How can dental practices prepare for a second wave of COVID-19?

Judith Husband discusses what practices need to do to prepare for a potential second wave of COVID-19 more deadly than the firstJudith Husband discusses what practices need to do to prepare for a potential second wave of COVID-19 more deadly than the first.

After the tumultuous last few months, the summer has taken on a relative calmness for many dental teams. Practices, although at slightly different stages of their journeys, are generally back to full clinical care delivery with an interesting – and some would argue incredibly generous – NHS offer in England.

Placed in an apparently high trust environment, we are caring for our patients without the burden of UDAs. We are introducing and being encouraged to work remotely. Virtual consultations are increasingly part of our practising life and all this with an expectation of a significantly reduced output.

At varying rates, colleagues in the devolved nations are also returning to full dental care provision at significantly reduced capacity.

As we settle into our new routines it is against a backdrop of significant changes in our communities. Face coverings are now common, schools have dates to reopen, quarantine for some travellers was introduced and guidance for isolation increased from seven to 10 days. Leicester is still in lockdown as I write – with shops, and most importantly hairdressers, still closed as we enter August.

Worst-case scenario

Prime Minster Johnson, no longer the jovial character, speaks determinedly of being ‘battle ready’ for autumn. It would be easy to think the worst is past. But the tone of the summer is shifting – and it needs to.

Calls for our future management of the pandemic to be founded on ‘tough local lockdowns’ are great as a principle, but rather different when it is a reality. One that some regions have faced already, and many will in the coming months.

The Academy of Medical Sciences published a report, commissioned by the government, titled: ‘Preparing for a challenging winter 2020/21’. The aim was to model the reasonable worst-case scenario for the evolving pandemic in the UK through winter and with a rise in infection rate to 1.7 from September 2020. It concluded starkly that:

‘Modelling of this scenario suggests there would be a peak in hospital admissions and deaths in January and February 2021 similar to or worse than the first wave in spring 2020, coinciding with a period of peak demand on the NHS. It estimates the number of COVID-19-related hospital deaths (excluding care homes) between September 2020 and June 2021 could be as high as 119,900.’

Critical for dentistry to prepare

It is clear without mitigation, and importantly without intense preparation, the winter will prove far more devastating than the first wave. Also evident is that action is now being taken with national strategies. It is critical that dentistry also uses this time to plan and prepare.

Tucked away in one of the report’s annexes is a recognition of how short our time horizons have become. By the very nature of the last few months, we have lived almost day to day in some cases. Planning months and years ahead was impossible and probably not that useful to our coping strategies.

The risk we face now is that this compressed view of our futures will lead to a failure to stop and look ahead. It is vital as healthcare providers and as businesses that we prepare now. We need to be ready, flexible and resilient for what is likely to be a long and challenging winter.

It is important for dental teams to use this time in summer to recharge. Build up physical and mental reserves. Encourage healthy lifestyle choices, enjoy time outside and reap the benefits of our short-lived sunshine, and take time away from practice to help us all build resilience. The value of vitamin D for a healthy immune system is well known. There are suggestions we should all take supplements this winter. Building a healthy and happy team has never been more important.

Easily overwhelmed

Dental team members are respected and trusted health professionals. We have a key role in our communities to help share health messaging. We are trusted sources and must leverage this and take the opportunities we have – both remotely and face to face with patients. And we must combine this with our practice communications to ensure simple, truthful information and messaging is shared.

With a significantly enlarged target population for this year’s influenza vaccination program, we must encourage take up in our communities and with our staff. Flu season alone can be devastating for the NHS. However, with SARS -COV-2, in addition to the myriad of seasonal respiratory infections, demand could easily overwhelm track and trace – and our local health service.

There are useful considerations with our team members. For example, with their work patterns across locations and how rotas are designed to reduce the risk of losing all staff if there is an outbreak in the practice. With our buildings – as autumn arrives, we need to know how the temperature and humidity can be maintained whilst ensuring good ventilation.

Renewed pressure

In a local lockdown, what procedures will be implemented and how will care be prioritised in case of reduced capacity? Can remote working be supported, enabling reduced travel and contact for team members? This could potentially utilise team members who may be self-isolating or shielding.

Workforce in the wider NHS will be under renewed pressure. Already, we are 100 000 nurses short. Brexit is expected to reduce recruitment further – and staff sickness will compound this pressure during a likely surge in demand. Dental team members may once again be called on to redeploy. Practice contingency planning for the loss of key staff members should be considered.

An important discussion for the profession needs to be a consideration of our treatment planning decisions. Should a patient, or the team, pause care, will the patient’s oral health be maintained? Should complex, advanced, elective procedures be undertaken?

As the summer rolls by, now is the time for the dental profession to prepare.

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