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ADEA and ADA Respond to WHO Guidance to Delay Non-essential Dental Care During COVID-19 Pandemic
ADEA’s President and CEO, Dr. Karen West, issued a strongly worded response to the World Health Organizations’s (WHO) most recent COVID guidance. “The fact is dental offices and clinics have already reopened their doors and are providing their patients with comprehensive and safe care,” Dr. West said. “Health care professionals, including those in oral health care, are dedicated to stopping the spread of COVID-19. We can fight the pandemic without sacrificing patient care if we continue to educate ourselves, take the proper precautions and work together.”
The WHO issued a guidance advising that non-essential dental care be delayed. Specifically, the guidance states, “WHO advises that routine non-essential oral health care—which usually includes oral health check-ups, dental cleanings and preventive care—be delayed until there has been sufficient reduction in COVID-19 transmission rates from community transmission to cluster cases or according to official recommendations at national, sub-national or local level. The same applies to aesthetic dental treatments. However, urgent or emergency oral health care interventions that are vital for preserving a person’s oral functioning, managing severe pain or securing quality of life should be provided.”
Other guidance includes:
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Patients should be given oral health advice through remote consults or social media on how to maintain good oral hygiene, as prevention and self-care are high priorities.
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Adequate ventilation is needed in dental settings. Facilities should “[a]void the use of split air conditioning or other types of recirculation devices and consider installation of filtration systems.”
- Ask the patient to rinse [their] mouth with 1% hydrogen peroxide or 0.2% povidone iodine for 20 seconds prior to examination or starting any procedure for the purpose of reducing the salivary load of oral microbes, including SARS-CoV-2.
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When aerosol-generating procedures (AGP) cannot be avoided, ensure assistance during procedures (four-handed dentistry); the use of high-speed suction and of a rubber dam, when possible; and the use of appropriate personal protective equipment—including a fit tested N95 or FFP2 respirator, or higher.
WHO is particularly concerned with possible infection spread caused by aerosolized particles. This follows recent calls for more research on possible aerosolization of the virus. As noted in last week’s ADEA Advocate, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease, announced that The White House’s Coronavirus Taskforce will be researching viral aerosolization claims to gain insight as to whether the coronavirus can spread through the air.
WHO’s guidance instructs providers and policy makers to follow the appropriate local, state and national government guidance in addition to WHO’s guidance. The pervasive community spread of coronavirus in the United States would mean that much of WHO’s guidance would be applicable to the United States. However, in the United States, WHO guidance is not mandatory. It is advisory and is considered in addition to federal, state and local guidance and regulations.
On July 7, President Trump submitted the United States’ withdrawal notice from the WHO, effective July 6, 2021. Currently, the United States is still a member of WHO.
The American Dental Association also “respectfully yet strongly disagreed” with WHO’s guidance and the National Dental Associaiton issued a statement that began “The National Dental Association (NDA) supports the work of the World Health Organization, but cannot in good conscience agree with its recent recommendation that “check-ups, dental cleanings, and preventive care be delayed until there has been sufficient reduction in COVID-19 transmission rates”.
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Trump Extends Student Loan Payment Deferments Until December
On Aug. 8, President Trump issued a Memorandum on Continued Student Loan Payment Relief During the COVID-19 Pandemic, extending student loan payment deferments, which initially began in March. This memorandum continues federal student loan payment deferments and continues to waive the interest rate on federal student loans until Dec. 31, 2020. The deferment and interest waiver only apply to federal student loans, not private student loans.
It’s not yet clear if the missed months will still count as payments for those enrolled in income-driven repayment plans or the public service loan forgiveness program.
The continued deferment is expected to be automatic, which means that borrowers shouldn’t have to call their servicers and ask that their loans be put on hold. Additionally, the memorandum allows those who would like to make their student loan payments to continue to do so.
For now, the continued deferment will apparently go into effect after Sept. 30, when the initial deferment was set to expire. We are awaiting implementation guidance from Department of Education on the continued deferment. However, because the president did not disclose how he would close the funding gap resulting from the deferment and the interest waiver, the constitutionality of the memorandum is being questioned since, per the Constitution, only Congress has the power to address funding issues.
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Court Denies States’ Efforts to Delay Implementation of New Title IX Regulations
Federal judges in both the Commonwealth of Pennsylvania v. Elisabeth DeVos, U.S. Secretary of Education and the State of New York v. U.S. Department of Education denied the states’ requests for injunctive relief against the implementation of the new Title IX regulations, set to go into effect on Aug. 14. The rulings in favor of the U.S. Department of Education (ED) effectively mean that the new Title IX regulations became effective on Aug. 14.
On June 4, 17 Democratic state attorneys general and the attorney general of Washington, D.C., jointly filed a lawsuit against ED in the District Court of the District of Columbia. The states that signed on to the lawsuit are California, Colorado, Delaware, Illinois, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington and Wisconsin along with the District of Columbia. The brief filed argues that the Title IX regulation “improperly narrows the definition of sexual harassment under Title IX,” and would also require students to “endure repeated and escalating levels of harassment.”
On June 23, the Democratic attorneys general also filed a motion for injunctive relief asking for the delayed implementation of the new Title IX regulations. The motion was denied on Aug. 12.
The underlying Democratic state attorneys general lawsuit has yet to be heard.
In the second case, New York state filed a lawsuit against ED in the Southern District of New York on June 5. The lawsuit asserts that the Title IX regulations violate the Administrative Procedures Act by:
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Imposing burdensome procedural requirements;
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Being arbitrary and capricious by failing to explain ED's departure from previous policy and not adequately considering the harm it will cause to students, institutions and the general public; and
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Failing to observe procedures required by law, as certain provisions were not included in the proposed rule by ED and were issued without adequate notice to the public.
On June 25, New York state also filed a motion for injunctive relief asking that the Aug. 14 implementation date be delayed. The motion was denied on Aug 8.
New York state’s underlying lawsuit has not yet been heard.
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