A post-pandemic future

 Image of Dr. Gehani
There is no playbook for a pandemic.

The global COVID-19 crisis is unlike anything we have seen in our lifetimes. There are very few, if any, practical models for us to follow.

Now, more than ever, each of us is acutely attuned to the plight of our neighbors and communities.

To the families, businesses, and economies in distress.

To the hospitals that have been buckling under the weight of increased numbers of critically ill patients, with bed space and personal protective equipment (PPE) at a premium.

To the essential workers in health care, grocery stores, mail and package delivery services, and other industries who cannot work from a social distance.

But we are most intimately familiar with the pandemic’s impact on dentistry.

Our profession is essential to public health, well-versed in universal precautions, and trained for such a time as this. So when the ADA issued its March 16 recommendation for dentists to focus only on urgent and emergency procedures, it was not to imply that dentists were of ancillary or diminished status. In fact, dentistry has played a key role in managing our nation’s evolving health threat — we have been doing our part to help flatten the curve.

When the pandemic is long behind us, “flatten the curve” is a phrase we are likely to remember — as in, mitigating the spread of COVID-19 through social distancing and other measures to keep too many people from getting sick at one time, lest the surge of patients place a deleterious burden on hospital resources.
The postponement of non-emergency dental treatment has helped to conserve necessary PPE for our medical colleagues caring for patients with a new, highly contagious disease. The ADA’s recommendation also sought to reduce the number of patients going to emergency rooms with severe dental pain, which would further tax hospital resources. There are two million of these types of visits each year.

For dentistry’s part, the ADA aimed to ensure that patients who needed urgent or emergency care during the pandemic wouldn’t go without it. Yet, to say that it’s been a difficult time for dentists is to describe the circumstances mildly. Certainly, we recognize the plight of our communities and our medical colleagues. But it’s natural to ask, “What about us? What about me?”

Perhaps you closed your office in agreement with the ADA’s recommendation. Or maybe you closed it begrudgingly. Maybe you did not close it at all. Your anxieties may have been flaring with these concerns: Will my practice survive this closure? When can I go back to work? How will my staff and I get back on our feet? Will my patients come back? How far has this set me back on my student loans? My practice loans? The household bills? My retirement plans? I hear the tremor in your voices when you call me. I read the anguish between the lines of the letters you write. You want to know what your Association is doing for you.

Sure, I can point you to the ADA’s resources, digital events, and ongoing communications. I can tell you that the ADA has been lobbying on your behalf on Capitol Hill. I can tell you that ADA leaders and staff have been working long hours and giving their best to help dentists through their challenges.

But in these times, our organization is ultimately beholden to something greater: an implicit human contract to look out for you in times of need and to help you do good and do well.

We are upholding this commitment as dentists look ahead to a recovery phase.

On March 19, California was the first to issue a statewide stay-at-home order in an effort to slow the spread of COVID-19, and most U.S. states soon followed suit. In recent weeks, the curve has begun to flatten in the crisis’ initial hotspots, and decreases in confirmed infections and COVID-related deaths have signaled that in the absence of a playbook, some of the right moves have been made.

National, state, and local governments have started to assess what it would take to re-open our communities. With this, many Americans—including dentists—are ready to go back to work.

Although the ADA extended its postponement recommendation to April 30th, we recognized that some cities and states may move to re-open earlier. Government mandates supersede the ADA’s recommendations, and dental offices may soon return to normal operations.

Even the use of the word “normal” bears some debate in light of a novel, potentially lethal disease for which there is no vaccine, reliable treatment, or proven prophylactic.

This will not be a return to business as usual as it existed two or three months ago. We will be entering a very different world than the one we left behind in March. Dentists need to prepare themselves for the new world and protect themselves (along with patients and staff) while working within it.

The ADA has its eye on dentistry’s post-pandemic future. We want to help dentists rebuild and return prudently to caring for patients in this new normal.

The newly appointed Task Force on Dental Practice Recovery, which is comprised of practicing dentists and informed by the counsel of ADA team experts, is charged with overseeing the Association’s efforts in the area. To date, the group’s work has yielded interim guidelines on PPE (issued by the ADA on April 18), particularly masks and face shields. The guidelines are among the many practical resources in a newly developed Return to Work Interim Guidance Toolkit.

In light of PPE shortages around the country (and the utter necessity of PPE for adequate infection control in dental practice), the task force and Association staff are also connecting with manufacturers and suppliers to help increase dentists’ access to PPE.

The ADA has also petitioned the U.S. Department of Health and Human Services asking for federal guidance that enables dentists to administer point-of-care COVID-19 tests in their offices, given that many people who are infected with the disease may be asymptomatic.

There is much, much more to come.

But the journey to recovery, just as with our current crisis, will be a fluid one — many unknowns remain about the novel coronavirus and the disease it causes.

However, one outcome of crisis is creation. After the 1918 flu pandemic and during the HIV/AIDS crisis decades ago, our profession improved its technologies and infection controls. In the face of this twenty-first century challenge, we can be assured by our track record.

There’s no telling just how long the long run will be. For now, we are doing the best we know to do, and as we learn more, we will adapt.

There may be no playbook for a pandemic, but the ADA has not been without strategy. As you think through the whens, whys, and hows of your existing challenges and future plans, the American Dental Association is also thinking of you.

I’ll leave with you a message I recently shared with ADA volunteers: Our community is in it together as we navigate these trying times. As dental practices reopen their doors and our colleagues get back on their feet, we will be in it together still.