Seemingly within days, the novel coronavirus, or COVID-19, has significantly impacted daily life all around the world. All 50 states have reported cases of COVID-19 to the Centers for Disease Control and Prevention (CDC).1 As small businesses began to close their doors, and individual states mandated levels of social isolation, dental professionals found themselves in a tenuous position, forced to consider the implications of their personal responses (and the actions of their employers).
Social media posts about this topic abound, and hygienists have been sharing various protocols that were implemented by employers when presented with the prospect of ceasing nonelective care. The outcome is mass confusion; responses range from doctors closing for the foreseeable future (and compensating employees until it isn’t economically feasible) to remaining open until it is no longer legal.
To work or not to work?
Clinicians who rely on their employers may be in a sticky position in which they must act in accordance with their personal conscience, even when they are in opposition to an employer’s wishes. It’s imperative to consider all recommended guidelines and acknowledge that our actions are going to be interpreted by the public that we serve. When we choose whether to work during the COVID-19 outbreak, we are essentially sending a message about our social responsibility as health professionals to the public and the level of urgency and sensitivity that we have toward this matter. This can be difficult to navigate when our feelings are in direct opposition to our employers’. Reducing both the rate and impact of disease spread is the primary goal of social isolation.
The recommendations
About a week ago, many dental hygienists began to share screenshots of a few essential pieces of information: The Occupational Health and Safety Administration’s (OSHA’s) guidelines for health professionals, the American Dental Association’s (ADA’s) statement on COVID-19, and literature about projected disease spread in the weeks to come. I will examine each of these topics and their implications for the dental hygiene profession.
Dentistry is considered a “high-risk” occupation by OSHA and falls under “health-care personnel” in a new document titled “Guidance on Preparing Workplaces for COVID-19.”2 As a modification to our regular personal protective equipment (PPE), OSHA recommends that “those who work closely with (either in contact with or within 6 feet of) patients known to be, or suspected of being, infected with SARS-CoV-2, the virus that causes COVID-19, should wear respirators.”2 To clarify, N-95 respirators differ from the loose-fitting, disposable level-3 masks that are recommended for routine patient care. N-95 respirators “are designed to form a seal around the nose and mouth. They are tested for fluid resistance, filtration efficiency (particulate filtration efficiency and bacterial filtration efficiency), flammability and biocompatibility.”3 If an employer fails to provide the proper personal protective equipment, this is an OSHA violation.
On March 16, 2020, the American Dental Association (ADA) issued a statement that “the ADA is deeply concerned for the health and well-being of the public and the dental team. For dentistry to do its part to mitigate the spread of COVID-19, the ADA recommends dentists nationwide postpone elective procedures for the next three weeks. Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.”4 I have heard from many colleagues that their malpractice insurers have made it clear that their coverage would lapse for nonemergency care provided during the COVID-19 pandemic.
Professionals are concerned about projections for disease spread, and they are doubly stressed about the idea of contracting the coronavirus and spreading it to others. The CDC states that “COVID-19 is a new disease and we are still learning how it spreads, the severity of illness it causes, and to what extent it may spread in the United States… The United States nationally is in the initiation phase of the pandemic. States in which community spread is occurring are in the acceleration phase. The duration and severity of each pandemic phase can vary depending on the characteristics of the virus and the public health response.”1 It’s clear from the CDC’s information that we still have much to learn about how severely this virus will impact our daily lives for the foreseeable future.
OSHA states that “guidance is not a standard or regulation, and it creates no new legal obligations. It contains recommendations as well as descriptions of mandatory safety and health standards.”2 The ADA can encourage dental professionals to follow certain guidelines, and the CDC can still caution people about the danger of not fully understanding the novel coronavirus. Many associations that exist to protect dental professionals lack the power to mandate the practice of dentistry. This places employers in a unique position in which they can either choose to follow recommendations in good conscience or remain open because they are not legally mandated to close. Legal guidelines vary by state but are trending toward mandatory closures for nonemergency care.
An ethical dilemma
Employer responses to the coronavirus pandemic vary. Some clinicians may work for a practice that will be closed indefinitely for safety reasons. Others may work for a government agency that will provide proper PPE and follow guidelines to continue care. Dental hygiene, however important, is still considered nonemergency care, and depending on the comfort level of the clinician and the employer’s actions, most hygienists will find themselves in a position of either being without work or choosing not to work for an indefinite time. Ceasing to work can be an ethical dilemma between clinician and employer, and the clinician should follow their ethical code and act in a way that upholds the interest of the general public and their license.
The shape of dentistry to come
During the COVID-19 outbreak, clinicians may find themselves in a position where they want to explore other avenues of preventive practice. Ultimately, as professionals who guide patients toward better health, we are all accountable for our responses to this public health crisis. Some dental hygienists have expressed that they may research other career options, while others are already feeling a void when faced with the prospect of not seeing patients. If you are unable to interact with patients in real time, it is likely that there will be a period of adjustment to a newer daily pace. Dental hygiene practice exists as a great passion for many of us, and it may be helpful to explore how we can still send messages to the general public about the best ways to maintain optimum oral health and maintain career satisfaction.
What will the dental hygiene professional look like and represent during an unpredictable pandemic? In the absence of a clinical workweek, in what creative and self-directed ways can dental hygienists still thrive in this profession? Will states respond to this pandemic by drafting policies that allow hygienists to utilize a more diverse skill set from home? Oral hygiene instruction and a desire for bettering the lives of others can be primary motivations for hygienists to remain passionate during this time. We can still exist as a resource for those whom we know, and we can exercise our knowledge as prevention specialists in daily life.
References
1. How coronavirus spreads. Centers for Disease Control and Prevention. Reviewed March 4, 2020. Accessed March 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html
2. Guidance on Preparing Workplaces for COVID-19. Occupational Safety and Health Administration. March 2020. Accessed March 23, 2020. https://www.osha.gov/Publications/OSHA3990.pdf
3. N95 respirators and surgical masks (face masks). US Food and Drug Administration. March 11, 2020. Accessed March 23, 2020. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks
4. ADA recommending dentists postpone elective procedures. American Dental Association. March 16, 2020. Accessed March 23, 2020. https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-recommending-dentists-postpone-elective-procedures
