Dr. Natalie Archer knows that getting herself and her employees vaccinated against COVID-19 won’t solve everything.
But as a dentist who serves more than 7,000 clients across three clinics in Toronto, Archer knows how important it is to do so, and soon.
“Medical appointments are considered essential. To me, that stresses how important it is to prioritize people in medical settings for vaccination… because those are the places we need to keep safest,” she said.
“That includes dentistry.”
Canada is in the first stage of its largest-ever vaccination campaign. The focus so far has been on long-term care facilities and front-line health-care workers.
There is no question that people working in COVID-19 wards, intensive care units, emergency rooms and other hospital settings should get the shots at the earliest, said Archer, but it’s crucial dental professionals be considered a priority in the medical field too.
That includes the whole dental team, from hygienists to assistants to technicians and receptionists.
“The virus is carried in the mouth. It’s carried in the nose. Who else is working so closely with patients day-in and day-out other than oral-care professionals?” she said.
“Everybody else’s patients are in masks. Ours aren’t.”
Earlier this month, the Ontario Dental Association called on the provincial government to give dental professionals “early access” to the COVID-19 vaccine, emphasizing how the sheer nature of the work puts dentists and hygienists at direct risk of contracting the coronavirus.
The request wasn’t a suggestion to bump anyone else out of line, said Archer. It’s to ensure timely and appropriate access to a health-care industry that, put simply, can’t keep their distance.
“I can’t describe the stress and the due diligence we put into going into work every day,” she said. “We are front-line workers. We were the ones who donated the PPE (personal protective equipment). We get it.”
It is up to each individual province to decide the prioritization of populations for vaccines. The federal recommendations, developed by the National Advisory Committee on Immunization (NACI) to help guide provinces, identify “key populations” but do not rank them.
Ontario recently identified dentists as part of its first-phase rollout, telling Global News in an email that “all those working for a health care organization,” including a dental office, are considered “part of health care worker prioritization.”
“But we’re not there yet,” said Dr. Caroline Fulop, a dentist working within the Ottawa Hospital.
As it stands, dentists who work within the framework of vaccine distribution to hospitals could be called, but community-based dentists and their staff are still on hold.
“The question we all have right now is, when will dentists actually be up for vaccination? When will we hear? How will we hear? How is it going to go? I think everyone, including our organizations, are waiting for clarity on that. That’s where the anxiety is coming from at this point.”
It’s not clear in other provinces’ vaccination plans either.
In Alberta’s, there is no explicit mention of dentistry, leaving some putting call-outs on Twitter for public health to consider dentists in the second phase of the rollout.
Quebec and Manitoba recently tapped dentists to help administer vaccines. Dentists in Manitoba who work as vaccinators will receive the vaccine as part of their work.
Some of the worries from dental experts concern the inclusion of “direct care teams,” as Fulop described it, meaning those who work in the dental space but aren’t dentists. Ontario has clarified that it will include all those in a “dental office” but it’s not as clear in other provinces.
“The whole dental team must be protected to keep themselves and the patients with whom they are in direct contact with safe,” said Aaron Burry, the Canadian Dental Association’s (CDA) deputy CEO of professional affairs.
“Dentist-led teams include dental hygienists, dental assistants, dental therapists, and all other dental office workers such as office managers and reception staff, as well as those who work in acute and long-term care settings.”
In the U.K., dentists and direct care teams all fall under the second priority risk group in the first phase of the vaccine rollout. The U.S. has recommended that dentists, dental teams and dental students be among the health-care personnel getting their first doses.
The CDA pressed the federal government for clarity in December, asking it to “confirm that dental health care professionals are included under the health care workers population group,” as identified by the NACI. Burry said the feds indicated dentists are considered essential workers, but “did not clarify under which category they would fall for prioritized vaccine access.”
Designating priority populations for vaccination is not an easy task, experts say.
Once Canada clears the top priorities, deciding what kind of health-care worker comes next requires mindful analysis, said Dr. Isaac Bogoch, an infectious disease expert based out of Toronto General Hospital. As a member of Ontario’s COVID-19 Vaccine Distribution Task Force, it’s something Bogoch knows all too well.
“It comes down to three factors,” he said in a previous interview. “One, who’s at greater risk of getting this infection. Two, who’s at greater risk of having a severe outcome from this infection. And three, are these people in settings where this infection can be significantly amplified.”
He argued that it shouldn’t necessarily be a decision based on an industry, like dentists or teachers.
“It should be expanded to essential workers, period,” he said.
Dentists’ unique place in the pandemic should emphasize their need for appropriate vaccine priority, Fulop added.
“There’s nothing particularly early about appropriately prioitizing a high-risk profession,” she said.
“It’s important to think about the broader scope of what we do as professionals. It’s not just check-ups, it’s oftentimes very acute emergencies. We’re trying to keep people out of the next phase of the health-care system, which is facing burden.”
Archer echoed that, saying her patients are coming in for appointments, amid a lockdown, “for valid, good reasons, and they’re scared.”
Archer admits she is a little bit scared too.
“I live with my family. I put them at risk every day going home,” she said.
“The vaccine is just an extra level of protection.”
— with files from Reuters