03 June 2020

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Chinese dentists’ experience during the coronavirus crisis

Article from Maxillaris

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Dentistry in China is the most private sector-oriented medical specialty and privately run clinics abound as in Spain. Forced closures have brought unexpected pressure and a dilemma to the entire industry. Clinic owners have to pay high rents, wages and other expenses while receiving no income for a long time. And a large number of workers (including nurses, hygienists, auxiliaries, manufacturers of dental materials and equipment, etc.), as there is no clinical activity, of course they have also been greatly affected in their activities.

Under this social context, the entire dental profession has also been renewed, looking for new business formulas. Some professionals started conducting online practices, answering patient questions telematically. Other doctors began programming webinars and online training, including participating in oral hygiene product announcements. Others instead opted for the explanation and promotion of various treatments online, to attract potential patients in order to remove the restrictions.

During this survey of Chinese professionals, all respondents agree on the importance of maintaining a positive attitude to this situation in a national emergency. Maxillaris interviewed some chinese dentists to understand their approach to this new reality.

Dr. Zhijin Li: Specialist in periodontics and implants. Wuhan Ichier Dental Private Clinic in Wuhan City (which features 11 million inhabitants and around 3,000 dentists).

Since the health crisis in your city in December 2019, what time has elapsed until you began to notice the effects on your work?
Dr. Zhijin: The effects began to be noticed suddenly on January 23. Before that date, even though we were seeing more cases in the news, we didn't give it any importance, so the close of January 23 was quite sudden. From that day on, movement limitations were imposed throughout Hubei province and the closure of all non-essential shops and, of course, all dental clinics. That day I realized that Chinese New Year's holidays were going to be longer, and surely they would also be the longest vacation in history.

What measures were taken in Wuhan regarding the activity of dental clinics? Were they effective measures?
Dr. Zhijin: On January 23, we received a statement from wuhan Health Department informing us of the immediate closure of all dental clinics. We contacted both Health and professional colleges to inform us more about the situation and were warned of the serious risk of contagion to which we were exposed by professionals in the dental sector. Moreover, due to this COVID-19 crisis, all dental clinics in China have been temporarily closing their doors on the orders of various local authorities.

After three months, what is the current status of dental clinics?
Dr Zhijin:    After these three months of quarantines and mobility limitations, currently in March the private dental clinics in Wuhan still do not develop clinical activity. Only public hospitals and some dental services integrated into universities have staff empowered to attend dental emergencies. The rest of the private clinics are still awaiting instructions from local authorities in order to resume our clinical practice. Being objective, due to the very nature and danger of our profession, it is to be expected that our collective will be one of the last to recover the clinical activity.

How have your clinic patients reacted? Is there fear, have they moved to other cities, or have they cancelled appointments?
Dr: Zhijin: Fortunately, on January 23, when quarantine and mobility limitations were decreed, the Chinese New Year's holiday had just begun, so the first two weeks of quarantine passed without much incident with patients. Then, in mid-February, as quarantine continued, we encountered the problem of not being able to see many patients reviewing, and this resulted in a lot of nervousness on the part of some patients. The uncertainty of not knowing how long quarantine was going to last was making a dent in all the inhabitants of Wuhan. This uncertainty grew as we were learning the news that friends and family were getting sick from this new coronavirus. I think we were all afraid at some point and the clinic's concerns were left in the background. As quarantine lengthened, online psychological aid initiatives and online talks emerged to help modulate our spirits during these times of uncertainty were also crucial to maintaining the psychological well-being of the population. In our case, from both the local government and the central government, supported by all health workers, a message of unity, tranquility and hope was conveyed to the rest of the population.

What work do you plan to do to get patients back confident and return to normal?
Dr Zhijin: The most important factor in regaining patient confidence is undoubtedly the total resolution of all positive COVID-19 cases in Wuhan. If the social situation does not stabilize, the patient will not go to the dental clinic. Now we are already seeing the light at the end of the tunnel and we are optimistic. For our part, we must strengthen the prevention of contagion in the dental clinic, replenish and reinforce all the materials of individual protection of the consultation and leave everything prepared for the imminent resumption of clinical activity. Emphasis should be placed on providing patient safety, continuing to make them informed about the importance of prevention, rigorous medical records, good follow-up, etc. It's about putting all the tools at our disposal to pass on confidence to patients. I

Is there concern in Wuhan about the stigmatization of your city?
Dr Zhijin: I don't think we'll ever forget these months. You can't change the past, but what's in our hands is the attitude we need to take in the future. In Chinese, the word crisis is the union of the characteristics of danger and opportunity. I trust that all citizens, through this crisis, have become more aware of the importance of health, that they will pursue greater physical and mental well-being. For us, a couple of months without work is horrible, but we have had more time to enjoy the family and learn new techniques that will be useful to me in my day to day. There were a lot of things I didn't have time to do before and I was putting them off. In these months I have been able to attend several webinars of prestigious European doctors and I am sure that they will be useful to me in my future clinical practice. I am confident that everything will return to normal, and I am optimistic about the future: dentistry is an essential profession for any society. Now in the news we see the critical situation that they are suffering in Spain and Europe, and I want to send them encouragement and let them know that all this is temporary. If the whole society rolls up our shoulders as one, we can win the battle for this pandemic! I'm sure of it.

Dr. Rongshuang Zhou: Specialist in periodontics and orthodontics. Nanjing Leader Clinic in Nakin City, which has 8.3 million inhabitants and about 5,000 dentists.

How has the COVID-19 health crisis affected your work?
Dr Rongshuang: Completely, since the end of January, at the direction of the Government, we closed the clinic on a temporary basis.

Were dental measures applied in your city or province to prevent contagion? Which of these measures were most effective for the dental clinic?Dr Rongshuang: By mid-March we were able to reopen Nankin's private dental consultations, although for now patients who have tested positive for Sars-Cov-2, nor any patients with disease-compatible symptomatology, are not allowed. In China there is a health application where each person has a digital medical ID, in it you can check their level of exposure during the last 14 days, which is the incubation period, and if they have been patient positive. We rely on reading this ID to decide if a patient can go to consultation. In the clinic, all healthcare personnel work with personal protective equipment, consisting of single-use pajamas, waterproof gown, FFP2 masks and watertight glasses.

Did you get your appointment closed or did you have to do without employees?
Dr Rongshuang: We closed the consultation according to local laws, but in my Leader clinic we did not make any dismissals, and we tried to make our employees as little disruption as possible to their daily life. The Government's indications were that payrolls should be at least 80% of the inter-professional minimum wage. In our clinic we issue payrolls while maintaining twice the interprofessional minimum wage. It's a complicated situation, as there was no income but, as an entrepreneur, the important thing in this situation was to maintain a good standard of living for all my employees. Workers are the lifeblood of the company.

How has the patient reaction been?
Dr Rongshuang: due to the general quarantine situation in Nankin city, patients understood that we had to postpone appointments. During the first week of dental clinic openings we have had approximately 50% of the usual volume of appointments; there are still many patients waiting for the situation to be resolved definitively. I also observe a small group of patients who are afraid to go to the dentist because of the possibility of cross infections, so I recommend extreme all protective measures to give safety to the patient and the worker.

What time do you estimate to return to normal?
Dr Rongshuang: We're starting recovery and we have to be patient, we still have to wait a while. 

This crisis arose in China, but its reach is global, what recommendation would you give to those fellow Spaniards who are now living the peak of the crisis?
 Dr Rongshuang:  My message to my Spanish colleagues is that you have to have confidence and perseverance. The contagion rate of this new virus is very high and you should never let your guard down. Always protect yourself when you go to work; as long as the health situation is not controlled, I do not recommend any dental treatment. The current sacrifice is for the good of the profession, of their families and of society at large.

Reading the fool article on: https://www.maxillaris.com/