BY NORMAN J CLEMENT RPH., DDS
..I remember a song from my childhood as the great opera singer Jessie Norman sang ” ..when Jesus was in Israel land let my people go… today Norman Jesse Clement RPh., DDS sings…. when COVID comes to the peoples land let my Dentistry GO,…they can save ours lives old pharaoh… all around the peoples land, I tell you, old pharaoh let OUR Dentist GO… “
CONGRESSMAN BOBBY RUSH H.R. 6666 PERMITS DENTIST TO BE APART OF TESTING
Today, U.S. Representative Bobby L. Rush introduced H.R. 6666, the COVID-19 Testing, Reaching and Contacting Everyone (TRACE) Act. This bipartisan bill would establish a grant program run by the Centers for Disease Control and Prevention (CDC) to fully mobilize coronavirus testing and contact tracing efforts. Grantees would include Community Health Centers, School Based Health Centers, academic medical centers, non-profits, and other entities who would hire and train individuals to operate mobile testing units, as well as outreach in hot spots and medically underserved areas.
“Reopening our economy and getting back to normal will be all but impossible if we do not step up our testing efforts and implement robust and widespread contact tracing,” said Rep. Rush. “Until we have a vaccine to defeat this dreaded disease, contact tracing in order to understand the full breadth and depth of the spread of this virus is the only way we will be able to get out from under this.
“The COVID-19 TRACE Act will allow us to do this by creating a $100 billion dollar grant program for local organizations to hire, train, and pay individuals and to purchase supplies to run mobile testing units and door-to-door outreach as is safe and necessary, with special preference being given to those operating in hot spots and medically underserved communities, as well as those entities who commit to hiring from these neighborhoods.
“I am immensely proud to see this bill receive bipartisan support and I hope to see the COVID-19 TRACE Act swiftly adopted by the House as a stand-alone bill or as part of a larger coronavirus response package.”
Rep. Rush answers frequently asked questions about the COVID-19 TRACE Act:
What is the COVID-19 TRACE ACT?
- The COVID-19 Testing, Reaching and Contacting Everyone Act is a comprehensive, bipartisan bill that would establish a 100 BILLION dollar grant program for local organizations to hire, train, and pay individuals to run mobile testing units and conduct door-to-door outreach, with special preference being given to those operating in hot spots and medically underserved communities.
- The bill has been officially endorsed by the American Diabetes Association and EverThrive Illinois.
What is Contact Tracing?
- Contact tracing is not a new concept and is used all over the world to combat infectious diseases such Ebola and tuberculosis. Because coronavirus is highly contagious, contact tracing helps us understand who has the virus, and who they might have come into contact with, so we can better protect those potential patients as well.
- According to the CDC, contact tracing is a core disease control measure and a key strategy for preventing further spread of COVID-19.
- Given that many people with coronavirus are asymptomatic, contact tracing becomes even more important if we are serious about getting back to work and back to normal.
- Moreover, we are currently witnessing more frequent testing in white, affluent communities but more COVID-19 cases and deaths in low-income, minority communities. In Illinois, even though black residents are dying of COVID-19 at more than three times the rate of the state’s white population, white residents are still tested nearly twice as often. That is why we need to ramp up testing and contact tracing in these communities and other medically underserves communities as well.
Who would qualify for grants?
- Federally Qualified Health Centers;
- School-based Health Clinics;
- Disproportionate-Share Hospitals;
- academic medical centers;
- non-profits, including faith-based organizations;
- high schools and universities; and
- Any other entity deemed eligible by the CDC.
Does the COVID-19 TRACE Act require testing?
- No. The COVID-19 TRACE is about providing testing to those who want/need it. Not everyone has the ability to visit drive-thru testing sites, and many others are unable to leave their homes to get tested for any number of reasons. This bill would allow the testers to come to you through mobile testing units and door-to-door outreach, as is safe and necessary, from members of your own community. However, if you don’t want to be tested for coronavirus, you won’t don’t have to be — but you should!
If I test positive for coronavirus, will I be forced to quarantine?
- Absolutely not. Again, these tests would be completely voluntary. The bill does not force you or your loved ones to do anything at all. With that being said, if you or a loved one does has the coronavirus, it is advised that you do self-quarantine and maintain social distance from others. If you are experiencing symptoms, you should contact your primary care physician immediately and look into getting tested.
Valerie Washington RPh, DDS
I, too am a Pharmacist and a Dentist. I have been away from my practice for 5+ weeks and wondering why Dentists are not a part of the screening and testing for COVID-19. All across the country our great resources, Dentists, are not being utilized.
Through first hand observation and examination of the oral cavity we can detail and document characteristics of this virus from an oral viewpoint and be screeners and testers to help do our part in identifying and eradicating the spread of this pandemic. Let Dentists along with Pharmacists partner with Medical professionals and researchers to get this job done.
DAVID APSEY DDS, MS., FAGD, A DENTIST FROM WARREN, MICHIGAN
” Mouth rinsing with disinfectant mouthwash, brushing teeth and flossing with baking soda and nasal lavage (rinsing out nasal cavity) with salt water solution can serve to prevent invasion of your body by the virus. The virus doses will be much reduced and less likely to become established. It can prevent person to person transmission by reducing dosage levels in aerosols produced during medical care or other activities in public. This is not a cure for covid, it is a preventive measure and is every bit as important as hand washing and disinfecting surfaces we touch. So far it has not received as much public attention as it deserves.
LAJUANA C ISAAC, DD.S. Detroit, Michigan
I agree that dentists should be on the frontline in the diagnosis tests for covid 19, not only to increase testing but for the protection of the dentists, their staff and patients.I also believe that due to quarantine, or with patients hospitalized, there will be an increase of plague and calculus due to poor oral hygiene or even lack of oral hygiene.
I hope the National Dental, Association (NDA) American Dental Association (ADA) stands behinds the dentists and allows additional codes for these circumstances, and the insurance companies will issue payment for additional needed PPE, face shields, isolation gowns additional precautionary antiseptic mouth rinses.We will all have to change our scheduling, meaning treating less patients,
1) due to fear of contracting the virus, some patients may not return to dentists or
2) to allowing for “super” disinfection of the entire office setting between patients and 3) treating less patients per day, let’s call that social distancing.I hope the, NDA, ADA, CDC, the local health departments step up to the plate to endorse the dentists by stressing the importance of good oral hygiene and dental prophylaxis, and scaling and root planing.
Such an announcement will aid the dental profession to rebuild, revive and places us as frontline essential workers. It is appalling that we were shut down out of fear of spreading the virus, when our profession inherently protects ourselves, our staff, and our patients by wearing masks, gloves, lab coats. We religiously disinfect our operatories, and sterilize our instruments,twice, once with a discide, and second in an autoclave.
However in comparison, we were thrust in the same whirlpool as tattoo artists, hair and nail salons and not permitted to return to practice, except for emergencies. Pardon my French, but wtf, why are those professions permitted to resume while we are limited to emergencies only.
Keep in mind most toothaches did not happen overnight, many of those patients are high risk, poor oral hygiene, many of those have not seen a dentist for several years. But they will permit us to render treatment for those circumstances.
THE JOURNAL OF THE AMERICAN DENTAL ASSOCIATION
The Journal of the American Dental Association, Vol 135, issue April 4, 2004, Pages 429-437, Aerosols and Splatter in Dentistry: A Brief Review of the Literature and Infection Control Implications, by Stephen K. Harreld, DDS., John Molinari, Ph.D.;(2)
” The saliva and nasopharyngeal secretions also may contain other pathogenic organisms. These may include common cold and influenza viruses, herpes viruses, pathogenic streptococci and staphylococci, and the SARS virus. The use of universal precautions with all patients initially was based on the assumption that all patients may have an infectious bloodborne infection, such as with hepatitis B virus, hepatitis C virus, and HIV. It also should be assumed that all patients may have an infectious disease that has the potential to be spread by dental aerosols; thus, universal precautions to limit aerosols also should be in place.”
SALIVA IS MORE SENSITIVE FOR SARS-CoV-2 DETECTION IN COVID PATIENTS THAN NASOPHARYNGEAL SWABS, YALE UNIVERSITY REPORT SAYS
Saliva sampling is an appealing alternative to nasopharyngeal swab, since collecting saliva is non-invasive and easy self-administered, states a Yale University study, which supports You’re Within The Norms (YWTN) earlier conclusions. Clearly, COVID-19, is and Oral pharyngeal disease, detectable in the mouth and there is a need for Oral Healthcare Armed Intervention, before it expresses itself as a Systemic Pulmonary disease with horrific deathly outcomes.(1)(3)
In a study conducted at Yale University School of Public Health, Yale School of Medicine, abstract published April 22, 2020, reported:
“Our (The Yale University) study demonstrates that saliva is a viable and preferable alternative to nasopharyngeal swabs for SARS-CoV-2 detection. We (Yale) found that the sensitivity of SARS-CoV-2 detection from saliva is comparable, if not superior, to nasopharyngeal swabs in early hospitalization and is more consistent during extended hospitalization and recovery. Moreover, the detection of SARS-CoV-2 from the saliva of two asymptomatic healthcare workers despite negative matched nasopharyngeal swabs suggests that saliva may also be a viable alternative for identifying mild or subclinical infections. With further validation, widespread implementation of saliva sampling could be transformative for public health efforts: saliva self-collection negates the need for direct healthcare worker-patient interaction, a source of 14–16 several major testing bottlenecks and overall nosocomial infection risk , and alleviates supply demands on swabs and personal protective equipment.”
YALE SCHOOL OF PUBLIC HEALTH AND YALE UNIVERSITY SCHOOL OF MEDICINE STUDY SUPPORTS DENTAL HEALTHCARE INVOLVEMENT
“As SARS-CoV-2 viral loads differ between mild and severe cases, a limitation of our (Yale)study is the primary focus on COVID-19 inpatients, many with severe disease. While more data are required to more rigorously compare the efficacy of saliva in the hospital setting to earlier in the course of infection, findings from two recent studies support its potential for detecting SARS-CoV-2 from both asymptomatic individuals and outpatients. As the infectious virus has been detected from the saliva of COVID-19 patients , ascertaining the relationship between virus genome copies and infectious virus particles in the saliva of pre-symptomatic individuals will play a key role in understanding the dynamics of asymptomatic transmission .”
“Stemming from the promising results for SARS-CoV-2 detection in asymptomatic individuals, a saliva SARS-CoV-2 detection assay has already gained approval through the U.S. Food and Drug Administration emergency use authorization. To meet the growing testing demands, however, our findings support the need for immediate validation and implementation of saliva for SARS-CoV-2 diagnostics in certified clinical laboratories.“
FOR NOW
YOU ARE WITHIN THE NORMS
ENDNOTES
- MedRxiv preprint doi: https://doi.org/10.1101/2020.04.16.20067835.this version posted April 22, 2020.
- The Journal of the American Dental Association, Vol 135, issue April 4 2004, Pages 429-437, Aerosols and Splatter in Dentistry: A Brief Review of the Literature and Infection Control Implications, by Stephen K. Harreld, DDS., John Molinari, Ph.D
3. Sample collection Inpatients, Nasopharyngeal, and saliva samples were obtained every three days throughout their clinical course. Nasopharyngeal samples were taken by registered nurses using the BD universal viral transport (UVT) system. The flexible, mini-tip swab was passed through the patient’s nostril until the posterior nasopharynx was reached, left in place for several seconds to absorb secretions then slowly removed while rotating. The swab was placed in the sterile viral transport media (total volume 3 mL) and sealed securely. Saliva samples were self-collected by the patient. Upon waking, patients were asked to avoid food, water, and brushing of teeth until the sample was collected. Patients were asked to repeatedly spit into a sterile urine cup until roughly a third full of liquid (excluding bubbles), before securely closing it. All samples were stored at room temperature and transported to the research lab at the Yale School of Public Health within 5 hours of sample collection.
