Questions received from members have been arranged under the following headings and will be updated regularly.
- Alert Level 2: Questions / comments and responses
- Protecting your patients
- Protecting your health
- Protecting your business
- Government and pandemic plans
If you have any important relevant questions, that aren't covered in the items below, please contact us.
Q. What is the process for treatment of patients who may have recently returned from travel to Auckland?
A. If you have a patient booked who has recently travelled to Auckland, a risk assessment for level 2 would apply for those patients.
Unless the patient has been identified as a close contact of a probable case (contacted via contact tracing or aware of contact with probable or positive case), according to the risk framework they would have a low likelihood of COVID-19 transmission.
However, a more precautionary approach could be followed if the patient has respiratory symptoms - practitioners could consider deferring the treatment if it is not urgent.
response provided by DCNZ
Q. Dentist working in private practice in the South Island, recently return from Auckland. During their stay in Auckland they did not come into contact with any unwell or high risk groups, and is asymptomatic.
Clarification being sought after staff member advised that all recent visitors from Auckland must stand down from work for 3 days - as no information could be found online to confirm this. (Patients cancelled as a precaution until further advise was received).
A. During a MOH briefing for allied health on Wednesday 12 August it was emphasised that at this point there was no need for people leaving Auckland on 12 August to self-isolate if they did not have any COVID-19 related symptoms.
Be vigilant, stay home and get tested should any symptoms occur which may then require self-isolation of close contacts should the tests prove positive.
However, at this point the risk of transmission was still considered low.
In addition, following good hand hygiene and taking other public health precautions such as physical distancing, in addition to the PPE that the dental practitioners wear during treatment, provide further protection measures against transmission.
response provided by DCNZ
Alert Level 2: Questions / comments and responses
1. NZDA Comment:
It is NZDA’s belief that undertaking the screening process with every patient and documenting this is highly important and as such please consider adding the following instructions within the Guideline
Patients must be screened, and the results of the screening recorded in the patient’s health record on three separate occasions:
– By telephone prior to dental treatment
– On presentation at the dental surgery by reception staff
– By clinical staff confirming reception question details
We agree with the intent but included in the Guideline less-specific provisions on how, when and by whom the information is collected or confirmed – these are processes individual practices can refine. (added to Steps to assessing a patient)
2. NZAO question:
With regard to high risk patients, are you able to please clarify when a high risk patient becomes low risk?
A patient will fall into the low risk patient category when “No” responses to all of the criteria listed are received. The MOH interpretation of COVID-19 recovered is when “people who had the virus, are at least 10 days since onset and have not exhibited symptoms for 48 hours, and have been cleared by the health professional responsible for their monitoring.” Conversely, aligned with the MOH case definition, people are treated as high risk patients if any of the responses are “Yes”
3. NZAO question:
When Orthodontists are treating patients in level 2 they will potentially have some patients under active treatment who are currently high risk, and so can only have urgent or emergency care, but eventually the Orthodontist will want to re-start routine care. The timing of this change from high to low risk, and so being able to continue with routine care, is not mentioned in the guidelines.
The orthodontist can start routine care as soon as the response to all the criteria defined in low risk patients are “No”.
4. NZAO question:
What should we do when we hear that one of our patient, who was triaged and treated as low risk at the time we saw him/her, has shifted to be high risk or become positive to COVID a few days after. Do we have any obligation in that case?
Since COVID-19 is a notifiable disease, and in line with the COVID-19 national response adopted, once confirmed or probable COVID-19 cases are identified, contact tracing will be enacted. We would encourage you to confirm any information with your local DHB Public Health Unit or the MOH contact tracing centre (09 801 3010). Follow the advice from the public health unit.
What to do if triaging leads to knowing a patient if COVID positive
1. The Guideline does not inform us with respect to wider health (beyond dental health) as to where practitioners refer a patient who, when triaged, answers YES to any screening questions
What do we do and who do we contact?
- If the patient responds ‘yes’ to any screening question
- The dentist is to be advised of the patient answering ‘yes’ to the screening questions prior to confirmation of any appointment time.
- The dentist is to determine if the patient is a confirmed, probable or a suspected case or if they are close or casual contact.
- The dentist must determine the COVID-19 test status of the patient and advise the patient to contact Healthline (0800 358 5453) or their GP for advice as necessary.
- If the patient has symptoms of acute respiratory infection the patient should be advised to contact Healthline (0800 358 5453) or their GP for advice.
- Dental treatment should be deferred if possible. If the dental care is essential and cannot be deferred the patient should be scheduled for care in accordance with the principles for managing a high-risk case (see below).
COVID-19 recovered patients
1. What is the status of “recovered” patients? Is it COVID +ve YES - but low risk?
There is no evidence of re-infection of recovered patients, so treat recovered patients as low risk patients. DCNZ have added a sentence to clarify this
1. Is taking temperatures no longer useful? (missing from the guidelines)
The MOH of Health approved the following provision in the guidelines: Consider introducing measures to monitor your own health and that of your team.
Practices may choose to implement temperature checks and respiratory symptom monitoring
1. Some DHB’s are using 0.2% chlorhexidine as there has been very significant supply challenges around hydrogen peroxide. We are not sure if these supply issues have been resolved or not? We think the inclusion of 0.2% chlorhexidine as a pre-procedural mouthwash should be recommended given this.
We acknowledge the very limited research in this area. The effectiveness of chlorhexidine on COVID-19 is unclear/questioned based on an online search. In the absence of clear guidance on its effectiveness we do not consider it appropriate to include as a potential example. However, it does not preclude practitioners to continue to use it, as its use to decrease microbial load is well documented in dentistry. The DCNZ have added a sentence expressing this to the mouthwash footnote.
2. I don’t understand the requirement to use a pre-procedural mouth rinse when there is not yet the scientific evidence to endorse it, just a recommendation from an article. If it is to be used just in case it helps, how long should the mouth rinse be held in the mouth to be effective?
Shouldn’t it be gargled to be most effective?
Isn’t there a real possibility that a child will cough or splutter when using this sort of rinse. Children (and even teens) that I treat are mostly unaccustomed to rinsing and spitting into a basin or spittoon, they tend to spray and make a mess, which is contrary to minimising aerosol. This is going to add to the clean up and down time between patients.
The guidelines propose that measures be used to reduce the extent and contamination of aerosols (when used), wherever possible, and one of the three examples of such measures given in the guidelines is the use of a pre-procedural mouthrinse.
While this is considered desirable (based on existing knowledge of the potential benefit this practice has in reducing the microbial load of dental aerosols), the guidelines acknowledge that there is limited information on the effectiveness of specific mouthrinses against COVID-19.
The guidelines allow for practitioners to apply their clinical judgement in deciding which measures are possible and appropriate, for a specific clinical situation:
Ideally, practitioners should use all three measures wherever possible. (‘should’, not a ‘must’)
This position is based on the recognition that it may not be possible or appropriate for the measures given as examples to be used in every clinical situation when aerosols are generated. Some of these scenarios may include the use by children and young adults.
When a pre-procedural mouthrinse is used, the directions for use supplied with the product should be used
1. From my understanding, you can wear your street clothes i.e. shirt and trousers and then put a tunic over the top of this. Does this mean we do not have to have the "trouser scrubs" portion?
Your understanding that you can wear your street clothes i.e. shirt and trousers and then put a tunic/gown/scrubs top over the top of this (as the outer protective layer of clothing), is correct; and meets the requirement in the IPC practice standard.
The decision to wear the "trouser scrubs" portion comes down to personal preference. The IPC practice standard does not require practitioners to wear outer protective clothing below the level that would typically be reached by wearing a dental tunic/gown/scrubs top.
1. The guidelines for eye protection when treating a low risk patient at level 2 includes the option of wearing safety glasses but they have to have side vents. A vent is an opening, so on that basis my prescription glasses should be ok because they are vented on the sides.
Does the Guideline really mean safety glasses with side extensions?
(If so, you can purchase clip on side extensions that fit on the arms of prescription glasses).
Also, how will loupes work if we need to wear face shields over glasses?
‘Safety glasses with side vents’ is the terminology used to describes safety glasses that have side extensions/protection incorporated into the frame. That being the case, the frame typically used for prescription glasses would not be equivalent. The intent is to have increased protection from contaminants entering the eyes from the side of the face.
If clip-on extensions to prescription glasses could be purchased that would provide the equivalent protection as ‘safety glasses with side vents’, this would meet the requirement of the guidelines.
When prescription glasses without side vents are worn, loupes (of the kind worn on a headband over the top of glasses) would need to be worn either under or over the face shield (whichever option is preferable to the practitioner). An alternative, if available, for practitioners with prescription glasses who wear loupes of this kind could be to purchase side extensions.
Where the loupes are ‘fixed’ to the lens of the glasses, practitioners could either wear a full face shield/visor; or purchase side extensions for their glasses.
Long sleeved gowns
1. There appears to be some conflicting advice (ambiguity) in IPC.
Are long sleeves mandatory for any aerosol producing procedures? As ‘we all breathed a sigh of relief' thinking back to normal however reading the fine print …
Level 2 Outer PPE link page 3 takes us to IPC page 15, 3rd item down “change long sleeved outer protective clothing at least between patients”
This would suggest that we should have been doing something we have not for years – wearing long-sleeve gowns, not just scrubs for any aerosol producing procedure.
Long sleeved gowns are only mandatory under Alert Level 2 guidelines when performing aerosol generating procedures for high risk patients (confirmed or suspected COVID-19).
There is no requirement in the IPC practice standard for long sleeved gowns to be worn.
In the event that a practitioner chooses to wear a long-sleeved gown (personal preference), then the long sleeved gown must be changed at least between patients (as stated in the IPC practice standard).
This is because, unlike the situation when a short-sleeved gown is worn, the forearm cannot be ‘cleaned’ between patients.
In essence, for low risk patients the usual practice for wearing gowns/tunics as the outer protective layer (2nd protective layer) resumes.
Protecting your patients
Q. Can I treat patients during Alert Level 2?
A. Please refer to the MoH & DCNZ Guidelines for oral health services at COVID-19 Alert Level 2.
During COVID-19 Alert Level 2, the risk assessment continues to focus on those who work in industries in direct contact with overseas travellers coming into the country (such as crew on international aircrafts or shipping vessels, staff at customs, immigration and quarantine/isolation facilities).
You can provide routine dental care and urgent or emergency dental care for those patients who fall into the low risk category.
You can provide only urgent or emergency care for patients who fall into the high risk category.
The Alert Level system can be activated at a localised or regional level, or nationally. Follow the COVID-19 guideline relevant to the government’s alert level applicable to the location in which you practise, and associated travel rules.
Q. Can we access the supply of necessary PPE?
A. NZDA is currently working on sourcing and/or having made available the necessary PPE for dentists to be able to provide treatment to patients. To date, we have referred a number of opportunities to the Dental Industry as they have the skills to assess the validity and compliance of the product.
Be careful of scammers and fake product that are emerging.
The bottomline is you need to be certain the safety gear you are using is not fake and that it meets the required standard.
Protecting your health
Q. As an employer, can I request that employees be tested for COVID-19?
A. No – However, if the person is unwell with upper respiratory tract symptoms you could recommend that they see their GP to have a formal medical assessment. If you are concerned about an individual you have an obligation to keep everyone safe in your practice so send the staff member home sick.
Q. How can testing be arranged?
A. Seek advice from your GP who will determine the need for testing.
Q. Would an A1 cartridge with a P2 filter be equivalent to an N95 Mask?
A. The difference between the N95 and the P2 classification for respirator face masks is the N95 is the NiOSH (USA testing requirements.) and the P2 represents the EC (European testing requirements). In practice, these differences have resulted in no impact on the level of protection to the wearer.
Protecting your business
Q. What are the procedures for employees if we are required to close down?
A. Please refer to the information contained in our Protecting your business page where ongoing updates will be published by NZDA.
Q. If my insurer does not meet the cost of wages/salaries under the business discontinuance insurance whose responsibility is it to pay employees?
A. The employer remains responsible under the employment agreements to pay wages/salary.
Q. Will assistance be provided to business owners in terms of tax relief?
A. The government has announced that they will be working on business cash flow and tax measures which include:
- increasing the provisional tax threshold from $2,500 to $5,000 from 2020/2021
- increasing the small asset depreciation threshold from $500 to $1,000 — and to $5,000 for the 2020/21 tax year
- allowing depreciation on commercial and industrial buildings from 2020/2021
- removing the hours test from the In-Work Tax Credit (IWTC) from 1 July 2020.
Your accountant will be able to explain these matters to you.
Guidance given at Alert Level 4
Q. Do I have to pay my staff for public holidays while we are at Alert Level 4?
A. If Fridays and Mondays are otherwise working days based on pre-COVID-19 working patterns, employees should be paid for the upcoming public holidays. The payment should be Relevant Daily Pay, or if it meets the criteria, can be Average Daily Pay.
Determining whether a day is an 'otherwise working day' should be based on the employee's pre-lockdown working pattern. However, if the employer and employee have agreed to a permanent change, this new arrangement can be used to assess whether the day is an 'otherwise working day'.
Employers can use the wage subsidy to cover some or all of their employees’ wages, including pay for the upcoming public holidays.
Employers must pass the full subsidy amount received onto the employee, except where a person’s income is normally less than the subsidy amount, in which case they can be paid their normal salary.
This information has been sourced from employment.govt.nz
Q. Under Alert Level 4, what happens if our practice is open for emergency treatments and a staff member refuses to work?
A. Any employee must comply with a lawful request from an employer that is within the terms and conditions of the employment relationship. The only exception to this is if the employee reasonably believes that there are health and safety issues that would make complying with the request unsafe. Consequently, an employer can insist on an employee carrying out work during the Level 4 Lockdown if there are no imminent health and safety considerations which might create a hazard and the work is permitted under the current Lockdown Regulations.
Q. How will the government's financial package effect contractors?
A. Contractors are now included in the governments financial package. To apply for financial assistance please refer to the Work and Income website. Many dentists (and the Association) have accessed these payments.
Q. What are the subsidy rates?
A. Payment rates under the modified wage subsidy scheme are unchanged from the original COVID-19 leave and wage subsidy schemes. They are:
- $585.80 (gross) per week for full-time employees, where full-time is 20 hours or more per week
- $350 (gross) per week for part-time employees, where part-time is less than 20 hours per week.
Guidance given at Alert Level 4
Q. What pay am I entitled while we are at Alert Level 4?
A. If your employer has applied for the government wage subsidy, then as per the Declaration – COVID-19 Wage Subsidy Scheme, they must;
- make best endeavours to pay at least 80 per cent of each named employee’s ordinary wages or salary; and
- pay at least the full amount of the subsidy to the employee; but
- where the ordinary wages or salary of an employee named in your application was lawfully below the amount of the subsidy before the impact of COVID-19, pay the employee that amount.
Q. Can I be made redundant during this time?
A. Employers need to try their best to retain employees that they are currently receiving the COVID-19 Wage Subsidy for. If your employer applied for the COVID-19 Wage Subsidy for any of their employees after 4pm on 27 March 2020, they must retain those employees or will be in breach of their obligations. Refer to Common questions on the COVID-19 Wage Subsidy
Government and pandemic plans
Q. Will an emergency plan be unified for all dentists to apply?
A. Please refer to the mandatory standard released by the Ministry of Health and Dental Council New Zealand.
To help find answers to your questions, please take a look at these other useful websites.