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Message from the President                                                               December 18, 2020

The MDA recently received a communication from Manitoba Health, Seniors and Active Living (MHSAL) related to their COVID-19 PPE requirements for close contacts of asymptomatic patients who are deemed to be in their ‘period of communicability.’

The period of communicability is defined as the period extending from 48 hours prior to the development of overt symptoms in the case until the case is classified as no longer infectious.  Note that the extent to which asymptomatic and pre-symptomatic transmission of COVID-19 is occurring is unclear. There is sufficient evidence to suggest that pre-symptomatic transmission is occurring, but based upon the current epidemiological evidence, it is not known whether truly asymptomatic transmission is also occurring and whether pre-symptomatic transmission is a major driver of transmission.  

A close contact is defined as a person who, within the period of communicability provided care for the case, including HCWs, family members or other caregivers, or who had other similar close physical contact without consistent and appropriate use of personal protective equipment.

The MDA pathway and interim IPC guidance for patient care during the COVID-19 response recommends, “Point of care risk assessment (PCRA) be undertaken for all patients at all times. Consideration for level of transmission in areas of outbreak or when extensive community transmission has occurred will affect risk assessment and determination of need for care, level of caution and level of PPE employed.”

In areas with higher levels of community transmission, there may be an increased likelihood of encountering patients that may not identify any symptoms or exposures, but be retrospectively found to be in their period of communicability during the visit.

MHSAL Medical Officer of Health, Dr. Carol Kurbis has provided the following information:

The period of communicability begins two days prior to symptom onset or two days prior to test sample collection if asymptomatic, so it is possible that clients may not identify any symptoms or exposures, but be retrospectively found to be in their period of communicability during the visit.

Public Health follows Shared Health’s guidance for AGMPs.  “Health care workers are recommended to wear a procedure or surgical mask with eye protection as well as gloves and gown for most care for a person confirmed or suspected to have COVID-19. AGMPs are the exception… While there is no conclusive evidence that opportunistic airborne transmission occurs after all AGMPs, enhanced safeguards are recommended when performing AGMPs to reduce the likelihood of transmission to health care workers.”

With respect to contact investigation, public health assesses whether a health care worker is considered a close contact to a confirmed case of COVID-19 based on the recommended PPE to be used during the procedure. This is consistent with the guidelines issued by Shared Health and Occupational and Environmental Safety and Health, and is irrespective of the screening of the client at the time of the procedure. While additional measures to reduce the risk of transmission during an AGMP as recommended by the Manitoba Dental Association are beneficial and encouraged, dentists will be identified as close contacts if they have not worn an N95 respirator during the AGMP, and will be required to self-isolate for 14 days from the date of the potential exposure.
Please consider the MHASL information and use it as part of your Point of Care Risk Assessment.

We are happy that dental health care settings have worked cooperatively with Public Health MB contact tracing teams when called upon.  Our professionalism and care have continued to allow us to provide much needed access to oral health care for Manitobans throughout the COVID-19 pandemic response in a caring and safe manner.

Kind Regards,

Marc Mollot, BSc, DMD
President and Chair of the Board
Manitoba Dental Association

For more information:

Public Health MB - Interim Guidance Public Health Measures - Managing Novel Coronavirus (COVID-19) Cases and Contacts in Community - updated Dec 10, 2020