Almost half of the nation’s dentists are back to work and open for “business as usual,” according to a recent survey by the American Dental Association. But when it comes to the supply chain for personal protective equipment necessary to provide full-service dentistry, business is anything but usual as the coronavirus pandemic lingers on.
According to the ADA’s ongoing survey, “COVID-19: Economic Impact on Dental Practices,” as of Sept. 7, just 60% of all dentists had a two-week supply of N-95/K-95 masks, which are now required when conducting all aerosol producing procedures, such as ultrasonic scaling, air polishing, and air abrasion.
A quarter of all dentists have a one-week supply of N-95/K-95 masks, and 11% have less than a week’s supply. The ratios are similar for surgical masks, face shields, gowns and disinfecting supplies.
The ADA national survey of 13,000 dentists is further broken down by type of practice: DSO, Non-DSO, Solo Dentists, 2 to 9 Dentists and Group (10+ Dentists).
Image: American Dental Association
This story refers to the aggregate numbers for all dentists unless otherwise noted, but there are some interesting variances between practices, including what appear to be higher shortages of PPE in larger dental organizations.
The current levels of PPE undoubtedly represent an improvement over the early months of the pandemic when 76% of all dentists were open for emergency services only and nearly 20 percent were closed outright. As practices began opening in May, it soon became apparent that the normal PPE supply chain had been severely disrupted by the pandemic.
In an interview in May with Patient Prism, Dr. Scott Drucker, DMD, president and co-founder of Supply Clinic, an online marketplace for medical and dental supplies including PPE, called the supply chain broken, especially in the case of masks.
“N-95s are extremely difficult to source right now,” Dr. Drucker said. “3M is shipping everything to hospitals and to governments, per FEMA’s directive. So, those aren't on the market. There are some foreign-manufactured N95s that do come in little spurts, and we try to get those on the site (for order) when possible.”
The ADA estimates the demand for PPE is 10 times the supply. As Drucker notes, that demand has driven prices up 400 percent and higher. For example, a box of 50 surgical masks that cost $5 before the pandemic now costs $40 on the Supply Clinic website.
Who pays those inflated prices? Apparently not all third-party insurers are willing to foot the bill, which can be substantial considering the number of people required to wear protective gear, from dentists, to technicians to office staff to patients. The ADA has issued “COVID-19 Coding and Interim Guidance: PPE” to help guide dental health providers through the myriad changes in billing practices.
Just how broken is the PPE supply chain? An alarming article on the Journal of the American Medical Association’s Health Forum website, “Personal Protective Equipment Shortages During COVID-19: Supply Chain–Related Causes and Mitigation Strategies,” pulls no punches:
“The frightening reality is that the routine U.S. PPE supply chain was not designed with the primary objective of protecting health care professionals. Rather, it was designed to fulfill demand while focusing on efficiency and price. While this supply chain can fulfill normal demand, it cannot meet unexpected increases that occur during a public health crisis, such as the current COVID-19 outbreak or the 2009 influenza A outbreak.”
The authors, two MDs, Preeti Mehrotra and Preeti Malani, and an MBA, Prashant Yadav, explain that U.S. PPE production is limited, and 70% of our respiratory protection supplies come from China, which dramatically reduced production during its battle with coronavirus earlier this year. As a result, “Some health care systems currently face estimated delays of 3 to 6 months for requested supplies.”
Suddenly that two-week supply of N-95 masks doesn’t seem like quite enough.
Ideally, we should be able to turn to the Department of Health and Human Services’ Strategic National Stockpile and state stockpiles to complete the PPE supply chain. That’s what they’re supposed to be for — emergencies.
But that hasn’t worked, the authors claim, because the “overall stock in the SNS was much lower than previous estimates of what would be needed to protect health care personnel in the event of a severe influenza pandemic” and the “lack of transparency regarding PPE and other inventory in the SNS as well as the logic behind the allocation of its limited supplies has hampered credibility.”
The authors believe good old American ingenuity will help mitigate some supply chain issues. PPE sourcing initiatives such as ProjectN95.org have provided protective equipment to frontline healthcare workers battling the pandemic across the United States. The growling list of U.S. companies repurposing factories to manufacture PPE includes Ford, General Motors, Lacerta, 3M and others can be found at supplychaindive.com.
The increasing use of telemedicine has helped conserve PPE in the physician’s office, but dentistry ultimately involves treating patients in the seats. So how does the average dentist decide whether he has enough N-95 masks on hand? The Centers for Disease Control and Prevention publication “Strategies for Optimizing the Supply of PPE during Shortages” offers and excellent tool to do just that.
It’s called the PPE Burn Rate Calculator. It’s a simple database program with simple instructions:
“To use the calculator, enter the number of full boxes of each type of PPE in stock (gowns, gloves, surgical masks, respirators, and face shields, for example) and the total number of patients at your facility.”
As mentioned previously, according to the ADA survey, about 60% of all dentists have a two-week supply of N-95/K-95 masks on hand right now. They can use the burn rate calculator to determine whether that’s enough.
