Should dentists close due to coronavirus concerns?
Postponing elective treatment while opening for emergency treatment may be best for now
by KEVIN KUO DDS, MMSc | March 15, 2020
There will be significant and rapid changes in the coming days regarding COVID-19. As a result, this article will be updated with quick successive ones. Or may even be deleted, if the coronavirus situation changes quickly. Also, check out my Instagram and Facebook accounts for more immediate stories.
There is a corresponding video commentary here.
Some background information for perspective.
Coronaviruses are a group of viruses that cause respiratory tract infections in humans. Typically, symptoms are mild, like the common cold caused by rhinoviruses. Some rare forms, such as the SARS-CoV-2, can be severe and lethal.
SARS-CoV-2 is the coronavirus we are concerned about today, giving rise to the disease called COVID-19. It causes fever, cough, shortness of breath, amongst other viral-like symptoms. Some cases can be lethal from pneumonia and multi-organ failure. This is the concern here. We have a novel virus that can be quite lethal for some population groups--particularly patients over the age of 70. To make matters worst, the community spread globally has now resulted in the World Health Organization, declaring the 2019-2020 outbreak as a pandemic. As of March 15th, there are over 150,000 cases with 5,800 deaths globally.
The virus is transmitted via respiratory droplets from coughing and sneezing. Biologically, the virus targets the lungs as they access host cells with ACE2, which is most abundant in alveolar cells in the lungs. The primary means to test for the disease is via real-time reverse transcription-PCR. Chinese scientists were able to isolate the strain of the virus and publish the genetic sequence for the rest of the world to develop testing. This can be done with swab or sputum samples.
China, the country of origin, has now surpassed its peak infection and has slowly recovered to normal, everyday life. Keep in mind the virus outbreak in China occurred on the absolute worst time as the largest event of the year looming with Chinese New Year. However, Italy, Iran, and South Korea also reported a sharp increase in cases as China started to recover towards the end of February.
On January 21st, the United States reported its first domestic case. A patient in his 30s traveled from China to the state of Washington. On January 30th, the U.S. reported the first community transmission. On February 10th, the U.S. reported 13 cases. Around the time of rapid spread in Italy, the U.S. reported 53 cases of coronavirus. On February 29, the U.S. reported its first death from the virus. On March 6th, the U.S. reported a surge in cases to 329, with 19 deaths reported in the following day.
Fast forward to March 15th, President Donald Trump of the United States declared a national emergency with over 3,400 confirmed cases and 65 deaths. The most striking aspect now is that it has become clear with several case studies that asymptomatic patients can spread the virus, a thought that was less popular just 1-2 months ago.
Right now, the United States is about to hit a sharp incline in cases this coming week. The U.S. is on a similar trajectory with Italy, thus far. We are looking at thousands of new, test-confirmed cases potentially, on the week of March 16th. To make matters worst, the U.S. has had issues with test kit availability as compared to other countries. The projections are thus likely underestimations, and the number of actually sick patients with COVID-19 will be higher.
The primary debate at the moment is whether or not to close dental offices completely.
This is undoubtedly a complicated question to answer. And I am here to give my thoughts and recommendations. First, there is no one right answer at this moment. There are likely many “correct” means to approach this growing coronavirus issue in the United States, relating to dental clinics, depending on your situation. Each geographical location in the United States is different with unique problems and needs. It is unlikely the federal government will enforce any sort of blanket policy towards all dental offices. Likely each state government and state dental society will have to offer more specific recommendations and guidelines to their respective communities. And even then, there will unlikely be any mandate of complete closure. Dentists are in healthcare. It will be improbable that any sort of governing agency will enforce wide-scale, complete dental clinic closures. Lastly, these pandemic situations change rapidly. So each decision needs to be re-evaluated and altered as we go.
With that said, out of the many potential solutions out there, closing your dental office completely is not the best idea for the community as a whole at this moment.
Many will ask: what about the many events and restaurant closures? Any social gathering of more than 50 people should be banned, according to the CDC. Governments are asking us to practice social distancing. Dentistry creates aerosols. Few dentists have N95 masks. Why should we not close? The difference is that our role in our community can still be an urgent need despite the global spread of the virus. Yes, we are not medical doctors directly involved with viral patient care. However, dentistry is also not in the food industry where it can be seen as non-essential services. There is a reason that pharmacies and grocery stores are still open.
Let us now review the role of the dentist in the community. We are healthcare providers. Although much of what we do are in fact elective, there are still several occasions where dentists are involved in emergency care. It is a known fact that dental-related ER visits at hospitals are on the rise. Yes, most of those patients do not have regular dental care and do not have dental insurance. But overall, dentists are absolutely crucial in serving the community to alleviate emergency dental problems, such as pain and infections. Complete closure of dental offices will likely give rise in many urgent dental patients into hospitals, where they are already slammed dealing with the coronavirus. The community still needs dentists, like you!
Instead, my recommendation is to keep the doors open a reduced capacity but significantly reduce patient load and postpone elective care if you are at a higher-risk location.
The solution does not have to be all or none. And again, depending on your location, keeping your schedule regular for now may be reasonable. Now, if your office happens to never receive emergency dental patients, closing completely would make more sense. But for the rest of us, particularly endodontics, emergency dental care is common. We should still be open somewhat.
UPDATE: As of this evening, a few state dental societies, like Virginia and Massachusetts, have echoed these same recommendations. Elective treatment should be postponed. But, dentists should still, be available for emergencies!
