Coronavirus and UK Dentistry

The Coronavirus Impact on Dentistry

The Dental industry has been massively hit by the coronavirus outbreak and has caused major distraught nationally. In the brewing midst of February, the nation announced a global shortage of face masks that would severely disrupt the UK dental practices. The majority of hygienic face masks are manufactured in China, but with their extensive COVID-19 spread, the government is prioritising unprecedented domestic demand – both from the health sector and from the public – over exports.

The British Dental Association suggests dental practices to scale-down non-urgent casualties by the end of the week. Although they recommend practices to make orders for only 100 masks a day, many dental practices are still using up their allocations. This global problem is hitting UK high street practices, both large and small and requires an urgent contingency plan to bypass this issue. A typical NHS surgery with one dentist can easily get through 250 masks a week! Despite careful rationing, dentists are facing critical depletion. Most dental practices make use of wholesalers for the supply of medical care products. With the massive shortage of the masks, retailers and suppliers have vested interest in continuing to raise the pricing or claim no stock. The pricing of available masks has tripled since January. While members working in secondary care are not currently reporting supply problems, primary care is feeling the impact as a result of separate supply chains. If this continues, there is no choice by to “down drills”.

BDA Chairman, Mick Armstrong, said, “We have well-established procedures to deal with supply problems, regardless of the cause, and work closely with industry, the NHS and others in the supply chain to help prevent shortages and to ensure that the risks to patients are minimised.” In response to the BDS, the Department of Health and Social Care have indicated significant central stockpiles exist, including reserves built up for the UK’s departure from the European Union. Supplies from these stockpiles are now being released to ease the immediate pressure and should reach practices very shortly.

Under the current guidelines, all dentists are to wear Personal Protective Equipment (PPE) including disposable face masks, clinical gloves, and eye protection. Only Scotland permits the use of disposable masks and visors interchangeably.

Another issue the dentists are facing due to the coronavirus outbreak is the exposure to imminent danger and high liability for contraction. For NHS practices in the UK and Wales operating under the 2006 NHS dental contract, new problems have arisen with the targets. With the outbreak, dentists are worried about the dental quota policied under the dental contract where every dentist is to meet a certain patient target at the end of the year measured in UDAs. The BDA has ensured the dentists that they would be calling on respective governments to invoke force majeure clauses should the situation deteriorate further. Force majeure refers to a clause that is included in contracts to remove liability for natural and unavoidable catastrophes that interrupt the expected course of events and restrict participants from fulfilling obligations. This means that you could be exempted from meeting the UDAs in the midst of such an epidemic.


The world as we know it has been infected with numerous selection of assorted communicable diseases over the last few years. On account of the 2003 SARS outbreak, various preventative measures were employed at levels of preliminary and secondary success. However, catastrophe struck as the clocks of the year 2019 wore out to rust. At the turning point of the year, a lone event occurred that shook the world and would very soon be one of the deadliest epidemics to ever hit the planet. On the 31st of December 2019, the World Health Organization was notified of a cluster of pneumonia-like cases of unknown origin and aetiology detected in Wuhan City, Hubei Province, China. On the 12th of January 2020, it was globally announced that a suspected novel coronavirus was suspected and was deemed as the causative agent for the outbreak. The virus was named SARS-CoV-2, and the associated syndrome as COVID-19 by the WHO on 11th February 2020.

The Outbreak – COVID-19

If you have been in the loop, you have probably gone through substantial information that refers to this ‘coronavirus’ outbreak. The source of the outbreak is yet to be confirmed. However, preliminary investigations identified environmental samples that tested positive for SARS-CoV-2 in Huanan Seafood Wholesale Market in Wuhan City although some of the initial laboratory-confirmed patients did not report visiting the market. A confirmed zoonotic source of the outbreak has not been identified, in spite of which some reports lean on the snakes as culprits for the epidemic. Investigations are ongoing.

Coronaviruses are a large family of infective viruses that are known to cause minor symptomatic illnesses like the common cold but on the other end of the spectrum have also been responsible for epidemics of severe diseases such as the Severe Acute Respiratory Syndrome (SARS) outbreak of 2003 that severed more than 770 lives and the Middle East Respiratory Syndrome (MERS) outbreak of 2015 that took more than 850 more lives. The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses has designated the aetiological agent ‘SARS-CoV-2’ which is a beta-coronavirus genetically similar to the SARS virus found in bats in Asia. In view of the current data, human-to-human transmission through large respiratory droplets and direct or indirect contact with infected secretions are the most accepted modes of spread for the coronavirus. Major symptoms of the COVID-19 include cough or tightness in the chest, shortness of breath (dyspnoea) and high fever.

Global impact and coronavirus in the UK

On 2nd March 2020, the WHO increased its warning of global spread and impact risk from “high” to “very high”. In response to the disease’s rapid and widescale spread, many countries have sought to tighten their borders, restrict flights, shut down schools, and cancel large political or religious events. As of 8th March 2020, over a hundred thousand (106,203) cases have been confirmed globally in over 89 countries (including mainland China) with a total of 3,600 unfortunate fatalities. Researchers in China estimate that on average individuals with COVID-19 have been spreading the illness to at least 2 people. With the current low mortality rate of almost 4%, experts say that without proper precaution, it could drastically increase.

The UK has also felt the impact of this dangerous epidemic and is strategically trying to contain the number of victims and circumvent the illness. Currently, the coronavirus outbreak has claimed over 200 cases with 2 fatalities both of who had underlying medical issues. Other than that, a British man also died from the virus last month in Japan after being infected on the Diamond Princess cruise ship. The UK has been noted to be ‘teetering’ on the edge of sustained transmission. Although the UK has seen mostly mild cases, the severity of the infection can significantly range from mild symptoms of upper respiratory tract infection (with or without fever) to fulminant pneumonia requiring hospitalisation, advanced respiratory support and intensive care.

The Reach of the UK Government

The current status quo argues that the government is ready to go all nine yards to prevent the further imminent spread of the infection and that the government’s overriding priority is to ensure that the public is kept safe from the virus. England’s deputy chief medical officer said that the UK remains in the “containment” phase of tracing coronavirus cases to prevent it from spreading in the community. The NHS has declared a ‘level 4’ incident. They have designated all medical institutes to uncover new support places available that can be modified as cohorting modes of infectious disease care and to review critical care and high dependency capacity.

The Government hinges on the stringent and urgent prioritization of the four parts of their battle plan against this rapidly circulating disease. The UK’s strategy on responding to the virus has three phases – containment, delay and mitigation – alongside ongoing research. The containment phase is involved with catching cases early and tracing all close contacts in order to evade or halt the spread of the disease for as long as possible. Moving into the delay phase could see the introduction of “social distancing” measures, such as closing schools and urging people to work from home. The delay phase would mainly focus on trying to prevent cases from rising too sharply and pushing the peak out of the winter season so that the NHS can deal with the epidemic better. The mitigation phase would commence when the disease has taken complete hold. Some non-urgent care may be delayed to prioritise and triage service delivery. Staff rostering changes may be necessary, including calling leavers and retirees back to duty.

Actions taken by the NHS

The Chief Medical Officer declares that the NHS and Public Health England (PHE) are well-prepared and well-equipped to manage the outbreak of new infectious diseases including the coronavirus. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also securing services are available to the public as normal. The approach taken by the NHS is to identify potential cases of COVID-19, isolate them and then contain the virus.

A letter was issued by Public Health England, Department of Health and Social Care and NHS England and NHS Improvement providing advice on the Wuhan Novel Coronavirus. The letter instated four key principles to follow for all medical professionals:

  1. Identify potential cases as soon as possible
  2. Prevent potential transmission of infection to other patients and staff
  3. Avoid direct physical contact, including physical examination, and exposures to respiratory secretions.
  4. Isolate the patient, obtain specialist advice and determine if the patient is at risk of COVID-19.

Protocol to be followed by the dentists

The guidance advises dentists and other dental staff to follow prompts from the NHS:

If a suspected patient books in by telephone or online

Patients booking in by phone or online who meet the case definition for COVID-19 should be directed to NHS 111. Advise the patient to stay at home whilst the appropriate transport can be arranged.

If a suspected patient enters the dental clinic

Identify an unwell patient with relevant travel history when they book in at the reception. A relevant travel history should include one of the three:

  • If the patient has in the previous 14 days been to Category 1 countries or regions whether or not if they exhibit symptoms of illness
  • If the patient displays even minor symptoms of cough, fever or shortness of breath within 14 days of returning to the UK from Category 2 areas
  • If the patient has been in close contact with people coming in from specified countries

The patient is eligible to receive primary care:

Isolate the patients along with their belonging and any accompanying family member in a side room with the door closed. No physical examination is to be performed.

All staff are to steer clear of the room. Practitioners are to leave the room immediately and wash their hands thoroughly if they have already started the examination.

Isolated individuals should not be allowed to use communal toilet facilities.

Ask the patient to call NHS 111 or any of its equivalents from their own phones. They will assess the patient and determine the appropriate next course of action using the COVID-19 Patient Pathway. Isolation rooms are to be decontaminated appropriately.

If a patient has come in close contact with unsymptomatic patients of COVID-19

The patient is eligible to receive secondary care:

Place the patient in respiratory isolation, and PPE is to be worn by people entering the room. Seek specialist advice from a local microbiologist, virologist, or infectious diseases physician

Accompanied by stratified data, the mainstream narrative today about the outbreak is of a dystopian agenda. There should be enough awareness in order to get rid of fear-mongering and hostage situations to the fear of contracting the illness. Dental practices are expected to take appropriate steps to effectively quarantine suspected individuals and help contain the virus. The government assures that they are taking proper precautions to stack the odds in their favour and prevent the further spread of the illness.