Letter from ADAA - March 2020

ADAA Statement on Infection Control - April 2020

ADAA Statement on Mitigating the Spread of COVID-19 - April 2020

ADAA Statement on Re-opening of Dental Facilities - May 2020

ADAA's Letter to the CDC about Reopening Dental Offices - May 2020

ADAA's Mandatory Infection Control Call to Action - June 2020

ADAA's Sample Letter to Legislators about the Mandatory Infection Control Call to Action - June 2020

ADAA's Letter to OSHA regarding Alternative PPE Combinations - June 2020

 

Quick Links

How COVID-19 Spreads How You Can Protect Yourself Environmental Cleaning When to Contact Occupational Health Services
Workplace Safety Wages, Hours and Leave Unemployment Insurance Flexibilities General Resources

 

 

What Healthcare Personnel Should Know about the COVID-19 Infection

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-bustersHealthcare personnel (HCP) are on the front lines of caring for patients with confirmed or possible infection with coronavirus disease 2019 (COVID-19) and therefore have an increased risk of exposure to this virus. HCPs can minimize their risk of exposure when caring for confirmed or possible COVID-19 patients by following Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings and the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.

How COVID-19 Spreads

There is much to learn about the newly emerged COVID-19, including how and how easily it spreads. Based on what is currently known about COVID-19 and what is known about other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts.

Close contact can occur while caring for a patient, including:

  • being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time.
  • having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets.

If close contact occurs while not wearing all recommended PPE, healthcare personnel may be at risk of infection.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-bustersHow You Can Protect Yourself

Healthcare personnel caring for patients with confirmed or possible COVID-19 should adhere to CDC recommendations for infection prevention and control (IPC):

  • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and placing them in an examination room with the door closed.
  • Use Standard and Transmission-Based Precautions when caring for patients with confirmed or possible COVID-19.
  • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.
  • Practice how to properly in a manner to prevent self-contamination.
  • Perform aerosol-generating procedures, in an AIIR, while following appropriate IPC practices, including use of appropriate PPE.


https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-bustersEnvironmental Cleaning and Disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed. Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2. Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.

When to Contact Occupational Health Services

If you have an unprotected exposure (i.e., not wearing recommended PPE) to a confirmed or possible COVID-19 patient, contact your supervisor or occupational health immediately.

If you develop symptoms consistent with COVID-19 (fever, cough, or difficulty breathing), do not report to work. Contact your occupational health services.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-bustersFor more information for healthcare personnel, visit: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

The U.S. Department of Labor has resources to help workers and employers prepare for the COVID-19 virus (also known as novel coronavirus).1

Workplace Safety

The Occupational Safety and Health Administration (OSHA) has resources to help employers and workers prepare for and respond to coronavirus in the workplace.


https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-bustersWages, Hours and Leave

The Wage and Hour Division is providing information on common issues employers and workers face when responding to COVID-19, including the effects on wages and hours worked under the Fair Labor Standards Act and job-protected leave under the Family and Medical Leave Act.

On Thursday, April 2, 2020, the Department of Labor (DOL) issued temporary regulations, effective immediately, implementing and interpreting the paid sick leave and emergency family leave provisions of the Families First Coronvirus Response Act (FFCRA). Key provisions include:

  • The rule explains the steps a small business must take to qualify for the small business exception (i.e., < 50 employees).
  • Paid sick leave and/or EFMLA is not available if the employer does not have work available for the employee, whether as a result of a quarantine order or other circumstances.
  • An employee has no right to the payment of unused emergency paid sick leave upon termination or separation from employment, or upon the expiration of the FFCRA, nor may an employee take more than a total of 80 hours of paid sick leave, even if he/she works for more than one employer.
  • Emergency Family and Medical Leave Act (EFMLA) and paid sick leave (if teleworking or caring for a child whose school has been closed) may be taken intermittently, but only upon the agreement of the employer and employee.

To see the regulations in their entirety, click hereThe regulations begin at page 83.


Unemployment Insurance Flexibilities
NOTE: Check with your state’s unemployment insurance program regarding the rules in your state.

The Employment and Training Administration announced new guidance outlining state flexibilities in administering their unemployment insurance programs to assist Americans affected by the COVID-19 outbreak.

Under the guidance, federal law permits significant flexibility for states to amend their laws to provide unemployment insurance benefits in multiple scenarios related to COVID-19. For example, federal law allows states to pay benefits where:

  • https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-bustersAn employer temporarily ceases operations due to COVID-19, preventing employees from coming to work;
  • An individual is quarantined with the expectation of returning to work after the quarantine is over; and
  • An individual leaves employment due to a risk of exposure or infection or to care for a family member.

In addition, federal law does not require an employee to quit in order to receive benefits due to the impact of COVID-19.

General Resources

- For further information about coronavirus, please visit the Centers for Disease Control and Prevention’s coronavirus website.

- For a listing of the state departments of health, click here.

- Learn what the U.S. government is doing in response to coronavirus at www.usa.gov/coronavirus (en Español: gobierno.usa.gov/coronavirus).2

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters- The World Health Organization (WHO) is tracking the spread of Coronavirus and is providing many other resources at https://www.who.int/emergencies/diseases/novel-coronavirus-2019.

- The latest official information from the Coronavirus (COVID-19) Task Force at the White House can be found at https://www.coronavirus.gov/.

- The American Dental Association has created a Coronavirus Center for Dentists at https://success.ada.org/en/practice-management/patients/~/link.aspx?_id=6C881EF4A7884989A80BA475F9A116ED&_z=z.

- OSAP has also created an index of credible sources at https://www.osap.org/page/COVID-19#Practice.

- The National Institutes of Health (NIH) has included several resources at https://www.nih.gov/health-information/coronavirus.

- The CDC issued guidance on optimizing supplies of N95 respirators when supplies are running low.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters- Download the Crosstex guide to face mask selection and use from their website.

Check the EPA “List N” of disinfectants effective against coronavirus

- An aluminum foil test is a method to evaluate the general cleaning intensity and soundwave coverage throughout the tank. L&R Manufacturing describes how to perform the test on their website.

- ProEdge provides a Video Tutorial and Protocol download on How to Shock Waterlines on their website.

CDC Guidance for Providing Dental Care During COVID-19​

A NIH Study Validates Decontamination Methods For Re-Use of N95 Respirators

ADA's Interim Mask and Face Shields Guidelines

ADA's Understanding Mask Types

ADA COVID-19 State Mandates and Recommendations

CDC COVID-19 Symptoms

FDA Coronavirus Update (April 27, 2020)

OSHA Recommendations for Dental Workers and Employees


- FDA Update.  Yesterday, the FDA issued warning letters to companies selling fraudulent COVID-19 products, and it was reported that the FDA has pulled nearly 60 emergency use authorizations (EUAs) on products, including masks.  I can’t find the link to that last statement, but I did find a link to where the FDA sent 42 warning letters to manufacturers.  
 
- How to identify fake products.  This morning, the ADA News has a story about how to identify counterfeit N95 masks, and given reports of unapproved masks that seem to be showing up and concerns by everyone that they are getting the real thing as they re-open their practices, I thought this was a very important communication to share with all of you.  Below is information straight from the National Personal Protective Technology Laboratory (NPPTL), part of the National Institute for Occupational Safety and Health (NIOSH):
 
Counterfeit respirators are products that are falsely marketed and sold as being NIOSH-approved and may not be capable of providing appropriate respiratory protection to workers.
When NIOSH becomes aware of counterfeit respirators or those misrepresenting NIOSH approval on the market, we will post them here to alert users, purchasers, and manufacturers.
How to identify a NIOSH-approved respirator:
NIOSH-approved respirators have an approval label on or within the packaging of the respirator (i.e. on the box itself and/or within the users’ instructions). Additionally, an abbreviated approval is on the FFR itself. You can verify the approval number on the NIOSH Certified Equipment List (CEL) or the NIOSH Trusted-Source page to determine if the respirator has been approved by NIOSH. NIOSH-approved FFRs will always have one the following designations: N95, N99, N100, R95, R99, R100, P95, P99, P100.
Signs that a respirator may be counterfeit:
•    No markings at all on the filtering facepiece respirator
•    No approval (TC) number on filtering facepiece respirator or headband
•    No NIOSH markings
•    NIOSH spelled incorrectly
•    Presence of decorative fabric or other decorative add-ons (e.g., sequins)
•    Claims for the of approval for children (NIOSH does not approve any type of respiratory protection for children)
•    Filtering facepiece respirator has ear loops instead of headbands

- The FDA amended their EUA for saliva testing and has approved the first at-home saliva collection test.  Below is an excerpt of the news brief:

The U.S. Food and Drug Administration (FDA) has approved the first at-home saliva collection test for COVID-19, which people could use to sample their own saliva and send it into a lab for results.

Developed by RUCDR Infinite Biologics, a biorepository based at Rutgers University in New Jersey, the test received "amended emergency use authorization" from the FDA late on May 7, according to a statement from the university. In April, the lab received emergency use authorization for their saliva collection method, which allowed health care workers to begin testing New Jersey residents at select sites throughout the state, The New York Times reported April 29. 


- Steps you can continue to take to reduce the spread of COVID-19:

• Health care professionals can take steps to protect themselves at work and at home. Older people and people with serious chronic medical conditions are at higher risk for complications.

• Follow the policies and procedures of your agency/organization related to illness, cleaning and disinfecting, and work meetings and travel.

• Stay home if you are sick, except to get medical care. Learn what to do if you are sick.

• Inform your supervisor if you have a sick family member at home with COVID-19. Learn what to do if someone in your house is sick.

• Wash your hands often with soap and water for at least 20 seconds. Use hand sanitizer with at least 60% alcohol if soap and water are not available.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash and immediately wash hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer containing at least 60% alcohol. Learn more about coughing and sneezing etiquette on the CDC website.

• Clean AND disinfect frequently touched objects and surfaces such as workstations, keyboards, telephones, handrails, and doorknobs. Dirty surfaces can be cleaned with soap and water prior to disinfection. To disinfect, use products that meet EPA’s criteria for use against SARS-CoV-2, the cause of COVID-19, and are appropriate for the surface.

• Avoid using colleagues’ phones, desks, offices, or other work tools and equipment, when possible. If necessary, clean and disinfect them before and after use.

• Practice social distancing by avoiding large gatherings and maintaining distance (approximately 6 feet or 2 meters) from others when possible.

• Please go to www.cdc.gov/coronavirus/ for the latest information about how to protect yourself or what to do if you think you are sick. 


- ADA asks the CDC to update its guidance to address how to protect dental personnel returning to work during the deceleration phase of COVID-19.

- NIOSH-Approved N95 Particulate Filtering Facepiece Respirators 

Considerations for Purchasing Respirators from Other Countries including KN95s from China

Decontamination and Reuse of Filtering Facepiece Respirators

- Factors to Consider when Planning to Purchase Respirators from Another Country, Including KN95 Respirators from China

NIOSH Assessments of International Respirators

Personal Protective Equipment (PPE) Burn Rate Calculator

Strategies to Optimize the Supply of PPE and Equipment 

Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic

Public Service Announcement from Federal Bureau of Investigation

- Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019

- Framework for Provision of non-COVID-19 Health Care During the COVID-19 Pandemic from the Centers for Disease Control and Prevention

Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission

COVID-19 Contact Tracing Training:  Guidance, Resources and Sample Training Plan

Operational Considerations for Containing COVID-19 in non-US Healthcare Settings

Food and Drug Administration (FDA) Authorizes First Standalone At-Home Sample Collection Kit

FDA Informs Public About Possible Accuracy Concerns with Abbot ID NOW Point-of-Care Test

NIOSH-Approved N95 Particulate Filtering Facepiece Respirators 

Considerations for Purchasing Respirators from Other Countries including KN95s from China 

Decontamination and Reuse of Filtering Facepiece Respirators 

NIOSH Assessments of International Respirators

Personal Protective Equipment (PPE) Burn Rate Calculator 

Strategies to Optimize the Supply of PPE and Equipment 

Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic 

ICD-10 Coding for COVID-19           

Face Masks and Surgical Masks for COVID-19

- Factors to Consider When Planning to Purchase Respirators from Another Country

- Battelle Critical Care Decontamination System

Food and Drug Administration (FDA) Emergency Use Authorizations page

Interim Guidance for Dentist Anesthesiologists Practicing In the Office-Based Setting During the COVID-19 Pandemic

American Dental Association Survey of Dental Practices

An Early Look at the Reopening of Dentistry:  What the Economic Data Tell Us (ADA Webinar May 2020)

Update from the International Association for Dental Research (IADR)

American Dental Hygienists Association:  Interim Guidance on Returning to Work

American Dental Association interactive COVID-19 reopening state-by-state map

Occupational Safety and Health Administration Guidance for Dentistry Workers and Employers

Occupational Safety and Health Administration (OSHA) occupational exposure risk pyramid

National Dental Association White Paper:  The Benefits of Preoperational Oral Rinsing during and after the Novel Coronavirus Pandemic

Centers for Disease Control and Prevention (CDC) Division of Oral Health Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response

American Dental Association Return to Work Interim Guidance Toolkit

Cochrane Oral Health:  Recommendations for the Re-Opening of Dental Services

Academy of General Dentistry (AGD) Return to Work Guidance

DentaQuest Fast-Track to Tele-dentistry

- Provider Relief Disbursements: For the past few months, HHS has moved at an unprecedented pace to distribute funds to support our healthcare providers who have been financially hit by the global COVID-19 pandemic through the HHS Provider Relief Fund.  You can view a high-level distribution summary here.

- COVID-19 Testing in Nursing Homes:  Over the weekend, CDC released revised and consolidated testing guidelines for seniors and staff in nursing homes, one of our most vulnerable populations. 

- FDA Pulls EUA on Drugs:  As the media has covered extensively yesterday, the FDA revoked the EUA for chloroquine and hydroxychloroquine.

- Signage to Prepare Your Practice for COVID-19: CDC updated Prepare to Care for COVID-19, a resource with practical tools clinicians can use to care for patients with COVID-19, and will be regularly updated to help clinicians adapt as the outbreak unfolds. It also includes outdoor and indoor signs. 

- PPE Burn Rate Calculator: CDC posted a PPE Burn Rate Calculator video on how to use the spreadsheet-based model that will help healthcare facilities plan and optimize the use of PPE for response to coronavirus disease 2019 (COVID-19).

- Considerations for Events and Gatherings: As some communities in the United States begin to plan and hold events and gatherings, the CDC offers considerations for enhancing protection of individuals and communities and preventing spread of COVID-19. Event planners and officials can determine, in collaboration with state and local health officials, whether and how to implement these considerations, making adjustments to meet the unique needs and circumstances of the local community.

- Staffing Resources: CDC updated guidance and resources for state, tribal, local, and territorial health departments on staffing the public health workforce.

- MMWR on COVID-19 Case Surveillance: CDC released an MMWR on surveillance data reported through April 2020 that indicated that COVID-19 leads to severe outcomes in older adults and those with underlying health conditions. As of May 30, 2020, among COVID-19 cases, the most common underlying health conditions were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.

- Platform to Harness Nationwide COVID-19 Patient Data to Speed Treatments: NIH launched a centralized, secure enclave to store and study vast amounts of medical record data from people diagnosed with COVID-19 across the country. It is part of an effort, called the National COVID Cohort Collaborative (N3C), to  help scientists analyze these data to understand the disease and develop treatments. This effort aims to transform clinical information into knowledge urgently needed to study COVID-19, including health risk factors that indicate better or worse outcomes of the disease, and identify potentially effective treatments. The N3C is funded by the National Center for Advancing Translational Sciences (NCATS), part of NIH. The initiative will create an analytics platform to systematically collect clinical, laboratory and diagnostic data from health care provider organizations nationwide. It will then harmonize the aggregated information into a standard format and make it available rapidly for researchers and health care providers to accelerate COVID-19 research and provide information that may improve clinical care. A demonstration of the platform can be viewed at ncats.nih.gov/n3c.

- ADAA recently received a communication from the President of the American Association of Dental Boards (AADB), the association representing dental boards across the country.  It read, in part,

Dear Members and Associates,

The American Association of Dental Boards encourages everyone to practice social distancing.  As health care professionals, the dental community must not only follow all directives from the White House Task Force, CDC, USPHS, National Institute of Allergy and Epidemiology, etc. but also be exemplary. The edicts pertaining to emergent care must be adhered to in order to minimize the spread of the Covid-19 virus. Anyone who ignores these guidelines negates the sacrifices by other practices who are doing their part to "flatten the curve".  Those who ignore these efforts not only unnecessarily endanger themselves and their staff, but more importantly endanger the entire community.  As a Nation, we must all do our part.

To protect our professionals on the front lines, the public, and promote social distancing, we encourage the use of Teledentistry as much as possible to minimize exposure.  Additionally, in conjunction with digital means, employing Immediate Vicinity Access to Care (IVAC) will better minimize risks.For example, patients may be triaged in parking areas, curbside, sidewalks, etc. in order to decrease the number of patients that actually enter the practice facility.  Some may only need prescriptions to delay treatment to a future date, emergency cases that need hands-on care could be filtered through the IVAC buffer.  We at the AADB encourage any suggestions from the dental community that would help improve our struggle with the Covid-19 virus to share them with the AADB Central Office.

In an effort to protect the public, we are offering a means to report alleged violations.

Reporting to this group may be done by clicking here