Posted on March 23:
ISDA/ADA on COVID-19
Idaho small businesses impacted by coronavirus can now access federal disaster loans
Following Governor Brad Little's request, the U.S. Small Business Administration (SBA) announced Friday it is now offering low-interest federal disaster loans for working capital to Idaho small businesses suffering substantial economic injury as a result of the 2019 novel coronavirus (COVID-19).
“Small business is the backbone of our economy, and that’s why I requested additional resources for Idaho’s small businesses during this time of hardship and uncertainty,” Governor Brad Little said.
Small businesses, private non-profit organizations of any size, small agricultural cooperatives and small aquaculture enterprises that have been financially impacted as a direct result of coronavirus since Jan. 31, 2020, may qualify for Economic Injury Disaster Loans of up to $2 million to help meet financial obligations and operating expenses that could have been met if the disaster had not occurred.
The loans may be used to pay fixed debts, payroll, accounts payable and other bills that cannot be paid because of the disaster’s impact. Eligibility for Economic Injury Disaster Loans is based on the financial impact of coronavirus.
The interest rate is 3.75-percent for small businesses. The interest rate for private non-profit organizations is 2.75-percent. The SBA offers loans with long-term repayments up to a maximum of 30 years.
The deadline to apply for an Economic Injury Disaster Loan is Dec. 21, 2020.
For more information, visit https://commerce.idaho.gov/covid-19/.
Posted on March 23:
A lot has happened in the past few days relative to options to fund our practices as we work through the ramifications of cut backs in treating patients.
Many of you are asking if you should pay employees for the next couple of weeks (and how if cash is tight), or have them file for unemployment. Many of you have expressed concern with SBA loans as the answer since that increases the debt load in an already highly leveraged industry.
While we are still working to get definitive answers on these questions and more, we do want to pass along the latest information as we understand it.
Many teams are working at the national level to advocate for dentistry and to get solutions in place that work well given our unique business dynamics. Here is a link to a conference call that was held Saturday afternoon between the Oklahoma Dental Association, and their Senator James Lankford who is working on the third piece of COVID -19 Relief legislation that is in the Senate. A recording of that call can be found HERE (in Dropbox). The call is about 30 minutes, and worth listening to through to the very end. As you have likely heard this legislation is still being negotiated in the Senate.
The good news is that the issues are related to concern that the relief efforts don’t get overly weighted to large corporations are instead focused on small businesses. That bodes well for the legislation to contain the elements that are critical for us. It’s possible that this legislation may get through the Senate today, and hopefully to the House as early as Tuesday 3/24 and could be to the President by Wednesday 3/25. Please click here to contact your Members of Congress to let them know how important these provisions are for your dental practice and other small businesses across the country.
If you haven’t already laid off staff / suggested they file for unemployment, you might want to hold off on doing so as we are seeking guidance relative to the applicability of both Families First and the newest bill relative to the impact on payroll tax credits and the potential for grants to cover payroll.
Working with your existing lenders to defer payments, or at least to pay interest only for the next few months is an immediate action that all should be taking.
SBA loans are available, and if the third piece of legislation passes with the SBA provisions, they will be faster and easier to get, and may carry some grant provisions.
ISDA has calls on Monday and Wednesday with Delta Dental of Idaho and Blue Cross of Idaho to discuss ways to help our dentists.
ISDA has contracted with a labor attorney to provide guidance on key employment questions. We expect to have the first set of questions posted to our website on Monday. As with the points above, much is dependent on the relief packages, and we will post more as we have clear guidance.
Again, much of this is still in development, but it definitely gives hope for solutions that are workable. We are committed to your success, and sustainability, and together we will get through this
Dr. Jill Wagers, ISDA President
Posted on March 20:
Idaho wants to hear from small businesses impacted by coronavirus
Businesses impacted may be eligible for SBA Disaster Economic Injury Loan Assistance
Boise, Idaho – Governor Brad Little announced the State of Idaho is seeking responses from small, non-farm businesses across Idaho whose operations and ability to conduct business have been disrupted by the 2019 novel coronavirus (COVID-19).
The information received will determine whether impacted businesses will be eligible for disaster assistance in the form of low interest loans from the U.S. Small Business Administration (SBA) though Economic Injury Disaster Loan assistance.
Coronavirus has caused disruptions in ordinary business functions and economic injury since the first confirmed case occurred in the United States in January.
The State of Idaho will need responses from small businesses to demonstrate economic injury as determined by the SBA in order to activate Economic Injury Disaster Loan assistance.
In order to respond, businesses should complete and the SBA Disaster Economic Injury Worksheet to assist with the qualification process. The worksheet can be found on the Idaho Commerce website at https://commerce.idaho.gov/covid-19/
Forms can be downloaded, completed, and e-mailed to Jerry Miller at the Idaho Department of Commerce at firstname.lastname@example.org For alternative submission options, call 208-287-0780.
Businesses impacted coronavirus who may not apply to receive financial assistance are still encouraged to submit worksheets to document the impact on their business. This information will help Idaho businesses who do apply for an Economic Injury Disaster Loan to be more likely to receive assistance.
If approved, the assistance will be in the form of low interest, direct loans from the SBA. These loans may be used to pay fixed debts, payroll, accounts payable and other bills that cannot be paid because of the disaster’s impact. The interest rate is 3.75-percent for small businesses. The interest rate for non-profits is 2.75-percent. The SBA offers loans with long-term repayments in order to keep payments affordable, up to a maximum of 30 years. Terms are determined on a case-by-case basis, based upon each borrower’s ability to repay.
Farms and ranches are not eligible for the SBA program but may seek information from their county U.S. Department of Agriculture, Farm Service Agency representative.
For additional information, visit the SBA disaster assistance website at SBA.gov/Disaster.
Posted on March 19:
Emergency or Non Emergency? ADA Offers Guidance for Determining Dental Procedures
In a statement
issued on March 16, the American Dental Association (ADA) called upon dentists nationwide to postpone elective dental procedures for three weeks in order for dentistry to do its part to mitigate the spread of COVID-19. Concentrating on emergency dental care only during this time period will allow dentists and their teams to care for emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.
The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is a fluid situation, and those closest to the issue may best understand the local challenges being faced.
The following should be helpful in determining what is considered “emergency” versus “non emergency.” This guidance may change as the COVID-19 pandemic progresses, and dentists should use their professional judgment in determining a patient’s need for urgent or emergency care.
1. Dental emergency
Dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include:
- Uncontrolled bleeding
- Cellulitis or a diffuse soft tissue bacterial infection with intra-oral or extra-oral swelling that potentially compromise the patient’s airway
- Trauma involving facial bones, potentially compromising the patient’s airway
Urgent dental care focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These should be treated as minimally invasively as possible.
- Severe dental pain from pulpal inflammation
- Pericoronitis or third-molar pain
- Surgical post-operative osteitis, dry socket dressing changes
- Abscess, or localized bacterial infection resulting in localized pain and swelling.
- Tooth fracture resulting in pain or causing soft tissue trauma
- Dental trauma with avulsion/luxation
- Dental treatment required prior to critical medical procedures
- Final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation
Other urgent dental care:
- Extensive dental caries or defective restorations causing pain
- Suture removal
- Denture adjustment on radiation/oncology patients
- Denture adjustments or repairs when function impeded
- Replacing temporary filling on endo access openings in patients experiencing pain
- Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa
2. Dental non emergency procedures
Routine or non-urgent dental procedures include but are not limited to:
- Initial or periodic oral examinations and recall visits, including routine radiographs
- Routine dental cleaning and preventive therapies
- Orthodontic procedures other than those to address acute issues (e.g. pain, infection, trauma)
- Extraction of asymptomatic teeth
- Restorative dentistry including treatment of asymptomatic carious lesions
- Aesthetic dental procedures
The ADA is committed to providing the latest information to the profession in a useful and timely manner. Please visit ADA.org/virus for the latest information.
Posted on March 18:
Dear ISDA members,
The ISDA Board of Trustees is issuing new and more definitive guidance to Idaho dentists following Governor Brad Little’s March 18 update on COVID 19. Governor Little is requesting that all Idahoans follow the recommendations of the President and the CDC guidelines. Accordingly the ISDA strongly urges all dental offices follow the ADA recommendations to postpone elective procedures beginning now until April 6, concentrating on emergency dental care. You can find the full ADA recommendation and COVID 19 related resources on ADA.org/virus.
Governor Little stopped short of mandating closures, however he was clear in his comments that they are watching the numbers and the experiences of other states, and they will take that step if communities aren’t following the guidelines and the number of cases warrant closure. The Governor did highlight that we do not YET have documented cases of community spread of the virus, and Dr. Christine Hann from the Department of Health Welfare indicated that community spread is likely to occur as new cases are diagnosed every day. Our best way to mitigate the spread and prevent mandatory closure is to follow the guidelines.
Here are some additional resources and guidelines that are in development or are currently available:
- We realize that the guidelines leave open questions regarding procedures and the ADA is working on a definition of elective procedures. This will be published through both ISDA and ADA websites and email as soon as it is available.
- The ADA is hosting a website for members to get an update on the virus and address key questions. A notice will be posted on ADA.org/virus once the program is available, and the ADA News will also carry that information. There is no need to pre-register for this webinar.
- The ISDA has received reports of shortages of PPE and we are working with the Department of Health and Welfare to understand availability of appropriate PPE for treating emergency patients. As soon as we have a definitive answer and protocol, we will share it. In addition, supply companies confirmed that they are experiencing some shortages, and that they have protocols in place to ship at adjusted levels. They also suggest that you work with your local rep to understand the options that may be available should your standard orders not be confirmed and shipped.
- If you suspect that members of your team have had exposure, it is recommended that you Impose self-quarantines – away from work – for those who have the coronavirus, who have traveled to an affected area, or who otherwise have been exposed to someone who has or even may have the coronavirus.
- If an Employee Tests Positive for the Coronavirus remove the employee from the workplace and contact the CDC for guidance, which will likely involve a period of quarantine and steps to identify other potentially affected employees. In general, employers should not identify infected employees by name due to confidentiality laws.
We recognize that this is a very trying time for all dentists and citizens across the state, and that you have many questions. We are continuing to update our guidance as new information becomes available, so please continue to watch for emails from both the ISDA and ADA.
Dr. Jill Wagers, ISDA President
Posted on March 17:
Dear ISDA members,
As you know, the landscape relative to COVID-19 is rapidly changing. The ADA issued a new national recommendation this afternoon that all dentists postpone elective procedures for the next three weeks (the full message is below). At this time, neither the State of Idaho, nor the CDC are calling for a shut down and the Governor’s direction is that we remain flexible and reasonable in our decisions. As healthcare professionals, we ask that you use discretion and judgement as to the best decisions for your patients, your employees, and yourself. In addition, a press release
regarding availability of low interest loans through the SBA and can be found here
The American Dental Association (ADA) recognizes the unprecedented and extraordinary circumstances dentists and all health care professionals face related to growing concern about COVID-19. The ADA is deeply concerned for the health and well-being of the public and the dental team.
In order for dentistry to do its part to mitigate the spread of COVID-19, the ADA recommends dentists nationwide postpone elective procedures for the next three weeks. Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.
As health care professionals, it is up to dentists to make well-informed decisions about their patients and practices. The ADA is committed to providing the latest information to the profession in a useful and timely manner.
The ADA is continually evaluating and will update its recommendation on an ongoing basis as new information becomes available. Please visit ADA.org/virus
for the latest information.
Dr. Jill Shelton Wagers, ISDA President
Posted on March 16, 2020:
Dear members of the ISDA,
We recognize how much uncertainty there is with the rapidly evolving status of the Corona Virus. The ISDA remains committed to sharing with you the latest information as it relates to Dentistry and the impact of COVID-19. At this time, the guidance from the CDC and ADA remains the same and is posted below. We are expecting updated information later today and the ISDA Board of Trustees will meet Monday evening to evaluate any recommended changes in our position relative to patient treatment and office operations.
We suggest you regularly check the ADA’s website: https://success.ada.org/en/practice-management/patients/infectious-diseases-2019-novel-coronavirus
for relevant updates, and we will push them out as quickly as possible.
In addition to the standard guidance, it would be prudent for all offices to implement increased screening procedures to help prevent exposure and spread of the virus. These include:
- Screening all patients at check in for fever and / or cough
- Delaying non-emergent treatment by at least 14 days in patients exhibiting symptoms
- Ensuring all areas, including waiting rooms and bathrooms have hand sanitizer available and are routinely disinfected throughout the day.
- Remove all magazines and children’s toys from the waiting area.
- Practice “social distancing” including allowing for six feet of space between patients in the waiting areas and limiting waiting rooms to patients only.
- Ensure any staff with symptoms are not in the work environment
Guidance from the CDC:
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:
- 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;
- 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.
- 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.
- 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.
*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” is recommended at this time. Also recommended is a review of Prevention Strategies for Seasonal Influenza in Healthcare Settings.
Jill Shelton Wagers, President
Linda Swanstrom, Executive Director