By: Margaret Scarlett, DMD
The Omicron variant of COVID-19 is driving a national surge in COVID-19 cases, serious illness, and hospitalizations. With more than 750,000 cases a day in the US, the incidence of new COVID-19 cases and lack of availability of reliable testing means that a “Zero COVID strategy” may be out of reach to stop community transmission.
Vaccination and boosters are critical to stopping the spread of the Omicron variant, and its most deadly consequences. Although “herd immunity” is invoked, we do not know whether immunity is to alpha, delta, beta, wild type, original, or Omicron variant
What are the Best Ways to Protect Against COVID-19?
The epidemic is evolving so rapidly that it is hard to monitor relevant scientific findings and policy responses, however, recent findings may shed light on where the epidemic is likely to go in the coming months.
Still, the fact that COVID-19 is an airborne, respiratory disease has NOT changed. There are concrete steps that can be taken to protect providers and patients from this disease, and these steps are no longer optional.
1. Respiratory Protection Plans
Getting a written respiratory protection plan in place along with a written vaccination policy is essential for your office. Balancing the risk vs benefit of everyday life and work is part of your customized equation for living with COVID-19.
It is now clear that neither prior infection nor vaccination provide lifelong immunity. A new equation for evaluating risks vs benefits of COVID-19 prevention strategies is emerging, taking into account your community vaccination rates, hospital capacity, and risk tolerance, for your office team and patients.
2. Monitor Hospital Occupancy
One key factor to assess is how full your local hospitals are. Right now, the discussion is underway to open field hospitals in hardest-hit areas.
Let’s look at some facts:
- Infectivity with Omicron comes sooner after exposure and results in higher rates of transmission, compared to the Delta variant.
- Available data suggests that serious illnesses and hospitalizations with Omicron are about 1/3 of other COVID-19 variants.
That’s the good news.
The bad news is that hospitals are filling up. Because of the sheer number of COVID-19 cases, now mostly Omicron, many community hospitals are already at or near capacity for hospital beds or ICU beds. The majority of hospitalizations for COVID-19, now mostly Omicron variant, are unvaccinated and immunocompromised or pre-existing conditions.
Your office may want to assess local hospital data, not necessarily the data of the total number of cases, to assess any risks for your patients. If the hospital is overwhelmed, this creates stress for health care, not just for COVID-19, but other conditions requiring skilled care.
To search utilization at your local hospital, click here. If it is at or above capacity, you may want to reassess your scheduling, based on your patient population and your community actions.
3. Review Community Guidelines
Different community interventions against Omicron vary geographically, adapting recommendations for your office and community. The “new normal” is learning to live and work with COVID-19.
Rapidly changing vaccination and testing recommendations included recent updating to the Centers for Disease Control and Prevention’s (CDC’s) recommendations for boosters 5 months after full vaccination and a booster vaccination recommended for adolescents 12-17. Children between 5 and 12 can receive a 2 dose vaccination. Science is evolving, and with it, recommendations are evolving.
Look for more changes, as we learn about Omicron.
New language from CDC focuses on staying up to date with vaccinations, following the release of two studies that show that a booster dose was effective at preventing severe illness, especially among those 50 years old and older.
4. Re-Schedule Patients at Higher Risk
What does this mean for scheduling patients from your community? For some patients, especially those who are immunocompromised, the risk of breakthrough cases of Omicron variant may warrant re-scheduling in a few months, if necessary.
When the spike of new cases has resolved in your community, the risks for elderly or immunocompromised patients may be less, following this spike. Data from South Africa and the UK suggest that the spike may go down in a few months, and that’s the best guess.
5. COVID-19 Prevention
What to do in the meantime? Vaccination, testing, masking, and social distancing remain the key messages for preventing community transmission.
Having a written vaccine policy has been recommended for some time, and may be important now. It is your choice whether this is mandatory or voluntary.
Some offices are performing routine rapid testing for all employees. However, false-negative results with the rapid antigen tests are being reported early in infection, from small studies assessing simultaneous testing by Polymerase Chain Reaction (PCR). PCR positivity occurred several days before the antigen tests.
Learning to Live and Work with COVID-19
What does this mean for your dental practice?
Monitor symptoms of yourself and your team and test, when needed. For COVID-19 positive employees, they should stay off work for a minimum of five to seven days and then be sure to wear an N95 or better mask. If the staff has not been vaccinated, do you still pay dental team members for those five days? This is not yet clear.
Even so, infectivity may decline after 5 days but may linger for a few more days, leaving controversy about five-day isolation for COVID-19 positive cases. Following the announcement by the UK of a post-infection quarantine for 7 days with a negative test, many health workers were instituting testing programs in health settings. However, using rapid tests or PCR may have its own set of issues. In some small studies, PCR could remain positive for up to 12 weeks, or more, rendering this test not practical for assessing workplace fitness. Clearly, gaps in the science remain, making us humble indeed.
What is clear is that re-enforcing a written respiratory protection plan for your office is critical for safety. Fortunately, dental offices upgraded their protocols, beginning in 2020. Not just for COVID-19, but influenza, respiratory syncytial virus (RSV), other pneumonias, and even a new one, human metapneumovirus (hMPV).
Just as the bloodborne pathogen standard in 1991 emerged from blood-borne infections of hepatitis B and HIV in the 1980s, many experts believe that a similar standard for respiratory protection from all respiratory pathogens will evolve. Until then, dental offices should continue to review and reinforce respiratory protection. These provide protection against ALL respiratory pathogens. Remember to ensure proper fit testing of N95 or better masks. If the supply of your favorite masks changes with your most recent order, remember to repeat the fit test for the new brand of N95 masks.
Learning to live, work and play with COVID-19 is balancing risks for community transmission with the benefits of human contact and socialization. Experts are calling for a national strategy to accept the inevitability of living, working, and practicing with COVID-19 and that’s not a bad idea. (1)
- Emanuel EJ, Osterholm M, Gounder CR. A National Strategy for the “New Normal” of Life With COVID. JAMA. Published online January 06, 2022. doi:10.1001/jama.2021.24282https://jamanetwork.com/journals/jama/fullarticle/2787944
MARGARET SCARLETT, DMD, is an infectious and chronic disease prevention specialist, dentist, and author. For 30 years, Dr. Scarlett has provided expert guidance on infectious diseases and infection control as a consultant to the Centers for Disease Control and Prevention, the World Health Organization, the Pan American Health Organization, the United States Agency for International Development, the American Red Cross, and many consumer health companies. Contact Dr. Scarlett at firstname.lastname@example.org or (404) 808-9980.