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Return to the Spring 2020 Newsletter Spring 2020 Newsletter: Response to the COVID-19 Outbreak — The West Virginia University School of Dentistry Experience
The West Virginia University School of Dentistry (WVU SOD) is located in the city of Morgantown, and is the only dental school in West Virginia (WV), providing education and training for future oral health care providers as well as serving the oral health needs of the citizens of the state. The next closest dental school is located at the University of Pittsburgh, PA about 80 miles from our location. There are several characteristics, which make the citizens of WV potentially more susceptible to the devastating outcomes of COVID-19 infection: 54% of the population is over 40 years of age, the highest rank in overall cardiovascular disease and chronic obstructive pulmonary disease prevalence in the nation as well as the second highest national prevalence of diabetes. Due to the facts mentioned above, during the lockdown our school has been one of the few oral health care facilities in WV and the surrounding region providing urgent care services for a high-risk population. In response to the pandemic, the governor of WV declared a State of Emergency for all 55 counties on March 16, 2020. The next day, the first COVID-19 case was reported in WV, and two days later, the WV Department of Health and Human Resources reported the first COVID-19 case in Monongalia County, where the main WVU campus, including the Health Sciences Center, is located. As part of the national COVID-19 strategy, the WVU SOD immediately began to work on plans to address this pandemic emergency. The dean of the SOD appointed a COVID-19 Task Force (TF) to develop a response framework to establish protocols in order to deliver emergency services, to prevent COVID-19 transmission within the school, and to safeguard students, residents, faculties, staff and patients from COVID-19 infection and spread. The members of the TF are:
On March 16, 2020, the WVU SOD cancelled all elective procedures including activities in the main clinic for all students, residents and faculty. Moreover, all the in-person lectures, seminars, and conferences were replaced by on-line delivery methods. The undergraduate simulation lab was closed and all classes postponed. The Urgent Care Clinic (UCC), which is under the direction of Department of Diagnostic Sciences, continued providing urgent care in conjunction with the oral and maxillofacial surgery, endodontic and pediatric dentistry clinics and periodontic, prosthodontic, restorative, orthodontic, services for those specific cases. The TF developed a weekly rotation schedule which was staffed by faculty who were permitted to provide care (many of the SOD faculty had one or more risk factors and were directed to remain home), and supported by residents from the specialty programs. In order to determine a patient’s need for urgent or emergency care, the TF applied the ADA guidelines for dental emergencies. EVALUATION/SCREENING OF PATIENTS A series of modifications were implemented including discouraging walk-in emergency visits, and telephone screening for COVID-19, medical history and chief complaint. Patients were scheduled in small groups (max of 4) every hour. A separate section of the appointment book was set up to record appointments for pediatric patients, who were seen directly by the pediatric dentist on emergency duty, and for patients who were given an endodontic appointment. The patient was notified to come to the SOD wearing a mask and with no accompanying person, unless it was completely necessary. PATIENT PROCESSING DURING APPOINTMENT At the check-in time, the COVID-19 screening form was updated and the patient’s temperature was taken. If the temperature was > 99° F, the UCC faculty was informed and further evaluation was made. Patients were given either 1% hydrogen peroxide or 0.2% povidone-iodine and instructed to rinse for 1 minute. Extraoral imaging, specifically, panoramic radiographs were taken for most the patients to avoid the gag reflex or cough that may occur with intraoral imaging. Periapical/bitewing films were taken whenever they were extremely necessary. After the clinical exam and acceptance of the treatment plan, the patient was referred to the appropriate service. Despite the large-scale community transmission of coronavirus in the U.S., demand for urgent dental treatment has been steady and recurring. In our school, this need decreased by only 10% compared with the same period in 2019. The creation of a COVID-19 task force, consisting of members with expertise in various areas, allowed an efficient response, in a coordinated manner, to the pandemic threat. In our school, this group was able to bring together a specific set of knowledge and skills to accomplish a critical short-term task, which was necessary as soon as the crisis started. Valuable resources such as previous studies from diverse groups in different countries, dental associations/institutions’ recommendations, regulatory and advisory bodies as well as experts’ opinions were all an important inputs into the decision making process of the TF. This task force is working, currently, on the development of tools and guidelines to support our entire community to return to work after the COVID-19 closures and practice restrictions are lifted.
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“The School’s COVID-19 Task Force was able to work collaboratively with the rest of the school, to deal not only with the daily decisions that needed to be made, but also to develop and successfully execute the resumption of elective care. The entire institution is indebted to the task force members”