In an episode of the TV show Mad Men, one of the characters is at the doctor’s office for an exam. Set in the 60’s, the physician is shown with no safety glasses, no mask, and no gloves. While I found this amusing, the doctor then leans back and takes a puff from his cigarette. Now that was truly shocking, but my parents assured me that’s the way it was back then. The example served as a reminder of how safety, knowledge, and personal protection in healthcare have evolved, along with the pathogens we face.
The history of personal protective equipment, or PPE, began in the first century with a Roman named Pliny the Elder developing a breathing filter for dust particles. In the 16th century Leonardo Da Vinci improved on this early respirator to create a device that was more effective and filtered a broader range of particles. In these early stages the goal was simply to remove irritants, the existence of bacteria and viruses was still unknown. A tragic example is the Black Death which killed up to 200 million people in the mid-14th century, caused by bacteria that spread primarily through unsanitary conditions. It’s interesting to think how handwashing and clean water, things we take for granted today, could have changed the course of human history.
Further improvements in PPE came slowly as we learned more about the microscopic dangers around us, and it wasn’t until 1970 that the CDC codified its use in a seminal document titled “Isolation Techniques for use in Hospitals.” Similar to kindergarten, it was pretty basic, but it was a good start. Not surprisingly, also that year Congress created the Occupational Safety and Health Administration (OSHA). Why? The CDC only makes the guidelines; OSHA was created to enforce them.
The early 80’s saw the emergence of antibiotic-resistant pathogens, and then with the emergence of HIV in the US in 1981, the CDC realized that a more robust system was needed. In 1985 they introduced Universal Precautions which included not only protective clothing and devices, but also safety protocols and procedures. In essence, universal meant that all patients are to be considered infectious.
In 1996, the universal precautions were further enhanced and given the name standard precautions, and that’s the system we have today. (The terminology may seem rather generic, but hey, they’re scientists, not writers). The requirements are thorough and well-reasoned, but in the age of coronavirus, the question is: Are they still good enough? The simple answer is: We don’t know.
Governmental agencies like the CDC, OSHA, and state licensing boards are all weighing in on what they believe is necessary to protect the public and healthcare workers alike. Given the rapid onset of the pandemic, their advice isn’t always consistent. To a degree, healthcare workers are therefore relied upon to use their own professional judgment to determine what level of PPE, protocols, and devices are necessary to ensure the safe delivery of their services. The general rule right now: More is better.
What does this mean for you? First of all you may notice slight differences from one facility to the next. That doesn’t mean that one is right and one is wrong, just that each facility is different, offering different services and conferring different levels of transmission risk. Also, getting through your visit may take longer than usual, so plan extra time both before and after. Lastly, if you fall into a high-risk category or simply have additional concerns, contact your provider and they likely will have the flexibility to accommodate your needs.
The good news is that seeking healthcare services is still very safe, so certainly don’t wait if you’re due for a dental visit, a medical exam, or any other regular appointment. All healthcare facilities have been routinely observing standard precautions, so these additional measures have been fairly easy to implement. In fact, as of this writing, both the World Health Organization and the CDC say there have been no confirmed cases of COVID-19 transmitted in a dental office1.
Remember, this isn’t going to last forever. As we learn more about the COVID-19 virus, and as more medications are developed to treat and prevent infections, many of these extra precautions will be scaled back. What is considered “normal” in the future will certainly look different than our pre-coronavirus “normal,” but it’s all part of the evolutionary process.
1Kritz, F. The dentist will see you now. But should you go? MPRnews, July 6, 2020