I have read a lot of articles in the last eight weeks about what the future holds. How long can we be expected to maintain social distancing? When will parks reopen? When will the dentists reopen and what will that be like? This blog article highlights how adaptable medicine can be in the face of a new enemy.
Click the images to learn more, disappear down a YouTube history of medicine rabbit hole.
The fact is some of the suggestions for a "new normal" seem unusual to us. We have to ask do we want to return to normal? It has been the norm in parts of Asia to wear a face mask if you have been feeling unwell in public for decades. Not so in Europe, well I only really have experience of the UK, Ireland Spain and maybe Sweden, but I've never really seen it. It's such a good public health precaution though, if you must leave the house when you are dying of "man flu" why would you risk it spreading to all the other poor defenseless men on the Luas or at the coffee dock in Obama's Plaza. Think of their poor wives and girlfriends.
I think this is part of the "new normal" that I would be happy to keep.
In terms of delivering healthcare, the dental profession has been tying itself in knots for the last 8 weeks trying to ready itself for the delivery of safe and affordable dentistry in the aftermath of a global pandemic. Some dentists have been concerned that we are over-reacting, that there is no requirement to need respirator masks and gowns, some have gone even further and invested in expensive air filtration systems despite very poor quality scientific evidence for them.
It would have been better I think if our governing bodies and insurance providers had been able to sit down with the Irish Dental Associations patient safety committee and come up with a universal approach, but as a scientific profession who are used to reading and surveying the science, we all came together privately to collaborate. This has been an amazing side-effect of a normally lonely profession, too often neighbouring dentists have little contact except maybe the annual conference and maybe an awards ceremony if we are lucky. It has been so rewarding to collaborate with dentists all over the country to produce a rapid and safe approach to this COVID threat.
As a profession we are very good at adapting to change and making dramatic overnight changes to the way we offer our services.
In the 1980's dentists routinely treated patients without gloves, then when the HIV epidemic became apparent suddenly they were all wearing gloves, masks and glasses. The idea of me putting an ungloved hand into someone's mouth to mix with saliva and blood is unconscionable.
In the early 2000's dentists used to sterilise instruments used in root canal treatments. They were deemed clean. Then the "mad cow disease" and vCJD crisis hit, and we all started with single use files. No complaints, just read the science, understand the logic and make the changes. Maybe COVID19 is the event that will make us change the way we deal with dental sprays, and introduce rules regarding uniforms, gowns and masks.
Even in medicine what seems normal today would have been viewed as unjustified and unnecessary in the past. Doctors only began washing their hands because of Dr. Semmelweis in 1847 and Joseph Lister in 1867, before that it was seen as a badge of honour to see your surgeon's apron covered in the blood of his previous victims - "There's a hard-working chap!"
Dr. Semmelweis reduced death during childbirth in his hospital by 90% by introducing hand washing for his student doctors after noticing what a stellar job the midwives were doing in the hospital next door. What a novel idea, the start of allied healthcare.
Clean drinking water wasn't a thing, diseases believed to to have been caused by bad smells (miasma), the
best way to avoid catching something disgusting
was to carry around a little fragrant bouquet. Dr John Snow pointed out that maybe something about the putrid manky water they were all drinking could be the cause.The medical profession upon realising their mistake started to ask water companies to treat water instead of pumping drinking water straight out of the sewage clogged Thames river. This was resisted by water companies as an unnecessary expense.
Even as late as the 1950's before the widespread introduction of antibiotics, a simple cut or wound could have resulted in the need for a radical amputation or even death, but then we made a revolutionary advance, understood the benefits and overhauled our scientific approach to treating patients. Penicillin transformed the survival of battlefield wounds in World War 2 and was soon available to all. As antibiotic resistance increases we are at a great risk of returning to these types of radical surgeries as the antibiotics we rely on are becoming much less effective.
Dentistry and medicine are always shifting their standards, COVID19 is likely to be the next major event that makes us examine the science, sit down and make changes required to benefit our health, our patients health and our staff's health. The point of this blog really is to highlight, that when something devastating comes our way, like the great plague pandemics of Europe, the cholera epidemics in London, and the HIV crisis in the 80's, we are an adaptable profession, we can make changes to continue to provide appropriate care, but it can mean a change from what we are used to. Change can be inconvenient and sometimes expensive, but we can adapt.
Some of the changes we make during this pandemic will be temporary, like having our kids home 24/7. Some may be more permanent.