Page 6 - RADC 2020

Reflections on COVID-19
Maj H Walker SDO Edinburgh
Being asked to write an article about COVID-19 for the RADC Bulletin in
the Autumn of 2020, feels a little like a Hogwarts student being asked to write an article on ‘He Who Shall Not Be Named’ – it dominates our lives but everyone is tired of talking about it. In reading this, I kindly ask that you don’t shoot the messenger and
I won’t be offended if you turn to a more interesting article or even to the eternally confusing advert for pulp preserving dentine pins. Poor quips and tooth vitality preservation aside, this pandemic has upturned all our lives and is deserving of a Bulletin entry, even if yet another article on the topic is hard to stomach.
COVID-19 or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was formally named by the World Health Organisation1 on the 7 January 2020 after swab sampling by the Chinese Centre for Disease Control of patients presenting with acute respiratory distress and pneumonia symptoms at Wuhan hospitals2. It was quickly established that these patients lived and worked around the Huanan Seafood Market and that the human to human spread of the virus occurred through close quarter transmission of respiratory droplets or aerosols3. On 11 March 2020 the virus had spread to such an extent that the WHO declared it a pandemic; “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”4 To date, the global number of confirmed cases stands at 35 million with 1 million deaths5.
The notoriety of COVID-19 overshadows the preceding Severe Acute Respiratory Syndrome Coronavirus outbreaks which include SARS ‘The Original’ back in
2002 and the Middle Eastern Respiratory Syndrome in 2012. Neither of these
became global pandemics and there are several hypotheses as to why. Firstly, patients infected with SARS-CoV-2 begin viral shedding a few days before symptom onset which makes quarantine measures challenging. A second, more humanistic, reason is that air and rail travel within China and the Middle East is significantly higher than it was during the 2002 SARS outbreak or the 2012 MERS outbreak in the Saudi Arabian Peninsula6. Comparisons are frequently drawn with the familiar influenza virus and I’m sure we’ve all heard people say ‘flu kills lots of people each year, what’s the difference’ and become frustrated by the insensitivity. Influenza virus strains do appear
each year and do kill people whose immune systems are unable to process them, however, at nowhere near the death rate caused by SARS-CoV-2. Furthermore, the majority of people suffering from influenza viruses tend not to require the support of hospital intensive care units, that many fighting SARS-CoV-2 do6.
For the majority of us, the effects of COVID-19 came with the shock and awe
of a well-planned military invasion of our professional and personal lives. However,
a look back at the literature holds some startling evidence that the scientific community has been considering the
effects of SARS viruses on dentistry over the last twenty years. A two-part series
in the BDJ from 2004, suggested that
the use of enhanced PPE and aerosol extraction systems within a dental surgery were necessary to prevent the spread of these types of viruses7. A later BDJ article written in 2016 related the effects of a SARS pandemic to dentistry with an almost mystic meg accuracy8.
With the UK Lockdown announced on
23 March 2020; NHS, Private, Salaried Services and Secondary Care routine dental provision was halted with emergencies being managed via telephone or video consultation to prevent interactions. A widely publicised New York Times article provided some world-wide media attention to our profession, by placing dental care professionals at the top of their chart of COVID-19 contraction and spread risk with scores of 95% for exposure to diseases
and 99% for physical proximity with staff and patients9. These risks were well understood by Public Health England and the Chief Dental Officers of England and
the Devolved Nations, who then began the slow and unenviable process of rebuilding the professions ‘new norm’ with varying degrees of popularity along the way. A
wave of confusion abounded as to why
our PPE no longer was acceptable when
it had been deemed fit for purpose as a universal precaution against Hepatitis B, Hepatitis C, AIDs and influenza outbreaks. The primary difference is that transmission of these viruses requires blood to bodily fluid interactions and not inhalation transmission like SARS-CoV-2. The unique quality of
the SARS-CoV-2 virus within dentistry is
its very small particle size of 0.12μm and
the associated risk of the virus found in saliva or blood being weaponised by rotary or ultrasonic instruments for subsequent inhalation10.
The RADC Response
RADC personnel across Surgeon Generals Department, DPHC(D) and the Field Army were thrust into new and very different ways of working and, as ever, our small cohort punched above its weight in providing personnel to supplement Defence’s response to COVID-19. The list below offers a snapshot summary of some of the RADC taskings:
• Through the Liaison Network, RADC Officers were deployed to support COVID-19 Ops Cells in a range of formation headquarters, including:
• MOD Main Building • Army Headquarters • Surgeon General’s
Department
• Defence Logistics
• DPHC Headquarters
• RADC NCO’s were redeployed to work in the DPHC J4 department
• RADC DNs were stood up for assisting in DPHC COVID-19 bedding down facilities and to supplement staff at the Nightingale Facilities across the UK
• The lead elements of the RADC deployed dental teams, led by our Chief Dental Officer, looked to ways to utilise Medical Regiment Dental Teams and their deployable field dental units to care for patients without the fallow time constraints of hard building infrastructure
• The 16Med Dental Officer ran the Brigade Bedding Down Facility
• RADC DOs worked on innovative ways of communicating with our patients
• RADC Command & Staff Officers delivered organisational outputs despite the constraints around them.
Patient Care within a Dental Hub
Within DPHC(D) at the patient coal face, RADC personnel within DPHC moved to
a hub setup, with larger Dental Centres enveloping smaller ones to streamline patient care and apportion the ‘unicorn tears’ enhanced personal protective equipment (ePPE). Patients were triaged and managed remotely using the dreaded ‘AAA’ - advice, analgesics and antibiotics over the phone, with staff set up in rotas to provide 24h emergency cover.
I cannot find a period in history, since the advent of Dentistry as a formal profession, where dentistry has come to a complete standstill and the effect on staff was
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