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 November 13, 2020.

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

CDA’s COVID-19 Team Lead, Dr. Aaron Burry, Associate Director for Professional Affairs, provides a video update on trends and case growth related to COVID-19 across Canada and in other parts of the world. Click on the image below to view the video discussion.

Video Length: Approximately 8 minutes. Recorded: November 10, 2020.

Highlights:

• Currently, Canada has several COVID-19 “hot zones.” You are in a “hot zone” if you have increasing number of cases, community transmission and a rise in three other COVID-19 related indicators, including: 1) hospitalization rates; 2) ICU utilization; and 3) death rates.
• These indicators have been steadily increasing across several Canadian communities at rates greater than Spring, 2020.
• Over the last week, Canada has seen an increase of 12% in case growth with new daily records being set, which has led to calls for additional measures at the provincial level and new safety messages being issued by the Public Health Agency of Canada (i.e. recommendation to use multi-layer masks to improve an individual’s protection against COVID-19).
• Infection patterns and increased government measures to stem these patterns are tracking approximately 2-3 weeks behind trends noted in Europe (Canada mirrors Sweden and Germany closely). This provides some level of insight into the types of measures that may be considered in your province.

Tips and Clarification for Dentistry:

• Be extra cautious if you are in a “hot zone.” Be aware of your local indicators and patterns.
• Continue to respect social distancing.
• Keep up with screening protocols and/or adapt screening questions as the local situation continues to evolve.
• Wearing multi-layer masks is a current recommendation made by the Public Health Agency of Canada. At this point in time, this is not a requirement for dental offices to provide three-layer masks to patients while in the office prior to their appointment or after treatment.
• Dentists and dental teams are infection control experts and have always followed strict protocols and procedures to protect patients and staff. With added COVID-19 provincial guidelines, dentists are already doing everything possible to put additional levels of protection in place to create a safe environment for their patients and the dental team.
• To date, dentistry has demonstrated that dental offices can offer care safely and that infection prevention and control practices are effective, allowing oral health care provision during the pandemic. Remember to be as vigilant outside the op as you are in the op.

Advocacy

New! Bill C-9 to Extend Canada Emergency Wage Subsidy and Transition the Emergency Rent Subsidy to New Program

On November 6, 2020, Bill C-9 passed in the House of Commons, and was referred to the Senate. This bill will bring into law the announced changes to the Canada Emergency Rent Subsidy (CERS) and Canada Emergency Wage Subsidy (CEWS). If enacted, Bill C-9 would implement amendments to the Income Tax Act to extend the CEWS until June 2021 and implement the CERS, which replaces the Canada Emergency Commercial Rent Assistance Program.

CERS is a more simplified program that provides easier-to-access rent and mortgage support until June 2021. It would support businesses, charities, and non-profits that have suffered a revenue drop, by subsidizing a percentage of their expenses, on a sliding scale, up to a maximum of 65% of eligible expenses until December 19, 2020. A top-up of 25% will be available for organizations temporarily shut down by a mandatory public health order. CERS would be retroactive from September 27, 2020.

CDA is closely monitoring the situation and anticipates that the application process will become available before the end of November 2020.

Ongoing Discussions with Public Health Agency of Canada and Health Canada

CDA remains in communication with Health Canada and the Public Health Agency of Canada (PHAC) and receives regular updates from the agency. Recent topics included COVID testing and government-procured PPE.

Update! COVID-19 testing
Three types of tests remain available. No one type of test is perfect. Each test provides a specific piece of information and comes with its own limitations.

1. Reverse Transcription Polymerase Chain Reaction (RT-PRC):
   The RT-PRC test is the gold standard, and detects the presence of the COVID-19 virus RNA in the test sample. Simply put, this test breaks down pieces of the virus and amplifies parts of it to show whether the virus is present in the sample collected from the patient.

   Limitations:
   

   • RT-PRC tests are susceptible to sampling errors. For example, if a sample is taken from an area where the virus is not present (i.e. not going deep enough), this test will produce a false negative.
   • These tests do not rule out if a patient is infectious.

2. Antigen Tests:
   Antigen tests look for the presence of antigens from the virus envelope in bodily fluids (i.e. blood or saliva). Antigen tests are much less susceptible to producing false negatives since the distribution of the virus is more even in the bodily fluids.

   Limitations:
   

   • This type of test does not include an amplification step. This means that if the presence of the virus is low, the test will not detect it.
   • This type of test is not as equally sensitive throughout the course of the disease. It is much more sensitive early in the disease, compared to the later stages.
   • Some parts in the United States have experienced false positives with this type of test.

3. Antibody Tests:
   Antibody tests reflect the immunological reaction of the patient by detecting the presence of anti COVID -19 antibodies (most commonly IgG antibodies) signally that the patient was infected.

   Test results are negative early in the course of the disease and do not allow for the detection of active cases.

   IgG antibody tests become positive around 14 days after the onset of the disease, once the patient is no longer infectious. Patients who test positive for the presence of anti-COVID-19 IgG can be treated using only standard precautions, without the need for additional PPE and other COVID specific precautions.

   Limitation:
   

   • These tests do not allow the identification of the infectious status of a patient.

Currently available rapid point-of-care tests are all RT-PRC tests, all of which suffer from the limitations of these types of test. As a result, none of the available rapid point-of-care tests can determine the infective potential of a patient with any degree of certainty.

CDA will continue to monitor further updates on testing for COVID-19, and will report new updates as they become available.

Update! Personal Protective Equipment
Health Canada and the Public Health Agency of Canada continue to do work diligently to procure PPE for all sectors of the Canadian economy.

The good news is that more PPE is starting to be produced by Canadian suppliers in Canada. Although this promises a more stable supply chain as Canada moves forward in the pandemic, individuals and businesses should not be surprised by the higher costs, as Canadian production is generally more expensive.

Update! Discussions around Priority Access to COVID-19 Vaccine
In CDA’s September 19, 2020 COVID-19 update, CDA indicated that we have been pressing for the prioritization of dentists as essential health care providers. This includes highlighting the need for dentists to receive priority access to a vaccine when it becomes available and ensuring that dental offices are not closed as part of any subsequent widespread mandated closures. At that time, CDA co-signed a letter with the Extended Healthcare Providers Coalition, sent to the Prime Minister and the relevant ministers as well as the Chief Medical Officer of Health, to express our joint concerns of the potential for care to be interrupted again.

This week, the National Advisory Committee on Immunization released preliminary guidance for early immunization, which identifies what the key priority populations include. This group is an external advisory body that provides advice to the Public Health Agency of Canada (PHAC). There was no specific mention of dentists in this guidance, although it did refer broadly to health care workers. The guidance leaves open some specifics to be defined by federal/provincial/territorial discussions: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-key-populations-early-covid-19-immunization.html

Health Canada and PHAC continue to research and evaluate different types of occupations’ priority access to a vaccine. In order for dentists to be potentially considered as priority recipients, the best course of action would be to raise the profession’s profile with the provincial Health Minister, Chief Medical Office of Health, and working with the provincial Dental Director to maintain pressure on this file.

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 works together 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.

In Development: Over the last month, the Task Force has been working on developing a resource document that would offer clarification on the administration of vaccinations in the dental office. The resource will include information on training requirements, as well as a range of other key considerations.

Coming Soon! Holidays approaching. New Office Posters added to the Be Vigilant Series: Often patients and dental office staff bring food to the office to recognize special events and holidays. However, celebrating with food and beverages in common areas during the COVID-19 pandemic must be done safely to help prevent the spread of the virus.

CDA added two new posters to the “Be Vigilant Inside and Outside the Op!” series. The posters provide tips for common areas and how to safely enjoy food in a dental office setting. Discussion points are available in this package for dentists to use with their teams, and also include tips for safely hosting holiday or year-end parties by spreading cheer virtually this year.

All materials will be available in English and French, and can be used not only around the holidays, but also for other special events (i.e. staff birthdays, etc.). The final materials will be distributed to Corporate Members via CDA’s Dental Communications Group. Corporate Members can co-brand and adapt the content, as deemed appropriate.

A preview of two posters in the celebration edition of the Be Vigilant Inside and Outside the Op! series. Colours and text may vary as PDAs may adapt the materials for use by their member dentists.

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.

CDA’s Infection Control Working Group (“The 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 meets 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.

Coming soon! In collaboration with the Return to Practice Task Force, the Working Group is developing a resource regarding the use of medical gowns in dentistry. It provides a cross-reference from the medical system to the dental system, and provides generic information regarding gown use in dentistry. The document will be made available to Corporate Members, once final.

Statistics Canada Survey: Impacts of COVID-19 on Health Care Workers: Infection Prevention and Control

CDA received a notification from Statistics Canada on an upcoming survey that Corporate Members may wish to share with member dentists, as deemed appropriate.

Survey Details: From November 24 to December 13, 2020, Statistics Canada will conduct a survey with a focus on access to personal protective equipment (PPE) and infection prevention and control (IPC) measures in the workplace. Participants will also be asked about their job and personal health. It will take approximately 10 to 15 minutes to complete the questionnaire.

Any person living in Canada and working in a health care setting can participate. This includes those providing direct health care services to individuals (e.g. physicians, nurses, massage therapists, dentists, dieticians), technical support to medical staff (e.g. receptionists, technicians), or other services in a health care setting (e.g. cleaning and food services staff, security).

On November 24, go to https://www.statcan.gc.ca/COVID-IPC. From there, you can easily access the online questionnaire by selecting “Participate now” at the top of the page. You may also access the questionnaire directly at https://www.statcan.gc.ca/COVID-questionnaire-IPC.

The more Canadians participate, the clearer Statistics Canada’s picture will be of the current situation, and the better equipped to address it. Together, we can make a difference.

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. Don’t forget to check out the following discussion:

The Incidence of COVID-19 Among Canadian Dentists:
In this edition of the Canadian Association for Dental Research Roundtable, Dr. Sreenath Madathil, Dr. Walter Siqueira, and Dr. Paul Allison introduce their ongoing study into the incidence of COVID-19 in Canadian dentists. (October 29, 2020)

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

Reminder! CDA Essentials, Issue 6 is available online. Here are some of the edition’s highlights:

• Starting a Dental Career During COVID-19;
• By the Numbers: Business Recovery from the Pandemic;
• Your COVID-19 Questions Answered;
• Being Vigilant Inside and Outside the Op; and
• Investigating an Increase in Tooth Fractures During COVID-19.

Mental Health and Wellness:

Safeguard your mental health and overall wellness - especially during the COVID-19 pandemic.

Reminder: Access mental health and wellness support through CDSPI’s Members’ Assistance Program (MAP) by calling 1.844.578.4040 or visiting www.workhealthlife.com. MAP provides a variety of resources to help individuals deal with life's challenges. It is a confidential counselling, referral and information service for individuals who are dealing with mental health challenges or need advice on topics such as physical fitness, nutrition or parenting. MAP services and resources are offered through Shepell, Canada’s largest provider of Employee and Family Assistance Programs.

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:

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. As of November 2020, resources listed below and posted in the repository appear in the language it was created in. 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

• HPI Webinar: Are We at the Cusp of a Slowdown in Patient Volume? (October 30, 2020). The latest COVID-19 Economic Impact Poll data from HPI show a slight decline in patient volume and staffing levels in dental offices. Is this hinting at a coming slowdown as COVID cases rise in the U.S.?

The Organization for Safety Asepsis and Prevention (OSAP)

• COVID-19 Webinar Series offered on various dates [Nov 6, 2020 – January 8, 2021] (November 9, 2020) : Respiratory Protection Program; PPE Optimization; COVID-19 Guidance for Dental Assistants; Airborne Precautions and Ventilation; and more.

Provincial Dental Association / Regulatory Body Resources:

British Columbia Dental Association

• Masks in Dental Offices, Casting Call for Dentists, TMJ CE Webinar (November 10, 2020)
• Developing Issue: Medical Masks in Healthcare Facilities (November 6, 2020)
• Job Seekers Headed Our Way, TMJ Webinar, BCDA Award Nominations Open (November 5, 2020)
• Upcoming TMJ Webinar, Dental Assistant Enrollment Update (November 3, 2020)
• Quarantine After Travel, Advertise Dental Jobs for Free, BCDA Awards Nominations (October 29, 2020)

New Brunswick Dental Society

• President's Message (November 12, 2020)
• COVID-19 Update (November 5, 2020): Zone 5 returns to Yellow level
• COVID-19 Update (October 30, 2020)

Nova Scotia Dental Association:

• NSDA News Brief (November 9, 2020): Remembrance Day, Health Canada Advisory re GUM Paroex, CE Opportunities, Student Surveys; And More
• NSDA News Brief (October 29, 2020): MSI Children's Oral Health Program Survey, PDBNS Webinar Tonight, CE Opportunities, Student Surveys ; And More

Ontario Dental Association

• Weekly COVID-19 Update (November 11, 2020) ODA Fall/Winter Ad Campaign; Province Releases Fall 2020 Budget; Hospital-Based Dentists Get Temporary Fee Codes for Virtual Care; The New COVID-19 Framework: Yellow, Orange, and Red, Oh My!; Offers on Gowns, Masks and More
• Weekly COVID-19 Update (November 4, 2020): ODA Launches Fall/Winter Ad Campaign; Province Develops New COVID-19 Framework; Cases Rise, So Should Your Vigilance; Applications Closed for Small Business Relief Fund; and more.
• Weekly COVID-19 Update (October 28, 2020): ODA Employment Guidelines Updated; Changes to Sun Life’s Dental Claims Practices; Reducing the COVID-19 Risk in Offices; New Relief Grant for Small Businesses; and more.

Royal College of Dental Surgeons of Ontario (RCDSO)

• COVID-19 Update: Enhanced Regional Precautions (November 12, 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.