2019 Novel Coronavirus (COVID-19) – ADA Update

Last Updated: March 16, 2020

The Centers for Disease Control and Prevention provides important and up-to-date information to the public and healthcare providers on the status of reported cases of 2019 Novel Coronavirus (COVID-19) across the United States. Initial cases were reported in Wuhan, China and it is currently thought that the most likely mode of transmission is human to human. There are several reports of transmission from an asymptomatic person with the infection, so there remains much to be learned about how COVID-19 spreads.

Dentists are urged to view the CDC COVID-19 situation summary web page for current insight (https://www.cdc.gov/coronavirus/2019-ncov/summary.html). The risk of transmission in the United States is low at this time. Standard precautions should be taken with all patients, at all times.

Availability of Personal Protective Equipment

The CDC has not changed its guidance on single-use disposable facemasks, which are regulated by FDA to be single use and should be worn once and discarded.

Page 41 of the CDC Guidelines for Infection Control in Dental Health-Care Settings has the following guidance:

1. Wear a surgical mask and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering of blood or other body fluids;
2. Change masks between patients, or during patient treatment if the mask becomes wet.

CDC urges Dental Health Care Personnel (DHCP) concerned about healthcare supply for PPE to monitor Healthcare Supply of Personal Protective Equipment for updated guidance, and to be familiar with the Interim Infection Prevention and Control Recommendations.

The CDC guidelines notes that, in cases when a patient presents with symptoms of a respiratory infection, DHCP may consider postponing non-emergency or elective dental procedures until a patient is no longer contagious with diseases that may be transmitted through airborne, droplet, or contact transmission (e.g., sneezing, coughing, and contact with skin).

If urgent dental treatment is necessary, DHCP and medical providers should work together to determine the appropriate precautions on a case-by-case basis to avoid the potential spread of diseases among patients, visitors, and staff. Because dental settings are not typically designed to carry out all of the Transmission-Based Precautions that are recommended for hospital and other ambulatory care settings, DHCP and medical providers will need to determine whether the facility is an appropriate setting for the necessary services for a potentially infectious patient.

Prevention of Suspected Respiratory Disease Transmission in the Dental

Healthcare Setting

Patients with an acute respiratory illness may present for dental treatment at outpatient dental settings. The primary infection control goal is to prevent transmission of disease. CDC recommends a multi-step approach that begins before the patient arrives at the practice and includes guidance regarding their arrival and for the complete duration of the affected patient’s presence in the practice.

It may not be possible to know the cause of any patient’s illness so it is important to follow this guidance and standard precautions at all times.

Infection control issues during patient assessment:

• Patients with an acute respiratory illness should be identified at check-in and placed in a single-patient room with the door kept closed.
• Seek to prevent the transmission of respiratory infections in healthcare settings by adhering to respiratory hygiene/cough etiquette infection control measures at the first point of contact with any potentially infected person https://www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm
• Offer a disposable surgical mask to persons who are coughing; and provide tissues and no-touch receptacles for used tissue disposal.
• Ill persons should wear a surgical mask when outside the patient room.
• Dental healthcare personnel assessing a patient with influenza-like or other respiratory illness should wear disposable surgical facemask*, non-sterile gloves, gown, and eye protection (e.g., goggles) to prevent exposure. Since recommendations may change as additional information becomes available it’s a good idea to check the CDC website for COVID-19 updates at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection- control.html
• Patient and dental healthcare workers should perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
• Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management for COVID-19. More information can be found at http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html.

*Until additional specific information is available regarding the behavior of COVID-19, the guidance provided in the “Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission” https://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm is recommended at this time. Also recommended is a review of Prevention Strategies for Seasonal Influenza in Healthcare Settings https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm.

Frequently Asked Questions

1) What are the signs/symptoms and risk factors for COVID-19?

Similar to patients with other flu-like diseases, patients with known COVID-19 have reported

mild to severe symptoms which can include fever, cough and shortness of breath. Patients may also report a recent trip to China, or a close contact with someone who traveled to China within the past 14 days.

2) Where can I find current, credible information about COVID-19?

CDC’s website includes numerous resources for healthcare workers including:

• Interim CDC Guidance for Healthcare Professionals at https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html
• A one-page Flowchart to Identify and Assess 2019 Novel Coronavirus at https://www.cdc.gov/coronavirus/2019-ncov/hcp/2019-nCoV-identify-assess-flowchart-508.pdf
• The 2019 Novel Coronavirus (2019-nCoV) Situation Summary at https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
• Resources for Hospitals and Healthcare Professionals Preparing for Patients with Suspected or Confirmed COVID-19 at https://www.cdc.gov/coronavirus/2019- ncov/hcp/preparedness-checklists.html
• Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients Potentially Infected with COVID-19 at https://www.cdc.gov/coronavirus/2019- ncov/hcp/hcp-personnel-checklist.html
• CDC’s Influenza Updates and Recommendations https://www.cdc.gov/flu/

3) I know it is much more likely that a patient with the flu may come to the office for dental treatment. What are the CDC recommendations for dental staff to receive the flu vaccine?

CDC recommends that all health care workers, including dentists and staff, receive the flu vaccine. Information on CDC’s recommendations for immunization can be found at https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html.

4) Should staff report to work with acute respiratory symptoms?

• Staff experiencing influenza-like-illness (ILI) (fever with either cough or sore throat, muscle aches) should not report to work.
• Staff who experience ILI and wish to seek medical care should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician’s office, or hospital.
• Staff who have difficulty breathing or shortness of breath, or are believed to be severely ill, should seek immediate medical attention.

Summary

Respiratory hygiene/cough etiquette infection control measures along with contact precautions are currently recommended for preventing transmission of COVID-19 and all flu-like illnesses in a dental healthcare setting. CDC continues to monitor activity relating to COVID-19 and is coordinating efforts with health departments in Arizona, California, Illinois, Massachusetts, Washington, and Wisconsin and communicating with the World Health Organization. This is an evolving situation and CDC is updating its guidance and information as it becomes available.

Brought to you by the ADA Practice Institute. For more information, please contact the Center for Dental Practice at dentalpractice@ada.org or 312-440-2895.