USA: COVID-19 What Does This Mean for Your Dental Practice?

      USA: COVID-19 What Does This Mean for Your Dental Practice?

      First and foremost, we hope you and your family are healthy and we want to let you know that we are very aware of the situation with COVID-19 and are staying informed as the situation continues to develop.

      Our primary concern is your health, the health of your staff and the health of your patients.

      We understand here at Stream Dental HR that you are facing some uncertain times ahead. With conflicting information and differing opinions, it can be difficult to know what course of action you should take in this time of ambiguity.

      Your regulatory dental bodies are likely highly recommending that you close your practices for the time being in order to follow social distancing policies and to maintain a safe and healthy workplace. As a health care practitioner, your duty of care may still extend forward to emergency procedures and it will be important that you follow your occupational health and safety best practices in order to keep your employees safe during this time.

      Below are recommendations for two scenarios, whether you choose to keep your practice open with skeleton operations, or if you close entirely.

      If you keep the practice open with regular operations (if your regulatory body has not issued a notice where you must close):

      1.  Educate your employees on COVID-19

      • COVID-19 spreads in a manner similar to the flu - when there is close contact between people. This disease may be contracted by inhaling infected fluid and by touching contaminated surfaces and/or objects. The most identified at risk population for this disease appears to be people over 40, or those with weakened immune systems or other underlying health conditions such as diabetes, heart and lung disease. 
      • Based on the fact that dental offices have direct contact with the mouths and saliva of patients, it is important to ensure that all risk management practices are followed as thoroughly as possible. If an employee has travelled back from an area with severe outbreak or has been in contact with anyone who has returned from an area with severe outbreak, they may be asked not to come into work during the 4-14-day incubation period of this disease.

      2.  Practice the following methods to prevent the spread of infection: 

      • Wash hands with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available
      • Avoid touching eyes, nose and mouth with unwashed hands
      • Avoiding close contact with people who are sick
      • Staying home when sick
      • Covering a cough or sneeze with a tissue, then throwing the tissue in the trash
      • Cleaning and disinfecting frequently touched objects and surfaces
      • Utilizing remote work opportunities as much as possible
      • Refraining from shaking hands 
      • Using more teleconferencing (video conferencing/telephone calls instead of face to face meetings)
      • Pack your own lunch and eat it at your own workstation.
      • Screen patients for travel and any signs or symptoms of infection when they update their medical history
      • Take temperature readings
      • Make sure PPE is being used correctly
      • Use rubber dams when able to
      • Avoid high speed evacuations for dental procedures that require the use of aerosol
      • Autoclave handpieces after each use
      • Patients should rinse with a 1% hydrogen peroxide solution before all appointments
      • Public areas should be cleaned and disinfected frequently
      • If urgent dental treatment is necessary, dentists and patient's medical providers should work together to determine (on a case-by-case basis) and determine what is best for the patient and where it would be best to do the treatments
      • If you do stay open, and have a patient that tests positive for COVID-19, you do have a duty to report this OSHA. You as an employer must lays out PPE for all workers with an exposure risk in the workplace. 
      • If you are requiring people to come to work then you must provide them with this PPE.
      • Wash hands with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available
      • Avoid touching eyes, nose and mouth with unwashed hands
      • Avoiding close contact with people who are sick
      • Staying home when sick
      • Covering a cough or sneeze with a tissue, then throwing the tissue in the trash
      • Cleaning and disinfecting frequently touched objects and surfaces
      • Utilizing remote work opportunities as much as possible
      • Refraining from shaking hands 
      • Using more teleconferencing (video conferencing/telephone calls instead of face to face meetings)
      • Pack your own lunch and eat it at your own workstation.
      • Screen patients for travel and any signs or symptoms of infection when they update their medical history
      • Take temperature readings
      • Make sure PPE is being used correctly
      • Use rubber dams when able to
      • Avoid high speed evacuations for dental procedures that require the use of aerosol
      • Autoclave handpieces after each use
      • Patients should rinse with a 1% hydrogen peroxide solution before all appointments
      • Public areas should be cleaned and disinfected frequently
      • If urgent dental treatment is necessary, dentists and patient's medical providers should work together to determine (on a case-by-case basis) and determine what is best for the patient and where it would be best to do the treatments
      • If you do stay open, and have a patient that tests positive for COVID-19, you do have a duty to report this OSHA. You as an employer must lays out PPE for all workers with an exposure risk in the workplace. 
      • If you are requiring people to come to work then you must provide them with this PPE.

      3. OSHA-OSHA has divided workplaces and work operations into four risk zones, according to the likelihood of employees’ occupational exposure during a pandemic. These risk zones are useful in determining appropriate work practices and precautions.

      Very High Exposure Risk:

      • Healthcare employees performing aerosol-generating procedures on known or suspected pandemic patients.
      • Healthcare or laboratory personnel collecting or handling specimens from known or suspected pandemic patients.

      High Exposure Risk:

      • Healthcare delivery and support staff exposed to known or suspected pandemic patients.
      • Medical transport of known or suspected pandemic patients in enclosed vehicles.
      • Performing autopsies on known or suspected pandemic patients.

      Medium Exposure Risk:

      • Employees with high-frequency contact with the general population (such as schools, high population density work environments, and some high-volume retail).

      Lower Exposure Risk (Caution):

      • Employees who have minimal occupational contact with the general public and other coworkers (such as office employees).

      4. Ensure that your team knows who to talk to

      • As an employer you have a statutory duty of care for people's health and safety by providing a safe place to work. As well, there is a strong moral responsibility to ensure that your employees feel safe and secure in their workplace. As an employer, ensure that you remain proactive throughout this situation so that you can protect the people within your workplace and further minimize the risk of the virus spreading. 

      5. Continue to follow best practices for Infection Prevention and Control. Here is a copy of OSHA’s Guidance on Preparing Workplace for COVID-19.

      If you are going to be operating with a skeleton staff:

      1. Meet with your team to discuss the fact that the office will be closed for the foreseeable future until the need for closure has passed
      2. Discuss with your team that certain roles may be able to continue to work from home and will be compensated appropriately 
      • For example - the office manager may be able to do their job completely from home in a remote working capacity
      • Issue a Remote Working Policy to establish expectations and guidelines

             3. Any employees that cannot do any work for the practice can:

      • opt to take their PTO first (this is not mandatory, but highly recommended)
      • Some businesses might be eligible for the Families First Coronavirus Response Act. This Bill could provide free screening, paid leave and enhanced unemployment insurance benefits for people affected by COVID-19, the respiratory disease caused by the coronavirus.
      •  More information on this will be provided

            4.  Discuss with your team the risks involved for continued work:

      • Employers are responsible for practicing in a way that supports the continued health and safety of their employees using preventative measures.
      • If there is a risk of exposure to COVID-19 for employees while working, employers must:  A) Identify the Risk B) Assess the Risk C) Implement Proper Controls Through Hazard Prevention Programs
      • If an increase in Personal Protective Equipment is required, employers must provide training on these new procedures or equipment

             5.  Remind employees of their rights based on the U.S Department of Labor.

      •  Employees have:  A) The Right to Know B) The Right to Participate C) The Right to Refuse Dangerous Work

             6.  Follow the best practices (as listed earlier) to prevent the spread and transmission of infections

      If you close your practice:

      1.  Check with your business/practice insurance broker if you have any epidemic/pandemic coverage that will be able to help you through this situation.

      2.  Provide your team with notice of temporary layoff/ furloughs

      • For employee or employees who lose their jobs through no fault of their own, filing for unemployment benefits could be the next step. Eligibility is determined by the requirements of individual states, which have their own unemployment insurance programs. You must choose your state to find out specific requirements.

      3.  Employers are reeling from the workplace implications of this fast-moving pandemic. We've assembled these global resources to help employers with the many legal considerations they face:  

      Coronavirus(COVID-19) Resources for Employers

      COVID-19 Resource Center

      Coronavirus/COVID-19

      Must we keep paying employees who are not working?

      Under the Fair Labor Standards Act (FLSA), for the most part the answer is “no.” FLSA minimum-wage and overtime requirements attach to hours worked in a workweek, so employees who are not working are typically not entitled to the wages the FLSA requires.

      One possible difference relates to employees treated as exempt FLSA “white collar” employees whose exempt status requires that they be paid on a salary basis. Generally speaking, if such an employee performs at least some work in the employee's designated seven-day workweek, the salary basis rules require that they be paid the entire salary for that particular workweek. There can be exceptions, such as might be the case when the employer is open for business but the employee decides to stay home for the day and performs no work. A U.S. Department of Labor (USDOL) opinion letter addressing these matters can be accessed here.

      Also, non-exempt employees paid on a “fluctuating-workweek” basis under the FLSA normally must be paid their full fluctuating-workweek salaries for every workweek in which they perform any work. There are a few exceptions, but these are even more-limited than the ones for exempt “salary basis” employees. Of course, an employer might have a legal obligation to keep paying employees because of, for instance, an employment contract, a collective bargaining agreement, or some policy or practice that is enforceable as a contract or under a state wage law.

      Finally, we caution employers to consider the public relations aspect of not paying employees who may not be working if they have contracted or are avoiding the COVID-19 coronavirus. Given the publicity surrounding this outbreak, it is possible that situations involving these kinds of issues could reach the media and damage your reputation and employee morale. Consider the big picture perspective when making decisions regarding paying or not paying your employees.

      What if we stay open but my staff refuse to come to work?

      Employees are only entitled to refuse to work if they believe they are in imminent danger. Section 13(a) of the Occupational Safety and Health Act (OSH Act) defines “imminent danger” to include “any conditions or practices in any place of employment which are such that a danger exists which can reasonably be expected to cause death or serious physical harm immediately or before the imminence of such danger can be eliminated through the enforcement procedures otherwise provided by this Act.” OSHA discusses imminent danger as where there is “threat of death or serious physical harm,” or “a reasonable expectation that toxic substances or other health hazards are present, and exposure to them will shorten life or cause substantial reduction in physical or mental efficiency.”

      The threat must be immediate or imminent, which means that an employee must believe that death or serious physical harm could occur within a short time, for example, before OSHA could investigate the problem. Requiring travel to China or to work with patients in a medical setting without personal protective equipment at this time may rise to this threshold. Most work conditions in the United States, however, do not meet the elements required for an employee to refuse to work. Once again, this guidance is general, and employers must determine when this unusual state exists in your workplace before determining whether it is permissible for employees to refuse to work.

      In addition, Section 7 of the National Labor Relations Act (NLRA) extends broad-based statutory protection to those employees (in union and non-union settings alike) to engage in “protected concerted activity for mutual aid or protection.” Such activity has been defined to include circumstances in which two or more employees act together to improve their employment terms and conditions, although it has been extended to individual action expressly undertaken on behalf of co-workers.

      On its own website, the National Labor Relations Board (NLRB) offers a number of examples, including, “talking with one or more employees about working conditions,” “participating in a concerted refusal to work in unsafe conditions,” and “joining with co-workers to talk to the media about problems in your workplace.” Employees are generally protected against discipline or discharge for engaging in such activity.

      What if an employee appears sick?

      If any employee presents themselves at work with a fever or difficulty in breathing, this indicates that they should seek medical evaluation. While these symptoms are not always associated with influenza and the likelihood of an employee having the COVID-19 coronavirus is extremely low, it pays to err on the side of caution. Retrain your supervisors on the importance of not overreacting to situations in the workplace potentially related to COVID-19 in order to prevent panic among the workforce.

      Can we ask an employee to stay home or leave work if they exhibit symptoms of the COVID-19 coronavirus or the flu?

      Yes, you are permitted to ask them to seek medical attention and get tested for COVID-19. The CDC states that employees who exhibit symptoms of influenza-like illness at work during a pandemic should leave the workplace.

      During the H1N1 pandemic, the Equal Employment Opportunity Commission (EEOC) stated that advising workers to go home is not disability-related if the symptoms present are akin to the seasonal influenza or the H1N1 virus. Therefore, an employer may require workers to go home if they exhibit symptoms of the COVID-19 coronavirus or the flu.

      Ensure that you maintain your employees Human Rights.

      During this time, all human rights legislation still applies to all employees. This means that employees that are of certain ethnicity, race, ancestry, or place of origin cannot be discriminated against. Situations have taken place where employees of Chinese descent have been harassed or discriminated against since the outbreak of COVID-19. Maintain best practices by ensuring that your human rights related policies are all upheld to the highest standards.

      Communicate with your team!

      Remember, you are all in this together and no one is operating exclusively from the rest of your team! Talk with your staff and let them know their options, your expectations, and work together to create a plan for the future.

      Our primary concern is your health, the health of your staff and the health of your patients.

      We are currently putting together some information and recommendations that we will be helpful to you, as we all are doing our best to navigate through this situation. We want to support you during times like these so you can be the leader your team needs right now.

      Further Resources:

      World Health Organization

      https://www.who.int/emergencies/diseases/novel-coronavirus-2019

      Center for Disease Control and Prevention

      https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fsummary.html

      Fisher Phillips: Comprehensive and Updated FAQs For Employers on the COVID-19 Coronavirus

      https://www.fisherphillips.com/resources-alerts-comprehensive-faqs-for-employers-on-the-covid#L9

      OSHA Guidance on Covid-19 and Worker Safety (U.S. Dept of Labor)

      https://www.osha.gov/SLTC/covid-19/?fbclid=IwAR0nxKSu6yH9kRXfm-O3cCJFGdBloC1w8WOX-9ANLEU5_hftVpK8LfGKkNc

      Travel Advisories

      https://travel.state.gov/content/travel/en/traveladvisories/ea/covid-19-information.html

      Furloughs and Other Temporary Responses to Coronavirus Disruptions (Littler)

      https://www.littler.com/publication-press/publication/furloughs-and-other-temporary-responses-coronavirus-covid-19

      Families First Coronavirus Response Act

      https://www.natlawreview.com/article/families-first-coronavirus-response-act