COVID-19_smallCOVID-19 

Updated April 9, 2020

CDC has just released new interim infection prevention and control guidance for dental settings for the COVID-19 response, and it can be found at:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.

Key concepts have been updated, and the revisions include:

  • Description of risk to dental health care personnel (DHCP)when providing emergency care during the COVID-19 pandemic.
  • Recommendations for contacting patients prior to emergency dental care.
  • Recommendations for providing emergency dental care to non-COVID-19 patients including engineering controls, work practices and infection control considerations.
  • Potential exposure guidance.
  • Contingency and crisis planning.

PPE

Last week, Dr. Heidi Stark was introduced to Steve Peters and his company, Atom Collective, a distributor of PPE, through Rep. Fortenberry's Chief of Staff, Dr. Reyn Archer. Yesterday afternoon, the NDA Board of Trustees attended a Zoom meeting with Steve Peters. Also on the Zoom were representatives of the Nebraska Medical Association, Nebraska Hospital Association, Bryan Hospital and Lancaster County Medical Society.

We have been told by state and federal officials that for the short term, we are on our own to find PPE. We have tried our best to vet this organization. Unfortunately, since most of these businesses have not been working in this industry very long, we have very little research or data available on them. We are relying on the introduction from Dr. Archer and the FDA approval. 

The Atom Collective Product Brochure provides descriptions of the available PPE.

If you choose to order, use the Medical Supply PPE Request Form

Calculate the totals from your order and include the applicable sales tax for your area using the Local Sales and Use Tax Rates

Email the form to SALES@ATOMCOLLECTIVE.COM

Once Atom Collective receives an order, they will process and then send to each individual entity a purchase order which then can be paid for through Credit/Debit card and ACH. These are their prices as of now for the stock that’s available right now. This information will also be on the NDA COVID-19 page.

Atom Collective PPE Product Description; Atom Collective Medical Supply Order Form Fillable; Atom Collective Medical Supply Manual Order Form; NE sales tax rates


The recent Directed Health Measure now encompases the entire state of Nebraska.
Directed Health Measures Nebraska Counties















Summary through April 6th:
Until May 11, 2020
- Hooker, Arthur, McPherson, Logan, Thomas, Lincoln,  Dakota, Cedar, Dixon, Wayne, Thurston, Boone, Nance, Platte, Colfax, Otoe, Johnson, Nemaha, Pawnee, Richardson, Fillmore, Saline, Thayer, Jefferson, Gage, Blaine, Loup, Garfield, Wheeler, Custer, Valley, Greeley, Sherman, Howard, Keith, Perkins, Chase, Hayes, Frontier, Dundy, Hitchcock, Red Willow, and Furnas counties effective immediately and continuing until May 11, 2020 
Until May 15, 2020 - Boone, Colfax, Nance, Platte counties. (local DHM take priority over State DHM)
Until May 11, 2020 - 
Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce, Rock, Hooker, Arthur, McPherson, Logan, Thomas and Lincoln counties.
Until May 11, 2020 - Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties. 
Until May 11, 2020 -  Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties.
Until May 6th -  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt counties.
Until April 30th - Cass, Douglas & Sarpy counties.  


April 3, 2020

East-Central District Health Department issued a DHM for Boone, Colfax, Nance, Platte counties, extending to May 15, 2020.  Poorly written, the DHM excludes medical providers in paragraph 3, but later prohibits elective surgeries and procedures in paragraph 9.

Can I See My Patient TodayWe have created a Can I See My Patient Today? infographic to help offices operate during Directed Health Measures and the current NDA recommendation, to use in conjunction wth the ADA Guidance for Screening Patients COVID19, COVID-19 Pandemic-Patient Disclosures, COVID-19 Pandemic Emergency Dental Treatment and COVID-19 Protocol



April 2, 2020
DHHS issued another DHM, adding  Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce, Rock, Hooker, Arthur, McPherson, Logan, Thomas and Lincoln counties effectively immediately and continuing until May 11, 2020.
Directed Health Measures Nebraska Counties















Summary through April 3rd:
Until May 15, 2020 - Boone, Colfax, Nance, Platte counties.
Until May 11, 2020 -
Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce, Rock, Hooker, Arthur, McPherson, Logan, Thomas and Lincoln counties.
Until May 11, 2020 - Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties. 
Until May 11, 2020 -  Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties.
Until May 6th -  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt counties.
Until April 30th - Cass, Douglas & Sarpy counties.  


DHHS issued another DHM, adding Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties effectively immediately and continuing until May 11, 2020.

Summary through April 1st:
Until May 11, 2020 - Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties. 
Until May 11, 2020 -  Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties.
Until May 6th -  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt counties.
Until April 30th - Cass, Douglas & Sarpy counties.  

Sarpy County Health Department
called the NDA to inform us that they are now reporting dental offices that are still performing hygiene procedures in their offices, in violation of the DHM.  (*In the event of noncompliance with the terms of this Order, law enforcement and other Municipal and Local Public Health Department personnel will be required to aid the Department in enforcement of the Order, pursuant to 173 NAC 6 and NEB. REV. STAT.§ 71-502.)


March 31

Yesterday, DHHS issued another Directed Health Measures naming the following counties under the  Directed Health Measure: Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties effective immediately and continuing until May 11, 2020. 
For the counties not specifically listed in the DHM, the NDA  Board is recommending dental offices in Nebraska follow the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response issued by the CDC until April 30th.  

March 30

The NDA Board of Trustees met during a noon Zoom call and reviewed DHHS's recent expanded COVID-19-State Directed Health Measure on March 29th, which now includes Cass, Douglas & Sarpy counties through April 30th and  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt, counties through May 6th. This DHM is a mandate, not a recommendation.  Failure to comply with this mandate will result in legal action for enforcement by civil and/or criminal remedies.  Dentistry as usual is off limits.

The key language appears on page 4 of the DHM which the NDA believes applies to dental offices:

2.         Elective surgeries and elective procedures are hereby prohibited. For the purposes of this Order, this means a surgery or procedure that is scheduled in advance because it does not involve a medical emergency. Surgeries or procedures that must be done to preserve the patient's life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical provider.

Because some dental office believe that the DHMs do not apply to them, we asked Dr. Craft, NE State Dental Director at DHHS to consult with Thomas J. Safranek, M.D., DHHS State Epidemiologist.  Dr. Safranek agrees that the DHMs apply to both dental and medical providers and are working to include this language in the next updated DHM.

For the remainder of NE counties not affected by the DHM listed above, the NDA Board is recommending dental offices in Nebraska follow the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response issued by the CDC until April 30th.  In short, the Guidance states "Postpone elective procedures, surgeries, and non-urgent dental visits, and contact patients prior to emergency procedures. Stay at home if sick and know steps to take if a patient with COVID-19 symptoms enters your facility."

The Nebraska Board of Dentisty has previously issued a statement on what constitutes an emergent/urgent dental procedure.

CARES Act WebinarWatch the ADA Webinar What’s in the CARES Act and How It Can Immediately Impact My Dental Practice

The Academy of Dental CPAs and ADA provide a quick recap of the loans affected by the CARES act: Economic Injury Disaster Loan (EIDL) - Section 7(b) of SBA and Paycheck Protection Loan - Section 7(a) of SBA.

The Small Business Owners Guide to the CARES Act -  The programs and initiatives in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was just passed by Congress are intended to assist business owners with whatever needs they have right now. When implemented, there will be many new resources available for small businesses, as well as certain non-profits and other employers. This guide provides information about the major programs and initiatives that will soon be available from the Small Business Administration (SBA) to address these needs, as well as some additional tax provisions that are outside the scope of SBA.

Message from Mike Graham, Senior Vice President, ADA Government and Public Affairs

Like some of you perhaps, I have received some emails asking whether a dentist owner can apply for and receive funding from BOTH an Economic Injury Disaster Loan (EIDL) and Paycheck Protection (PPP) loan.

The simple answer is YES.

Unfortunately, there is considerable misinformation out there.  ADA staff has been working hard with our consultant experts, Capitol Hill staff from both the House and Senate Small Business Committees, as well as members of the Academy of Dentist CPAs – and they have confirmed our reading of the most recent versions of the final bill, bill summary and additional documents.  A dentist can receive funding from BOTH an EIDL loan and PPP loan.    The ADA issued March 28, 2020 - Small Business Owners Guide to the CARES Act
 
Therefore, we still recommend that dentists apply for the EIDL loan first – so that they can get the EIDL $10,000 grant and EIDL loan as quickly as possible. Then, if necessary, apply for the 7(a) loan, some or all of which is subject to loan forgiveness if used for eligible expenses. Bottom line is that you can roll the EIDL loan into the 7(a) loan if you like (you are not required to do so).
 
ADA staff is working with the Academy of Dentist CPAs to develop a Fact Sheet on EIDL loans and PPP loans as well as a "Decision Point Flow Chart" that may assist dentist owners in making decisions in the future.


March 25
Dear NDA Members,

The NDA Board of Trustees voted today to extend the NDA BOT COVID-19 Statement March 16 recommendation to April 6, 2020, aligning with the current ADA recommendation.

The NDA Board of Trustees realizes this is a fluid situation and will continue to aggressively monitor information from the ADA, CDC and the Nebraska Department of Health on a daily basis, until we are through this crisis. We are in uncharted waters. The uncertainty of this pandemic makes it impossible to predict at this time if or when the April 6th date will be extended. 

Thank You and Stay Safe!
NDA Board of Trustees

March 27

We have received forms used by dental offices performing procedures during the COVID-19. COVID-19 Pandemic - Patient Disclosures and COVID-19 Pandemic Emergency Dental Treatment along with CDC guidance for dental offices.

The ADA Webinars scheduled for March 27 will be available on ADA COVID-19 Resources for Dentists.

DHHS has issued two Health Directed Measures affecting Lancaster/Dodge/Sounder counties and Cass/Douglas/Sarpy counties.

http://dhhs.ne.gov/Documents/COVID-19-StateDirectedHealthMeasures-Lancaster-Dodge-Saunders-Counties.pdf

http://dhhs.ne.gov/Documents/COVID-19-StateDirectedHealthMeasures.pdf

USA_Map_State_Mandates_March 27The key language is:

2.         Elective surgeries and elective procedures are hereby prohibited. For the purposes of this Order, this means a surgery or procedure that is scheduled in advance because it does not involve a medical emergency. Surgeries or procedures that must be done to preserve the patient's life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical provider.

As of March 27, 2020, thirty states have issued statewide mandate for emergency procedures only.


On March 18th, the ADA issued What Constitutes a Dental Emergency? to assist dentists to determine which procedures should be allowed during these times.  Also, last week, the Nebraska Board of Dentistry considered the NDA and ADA recommendation, along with the ADA's What Constitutes a Dental Emergency and issued a Board of Dentistry Statement on March 20, 2020.  This Statement provides further guidance to Nebraska dentists on recommended allowable procedures to be performed in the office.  The March 20th bulletin from the CDC aligns with the NE BOD statement.

Finally, we know you have a lot of questions about what to do. We are trying to get answers for you so please be patient.  We are still drinking from the firehose here.  We are also asking for your help. If you could share any information you have please contact your NDA Leadership 

We believe the more we can share and learn from each other will help us get through this uncharted territory together. We will try to post all information we gather on this page.

We would like to remind you that it is our responsibility to take care of our patients of record who have dental emergencies. We do not want to overwhelm the emergency departments with dental emergencies that we should be seeing in our offices.

We understand you will have questions about what to do next following this announcement. For the most up-to-date information and support, continue checking this webpage.

The Association of State and Territorial Dental Directors (ASTDD) is a national non-profit organization representing the directors and staff of state public health agency programs for oral health.  The ASTDD suports the ADA recommendation. 

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