Claims Process, and more
• NLDA COVID-19 Update (May 4): NLDA Annual Report; Pandemic Plan Update; N-95 Fit Tests and more.
• NLDA COVID-19 Update (May 1): Message from the Executive Director

Ontario Dental Association

• Virtual ASM20 Coming Soon! (May 7)
• President’s Message to Members (May 6): A team is stronger than one
• May 4, 2020 Member Communication: What Do You Need to Return to Practice? Highlights include: a survey for Ontario-based dentists, which will help inform the development of guidance that dentists will need in the coming weeks, months and beyond; and more information about the ODA’s Return-to-Practice Working Group
• Your Weekly COVID-19 Wrap-up (May 1): Getting dentists ready to go back to work; Rapid COVID-19 Point-of-Care Testing; Clarification on Teledentistry codes; Federal Funding Information for Dental Practices; ODA in the Media

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.