March Covid: lockdown anniversary edition

[sent]

Mar 24, 2023 16:32:46 GMT -5 tacokick said:

Mar 24, 2023 16:04:45 GMT -5 sent said:

As I said in the beginning, dentists were wearing masks before COVID during aerosol generating procedures. What's changed now is the recommendation for the provider to wear an N-95 during an aerosol generating procedure. You shouldn't have to call a dental office to ask if the provider will wear a mask during your appointment. They should have been wearing them all along. The same is not true about medical providers as they did not all mask before COVID and I don't know what they do now. Unless there is a regulatory agency forcing changes like hand washing or wearing gloves which both of those changes happened over decades of time, how do you expect minimums to be set for all offices? Maybe they will be further updated and set as time goes on, but right now this is where we are. 

The special accommodations being asked for is what mpm described in her spoiler tag. Being the first patient in the office to minimize exposure. Being treated in a private room and not in an open bay treatment area. She also described the office having hepa filters in each room which many dentists did purchase and still use after COVID but it is not a requirement so not everyone has it. mpm , if a potential patient asked if my office had these specific accommodations you listed, I could accommodate someone being the first patient but I don't have the private room or the hepa filters. They are reasonable post-COVID accommodations and I know of offices that have all of that. I never thought to list on my website what precautions we take for COVID in particular since we don't list infection control precautions for any other transmissible diseases on our website. I also didn't think patients were necessarily looking for that information but there are patients like yourself who are looking. Some doctors may have chosen to place it on their website or on their door like you mentioned and that's their decision. 

You could require people to mask at all times (except during procedures) in the office and make this info clear to everyone.

It would be simple to add info to your site. You’ve written your views out here multiple times, cut and paste it on your site and be done with it. My dentist (and my other health care providers) somehow manages to post Covid info on their website and require masks. ETA I’ve also seen offices that say they do not require masks and take no Covid precautions. Let’s be up front with that info and not waste anyone’s time.

It’s strange to not see how people view Covid as a “new” and different risk and want to know this information. If you don’t want to take steps to further mitigate risk then be up front with that so people can find other providers that do.

Covid is the third leading cause of death after all cardiac related deaths and all cancer related deaths. Of course plenty of people have concerns. Many people are opting out of preventative health care because they can’t get it safely. Why be part of the problem when it’s so easy not to?

I can add it, I wrote that I never thought to add it. I used to see popups about COVID precautions for a while in 2020 but I don't see them on websites as often anymore.  The next time I get around to updating parts of it, I could add in a section about infection control since it's not hard for them to add pages. Actually, we can do an Instagram post showing all the layers the doctors wear during aerosol procedures. That would be more visual and put the info out there quicker so it will be there if someone is looking for it. That's actually a good idea to add in content about infection control in general.

[tacokick]

Mar 24, 2023 17:14:43 GMT -5 sent said:

Mar 24, 2023 16:32:46 GMT -5 tacokick said:

You could require people to mask at all times (except during procedures) in the office and make this info clear to everyone.

It would be simple to add info to your site. You’ve written your views out here multiple times, cut and paste it on your site and be done with it. My dentist (and my other health care providers) somehow manages to post Covid info on their website and require masks. ETA I’ve also seen offices that say they do not require masks and take no Covid precautions. Let’s be up front with that info and not waste anyone’s time.

It’s strange to not see how people view Covid as a “new” and different risk and want to know this information. If you don’t want to take steps to further mitigate risk then be up front with that so people can find other providers that do.

Covid is the third leading cause of death after all cardiac related deaths and all cancer related deaths. Of course plenty of people have concerns. Many people are opting out of preventative health care because they can’t get it safely. Why be part of the problem when it’s so easy not to?

I can add it, I wrote that I never thought to add it. I used to see popups about COVID precautions for a while in 2020 but I don't see them on websites as often anymore.  The next time I get around to updating parts of it, I could add in a section about infection control since it's not hard for them to add pages. Actually, we can do an Instagram post showing all the layers the doctors wear during aerosol procedures. That would be more visual and put the info out there quicker so it will be there if someone is looking for it. That's actually a good idea to add in content about infection control in general.

Yes, people appreciate basic information from their health care providers. Or any business, really! It’s 2023, most people are expecting basic info to be online and available.

[seeyalater52]

It’s 2023 and people don’t know that Covid is airborne. That means every person who shares air with you indoors is exposing you to whatever they are breathing into the air and vice versa. Of course the dentists are masked. It is idiotic for them not to be and it’s required. But every single other person in that office including other patients poses a covid risk and none of the discussed precautions are as effective as requiring masks for everyone who is not actively having their mouth treated. Imagine how it would linger in the air if someone in the waiting room were smoking. It’s like that. Sitting 6 feet away wouldn’t keep you from breathing the smoke, that’s why we don’t have smoking sections in (most) restaurants anymore!

Sitting indoors 6 feet apart and being in individual rooms honestly makes very little difference unless the air is being extremely thoroughly cleaned which is atypical even in medical settings (and most HEPA filters I’ve seen in offices and businesses aren’t sized correctly for the space and are not resulting in frequent enough air exchange to make air safe from covid.)

This isn’t even about you Sent. It’s just breathtaking how few people - even literally medical providers - have invested in learning about a pandemic that is ONGOING*. Failures at every single level. I don’t know how to keep living in this absurd society.

*to the extent that there’s even a “debate” about this scientifically it’s more whether it is responsible or reasonable to accept an endemic baseline that is so incredibly high at this point compared to other “low” points in the pandemic over the past few years, especially as there continue to be rapid mutations. Hundreds of people are dying every week of covid and many more suffering long term impacts and serious issues post-infection like cardiac arrest and stroke. If everyone was willing to do the bare minimum like mask we wouldn’t be in this position.

[curbsideprophet]

Mar 24, 2023 16:04:45 GMT -5 sent said:

Mar 24, 2023 14:50:34 GMT -5 tacokick said:

I really don’t think having masks at a dental or medical office should be considered a special accommodation or something you have to call in and ask your doctors to do.

Clearly it is but seriously, it should absolute bare minimum standard that a doctor’s office is safe for everyone. What’s next, begging your doctor to wash their hands?

As I said in the beginning, dentists were wearing masks before COVID during aerosol generating procedures. What's changed now is the recommendation for the provider to wear an N-95 during an aerosol generating procedure. You shouldn't have to call a dental office to ask if the provider will wear a mask during your appointment. They should have been wearing them all along.

You keep using the phrase during aerosol generating procedures. What does that mean? Would it not be basically anything where the patient has to have their mouth open?

Are you now saying dentists and hygienists should be wearing N95s when seeing patients?

As a patient, I would want everyone in the office to be wearing masks, front desk staff, anyone waiting, etc. I realize it is harder to require N95s for patients, but it certainly can be required of employees.

Covid is a mass disabling event. Covid is airborne. There are definitely people who have avoided routine care because of it. Especially the dentist since you have to take your mask off.

[wanderingback]

Mar 24, 2023 21:39:06 GMT -5 curbsideprophet said:

Mar 24, 2023 16:04:45 GMT -5 sent said:

As I said in the beginning, dentists were wearing masks before COVID during aerosol generating procedures. What's changed now is the recommendation for the provider to wear an N-95 during an aerosol generating procedure. You shouldn't have to call a dental office to ask if the provider will wear a mask during your appointment. They should have been wearing them all along.

You keep using the phrase during aerosol generating procedures. What does that mean? Would it not be basically anything where the patient has to have their mouth open?

Are you now saying dentists and hygienists should be wearing N95s when seeing patients?

As a patient, I would want everyone in the office to be wearing masks, front desk staff, anyone waiting, etc. I realize it is harder to require N95s for patients, but it certainly can be required of employees.

Covid is a mass disabling event. Covid is airborne. There are definitely people who have avoided routine care because of it. Especially the dentist since you have to take your mask off.

I’m not a dentist but aerosol generating procedure is a specific term used in infection control. So no it’s not just if the person has their mouth open, like eating and talking aren’t considered aerosol generating procedures. In medicine the term is used for things like intubation, cpr, bipap, etc.

I know when my dentist office reopened during Covid the hygientists did cleanings without using any of the electric tools as to lessen aerosol generating procedures.

[seeyalater52]

Mar 24, 2023 22:10:40 GMT -5 wanderingback said:

Mar 24, 2023 21:39:06 GMT -5 curbsideprophet said:

You keep using the phrase during aerosol generating procedures. What does that mean? Would it not be basically anything where the patient has to have their mouth open?

Are you now saying dentists and hygienists should be wearing N95s when seeing patients?

As a patient, I would want everyone in the office to be wearing masks, front desk staff, anyone waiting, etc. I realize it is harder to require N95s for patients, but it certainly can be required of employees.

Covid is a mass disabling event. Covid is airborne. There are definitely people who have avoided routine care because of it. Especially the dentist since you have to take your mask off.

I’m not a dentist but aerosol generating procedure is a specific term used in infection control. So no it’s not just if the person has their mouth open, like eating and talking aren’t considered aerosol generating procedures. In medicine the term is used for things like intubation, cpr, bipap, etc.

I know when my dentist office reopened during Covid the hygientists did cleanings without using any of the electric tools as to lessen aerosol generating procedures.

This approach was reasonable before we knew as much about covid as we do now, but breathing in a room with other people or where people have recently breathed poses substantial risk of catching covid, which for some people is incredibly dangerous. I think the big reactions in the dentist office is at least for me because I never go anywhere indoors in public without an N95 mask, but I obviously have to take it off to have my teeth cleaned or worked on. It’s one of my biggest points of exposure because it’s difficult to be safe in that environment.

I think the point is that yes, there are procedures that are classified as generating aerosols (and they may increase risk - I actually don’t know a ton about that) but that covid risk isn’t limited to those times and can spread just by regular breathing in a waiting room or the patient before you not masking in the room.

[sent]

Mar 24, 2023 21:39:06 GMT -5 curbsideprophet said:

Mar 24, 2023 16:04:45 GMT -5 sent said:

As I said in the beginning, dentists were wearing masks before COVID during aerosol generating procedures. What's changed now is the recommendation for the provider to wear an N-95 during an aerosol generating procedure. You shouldn't have to call a dental office to ask if the provider will wear a mask during your appointment. They should have been wearing them all along.

You keep using the phrase during aerosol generating procedures. What does that mean? Would it not be basically anything where the patient has to have their mouth open?

Are you now saying dentists and hygienists should be wearing N95s when seeing patients?

As a patient, I would want everyone in the office to be wearing masks, front desk staff, anyone waiting, etc. I realize it is harder to require N95s for patients, but it certainly can be required of employees.

Covid is a mass disabling event. Covid is airborne. There are definitely people who have avoided routine care because of it. Especially the dentist since you have to take your mask off.

"Aerosol generating procedure" definition in dentistry from the CDC - "In dentistry, using dental turbines, micro-motor or rotary handpieces, ultrasonic scalers, and air-water syringes are examples of tasks that can generate aerosols."

Some of my layman examples of this definition 1) The dentist has to drill into a tooth to do a filling or a crown or drill into the bone to take out an impacted wisdom tooth. 2) The hygienist uses the ultrasonic scaler to knock off the hard calculus pieces ("tartar") during a cleaning. 3) The hygienist polishes your teeth at the end of a cleaning with your mint flavored prophy paste and the spinning instrument to apply it to your teeth. 4) The dental assistant blasts air or water into your mouth using the syringe attached to the dental chair. This syringe and the drill are powered by a compressor machine located somewhere in the office. When an aerosol generating procedure is done, there is also a high vacuum suction right next to the aerosol being generated to suck in as much of the aerosol as possible to keep it from going out into the general air. Either the assistant stands there with the suction tip right next to the tooth as the doctor is drilling or there are different contraptions doctors can install into the mouth to suction the aerosols while drilling if an assistant isn't available. The compressor machine in the office usually has the vacuum machine right next to it. These machines are very loud. Mine are located in the basement and you can hear it when we turn them on for the day. This was all being done pre-COVID, no one thought to question anything because universal precautions were generally being followed and it was business as usual. 

So no, just because the patient has their mouth open and the doctor looks at the patient's tooth/tongue/tonsils/throat for a moment or a few minutes minute does not mean aerosols were generated. Using the syringe to numb your tooth or jaw does not generate aerosols. When the hygienist uses the instruments by hand to scrape teeth or measure your gums, aerosols are not generated (this is what wanderingback described in her post). Cutting gums with a scalpel, no aerosols. In my field, changing the colored little bands on braces or changing the patient's wires does not generate aerosols. Taking photos of the patient's teeth and face with the camera, no aerosols. The vast majority of our visits in orthodontics do not generate aerosols and many visits to the general dentist don't always general aerosols either. 

Before COVID, we always wore masks when treating a patient, whether we were doing an aerosol generating procedure or not. As a profession, we weren't so worried about catching an airborne disease from our patients even though the risk of catching a cold or flu virus was definitely there. We were more worried about transmission of bloodborne diseases (hepatitis, HIV) from a patient or transmitting a bloodborne disease from an infected provider to the patient so hence we wore gloves and other PPE which included face masks. The only time I had ever heard about using an N-95 mask pre-COVID was if you treating a patient with active tuberculosis in a negative pressure room which would only happen at a hospital so not your typical day to day scenario in the dental office or a typical medical office either. After COVID, the link I posted above from the CDC recommends using an N-95 anytime a procedure that generates an aerosol is performed. We do this in my office but I can't say it's done in all offices as it's a recommendation and not mandatory. 

Nearly every dental procedure out there is technically elective and has a non-aerosol way to solve the dental problem. It might not be the most esthetic or ideal solution, but it's there if a provider decides it is necessary for a patient based on reviewing the patient's medical history. In my office aerosols are usually generated when we take the braces off and have to remove the glue from the patient's teeth with the "drill." If we didn't want to generate aerosols during the glue removal, we have pliers to scrape the glue off by hand but this takes longer, the result won't be as smooth compared to using the drill, and this procedure is ergonomically taxing on the provider's hand. However it could be done if the situation or a patient's medical history called for it. 

[sent]

Mar 24, 2023 22:27:10 GMT -5 seeyalater52 said:

This approach was reasonable before we knew as much about covid as we do now, but breathing in a room with other people or where people have recently breathed poses substantial risk of catching covid, which for some people is incredibly dangerous. I think the big reactions in the dentist office is at least for me because I never go anywhere indoors in public without an N95 mask, but I obviously have to take it off to have my teeth cleaned or worked on. It’s one of my biggest points of exposure because it’s difficult to be safe in that environment.

I think the point is that yes, there are procedures that are classified as generating aerosols (and they may increase risk - I actually don’t know a ton about that) but that covid risk isn’t limited to those times and can spread just by regular breathing in a waiting room or the patient before you not masking in the room.

There are services out there where dentists will do house calls for patients and have mobile equipment to do a lot of standard dental procedures in someone's home. 

ETA - also if it is dangerous for the patient to be in a room where other people were breathing unmasked 10 minutes or 90 minutes earlier, the patient can be offered the first appointment of the day in a well ventilated room as a reasonable accommodation. 

[wanderingback]

Mar 24, 2023 22:27:10 GMT -5 seeyalater52 said:

Mar 24, 2023 22:10:40 GMT -5 wanderingback said:

I’m not a dentist but aerosol generating procedure is a specific term used in infection control. So no it’s not just if the person has their mouth open, like eating and talking aren’t considered aerosol generating procedures. In medicine the term is used for things like intubation, cpr, bipap, etc.

I know when my dentist office reopened during Covid the hygientists did cleanings without using any of the electric tools as to lessen aerosol generating procedures.

This approach was reasonable before we knew as much about covid as we do now, but breathing in a room with other people or where people have recently breathed poses substantial risk of catching covid, which for some people is incredibly dangerous. I think the big reactions in the dentist office is at least for me because I never go anywhere indoors in public without an N95 mask, but I obviously have to take it off to have my teeth cleaned or worked on. It’s one of my biggest points of exposure because it’s difficult to be safe in that environment.

I think the point is that yes, there are procedures that are classified as generating aerosols (and they may increase risk - I actually don’t know a ton about that) but that covid risk isn’t limited to those times and can spread just by regular breathing in a waiting room or the patient before you not masking in the room.

Oh yes I 100% agree with you and I’m still masking everywhere. I was just answering the question to show that aerosol generating procedures isn’t a term that sent made up and that it has a specific definition in regards to infection control. Now whether that definition needs to be updated or if dentists need to be forced to follow updated protocols now that we’re in a pandemic is a different question/discussion. I was just pointing out the current term does have a specific definition.

[curbsideprophet]

Thanks for definitions, I assumed it meant something specific.

However as a patient, for my protection, anyone working on my mouth should be in an N95 or better since I can’t have a mask on.

[mpm]

Aerosols are produced every time we breathe. More aerosols are produced during certain procedures or activities, which is why the CDC issued specific protocols for those medical procedures early in the pandemic (and did not appropriately update them as we learned more about transmission of more contagious newer variants…) but that does not mean those procedures are the ONLY things that produce aerosols. Current variants are able to transfer virus even in a very small amount of aerosols and in a very small amount of time. This is why medical providers should always be in high quality masks, and everyone should be masking in all facilities where one must remove their own mask in order to receive treatment. Again, it’s so frustrating that we’re still talking about this 3 years in.

I also caution everyone in their reference to at risk or vulnerable people. There are two ways to look at risk from covid infection now: 1) risk of acute illness, and 2) risk of long-term issues. We probably won’t know the full extent of 2 during our lifetimes. But in 3 years we’ve learned quite a bit about 1. The pressure for public health communications to stick to the facts and not guess or speculate has led current guidance to discuss primarily the risk of acute illness since it’s what they definitely know. For example, we know the very old and @the very young are at heightened risk (though risk to @the very young has not been very well communicated at all). But that doesn’t mean acute risk is not there for others or that long-term risk isn’t something that everyone should be concerned about. It is abundantly clear already that long covid exists and is not limited to those with abnormal immune systems or other illness or conditions. The remaining questions are how common it is, how do we treat it, does it eventually go away, and what issues might arise more than three years post acute infection.

And while there is absolutely a societal need to protect those who are vulnerable, it is not for us to decide what the appropriate risk appetite is for others or to limit available protections to ”the vulnerable.” It needs to be socially acceptable for everyone to demand similar protections for themselves.

Even ignoring unknown long-term risks, maybe because I have a normally functioning immune system my risk of dying from acute infection is very low, but dying isn’t everything I’m worried about. Maybe I have a high deductible insurance plan and hospitalization for even a few days (even if I ultimately fully recover) would wipe out my savings and wreck havoc on my @

SPOILER: Click to show

childcare arrangements and potentially traumatize my sensitive toddler who has never had to go to bed without me

. Maybe if I’m sick for three weeks, even if I don’t need hospitalization, I won’t be able to meet my billable hours for the year and I won’t get my full bonus, which my family depends on. Maybe I’ll even lose my job if I’m out sick that long. Why does my dentist get to decide that these health and financial risks to me are acceptable simply because their hygienist or other covid-denying patients loudly complained about having to wear a mask all day at work?

[sent]

Mar 25, 2023 8:02:53 GMT -5 mpm said:

Why does my dentist get to decide that these health and financial risks to me are acceptable simply because their hygienist or other covid-denying patients loudly complained about having to wear a mask all day at work?

Your dentist has nothing to do with your financial risks.

Your dentist has to follow the CDC guidelines I posted earlier and anything else that is in place locally where you live such as your state dental board's laws and statues for the practice of dentistry. If they are not following those minimum guidelines, you can report the office to the appropriate local authority, most likely your Board of Health. Anything beyond the minimum, we can complain all day on a message board that dentists and doctors and hospitals should be doing more but we still work and live by laws and regulations in this country. Unless those laws and regulations change, your dentist is only obligated to follow what the regulatory agencies in the profession require them to do for patients. 

You are always free to chose another dentist for any reason you want. The dentist is not obligated to keep you as a patient either and can dismiss you as a patient as long as the reason for dismissal isn't discriminatory. 

[mpm]

You know, I was getting ready to come back in here and say that I’m not mad at sent or any individual dentists, but at the CDC and the dental association that have set an abysmally low standard of care but no, sent has demonstrated that she is absolutely part of the problem too.

[sent]

Mar 25, 2023 8:40:28 GMT -5 mpm said:

You know, I was getting ready to come back in here and say that I’m not mad at sent or any individual dentists, but at the CDC and the dental association that have set an abysmally low standard of care but no, sent has demonstrated that she is absolutely part of the problem too.

Yeah ok. If that makes you feel better then keep complaining. I've already said accommodations can be made specific to each patient's individual history which you must discuss with your individual provider.  At this time, what you are demanding is not a universal precaution and until it is, your dentist does not have to oblige to your wishes.

I don't have time, energy or money to fight all the fights. Just like you have to do whatever it is your wrote to make your bonus at work, I have to operate my practice profitably within the currently published regulations so I can also provide for my family. 

[rubytue]

Mar 24, 2023 11:35:20 GMT -5 fuckyourcouch said:

When I got my (immune suppressing chemotherapy!) infusion 2 weeks ago, none of the infusion center staff were wearing masks. They are literally only around extremely vulnerable patients all day every day. It’s infuriating.

I’m so sorry. I was in my cancer center in mid Feb and it was still all masks, even in the waiting room. It probably the one place I haven’t seen people maskless, well, save the occasional old, white male (and yes, it is always such) who is “eating and drinking” or takes the mask off to ,a,e a phone call from the waiting room. it makes me so sad that this is not consistent and just depends on where you have the privilege of living. This is still the policy at my facility. www.umms.org/coronavirus/patient-safety/universal-masking

[seeyalater52]

mpm that’s a great point - I’m using “at risk” here in a context that I think people on this board generally understand but I definitely recognize we are ALL at risk from covid and ultimately the people we come into contact with every day (whose level of risk we don’t know) are also at risk from us if we have lax safety practices. I don’t have any reason to think a covid infection would be life threatening for me, but I’m not interested in testing that hypothesis or how my wife or other family members would respond or if any of us would get long covid. Of if we spread it to someone who has a worse outcome or who is trying really hard to avoid infection for whatever reason.

I also fundamentally think it is wrong to expect everyone who wants covid precautions to disclose it as if it’s a need for accommodation or a special request when we are STILL in the pandemic phase of this thing. Especially given that the overwhelming response to such requests is scorn and lack of accommodation or requests about health details that are not that person’s business. Believe me - I know because I’ve requested and been told many times that basic covid safety cannot be accommodated.

And frankly Sent’s position has become more absurd as this conversation has gone on. The idea that it’s fine to follow the minimum letter of the law even when confronted with massive amounts of evidence that those measures aren’t sufficiently protective is just a jerk move. It’s a values thing for me, especially when it comes to proactively letting people know what standards you adhere to, what they can ask for if they are so inclined (and what the office is willing to offer), and doing bare minimum easy things like asking patients to mask in common areas of a practice. You’re being told this is extremely important to a not insignificant number of people but hiding behind what “regulations” say you HAVE to do instead of thinking about the complexity of what covid means to different people and how behind the regulations are in adjusting for new knowledge.

And to echo mpm if others continue to put us at risk of whatever outcomes we could expect from a covid infection (health, loss of income short or long term, etc), especially when we are taking every precautions we can individually, that is essentially a policy/personal mindset that personal responsibility doesn’t fall to you or to anyone collectively to stop this mass disabling event. I will always think that is shitty. So yeah you’re partially at fault. Sorry that’s how it works to live in a society - you have responsibility to think about how your actions impact other people even if the government isn’t forcing you to do it.

[rubytue]

Mar 24, 2023 17:55:21 GMT -5 seeyalater52 said:

It’s 2023 and people don’t know that Covid is airborne.

This still surprises me. I mean, it shouldn’t, but it does. Like Lordy the number of people I’ve seen online who insist that they wash their hand, so how did they get Covid.

And I think I mentioned it before, but I have a friend who still get angry when people get closer than 6 feet outdoors with her (her job is a city job where she talks to homeowners a lot). And the she added that she “feels funny with something on her face during flu season.” 🤦‍♀️🤦‍♀️🤦‍♀️ The stuff she says about Covid makes me wonder how we went to the same college and shit. I do note that she is the most conservative/republican person I know, but not a MAGA conservative. Her mother is though, and my friend has quoted Tucker Carlson talking points to me that she got from her mother (on other things). And it just goes to emphasize the political divide and how public health got caught up in it. That said, friend hasn’t gotten Covid 🤷‍♀️

Edit - trying to fix the quote and also to add… FWIW, my dentist only sees on patient at a time in the office. Like the door is locked, you have to call and they come let you in. No waiting room of patients. She doesn’t take insurance though, so I just pay with FSA funds. My dental coverage was pretty terrible anyway. It covered cleanings and nothing else (under medical, I don’t have separate dental insurance)

[wanderingback]

I go back to work in about a week after being away for 5 months. Required masks in healthcare facilities expired in the state last month :/ I’m not looking forward to seeing what I’m walking back in to as I’m guessing we no longer are strictly requiring masks of patients. I’m sure most of the providers are still wearing masks and I absolutely will be wearing a mask. I was very strict about requiring patients to wear masks and there were about 3-4 over the last year who refused so I didn’t see them (no acute emergencies happening, if they needed refills I would refill them) and the nurse backed me up.

But maybe I’ll be presently surprised and it’s all still required. If it’s not I’m guessing it might be too late to be the lid back on, but lll speak up.

[mpm]

I have dental insurance but would drive very far and be willing to pay quite a bit more OOP than my insurance reimbursement (easily 10x as much) for safe dental service. I don’t think I’m alone in that based on internet groups I’m in. (At one point there was even discussion amongst those same people about privately charting a jet to Germany to @ vaccinate our toddlers.) It’s bullshit that that kind of safety should be limited to those who can pay for it, but also since the economic argument was brought up, if someone wanted to make that a business model I do think they’d be able to find a very loyal patient base.

[tacokick]

Mar 25, 2023 8:34:30 GMT -5 sent said:

Mar 25, 2023 8:02:53 GMT -5 mpm said:

Why does my dentist get to decide that these health and financial risks to me are acceptable simply because their hygienist or other covid-denying patients loudly complained about having to wear a mask all day at work?

Your dentist has nothing to do with your financial risks.

Your dentist has to follow the CDC guidelines I posted earlier and anything else that is in place locally where you live such as your state dental board's laws and statues for the practice of dentistry. If they are not following those minimum guidelines, you can report the office to the appropriate local authority, most likely your Board of Health. Anything beyond the minimum, we can complain all day on a message board that dentists and doctors and hospitals should be doing more but we still work and live by laws and regulations in this country. Unless those laws and regulations change, your dentist is only obligated to follow what the regulatory agencies in the profession require them to do for patients. 

You are always free to chose another dentist for any reason you want. The dentist is not obligated to keep you as a patient either and can dismiss you as a patient as long as the reason for dismissal isn't discriminatory. 

Yes, following CDC recs are the bare minimum but doctors can show that they understand that these guidelines are more about politics and capitalism than being rooted in public health and reality and decide to hold themselves to a higher, science based standard for their patients. Many doctors and dentists do! I’m lucky to find them in my area.

But yeah, no one legally has to worry about their own health, that of their staff or patients and can keep doing the bare minimum all they want.

It would be nice if everyone felt comfortable getting their teeth cleaned or getting routine preventative health care though.

[sent]

Mar 25, 2023 9:16:05 GMT -5 seeyalater52 said:

And frankly Sent’s position has become more absurd as this conversation has gone on. The idea that it’s fine to follow the minimum letter of the law even when confronted with massive amounts of evidence that those measures aren’t sufficiently protective is just a jerk move. It’s a values thing for me, especially when it comes to proactively letting people know what standards you adhere to, what they can ask for if they are so inclined (and what the office is willing to offer), and doing bare minimum easy things like asking patients to mask in common areas of a practice. You’re being told this is extremely important to a not insignificant number of people but hiding behind what “regulations” say you HAVE to do instead of thinking about the complexity of what covid means to different people and how behind the regulations are in adjusting for new knowledge.

I patiently waited for the massive amounts of evidence cited here thinking I missed something huge from a regulatory agency. Someone posted a link to an article from MIT. I don't see the massive amounts of evidence on the CDC or the ADA's websites (which the ADA is not a regulatory agency but the post things they think all dentists should know). Although COVID is an important health concern and a very passionate topic for the posters here, I come across patients who want to just as passionately present their "massive amounts of evidence" on why COVID vaccines = bad and then yell at doctors for not taking them just as seriously. If it's not coming from a regulatory agency, then I as a provider have to decide if I want to incorporate the "evidence" into my practice or not. 

[tacokick]

Mar 25, 2023 9:35:55 GMT -5 mpm said:

I have dental insurance but would drive very far and be willing to pay quite a bit more OOP than my insurance reimbursement (easily 10x as much) for safe dental service. I don’t think I’m alone in that based on internet groups I’m in. (At one point there was even discussion amongst those same people about privately charting a jet to Germany to @ vaccinate our toddlers.) It’s bullshit that that kind of safety should be limited to those who can pay for it, but also since the economic argument was brought up, if someone wanted to make that a business model I do think they’d be able to find a very loyal patient base.

My dentist takes Covid very seriously and is always busy! So are my other doctors. I’m lucky to live in a place where a lot of people mask routinely and have a lot of hospitals/providers to chose from. I can only imagine in areas where this is rarer, a doctor or dentist could really fill the Covid careful niche and make bank.

I don’t belong to any Covid groups but it does come up in conversation and we all share which practices have some sense

[fuckyourcouch]

Mar 25, 2023 9:11:38 GMT -5 rubytue said:

Mar 24, 2023 11:35:20 GMT -5 fuckyourcouch said:

When I got my (immune suppressing chemotherapy!) infusion 2 weeks ago, none of the infusion center staff were wearing masks. They are literally only around extremely vulnerable patients all day every day. It’s infuriating.

I’m so sorry. I was in my cancer center in mid Feb and it was still all masks, even in the waiting room. It probably the one place I haven’t seen people maskless, well, save the occasional old, white male (and yes, it is always such) who is “eating and drinking” or takes the mask off to ,a,e a phone call from the waiting room. it makes me so sad that this is not consistent and just depends on where you have the privilege of living. This is still the policy at my facility. www.umms.org/coronavirus/patient-safety/universal-masking

Yes, at my February appointment staff were still masked. This month, no. All patients I saw were still masked so you would think the staff could bother to.

[seeyalater52]

Mar 25, 2023 9:49:07 GMT -5 sent said:

Mar 25, 2023 9:16:05 GMT -5 seeyalater52 said:

And frankly Sent’s position has become more absurd as this conversation has gone on. The idea that it’s fine to follow the minimum letter of the law even when confronted with massive amounts of evidence that those measures aren’t sufficiently protective is just a jerk move. It’s a values thing for me, especially when it comes to proactively letting people know what standards you adhere to, what they can ask for if they are so inclined (and what the office is willing to offer), and doing bare minimum easy things like asking patients to mask in common areas of a practice. You’re being told this is extremely important to a not insignificant number of people but hiding behind what “regulations” say you HAVE to do instead of thinking about the complexity of what covid means to different people and how behind the regulations are in adjusting for new knowledge.

I patiently waited for the massive amounts of evidence cited here thinking I missed something huge from a regulatory agency. Someone posted a link to an article from MIT. I don't see the massive amounts of evidence on the CDC or the ADA's websites (which the ADA is not a regulatory agency but the post things they think all dentists should know). Although COVID is an important health concern and a very passionate topic for the posters here, I come across patients who want to just as passionately present their "massive amounts of evidence" on why COVID vaccines = bad and then yell at doctors for not taking them just as seriously. If it's not coming from a regulatory agency, then I as a provider have to decide if I want to incorporate the "evidence" into my practice or not. 

You’re a health care provider. If you were interested I’m sure you’d be able to assess what reputable scientific evidence looks like. Pro tip: the evidence provided by people who are promoting covid precautions is not equal in any way to the “evidence” of people who are denying covid risk or are anti-vaccine.

Notably, regulatory agencies and government agencies do not necessarily have to cite evidence for their recommendations. In fact I’d usually consider an uncited claim or requirement without a citation to be pretty weak evidence on its own, especially when contrasted with a lot of other evidence that has emerged in the past 2 years and which has not been incorporated.

I’d be a lot more willing to spend my time providing sources and evidence for the literally hundreds of studies on this topic if you showed any interest at all in being educated on the topic.

[sent]

Mar 25, 2023 9:35:55 GMT -5 mpm said:

I have dental insurance but would drive very far and be willing to pay quite a bit more OOP than my insurance reimbursement (easily 10x as much) for safe dental service. I don’t think I’m alone in that based on internet groups I’m in. (At one point there was even discussion amongst those same people about privately charting a jet to Germany to @ vaccinate our toddlers.) It’s bullshit that that kind of safety should be limited to those who can pay for it, but also since the economic argument was brought up, if someone wanted to make that a business model I do think they’d be able to find a very loyal patient base.

What you are describing is a minority of all dental patients in the US. And I think this already exists. You can look for holistic dentists.  They were using hepa filtration in their offices before that came on the scene post-COVID. Since what you are desiring is a small demographic, I have never looked into catering to this demographic specifically. The demographic where I am located wonders where the cheapest gas station is in town and not how to charter private jets to Germany.

Which do what you must do to keep your family safe, but this is a paragraph full of privilege if I ever read one.

[tacokick]

Mar 25, 2023 9:49:07 GMT -5 sent said:

Mar 25, 2023 9:16:05 GMT -5 seeyalater52 said:

And frankly Sent’s position has become more absurd as this conversation has gone on. The idea that it’s fine to follow the minimum letter of the law even when confronted with massive amounts of evidence that those measures aren’t sufficiently protective is just a jerk move. It’s a values thing for me, especially when it comes to proactively letting people know what standards you adhere to, what they can ask for if they are so inclined (and what the office is willing to offer), and doing bare minimum easy things like asking patients to mask in common areas of a practice. You’re being told this is extremely important to a not insignificant number of people but hiding behind what “regulations” say you HAVE to do instead of thinking about the complexity of what covid means to different people and how behind the regulations are in adjusting for new knowledge.

I patiently waited for the massive amounts of evidence cited here thinking I missed something huge from a regulatory agency. Someone posted a link to an article from MIT. I don't see the massive amounts of evidence on the CDC or the ADA's websites (which the ADA is not a regulatory agency but the post things they think all dentists should know). Although COVID is an important health concern and a very passionate topic for the posters here, I come across patients who want to just as passionately present their "massive amounts of evidence" on why COVID vaccines = bad and then yell at doctors for not taking them just as seriously. If it's not coming from a regulatory agency, then I as a provider have to decide if I want to incorporate the "evidence" into my practice or not. 

You can make a little effort and read actual studies about the risks of Covid yourself. They are all around, many are even published by the CDC.

It’s strange to give random patients the same amount of credibility as infectious disease experts.

[mpm]

Mar 25, 2023 9:50:51 GMT -5 tacokick said:

Mar 25, 2023 9:35:55 GMT -5 mpm said:

I have dental insurance but would drive very far and be willing to pay quite a bit more OOP than my insurance reimbursement (easily 10x as much) for safe dental service. I don’t think I’m alone in that based on internet groups I’m in. (At one point there was even discussion amongst those same people about privately charting a jet to Germany to @ vaccinate our toddlers.) It’s bullshit that that kind of safety should be limited to those who can pay for it, but also since the economic argument was brought up, if someone wanted to make that a business model I do think they’d be able to find a very loyal patient base.

My dentist takes Covid very seriously and is always busy! So are my other doctors. I’m lucky to live in a place where a lot of people mask routinely and have a lot of hospitals/providers to chose from. I can only imagine in areas where this is rarer, a doctor or dentist could really fill the Covid careful niche and make bank.

I don’t belong to any Covid groups but it does come up in conversation and we all share which practices have some sense

And on the inverse, someone posted on our neighborhood message board asking which primary care offices are no longer wearing masks (because they like seeing smiles 🙄). My husband’s PCP was mentioned several times in response, so my husband isn’t going to waste his time calling his PCP to complain now that they’ve already changed their policies since his last visit; he’s just going to quietly look for a new doctor and in the meantime skip routine care until he finds one that has safety protocols he’s comfortable with.

[tacokick]

Mar 25, 2023 9:55:10 GMT -5 sent said:

Mar 25, 2023 9:35:55 GMT -5 mpm said:

I have dental insurance but would drive very far and be willing to pay quite a bit more OOP than my insurance reimbursement (easily 10x as much) for safe dental service. I don’t think I’m alone in that based on internet groups I’m in. (At one point there was even discussion amongst those same people about privately charting a jet to Germany to @ vaccinate our toddlers.) It’s bullshit that that kind of safety should be limited to those who can pay for it, but also since the economic argument was brought up, if someone wanted to make that a business model I do think they’d be able to find a very loyal patient base.

What you are describing is a minority of all dental patients in the US. And I think this already exists. You can look for holistic dentists.  They were using hepa filtration in their offices before that came on the scene post-COVID. Since what you are desiring is a small demographic, I have never looked into catering to this serious as the demographic where I am located wonders where the cheapest gas station is in town and not how to charter private jets to Germany.

Which do what you must do to keep your family safe, but this is a paragraph full of privilege if I ever read one.

I think that this point you are being willfully obtuse.

What people want is a dentist office with masking and some air flow so they don’t die, get sick or disabled while getting their teeth cleaned.

Maybe you aren’t seeing these patients because they know you don’t take this seriously. I know ton of people who just haven’t been to a doctor or dentist for years because they don’t have access to one that will provide the bare minimum of Covid safety.

[curbsideprophet]

What types of evidence do you want to see?

That Covid is airborne and remains in the air? That six feet does not magically make everything safe? That just talking is enough to generate aerosols?

www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html



pubmed.ncbi.nlm.nih.gov/34446582/

[pixy0stix]

Sent is acting within the guidelines of her field, which has been verified by posters who are trying to find medical care that does not exist currently. While I understand the underlying frustration, this is the standard of care in the US. Berating someone for following the actual guidelines of their profession is not going to change how she operates her business. Since she is a poster here, all your frustration is bleeding out to her.