Monday, March 30, 2020

A Nifty DIY Respirator that has the Potential to Provide Better Filtration than N-95

     

 


One of the things I truly love about dentistry is the passion that many of us feel for the profession.  This morning's post is going to go right along with that sentiment.  As we all know, the big news story of the last month has been the novel Corona  Virus with can lead to Covid-19.

The virus originated in the province of Wuhan, China and then rapidly spread across borders, demonstrating how amazingly contagious the virus is.  As it initially began to infect people in China, doctors, public health officials, and epidemiologists tried to get a handle on how the virus managed to spread so rapidly and efficiently.

A virus has always been trickier to deal with than a bacterium for a variety of reasons.  We won't get into all of those here today, however I would like to detail ONE trait that a lot of folks  outside  of medical realms are unaware of.  A virus (or viral particle) is *tiny* compared to a true bacteria.  Due to their size, they can frequently get through filtration mediums that stop other infectious agents in their tracks.

In many practices of medicine, dentistry included, a surgical mask is part of the everyday PPE (Personal Protective Equipment) that practitioners wear.  The surgical mask is a 2 way street.  It not only protects the healthcare worker from receiving infectious particles from the patient, but it also prevents the patient from receiving infectious particles from the healthcare worker.

It's also the same story for gloves.  Studies that had been done back in the times when dental professionals worked without gloves found that bacteria from the mouths of patients seen on Monday could be cultured from under the fingernails of workers on Friday afternoon.  Basically that meant that every patient seen for a week left their bacteria on the dentist's hands and therefore into the patient's mouth.  Scary right?

But for this discussion we're going to concentrate of the mask.  Recent studies of the Novel Corona Virus show it to be somewhere between 140 nanometers and 60 nanometers in size while the average size of bacteria is around 300 nanometers.  Surgical masks usually filter to about 100 nanometers while N-95 respirators filter to 30 nanometers.

Surgical masks are designed to cover the moth and nose loosely but are not sized for individual fit.  However, N-95 Respirators are designed to fit the wearer closely.

As the Covid-19 pandemic has progressed we, in healthcare, have seen an incredible shortage of N-95 masks as there is a scramble to protect healthcare workers from becoming infected and potentially passing the virus along to other patients and healthcare providers.

Now one of my pet peeves, as many of you know, is that when someone asks why we do something a certain way, the answer is "because we've always done it that way."  That's just a plain lousy answer.  So the question I've been asking the past week or 2 is "why do we always buy masks from distributors" and the answer is... you guessed it.

Then I came across a small website called www.firedbycorona.com  This website was put together by Dr. Mark Causey who is an orthodontist in Georgia.  Dr. Causey is a forward thinking guy and uses a 3D printer in his office.  His idea was, rather than buy N-95 masks and then throw them away, why not print a N-95 framework that you could theoretically use for years and simply replace the filtration when it was no longer working.  Genius!  Dr. Causey even designed the framework, saved it in an stl file, and made it available *for free* on his website.

His thought process is that if everyone that has a 3D printer started to produce these frameworks, we might very well cut the N-95 mask shortage.  His website goes through the entire process of creating a N-95 mask from a printed frame and readily available HEPA filters.

Since discovering this website, I've been printing these mask substructures pretty much non-stop on my Ender-3 printer in my home.

We are now creating masks that help prevent the spread of the Novel Corona Virus while also keeping masks out of the landfill.

I'll be doing more posts on this fascinating subject in the next few days.  I'm proud of Dr. Causey for his hard work and outside the box thinking.



Friday, March 27, 2020

More Information from the Academy of General Dentistry

AGD Special Alert
Special AGD Update: COVID-19 Relief and Resources
Dear Member,
 
I hope this note finds you safe. These are trying times for us as general dentists but also as family and community members. Our profession and the world around us are changing so rapidly. I encourage you to continue to connect with your AGD colleagues. We are all in this together, and we will get through this together. 

Today I want to remind you that AGD remains available to support you during this tumultuous time. Here are a few updates:

Economic Relief Legislation
The economic stimulus legislation being finalized in Congress will serve as a lifeline for most dental practices. Our team has broken down some highlights to help you understand how to access the financial relief opportunities. We are also monitoring the U.S. Small Business Administration for loan opportunities that might be beneficial to members. We ask that you watch for AGD requests to communicate with legislators to ensure that the needs of general dentists are not forgotten. 
 
Center for Disease Control Guidelines Updated
The CDC has released Interim Infection Prevention and Control Guidance for Dental Settings during COVID-19 Response. Check out the update.
 
AGD Webinar Series: Staying Connected During COVID-19 
We are launching a free webinar series to help answer questions about how COVID-19 is impacting general dentists. All programs are scheduled from 7:30 to 9 p.m. CDT. The first three in the series are below:
Don't forget the Tuesday, March 31 free webinar: Patients Judge Your Practice by Your Online Reputation. Watch for additional webinars in the series.  Many other events are being added or made available free of charge. Visit our website to see the full list of offerings.

AGD2020
We are preparing for any influence this pandemic may have on AGD's upcoming meetings, including our scientific session scheduled for July 15–18 in Las Vegas. We want you to assure you that if AGD2020 is cancelled as a result of COVID-19, all registered attendees will receive a full refund, including conference registration and course fees.

Help for your practice now
Addressing your business operations and staying in front of your patients and communities are as important as ever. We have contacted several of AGDs Exclusive Benefit providers to ask them to help you now.
  • Stay in Touch with Your Patients: AGD's new Exclusive Benefit provider Optio Publishing has generously offered to provide all AGD Members with free social media content to help you communicate with your patients about COVID-19. Check out the free content. Watch for more news about other offers from this new Exclusive Benefits provider.
  • Cash Flow Help: A new Exclusive Benefit provider, U.S. Bank is now offering temporarily reduced pricing on its Quick Loan and Cash Flow Manager products. For more information, contact Jeramie Eimers or 651.681.7371. Please note that they do not cover all states.
  • Payment Deferrals: Hagan Insurance Group employees are available to answer coverage questions. If these hard times are causing issues with paying your insurance premiums please do not hesitate to contact their office at 877.280.6487 to see what payment options may be available to help you through this difficult time.  
  • Keep Your Dental Team Sharp: All-Star Dental Academy is making its Survival Kit: Resources for Dentists including a video on "Training While Your Office is Closed" available to all AGD members free of charge. It outlines issues to address during this crisis and steps to ensure that your practice can continue to grow.
PPE Supplies
AGD is encouraging members to donate surplus personal protection equipment (PPE) to your local public health offices or first responders. Please retain the supplies you need to cover emergencies and to re-open your office when the time comes, but also consider how you can support the safety of healthcare professions on the frontlines. AGD has been reminding the public to avoid hospital emergency rooms if they have a dental need during this time. We want to reduce the burden those dental visits would have on sites that are focusing on the diagnosis and treatment of COVID-19 patients.

Our website, agd.org, has special COVID-19 updates. Events, news, analysis and other links to helpful resources are being added regularly, so please check in periodically for updates.

On behalf of the AGD family, I want you to know that we stand ready to help you through this unprecedented time. Please let us know how we can help.
 
Sincerely,

ConnieWhite.png?r=1576870814899
Connie L. White, DDS, FAGD
President, Academy of General Dentistry

Wednesday, March 25, 2020

Academy of General Dentistry says Let's Work Together and Get Through This



Here is a letter I received yesterday via email.  I've known Dr. Connie White for over 30 years.  She is a dedicated professional with a heart of gold.  We couldn't ask for better person at the helm of the Academy right now.  Read on to see what Dr. White has to say...

Dear Member,

I know you are facing an unimaginable level of stress and anxiety because of COVID-19. Despite the uncertainty for the future, I am optimistic. AGD is here for you.

We continue to post information about the coronavirus to www.agd.org/coronavirus. This week we will add a new section on the AGD website that will direct you to resources, tools and options to assist you, our AGD family members, during closures and once operations resume. In the meantime, I wanted to list some of the other ways we are working to assist you.

No-Cost Webinars and Online Learning: We know our members want CE that will help them manage their financial and staffing needs during this crisis, as well as provide guidance on how to plan for the future. Our Education team is currently developing several webinars that address these needs, and we plan to roll these out as soon as possible.

We are also waiving the fees for upcoming CE, including the tonight's webinar "The Science of Sleep and the Importance and Management of Oral Appliance Therapy." The March 31 webinar "Patients Judge Your Practice by Your Online Reputation" is a free course sponsored by Henry Schein One. 

The AGD Online Learning Center continues to provide a wealth of educational content, and we are working with the Dental Education Council to expand free offerings. We will provide updates as those details become available.

Financial Relief for General Dentists: AGD sent a letter to Congress strongly recommending that general dentists be compensated in the amount of $500 million to make up for lost patients. Further, the AGD Government Relations and Dental Practice teams are reviewing the economic stimulus package and other policies that are in place or being discussed that could help our members. We are distributing information to members on ways they can advocate for the profession by contacting federal legislators. (See how New Jersey AGD members are working locally.) We will continue to report on these details in the coming days and weeks. 

Other Support Options for You: We have already arranged with an AGD banking partner to offer reduced interest rate loans. The ability to check it out and apply online should be available in the coming days. 

Please contact our Membership Services team if we can be of assistance with dues payments. We will work with you to ensure you are able to continue benefiting from your AGD membership. 

We are also working directly with our Exclusive Benefit providers and corporate sponsors to help our AGD family during this time of need. 

Don't Isolate Yourself: We are being asked to distance ourselves socially, but this isn't a time to isolate from your colleagues and the profession. To help you connect with other general dentists about ways they are navigating this new territory, AGD has created online communities so that you can share information and connect with other members. We have created a new one devoted to allowing members to share specifically about their experiences and suggestions to others in the AGD family about COVAD-19. To sign up for these communities, please email AGDConnect@agd.org

We fully expect our profession to rebound. I've heard remarkable stories about members helping members, colleagues, students, families and communities. Now more than ever, we must remain strong to support each other. 

Please keep watching for updates and let us know if you have additional needs, requests or suggestions on how we can serve you.

In the meantime, stay safe and healthy.

Sincerely,

ConnieWhite.png?r=1576870814899
Connie L. White, DDS, FAGD
President, Academy of General Dentistry

Tuesday, March 24, 2020

Shelter at Home... Day One

 


I’m posting this from my office where I’m still open on a limited basis for emergencies.  This is day one of the greater Kansas City area “Shelter at Home” directive.  As a healthcare provider I’m exempt from the restriction as dentistry is considered an “essential” business.

Traffic on the way to the office was light… as in really light.  It seems that most people are following the guidelines.

Amazingly for the office, we have seen more emergencies than normal.  However, with that being said, we will be going to a much more abbreviated schedule next week.  While we are seeing more emergencies than normal, that certainly does not mean we’re dealing with a full schedule.  It’s been interesting the last few days.  Yesterday I was contacted via Facebook Messenger from a nurse on the east coast who works in the ER.  She was having trouble finding dental offices that were open and she was seeing quite a few dental emergencies that were creating backlogs in the ER.

I would strongly urge offices that are completely shut down to consider at least a limited schedule to help those in need.

More news as things progress...

Monday, March 23, 2020

News from the Drug Enforcement Administration...

DEA COVID-19 Information

COVID-19 Virus
Dear Registrant,
On March 16, 2020, the DEA published a COVID-19 Information Page on the Diversion Control Divisions Web Site. This page contains important guidance concerning COVID-19 and the national drug supply, electronic prescribing of controlled substances, telemedicine, medicated assisted treatment, and other important federal and state information. This site will be updated frequently as new information and guidance is issued. Please check back frequently for further information.
Please continue to direct all policy questions concerning COVID-19 to the Policy email box at Natural.Disaster@usdoj.gov

DEA Call Center

Effective March 23, 2020, the DEA Call Center has temporarily suspended phone operations due to COVD-19 health epidemic. Assistance will only be available through email at DEA.Registration.Help@usdoj.gov. The DEA has a large number of personnel answering these emails as quickly as possible.

The Day Before the Lockdown...



Welcome to "The Final Countdown" in the Greater Kansas City Area.  For those of you who are unaware, the area where I live and practice is going on a "Shelter at Home" order starting at midnight tonight.  When the sun rises Tuesday the 24th almost everyone here will be expected to be at home unless making trips for necessary items or services.

Only certain businesses will be open and employees of those businesses are cleared to go to work.  Fortunately, healthcare is considered necessary.  That means I won't be totally stuck at home, although I'll be at the office handling emergencies.

I'm going to be blogging on a less structured schedule going forward.  I normally try and post Monday thru Thursday but there may be multiple posts a day and more than usual simply because we're all in a situation we've never been in before.

I'm also going to be tinkering with my tech more now that I have fewer demands on my time since patient time will be less and my travel schedule is now non-existent.

One thing you might look into, if you are looking for some CE to fill your time, the Western Regional Dental Experience is going virtual this year.  I've got a course I'm giving virtually on April 2nd so feel free to sign up.  I'd love to be able to help my peers during this time when we're all going to be trying to find ways to improve our skills while we are idle.

More tomorrow as the shutdown continues..

Sunday, March 22, 2020

ADA Releases Emergency Procedure Guidelines



What Constitutes a Dental Emergency?
The ADA has released the following guidelines.  They are reposted here to help with the current crisis.  Any questions should be answered by going to this web address.



The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is fluid situation and those closest to the issue may best understand the local challenges being faced.


DENTAL EMERGENCY

This guidance may change as the COVID-19 pandemic progresses. Dentists should use their professional judgment in determining a patient’s need for urgent or emergency care.
Dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include:
  • Uncontrolled bleeding
  • Cellulitis or a diffuse soft tissue bacterial infection with intra-oral or extra-oral swelling that potentially compromise the patient’s airway
  • Trauma involving facial bones, potentially compromising the patient’s airway


Urgent dental care focuses on the management of conditions that require immediate attention
to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These should be treated as minimally invasively as possible.
  • Severe dental pain from pulpal inflammation
  • Pericoronitis or third-molar pain
  • Surgical post-operative osteitis, dry socket dressing changes
  • Abscess, or localized bacterial infection resulting in localized
    pain and swelling

  • Tooth fracture resulting in pain or causing soft tissue trauma
  • Dental trauma with avulsion/luxation
  • Dental treatment required prior to critical medical procedures
  • Final crown/bridge cementation if the temporary restoration is lost,
    broken or causing gingival irritation
  • Biopsy of abnormal tissue
Other Urgent Dental Care
  • Extensive dental caries or defective restorations causing pain
  •  Manage with interim restorative techniques when possible (silver diamine fluoride, glass ionomers)
  • Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa
  • Suture removal
    Denture adjustment on radiation oncology patients
  • Denture adjustment or repairs when function impeded
  • Replacing temporary filling on endo access openings in patients experiencing pain





DENTAL NON EMERGENCY PROCEDURES

Routine or non-urgent dental procedures includes but are not limited to:
  • Initial or periodic oral examinations and recall visits, including routine radiographs
  • Routine dental cleaning and preventive therapies
  • Orthodontic procedures other than those to address acute issues (e.g. pain, infection, trauma)
  • Extraction of asymptomatic teeth
  • Restorative dentistry including treatment of asymptomatic carious lesions
  • Aesthetic dental procedures

Friday, March 20, 2020

Too Much Time on my Hands...




Too Much Time On my Hands


My buddy Dr. Paul Feuerstein always uses song titles for his articles.  I suppose imitation is the sincerest form of flattery… sorry Paul. Oh and also my apologies to the band Styx...

Last week, Covid-19 was a topic of discussion and an annoyance.  This week, it rocked the world. On Monday March 16th and Tuesday March 17th, my office was cranking along at a pace that made me proud.  Patient satisfaction was high, employees were happy, and the financial numbers were more than sound. Then there was “that huge sucking sound” that was Covid-19 tearing through the social fabric.  On Wednesday March 18th, everything changed for the office.

I was forced to furlough 6 employees, cut the hours of those who remained, and begin dismantling a schedule that was a snapshot of front office efficiency.

I’m pretty sure that all of you have similar stories to tell.  This has been an incredibly awful week and, even worse, there doesn’t appear to be any consensus on when this all will end.

My practice is now only treating emergencies and non-aerosol generating procedures.  Unfortunately those procedures are not nearly enough to cover overhead. I’ve done a little research in my limited downtime and from what I’ve discerned, cutting back to the level advised by multiple agencies and organizations will drop office production 85-90%.  You read that right. If your office has been producing $5000 per day, you can now expect about $750, and that would be on a good day. Covid-19 is not only going to affect biologic health, it is going to have a massive effect on financial health as well.

By limiting procedures in our offices we are helping to fight this disease on the front lines ( and as we know, we ARE on the front lines).  Our next step is to try and figure out ways to fight the other problems that this crisis is causing.  What follows here are some ideas on what to do with all of this time on our hands.

Clean, Clean, Clean
According to the Harvard Coronavirus Resource Center, a recent study found that the COVID-19 coronavirus can survive up to four hours on copper, up to 24 hours on cardboard, and up to two to three days on plastic and stainless steel. The researchers also found that this virus can hang out as droplets in the air for up to three hours before they fall. But most often they will fall more quickly.

Because we cannot be sure who in our office was positive for Covid-19 without showing symptoms, use this downtime to disinfect everything like you have never disinfected before.  I have instructed staff to clean and disinfect everything in our clinic.  When they are done doing this, I am going to instruct them to do the complete disinfection process again.  Perhaps that is overkill, but when it comes to the health of our patients, I think this thought process is the best one.

I am also going to have a similar strategy for our reception area.  Sometimes we forget about that spot when we are thinking about infection control.  Hopefully any virus left in that area would be dead in a few days, but in this case, better safe than sorry.

There have been some questions about surface disinfection.  Here is info from Kavo/Kerr regarding the surface disinfection product CaviWipes.  It is a short but enlightening read.

We are also going to devote time to completely cleaning and refreshing the office in general.  Not just for Covid-19 but to eliminate those embarrassing “dust bunnies” that can hide under furniture, cobwebs in corners, etc.  I will sometimes lay on the floor in the reception area and just look around to see if there are things that need to be cleaned. We’ve been so busy lately that I haven’t had a chance to do that, so now is the time!

Organize
If your office is like ours, these past few months have been very busy.  One of my associates, Dr. Sainy Adel, mentioned to me the other day that “since I’ve come on board, we’ve been pretty much pedal to the floor every day.”  He’s right. It has been a tremendously busy and productive time lately.

Like everything, that can be a blessing *and* a curse.  When things are busy, tasks such as organizing usually get less attention.  That means entropy sets in and things become more disordered. To that end, this is a great time to have dental assistants tear the operatories down to the bolts and get everything restocked and re-organized.  That will greatly help when this is over and the gates open. I am optimistic that when those gates open, there will be a flood of patients coming in and we will need to be prepared for that.

This also applies to the business office area.  We have 3 members on our Admin Team and sometimes even that many isn’t enough.  That means that their workspaces also get affected by entropy. They should also get ready for the tidal wave of things they’ll need to do when offices re-open.

Stay in Contact with Patients
Utilizing the technologies that we have at our disposal allows us to make sure that patients continue to think of us and put dentistry high on their priority list when all of this begins to fade.

Let patients know how much you miss being able to provide their care and what you are doing during this time to ensure their safety when you re-open.

Another good idea I heard lately was to have staff reach out to your elderly patients.  Let them know you care and ask if they need anything. Many of our elderly patients are frightened, immunocompromised, or both.  If you community allows you to be out in public, offering to make a grocery or pharmacy run could be a huge help to these people.  Plus it’s just the right thing to do. Dentistry has always had a tremendous social conscience and this is just one more way to help and to show our concern for  our older demographic.

Focus on Things You Can Control
We all have things in our offices that need more focus.  Maybe you’ve been wanting to improve your endo skills. Maybe you have been wanting to decide with CBCT system you’d like to purchase.

As Technology Evangelist, I’ve always got a long list of products to test and/or new things to focus on and implement.  I’m using this time to get my “To Do List” straightened up and things checked off. We’ll be working on making our newer implementations have tighter impact on our every day systems.  I’m going to be spending a lot of time with our Axsys 5x400 Mill and our SprintRay 3D printer.

I tell people all the time that dentistry is one of the few jobs where the CEO is also the one in charge of creating the majority of the product.  There are so many times when, as CEO, we think “if only I had some time to devote to ‘X’ business practice”. Guess what? Now you have that time.

Wrapping It Up
Work hard on being the leader you need to be.  Guide your team and your patients through this difficult time.  Before we know it, we’ll be back to full schedules and all the time eating problems we normally face.  Take this time to work on and fix those things you’ve been dreaming of fixing. Then get out there and work on making those dreams a reality!!!

Thursday, March 19, 2020

Facts about CaviWipes and SARS-COV-2 (novel coronavirus)

 


Protocols for Disinfection Efficacy on COVID-19

As of the date of this writing, there is currently no EPA recognized test protocol to evaluate disinfection efficacy against this specific novel coronavirus virus strain, SARS-COV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), which causes COVID-19 (Coronavirus Disease 2019). Therefore, there is no EPA-registered surface disinfectant that bares a label claim against CDC recommends using products with EPA-approved emerging viral pathogens claims against COVID-19.
If an EPA-registered disinfectant with the Emerging Viral Pathogen claim is not available, products with the label claim against Human Coronavirus should be used according to the label instructions1.
CaviCide and CaviWipes Efficacy Regarding Coronavirus

CaviCide, which is the solution used to impregnate CaviWipes, has an EPA-registered label claim against Human Coronavirus. Metrex has recently performed an efficacy study on CaviWipes against the SARS-CoV (SARS-associated Human Coronavirus) in a third-party test lab. According to the study report, the study results passed the Viricidal Hard Surface Efficacy Test by exceeding a 3-log/ 99.9% reduction of the virus. However, this study result has not yet been reviewed or approved by the US EPA. CaviWipes does not have an Emerging Viral Pathogen claim, nor a labelling claim against Human Coronavirus.

Even though SARS-CoV, Human Coronavirus, and SARS-CoV-2 are not the same virus strains, all coronavirus strains are enveloped viral particles that belong to the same virus family of Coronaviridae. Enveloped viral particles are typically more susceptible to chemical disinfectant formulations than are other common pathogens2.

REFERENCES:
1. 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. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html. Accessed 3.3.2020.

2. Sattar, S. “Hierarchy of Susceptibility of Viruses to Environmental Surface Disinfectants: A Predictor of Activity Against new and Emerging Viral Pathogens”. Journal of AOAC International. 2007. Vol 90.6. https://www.researchgate.net/publication/5657319_Hierarchy_of_Susceptibility_of_Viruses_to_Environmental_Surface_Disinfectants_A_Predictor_of_Activity_Against_New_and_Emerging_Viral_Pathogens. Accessed 3.3.2020.

Wednesday, March 18, 2020

This Changes Everything...

 


It’s incredible how quickly the world changes.  Probably 2 weeks ago you wondered what that little ball in the picture above was.  Now you are probably tired of seeing it on every page you visit...

If you would have spoken with me on Sunday March 15th, I would have told you that the biggest problem we faced was the “toilet paper shortage of 2020”.

That just goes to show you how fast things can change.  In the short span of about 48-72 hours, life here in the U.S. was turned on its ear.  Suddenly we were told to avoid groups of 50, then 25, then 10.  States suddenly began to create programs of their own to deal with the spread of Covid-19.  The public and medical professionals needed guidance.  Unfortunately, the guidance was haphazard at best and non-existent at worst.

I spent a great deal of time on Sunday researching the science behind the pandemic and its spread.  I began reaching out to people who I consider much smarter than myself.  The problem I encountered was that there lots of “educated guesses” based on extensive training and years of professional experience, but there was one caveat… No one was sure… and *that* was the problem.

Throughout this crisis, those of us in the trenches, on the front lines of the attack, whatever analogy you want to use, we’ve been waiting for someone to make the decision.  No matter where I looked (and I looked at *a lot* of websites), the consensus was “use your best judgement as a practitioner”.  However, as a practitioner part of my decision making process is to know when I don’t have enough information and NEED more.  So I turned to the experts who, instead of providing leadership and recommendations, went with the “use your best judgement” approach.

This approach lead to a huge hole in our defenses as tens of thousands of us tried to figure it out by ourselves.  Emails were bouncing around the Internet like Super Balls at a county fair.  No one knew what to do and no one was offering direction on what to do.  The Hypcratic Oath states “above all, do no harm”, but we didn’t have any idea what would and what wouldn’t cause harm. 

On Monday morning, one state in the union advised offices to voluntarily cease treatment of elective procedures for 14 days.  I read the web page and found very little scientific information given for the recommendation.   Several hours later, in the late afternoon in the central U.S. I received an email from the American Dental Association asking all offices to do away with elective treatment for 21 days.  Even *less* scientific information and reasoning was given for their recommendation.  

One state advising 14 days caused some commotion.  The ADA advisory rolled a shockwave through the profession.  I feel there were 2 main reasons for the shockwave.  The first was the failure to disclose why this was advised.  Dentistry is a very data driven and scientific profession.  Doctors were wondering if they had missed some vital piece of information.  Was there something we missed?  Was there a previous announcement of data that we failed to see?

The second was the simple fact that most dental offices are small independent business entities.  Our employees *need* their jobs and doing away with elective treatment meant that not nearly as many staff would be needed.  Doctors *know* that their staff relies on them for steady income and suddenly hours would be drastically cut.  Layoffs would follow.  What would happen?  What about single parent staff members with children depending on them?  How do we deal with that?

The powers that be in the government had failed to even *remotely* prepare people for this.  It was also happening all across the country.  However as this situation unfolded, the CDC was still advising Universal Precautions and asking Covid-19 interview questions of patients pre-operatively.  I feel that IF leadership from the CDC had better informed us and better prepared us, perhaps the situation could have been handled much better.  Instead we were forced to sort of “make it up as we go along” which is rarely the proper way to deal with emergent situations.

Today March 18th, 2020 a White House press conference finally addressed the situation in a way I wished the federal government had from the beginning.  Seema Verma the Administrator for the Center of Medicare and Medicaid services said directly that elective procedures, including dental procedures, should be postponed.  At long last, we have someone standing up as a leader and telling us their best recommendation of how to deal with this, something that allows us to know what to do.  If that advice had come earlier there wouldn’t have been such a scramble and confusion.




Tuesday, March 17, 2020

Academy of Laser Dentistry Cancels Annual Meeting Citing National Emergency Caused by the Coronavirus

 


The Academy of Laser Dentistry (ALD), recently announced that the 27th annual conference and exhibition, which was scheduled to take place April 2-4 at the Paradise Point Resort in San Diego, cannot be held due to the coronavirus pandemic.

According to ALD Executive Director, Gail Siminovsky, CAE, “Our annual conference is international in scope and in light of the global pandemic, international travel bans and President Trump’s recent declaration of a national emergency, the ALD Board of Directors made this difficult decision. Adhering to CDC and WHO recommendations and supporting the health and safety of our members and guests is our top priority.”

Despite this unfortunate situation, the ALD is moving swiftly in its preparations for Dentistry’s Laser Meeting in 2021, scheduled for April 8-10 in Alexandria, Virginia. Preliminary information will be available on the ALD website, www.LaserDentistry.org during the next few weeks.

In the meantime, the ALD is making every effort to accommodate everyone registered to participate in this year’s conference. For example:
• This year’s attendees will have the option for a full refund or to apply ALD 2020 tuition to next year’s conference.
• ALD 2020 speakers will have an opportunity to present during ALD 2021 and participate in a webinar in 2020.
• Exhibitors for ALD 2020 will have the option of exhibiting at ALD 2021 at no additional charge.

“Not holding this year’s conference was a difficult decision for the ALD Board of Directors,” explained Siminovsky. “So many people worked incredibly hard to develop and plan for ALD’s global meeting this year. We are all confident that ALD 2021 will raise the bar of laser education and training.”

About the Academy of Laser Dentistry:
The Academy of Laser Dentistry (ALD) is the only independent and unbiased non-profit association devoted to laser dentistry and includes clinicians, academicians and researchers in all laser wavelengths. The Academy is devoted to clinical education, research, and the development of standards and guidelines for the safe and effective use of dental laser technology. ALD was founded in 1993, with the merging of the International Academy of Laser Dentistry, the North American Academy of Laser Dentistry and the American Academy of Laser Dentistry. For more information, visit www.LaserDentistry.org.

Amidst All the Health Scares in the News Currently, Scammers Now Use False Health Reports to Steal Individuals Data



As we all know, the current news climate is wrought with scary stories and many, many individuals are worried about potential threats from the Covid-19 infection among other things.

As I’ve written before, the best way to break into systems is not through the systems themselves, but through the human beings that are gatekeepers of those systems.  The human being is  always the weakest link in the security chain.  That’s not because people lack intelligence, no, it’s because they can be convinced to give things up in order to help another human being.  The other way to coerce people is to apply some type of psychological pressure… a feeling of impending doom if they do not immediately do something.  When we are under stress and reacting while in a panic we often do not make the best choices.  That’s a scientific fact.

Scammers are taking advantage of this by using the current climate of fear mingled with healthcare to try and create panic in individuals who will then click links they wouldn’t if they were in a rational state of mind.  Basically the hackers use fake HIV test results to get individuals and employees to click links.

The smart people at security company Proofpoint have determined the following:


Healthcare concerns drive us to do a lot of things like change our diet, work out more, and take medication. But they should never lead us to fall victim to phishing campaign. Threat actors regularly use purported health information in their phishing lures because it evokes an emotional response that is particularly effective in tricking potential victims to open malicious attachments or click malicious links.
In the latest example, Proofpoint researchers observed cybercriminals impersonating Vanderbilt University Medical Center and sending out fake HIV test result emails that attempted to lure recipients into opening malicious content embedded into the message. This low volume campaign had top targeted industries: global insurance, healthcare, and pharmaceutical organizations, but others were targeted as well. This attack leveraged Koadic RAT, if successful and Koadic is installed, attackers can run programs and access victims’ data, including sensitive personal and financial information.
Campaign Overview
This campaign was a small attack in which the emails claim to come from “Vanderbit [SIC] Medical” and have the subject line “Test result of medical analysis”. The body of the email encourages recipients to open a malicious Microsoft Excel attachment titled “TestResults.xlsb” and claims that the recipient’s HIV results are contained within it. Figure 1 shows a sample below.
Figure 1 Email with Malicious Excel Attachment Claiming HIV Results
If the recipient opens the attachment, the Excel document opens and prompts the user to enable macros as shown in Figure 2.
Figure 2 Malicious Excel Document Prompting to Enable Macros
If the recipient enables macros, the document then downloads Koadic. Originally Koadic was intended as a tool for network defenders and allows the actor to take complete control over a user’s system. In recent years it has been used by a variety of nation state actors, including both Chinese and Russian state-sponsored groups, as well as attackers associated with Iran.
This latest campaign serves as a reminder that health-related lures didn’t start and won’t stop with the recent Coronavirus-themed lures we observed. They are a constant tactic as attackers recognize the utility of the health-related “scare factor.” We encourage users to treat health-related emails with caution, especially those that claim to have sensitive health-related information. Sensitive health-related information is typically safely transmitted using secured messaging portals, over the phone, or in-person. If you receive an email that claims to have sensitive health-related information, don’t open the attachments. Instead, visit your medical provider’s patient portal directly, call your doctor, or make an appointment to directly confirm any medical diagnosis or test results.

Monday, March 16, 2020

Covid-19 Information from the Centers for Disease Control and Prevention

 


As focus increases more and more on the Cover-19 virus, the world is, unfortunately, awash is poor information, misinformation, and straight out lies.

Scammers are no using people’s fears to fleece them of huge amounts of money.  Global panic has ensued.  Reason has taken a backseat to information such as “well I heard…”.

With those types of situations going on, it is difficult to sort out science from fiction or manipulation.  Trust me when I say the only way we are going to effectively deal with this is with science and reason.  That all stars with knowing where to find good, scientific, and reliable information.  For today’s  post I’d like to give you the most recent information from the CDC (Centers for Disease Control and Prevention).    Any time that you need the most current information on Covid-19, this link will take you to the CDC webpage with the most current Situation Summary.

Here is what they have to say currently:

Background

CDC is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in China and which has now been detected in more than 100 locations internationally, including in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).
On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the outbreak a “public health emergency of international concernexternal icon” (PHEIC). On January 31, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19. On March 11, WHO publiclyexternal icon characterized COVID-19 as a pandemic. On March 13, the President of the United States declared the COVID-19 outbreak a national emergencyexternal icon.

Source and Spread of the Virus

Coronaviruses are a large family of viruses that are common in people and many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoVSARS-CoV, and now with this new virus (named SARS-CoV-2).
The SARS-CoV-2 virus is a betacoronavirus, like MERS-CoV and SARS-CoV.  All three of these viruses have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.
Early on, many of the patients at the epicenter of the outbreak in Wuhan, Hubei Province, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Person-to-person spread was subsequently reported outside Hubei and in countries outside China, including in the United States. Some international destinations now have ongoing community spread with the virus that causes COVID-19, as do some parts of the United States. Community spread means some people have been infected and it is not known how or where they became exposed. Learn what is known about the spread of this newly emerged coronaviruses.

Severity

The complete clinical picture with regard to COVID-19 is not fully known. Reported illnesses have ranged from very mild (including some with no reported symptoms) to severe, including illness resulting in death. While information so far suggests that most COVID-19 illness is mild, a reportexternal icon out of China suggests serious illness occurs in 16% of cases. Older people and people of all ages with severe chronic medical conditions — like heart disease, lung disease and diabetes, for example — seem to be at higher risk of developing serious COVID-19 illness.
Learn more about the symptoms associated with COVID-19.

COVID-19 Now a Pandemic

A pandemic is a global outbreak of disease. Pandemics happen when a new virus emerges to infect people and can spread between people sustainably. Because there is little to no pre-existing immunity against the new virus, it spreads worldwide.
The virus that causes COVID-19 is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide and community spread is being detected in a growing number of countries. On March 11, the COVID-19 outbreak was characterized as a pandemic by the WHOexternal icon.
This is the first pandemic known to be caused by the emergence of a new coronavirus. In the past century, there have been four pandemics caused by the emergence of novel influenza viruses. As a result, most research and guidance around pandemics is specific to influenza, but the same premises can be applied to the current COVID-19 pandemic. Pandemics of respiratory disease follow a certain progression outlined in a “Pandemic Intervals Framework.” Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic.
There are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.

Situation in U.S.

Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states where community spread is occurring are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.
  • CDC and state and local public health laboratories are testing for the virus that causes COVID-19. View CDC’s Public Health Laboratory Testing map.
  • More and more states are reporting cases of COVID-19 to CDC.
  • U.S. COVID-19 cases include:
    • Imported cases in travelers
    • Cases among close contacts of a known case
    • Community-acquired cases where the source of the infection is unknown.
  • Three U.S. states are experiencing sustained community spread.
  • View latest case counts, deaths, and a map of states with reported cases.

Risk Assessment

Risk depends on characteristics of the virus, including how well it spreads between people; the severity of resulting illness; and the medical or other measures available to control the impact of the virus (for example, vaccines or medications that can treat the illness) and the relative success of these. In the absence of vaccine or treatment medications, nonpharmaceutical interventions become the most important response strategy. These are community interventions that can reduce the impact of disease.
The risk from COVID-19 to Americans can be broken down into risk of exposure versus risk of serious illness and death.
Risk of exposure:
  • The immediate risk of being exposed to this virus is still low for most Americans, but as the outbreak expands, that risk will increase. Cases of COVID-19 and instances of community spread are being reported in a growing number of states.
  • People in places where ongoing community spread of the virus that causes COVID-19 has been reported are at elevated risk of exposure, with the level of risk dependent on the location.
  • Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure.
  • Close contacts of persons with COVID-19 also are at elevated risk of exposure.
  • Travelers returning from affected international locations where community spread is occurring also are at elevated risk of exposure, with level of risk dependent on where they traveled.
Risk of Severe Illness:
Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:
CDC has developed guidance to help in the risk assessment and management of people with potential exposures to COVID-19.

What May Happen

More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread. CDC expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.
Widespread transmission of COVID-19 could translate into large numbers of people needing medical care at the same time. Schools, childcare centers, and workplaces, may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and sectors of the transportation industry may also be affected. Healthcare providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Nonpharmaceutical interventions will be the most important response strategy to try to delay the spread of the virus and reduce the impact of disease.

CDC Response

Global efforts at this time are focused concurrently on lessening the spread and impact of this virus. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat.
CDC is implementing its pandemic preparedness and response plans, working on multiple fronts, including providing specific guidance on measures to prepare communities to respond to local spread of the virus that causes COVID-19. There is an abundance of pandemic guidance developed in anticipation of an influenza pandemic that is being adapted for a potential COVID-19 pandemic.

Highlights of CDC’s Response

  • CDC established a COVID-19 Incident Management System on January 7, 2020. On January 21, CDC activated its Emergency Operations Center to better provide ongoing support to the COVID-19 response.
  • The U.S. government has taken unprecedented steps with respect to travel in response to the growing public health threat posed by this new coronavirus:
    • Foreign nationals who have been in China or Iran within the past 14 days cannot enter the United States.
    • U.S. citizens, residents, and their immediate family members who have been in China or Iran within in the past 14 days can enter the United States, but they are subject to health monitoring and possible quarantine for up to 14 days.
    • On March 11external icon, a similar policy was expanded to include 26 European countries for a period of 30 days.
    • On March 8, CDC recommended that people at higher risk of serious COVID-19 illness avoid cruise travel and non-essential air travel.
    • Additionally, CDC has issued the following additional specific travel guidance related to COVID-19.
  • CDC has issued clinical guidance, including:
  • CDC has deployed multidisciplinary teams to support state health departments case identification, contact tracing, clinical management, and public communications.
  • CDC has worked with federal partners to support the safe return of Americans overseas who have been affected by COVID-19.
  • An important part of CDC’s role during a public health emergency is to develop a test for the pathogen and equip state and local public health labs with testing capacity.
    • CDC developed an rRT-PCR test to diagnose COVID-19.
    • As of the evening of March 10, 79 state and local public health labs in 50 states and the District of Columbia have successfully verified and are currently using CDC COVID-19 diagnostic tests.
    • Combined with other reagents that CDC has procured, there are enough testing kits to test more than 75,000 people.
    • In addition, CDC has two laboratories conducting testing for the virus that causes COVID-19. CDC can test approximately 350 specimens per day.
    • Commercial labs are working to develop their own tests that hopefully will be available soon. This will allow a greater number of tests to happen close to where potential cases are.
  • CDC has grown the COVID-19 virus in cell culture, which is necessary for further studies, including for additional genetic characterization. The cell-grown virus was sent to NIH’s BEI Resources Repositoryexternal icon for use by the broad scientific community.
  • CDC also is developing a serology test for COVID-19.

CDC Recommends

  • Everyone can do their part to help us respond to this emerging public health threat:
    • Individuals and communities should familiarize themselves with recommendations to protect themselves and their communities from getting and spreading respiratory illnesses like COVID-19.
    • Older people and people with severe chronic conditions should take special precautions because they are at higher risk of developing serious COVID-19 illness.
    • If you are a healthcare provider, use your judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Factors to consider in addition to clinical symptoms may include:
      • Does the patient have recent travel from an affected area?
      • Has the patient been in close contact with someone with COVID-19 or with patients with pneumonia of unknown cause?
      • Does the patient reside in an area where there has been community spread of COVID-19?
    • If you are a healthcare provider or a public health responder caring for a COVID-19 patient, please take care of yourself and follow recommended infection control procedures.
    • If you are a close contact of someone with COVID-19 and develop symptoms of COVID-19, call your healthcare provider and tell them about your symptoms and your exposure. They will decide whether you need to be tested, but keep in mind that there is no treatment for COVID-19 and people who are mildly ill are able to isolate at home.
    • If you are a resident in a community where there is ongoing spread of COVID-19 and you develop COVID-19 symptoms, call your healthcare provider and tell them about your symptoms. They will decide whether you need to be tested, but keep in mind that there is no treatment for COVID-19 and people who are mildly ill are able to isolate at home.
  • For people who are ill with COVID-19, but are not sick enough to be hospitalized, please follow CDC guidance on how to reduce the risk of spreading your illness to others. People who are mildly ill with COVID-19 are able to isolate at home during their illness.
  • If you have been in China or another affected area or have been exposed to someone sick with COVID-19 in the last 14 days, you will face some limitations on your movement and activityPlease follow instructions during this time. Your cooperation is integral to the ongoing public health response to try to slow spread of this virus.

Other Available Resources

The following resources are available with information on COVID-19