Pandemics In A Connected World

Pandemics are not new. But the world in which they exist is.

We live in an interconnected global society where we — and the diseases we carry — can jet around the world in hours. In the 1970s, most dentists had a caviler attitude toward pandemics, since anything transmitted in the office could be cured with antibiotics or antivirals. Human immunodeficiency virus changed all that. For the first time, we were faced with a bloodborne disease that was widespread, initially difficult to diagnosis, and deadly if acquired. Many dentists were appalled they were required to wear gloves and masks. How things have changed!

At one time, most disease outbreaks were easily isolated — but thanks to the pace of international trade and travel, that is no longer the case. As a result, we have seen a parade of diseases from Middle East Respiratory Syndrome to the 2019 novel coronavirus spread around the world in record time.

Unfortunately, pandemics are here to stay and will continue to affect how we practice. While a well-coordinated national plan for handling the current — as well as any future — pandemic would be helpful, it has yet to materialize. In the interim, we are seeing major changes in regulations. As more information becomes available about COVID-19, the Occupational Safety and Health Administration will provide a new set of requirements — hopefully that agree with the U.S. Centers for Disease Control and Prevention and are not changed weekly. Expect them to be more stringent and with greater penalties for noncompliance. Many will be permanent.

THE NEXT PANDEMIC IS NOT FAR OFF, SO PLAN ACCORDINGLY

The current regulations mandate significant physical and procedural changes for almost every office. Production, containment and elimination of aerosols are significant issues. To reduce aerosols, you need to isolate patients. This will require significant structural changes in many practices, as we move away from the open bay concept. Negative airflow in operatories can have a major effect on aerosol reduction, so do not be surprised if it is mandated.

In most offices, the number of patients will remain at reduced levels until the pandemic is over; at the same time, requirements for staff training have increased. All of the changes required to treat patients safely have put tremendous economic pressures on dental practices.

Eventually, this pandemic will pass. The U.S. Food and Drug Administration has said it will accept a vaccine that has 50% efficacy, but expect problems with development as vaccine testing continues. Adjunct drugs (think monoclonal antibodies) and other approaches will reduce mortality, but long after this pandemic ends, its effects will linger. Even if a vaccine proves effective, it may be well into 2021 before this has a significant effect on dental practice. In the meantime, clinicians need to develop plans for permanent office and staff reconfigurations, as well as strategies for dealing with those who refuse to be vaccinated. As we navigate the COVID crisis, we must stay current on new information to keep our patients, staff and ourselves as safe as possible.

Remember, the next pandemic is not far off, so plan accordingly.

Thomas G. Wilson Jr., DDS
Editor in Chief
twilson@belmontpublications.com

From Decisions in Dentistry.September 2020;6(8):6.