Post by Nadica (She/Her) on Nov 12, 2024 0:53:14 GMT
Interview with the Organizers of an Outdoor Masks-Required Dental Clinic - Published Nov 10, 2024
Below is an interview with Katie and Rachel, the organizers of a masks-required outdoor dental clinic in Kansas.
How did the idea for the clinic come about?
Katie: We have all been trying to find a COVID-safe dentist for a while now. Dental care is the most high-risk situation for most of our group members as it’s the only situation we can’t compensate for others’ lack of precautions by wearing a high-quality mask. We are completely vulnerable—if an asymptomatic COVID+ hygienist walks around the office setting up right before we get there, there’s not much to keep us safe once our mask is removed.
We found a local dentist who said she’d take precautions, but she and her staff clearly didn’t understand airborne transmission, and staff weren’t wearing masks until AFTER we arrived.
Several members of our group called other offices trying to find someone willing to take precautions, and most simply wouldn’t call us back. Others would get upset that we were implying the ADA recommendation to wear a surgical mask when in the patient’s face wasn’t enough. We probably called 30 different dental offices.
So, when we finally found one who said, “Yes!” we were ecstatic. Rachel (a member of my COVID group who has a lot of knowledge about clean air) and I had a Zoom call with one of the dentists and the office manager, and they are the ones who suggested we could set up some exam chairs outside. We still can’t get over how fortunate we are to have found them.
Rachel: Part of why they gave us such enthusiastic cooperation is because their practice is already equipped to be mobile. They’re hybrid where they have two offices and also go to skilled nursing facilities and elderly people’s homes to provide all the services patients receive in the office. That’s why the request for outdoor exams seemed so feasible to them. The other key component to their agreement was because they’re good humans who are also smart and realize that it’s a profitable business strategy to accommodate everyone.
Does the dentist practice Covid precautions on a typical day?
Katie: No, they do not. So if you do call for an appointment, you HAVE to say you are calling about a COVID-safer appointment. They’ll put you in touch with the practice manager, Gabriella, and she’ll either tell you the next clinic date or put your name on a waitlist. She can also check your insurance information and give you a cost estimate.
Rachel: That’s just for now, though. The dentist / practice owner is considering adding many of the mitigation tools on a permanent basis so all patients and staff will benefit whether a patient requests it or not.
Was there any uncertainty or questions from the dentist’s office?
Katie: The first phone call with Gabriella, the office manager, was a shock because when I gave her my spiel about our group of patients looking for a dentist willing to take extra COVID precautions, instead of huffing and saying, “We don’t need extra precautions,” she said, “What could we do to keep you safe?”
Rachel: And I really, really want to emphasize Gabriella’s word choice. She did NOT say “What can we do to make you feel comfortable?” We’re often asked this and it’s better than animosity for sure. But to be asked what actually needs to be done to physically BE safe, not just “feel” better, is huge.
Can you talk about the precautions being taken during the clinic, both inside and outside?
Katie: The main thing I emphasized before the clinic was that I didn’t want anyone in the building without a mask in the hours before our appointment. I knew we were in good hands when the dentist said he’d even make sure no cleaning staff came in the building on our clinic days.
Rachel: Here’s what we asked for and what I offered to bring, and the dentist happily agreed to all of it.
Masks before coming into the building and only removed outside several feet from exam tents for staff breaks
Bathroom: AirFanta 3Pro on full power (~400 cfm clean air delivery rate or 30+ air changes per hour) – in case a staff member removes their mask in the bathroom even though they were asked not to
Ventilation: front door and back door remained open (in extreme summer and winter weather, we’ll rely on the other layers of protection, but this one was excellent since our first clinics have been on nice fall Kansas City days)
Outdoor exams: two tents in the back of the building
Indoor exams: Three of the four inside exam rooms were used at different times throughout the day, but the staff made sure there was at least one hour between room use. That meant whatever the patient exhaled at the 10 am appointment, for example, was ventilated out with the open doors (or inactivated by far uvc and filtered by an air purifier) by the time the 12 pm appointment started in the same room.
Air purifiers: Each inside room had at least one CleanAirKits purifier (a Luggable XL, or Triple Exhalaron). One Exhalaron was provided if a patient wanted to hold it on their lap for extra protection.
Far UV: Legacy Guards on tripods were in two of the inside exam rooms. One Krypton MVP (portable, cell phone-sized) was available if a patient wanted to hold it in their lap.
(All Far UV and air purifiers were borrowed by the dental clinic from Clean Air KC lending library since the practice hasn’t purchased their own tools yet.)
Thanks to good fortune, it’s a small, standalone building, so we didn’t have to worry about sharing HVAC with other offices next door
Testing: One of the three clinic days, I arrived 30 minutes early and administered a pooled PlusLife PCR-quality test for the staff that was there setting up. I was able to run it from my car. The consensus is that negative PlusLife tests assure no contagiousness for 6 hours (conservatively), but more likely 12-24 hours. So that was a big reassurance that even if a staff member’s mask wasn’t fit-tested, the patients that day at least wouldn’t be catching the virus I tested them for. (Many members in our community cannot afford to catch any virus, so we would never drop any of these mitigations just because of one negative test for one virus. But it was a great added layer!) We don’t plan to test every clinic day, but I will do it again if a patient asks me to.
What has the response been to the clinic from the Covid Cautious community?
Katie: It’s been an amazing response. With the clinic not accepting all types of insurance, we were worried we wouldn’t have enough patients to fill an entire clinic. We’ve now had three in one month and a fourth planned for Nov. 20. I hope word gets out about this, beyond the dental world, so healthcare providers will realize there is a need and profitable market for safe care.
Rachel: We expected to check an important task off our list (preventive dental care) or take care of overdue dental issues in some cases. But I don’t think a lot of us expected the emotional and mental health boost we received. After years of providers acting like our requests were a nuisance or outright refusing, this was literally and figuratively a breath of fresh air.
Do you consider the clinic a success?
Katie: Yes. People who have been holding off on getting cavities filled, teeth pulled, etc. were finally able to get the necessary care without worrying about getting sick.
Will there be more outdoor dental clinics in the future?
Katie: The office has a running waiting list, and I believe as long as it keeps filling up, they’ll keep adding new clinics. Everyone who went to these last few clinics will be due for cleanings in six months, so we’ll definitely have them again at that time.
Rachel: Even if the demand wanes, a patient could call and ask for a covid safer appointment and get the first one of the day and ask that all staff mask before and during their appointment. I’m not just guessing that. The dentist said he could work out something like that for patients who need more urgent care.
Have you considered organizing outdoor clinics for other medical specialties?
Katie: I would love for that to happen, but haven’t personally looked into it.
Rachel: Next up is eye care, but I haven’t started that endeavor yet.
What would you say was the biggest hurdle in organizing these outdoor dental clinics?
Katie: Once we found a dentist willing to do the clinic and honor our requests, it was pretty smooth!
If someone wants to organize a similar clinic in their city, what would you tell them? Is there a certain way they should approach a dentist or other medical provider?
Katie: If I had to do this over, I would have started by calling local nursing homes and asking if they have a mobile dentist come in to treat their patients. I then would have called those dentists to see if they were interested in setting up a clinic at one of our members’ houses (in the garage or outside), and if so, if we could have a group rate since most of the mobile dentists are significantly more expensive. If they only have to set up once, hopefully they’d be willing to offer a reduced rate, and with the clinic being at a COVID-cautious persons’ home, the group could set up the air filters, open windows, etc. exactly how they want them.
We got lucky that our dentist has an office that’s a freestanding building with room outside for chairs, but I know many mobile dentists might not have that available.
How can someone connect with the Covid Cautious community in Kansas?
Rachel: There are two mask blocs in the area: ICT Mask Bloc (Wichita, Kan.) and 816 Covid Crew (Kansas City metro). They can also message me on Instagram: @ CleanAirCommunications or email me at Rachel@CleanAirCommunications and I can add them to our Kansas City still Coviding Facebook group.
Is there anything else you’d like to add?
Katie: If you do find a dentist willing to put on a clinic like this, I think an important step is to ask if one of your group members can come in for a 15-minute COVID education meeting first. It was so disappointing how many receptionists or office managers I spoke to literally thought they were COVID-safe because they deep cleaned the office daily. A few suggested we’d be safe if we came at the end of the day when there were fewer patients, and had never heard that COVID can remain in the air (and infectious) for hours. They almost uniformly believe once a sick person leaves a room, it’s safe to enter maskless.
This lack of education explains why so many practices think it’s okay for us to mask while no one else does, or why they don’t need to mask before we get there. So a brief meeting with ALL staff (including front desk) who will be there on your clinic day is crucial. Education and not just ‘rules’ will help them keep you safe.
Below is an interview with Katie and Rachel, the organizers of a masks-required outdoor dental clinic in Kansas.
How did the idea for the clinic come about?
Katie: We have all been trying to find a COVID-safe dentist for a while now. Dental care is the most high-risk situation for most of our group members as it’s the only situation we can’t compensate for others’ lack of precautions by wearing a high-quality mask. We are completely vulnerable—if an asymptomatic COVID+ hygienist walks around the office setting up right before we get there, there’s not much to keep us safe once our mask is removed.
We found a local dentist who said she’d take precautions, but she and her staff clearly didn’t understand airborne transmission, and staff weren’t wearing masks until AFTER we arrived.
Several members of our group called other offices trying to find someone willing to take precautions, and most simply wouldn’t call us back. Others would get upset that we were implying the ADA recommendation to wear a surgical mask when in the patient’s face wasn’t enough. We probably called 30 different dental offices.
So, when we finally found one who said, “Yes!” we were ecstatic. Rachel (a member of my COVID group who has a lot of knowledge about clean air) and I had a Zoom call with one of the dentists and the office manager, and they are the ones who suggested we could set up some exam chairs outside. We still can’t get over how fortunate we are to have found them.
Rachel: Part of why they gave us such enthusiastic cooperation is because their practice is already equipped to be mobile. They’re hybrid where they have two offices and also go to skilled nursing facilities and elderly people’s homes to provide all the services patients receive in the office. That’s why the request for outdoor exams seemed so feasible to them. The other key component to their agreement was because they’re good humans who are also smart and realize that it’s a profitable business strategy to accommodate everyone.
Does the dentist practice Covid precautions on a typical day?
Katie: No, they do not. So if you do call for an appointment, you HAVE to say you are calling about a COVID-safer appointment. They’ll put you in touch with the practice manager, Gabriella, and she’ll either tell you the next clinic date or put your name on a waitlist. She can also check your insurance information and give you a cost estimate.
Rachel: That’s just for now, though. The dentist / practice owner is considering adding many of the mitigation tools on a permanent basis so all patients and staff will benefit whether a patient requests it or not.
Was there any uncertainty or questions from the dentist’s office?
Katie: The first phone call with Gabriella, the office manager, was a shock because when I gave her my spiel about our group of patients looking for a dentist willing to take extra COVID precautions, instead of huffing and saying, “We don’t need extra precautions,” she said, “What could we do to keep you safe?”
Rachel: And I really, really want to emphasize Gabriella’s word choice. She did NOT say “What can we do to make you feel comfortable?” We’re often asked this and it’s better than animosity for sure. But to be asked what actually needs to be done to physically BE safe, not just “feel” better, is huge.
Can you talk about the precautions being taken during the clinic, both inside and outside?
Katie: The main thing I emphasized before the clinic was that I didn’t want anyone in the building without a mask in the hours before our appointment. I knew we were in good hands when the dentist said he’d even make sure no cleaning staff came in the building on our clinic days.
Rachel: Here’s what we asked for and what I offered to bring, and the dentist happily agreed to all of it.
Masks before coming into the building and only removed outside several feet from exam tents for staff breaks
Bathroom: AirFanta 3Pro on full power (~400 cfm clean air delivery rate or 30+ air changes per hour) – in case a staff member removes their mask in the bathroom even though they were asked not to
Ventilation: front door and back door remained open (in extreme summer and winter weather, we’ll rely on the other layers of protection, but this one was excellent since our first clinics have been on nice fall Kansas City days)
Outdoor exams: two tents in the back of the building
Indoor exams: Three of the four inside exam rooms were used at different times throughout the day, but the staff made sure there was at least one hour between room use. That meant whatever the patient exhaled at the 10 am appointment, for example, was ventilated out with the open doors (or inactivated by far uvc and filtered by an air purifier) by the time the 12 pm appointment started in the same room.
Air purifiers: Each inside room had at least one CleanAirKits purifier (a Luggable XL, or Triple Exhalaron). One Exhalaron was provided if a patient wanted to hold it on their lap for extra protection.
Far UV: Legacy Guards on tripods were in two of the inside exam rooms. One Krypton MVP (portable, cell phone-sized) was available if a patient wanted to hold it in their lap.
(All Far UV and air purifiers were borrowed by the dental clinic from Clean Air KC lending library since the practice hasn’t purchased their own tools yet.)
Thanks to good fortune, it’s a small, standalone building, so we didn’t have to worry about sharing HVAC with other offices next door
Testing: One of the three clinic days, I arrived 30 minutes early and administered a pooled PlusLife PCR-quality test for the staff that was there setting up. I was able to run it from my car. The consensus is that negative PlusLife tests assure no contagiousness for 6 hours (conservatively), but more likely 12-24 hours. So that was a big reassurance that even if a staff member’s mask wasn’t fit-tested, the patients that day at least wouldn’t be catching the virus I tested them for. (Many members in our community cannot afford to catch any virus, so we would never drop any of these mitigations just because of one negative test for one virus. But it was a great added layer!) We don’t plan to test every clinic day, but I will do it again if a patient asks me to.
What has the response been to the clinic from the Covid Cautious community?
Katie: It’s been an amazing response. With the clinic not accepting all types of insurance, we were worried we wouldn’t have enough patients to fill an entire clinic. We’ve now had three in one month and a fourth planned for Nov. 20. I hope word gets out about this, beyond the dental world, so healthcare providers will realize there is a need and profitable market for safe care.
Rachel: We expected to check an important task off our list (preventive dental care) or take care of overdue dental issues in some cases. But I don’t think a lot of us expected the emotional and mental health boost we received. After years of providers acting like our requests were a nuisance or outright refusing, this was literally and figuratively a breath of fresh air.
Do you consider the clinic a success?
Katie: Yes. People who have been holding off on getting cavities filled, teeth pulled, etc. were finally able to get the necessary care without worrying about getting sick.
Will there be more outdoor dental clinics in the future?
Katie: The office has a running waiting list, and I believe as long as it keeps filling up, they’ll keep adding new clinics. Everyone who went to these last few clinics will be due for cleanings in six months, so we’ll definitely have them again at that time.
Rachel: Even if the demand wanes, a patient could call and ask for a covid safer appointment and get the first one of the day and ask that all staff mask before and during their appointment. I’m not just guessing that. The dentist said he could work out something like that for patients who need more urgent care.
Have you considered organizing outdoor clinics for other medical specialties?
Katie: I would love for that to happen, but haven’t personally looked into it.
Rachel: Next up is eye care, but I haven’t started that endeavor yet.
What would you say was the biggest hurdle in organizing these outdoor dental clinics?
Katie: Once we found a dentist willing to do the clinic and honor our requests, it was pretty smooth!
If someone wants to organize a similar clinic in their city, what would you tell them? Is there a certain way they should approach a dentist or other medical provider?
Katie: If I had to do this over, I would have started by calling local nursing homes and asking if they have a mobile dentist come in to treat their patients. I then would have called those dentists to see if they were interested in setting up a clinic at one of our members’ houses (in the garage or outside), and if so, if we could have a group rate since most of the mobile dentists are significantly more expensive. If they only have to set up once, hopefully they’d be willing to offer a reduced rate, and with the clinic being at a COVID-cautious persons’ home, the group could set up the air filters, open windows, etc. exactly how they want them.
We got lucky that our dentist has an office that’s a freestanding building with room outside for chairs, but I know many mobile dentists might not have that available.
How can someone connect with the Covid Cautious community in Kansas?
Rachel: There are two mask blocs in the area: ICT Mask Bloc (Wichita, Kan.) and 816 Covid Crew (Kansas City metro). They can also message me on Instagram: @ CleanAirCommunications or email me at Rachel@CleanAirCommunications and I can add them to our Kansas City still Coviding Facebook group.
Is there anything else you’d like to add?
Katie: If you do find a dentist willing to put on a clinic like this, I think an important step is to ask if one of your group members can come in for a 15-minute COVID education meeting first. It was so disappointing how many receptionists or office managers I spoke to literally thought they were COVID-safe because they deep cleaned the office daily. A few suggested we’d be safe if we came at the end of the day when there were fewer patients, and had never heard that COVID can remain in the air (and infectious) for hours. They almost uniformly believe once a sick person leaves a room, it’s safe to enter maskless.
This lack of education explains why so many practices think it’s okay for us to mask while no one else does, or why they don’t need to mask before we get there. So a brief meeting with ALL staff (including front desk) who will be there on your clinic day is crucial. Education and not just ‘rules’ will help them keep you safe.