The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
Episode #15 CDC Updates Mask Requirements
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The CDC recently changed its mask recommendations (again) and it is causing confusion as the recommendations seem to be flip-flopping. If you are wondering whether the requirements are different for vaccinated and unvaccinated individuals, what to tell patients, or if employers can require employees to be vaccinated, don't miss this episode!
Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.
SPEAKER_00I'm Olivia Juan. And together we are the Compliance Divas.
SPEAKER_01Welcome to the Compliance Divas podcast. My name is Mary Gavoni and I will be your moderator for this episode. We bring clarity and simplicity to compliance by navigating the regulatory environment to keep you on course. You can subscribe to the Compliance Diva podcast through your favorite podcast channel or go to our website, thecomplianced divas.com. Resources that we mentioned during our podcast can be found on thecompliancedivas.com on the resources tab. And you can also submit questions to us based on the podcast or other topics that you may have. And submit those questions to support at thecompliancedivas.com. So our topic for today is the changes that the CDC made in the last week to the mask mandates or mask recommendations for both vaccinated and unvaccinated individuals and why the changes have happened and why this is causing confusion for lots of us. So as we get started discussing what these changes are, just wanted to answer the question that a lot of people have is why is the CDC changing this again? And we all have heard that there are people who now have become sort of mistrustful, if you will, of the CDC because they keep changing their minds. And that's what it feels like or or it sounds like coming from the CDC. So the reason behind this is that we're dealing with a novel virus, one we've not seen before. We've only known about it for less than two years. And so we're still learning about this virus. And as the virus mutates, what we knew and based recommendations on previously needs to change and adapt. Now, in dentistry, that doesn't play so well because we are some of the folks that are very averse to changes. We like things black and white, we like things to stay the way they are, we like to be in our comfort zone and keep doing what we know we're supposed to do. And then all of a sudden, we hear from CDC or FDA or some other agency that things have changed. So we have to take that into consideration that as new variants are discovered, as we learn more about the existing virus and the variants, that this data, these recommendations will change. It's hard to go back to where we were prior to the loosening of some of the mask mandates, but it certainly is something that we need to do for everyone's safety, for ours and for our patients. So, Linda, what does the CDC currently say about vaccinated and unvaccinated individuals and wearing masks? Can you help us with that?
SPEAKER_03Yes, Mary, absolutely. So we, as you just stated, there's such a significant concern with the spike in the Delta variant and the transmissibility that there was a need for the CDC to update the guidelines once again, this time for vaccinated individuals. Because on rare occasions, some vaccinated people with the Delta variant, even after vaccination, can still be contagious and spread the virus to others. So while there's a high level of efficacy with all the vaccines, there's some small chance that we still may transmit that disease. So depending on where someone is located, what's going on in their community, the CDC is recommending that vaccinated individuals wear a mask indoors. Now, of course, this always applied in our dental settings because that requirement for us did not relax, if you will. We have to be mindful of source transmission in our practice, even when we're not seeing patients, that vaccinated and non-vaccinated team members still need to be wearing a mask for source control. But the CD study says that otherwise, when you're out in public and other places, you should be wearing a mask now. And this is because of the transmission of it's either substantial in areas or it's a high transmission. And let me go back and explain that a little bit more. So if you part of this of what the CDC is saying is that look at your community COVID transmissibility rate and the rate of the outbreak. And it's easy for our listeners to follow that if they simply do a Google search and look for CDC COVID data tracker versus trying to verbalize a whole URL here during a podcast. Those are four simple words that you can use to do a Google search and come up with this tracker and find out exactly what's going on in your county. I did that this morning for a couple of Florida counties, for example, to see what's going on. It's very easy to use. So if your community falls in a substantial transmission or a high transmission, then you need to be wearing the mask indoors. And a substantial transmission is defined as if there are 50 to 99 cases weekly per 100,000 residents, or if the positivity rate is between 8 and 9.9% in the last seven days. So what's happening every week? Are the numbers going up? Are they doubling? Are they quadrupling? Those are that's information that you need to know for your practice and for yourself. Now, the other category is high transmission. That category is defined that if you have a hundred or more weekly cases per 100,000 residents, or as a 10% or greater positivity rate in the last seven days. So that's more significant at that point. So it's just very important that for our listeners to pay attention to something that maybe they haven't quite paid attention to in their practice. And this helps them to be able to one, explain it to better and understand it themselves as a team, and then be able to answer patient questions even better. So, in addition to the community transmission rate, um, you know, there are reasons why vaccinated individuals may still want to wear a mask. You know, they may have unvaccinated children or they might have immunocompromised family members, or maybe if you find yourself someplace without good ventilation, you just want to take that extra precaution, as we say in the risk management world, in an abundance of caution. So, Mary, that's sort of a summary right there of the changes that we saw recently in the mask.
SPEAKER_01Thanks, Linda. And one of the confusing things that happened when the CDC made this announcement was they talked about the delta variant and the increased transmissibility, but a really important um study or report of transmission was not initially disclosed when the announcement was made. And then several days later, they disclosed one of the reasons why they're focusing on masking for vaccinated individuals again. And this was an occurrence that happened in Provincetown, Massachusetts, part of Barnstable County in Massachusetts, where over a week um period time period, kind of the 4th of July sort of week, there were 469 COVID-19 cases identified. And of those, there was a very high percentage. Something like, where's my statistic here? Something like 74%, 346 of those occurred in individuals who were fully vaccinated. So that's what got the CDC's attention that this was spreading in um vaccinated individuals. Linda.
SPEAKER_03Mary, let's make that that copy of the CDC Morbidity and Mortality Weekly that addresses that. Let's put that on our resources for our listeners. Yeah, that'd be great. Thank you for sharing.
SPEAKER_01Absolutely. And we'll also put the link to the COVID tracker so that our listeners can access that as well. So, Olivia, um, what we saw happen once many dental health care workers were becoming vaccinated were a lot of practices that stopped asking patients to wear masks when they came in the practice and they stopped doing screening procedures. So if a practice has stopped asking patients to wear masks when they came in, what are some verbal skills? How, what's a strategy for helping patients understand that whether they're vaccinated or not, they need to come into the dental practice with a face mask on.
SPEAKER_00It's a good idea to review the tracker, as Linda and yourself pointed out. So we have some numbers to share. Also, we're learning about the numbers of vaccinated persons that are having breakthrough COVID infections, uh, as well as those that are contracting the delta form. So it's a good idea to be familiar with the statistics so we can share those on a local level. But let's not just surprise people. Let's let them know about wearing the mask ahead of the appointment. So whether we include that message in the automatic appointment reminder via text, or we're letting patients know by telephone that they would need to mask up regardless of their vaccine status. Also, be sure that the posters are on the walls and the entryway doors so people can be familiar with it. My experience is that most people still have a mask in their purse or in their car that they can use on short notice, but let them know ahead of time. And also, one thing that's been helpful for me is looking at that tracker at local numbers so that we can quote and say, well, at this time our community is high risk. And based on that high risk, we're wearing these masks again. And this way they don't think that it's just uh an internal opinion of someone to make those changes. So that might be some helpful information for our listeners.
SPEAKER_01Great strategies, Olivia. And one of the things that I've been encouraging the practices that I work with to do is use their social media platforms, make those announcements via social media. This is what we're doing and this is why. And they can even put links to the COVID tracker and so forth in those social media um posts so that patients, and I so agree with with what you said, Olivia, about making sure that you don't surprise them. Let's let them know ahead of time what we expect from them. So, Leslie, um, I mentioned earlier that a lot of practices stopped screening patients, and we've addressed this um in a previous podcast related to the OSHA emergency temporary standard. Um, talk to us about why we need to continue to screen and what we should be doing in terms of screening.
SPEAKER_02Well, I think uh, Mary, when people uh in dentistry heard that they could be exempt from the emergency temporary standard, they stopped paying attention to it, including what the conditions of exemption are. So the conditions of exemption, first of all, uh you it has to be a non-hospital ambulatory care setting, and dental offices by and large are. And all non-employees are screened prior to entry, and people with suspected or conferred COVID-19 are not permitted to enter. If you are following this, then you can claim exemption from the emergency temporary standard. So uh pay attention to a couple of things. All non-employees, so that means that we have visitors uh that are patients, we may have someone that accompanies the patient, we may have an IT person come in who's going to spend some time working on our computer system, a dental equipment repair person, uh, you know, maybe a lab person comes in and wants to spend a little time talking with the doctor over a case, everyone at point of entry. And uh if we are doing that, then we're doing a pretty good job of making sure that we can be exempt from the emergency temporary standard. Now, does that mean that we're gonna have uh everyone who could potentially have COVID uh be stopped at the door, likely, you know, with this crazy virus? Uh there are people who are asymptomatic. And the last time I checked, it was uh about 57% of people who test positive for, or I take that back, not test positive, but approximately 57% of people who are positive have COVID-19 are asymptomatic. You know, and again, uh how can you test positive if you don't know you're sick? How can you test positive if you don't know you're infected? But this is what the scientists are telling us is that uh asymptomatic transmission occurs and and uh that the data points to 57% of people uh who have COVID are asymptomatic. So it doesn't guarantee that we're not going to have someone enter our practice who doesn't have COVID, but we have complied with OSHA by asking. So that's one major point that we want to cover. The other is um there should be some protocols in place. Sometimes patients are uh feeling like since the May 13th announcement that we had freedom from our masks, that they shouldn't have to wear a mask, they shouldn't have to be screened, uh, you know, they don't want to be asked the COVID questions. But the fact of the matter is we are still a healthcare setting. And in screening our patients, there's there's a couple of real good reasons for doing that. One, of course, we want to protect uh ourselves and our own our other patients from exposure to someone who may have COVID-like symptoms, uh, but we also want to make sure that we can contact trace. And uh one of the questions that we're allowed to ask our patients is whether they're fully vaccinated. And and as a healthcare setting, we are entitled to that information. I'm not sure if people are having resistance uh with that type of question. I think some of my clients have told me that patients are not willing to answer that. But uh, you know, the same way that I would answer a question on a health history form. Do I have diabetes? Do I have high blood pressure? You know, uh do I have HIV? You know, this is all part of the the um information that a dentist needs to have. And um on a screening form, you don't really actually have to go through each and every single symptom that, you know, like you were reading the specials on a menu at the diner. You you can ask someone uh briefly at their confirmation call that they if if they've had any COVID-like symptoms lately. And uh I recommend that a screening form be filled out by the patient at the time of visit, even though they've had a confirmed call, maybe a couple of days before their appointment, but at the time of the appointment, they're seeing these questions again. And I still agree that we should be taking temperature, and the temperature set point is not 100.4, it's 100.0. So we want to make sure that you know we realize that that anybody over that 100.0 could be the tipping point of someone that might have uh asymptomatic infection of COVID. And uh, you know, really it's only about seven or so questions, the temperature taking, and you know, and then at the end of a questionnaire, it is a great idea for there to be a statement that the patient signs that they agree to notify the dental practice within two days if they become ill with COVID-19 symptoms or they test positive, because the dental practice has a legal and ethical obligation to inform any person, any staff member who's had close contact with that patient, uh, or even any other patients who have had close contact with that patient. So it's the screening process works not only to help comply with OSHA regulations, exempt a practice from the emergency temporary standard, but it helps to protect the reputation of the practice. We are a healthcare setting. And so we should continue to do that and make sure that our patients understand we're doing this not because uh, you know, we're we're we're so afraid of COVID or we're so worried that you know, we we don't want to have an outbreak. We're doing this because there are regulations that guide us for that and it's the for the protection of all. And I think our patients would feel that they want to know they're in a dental practice where their safety is top of mind and that we're doing all the things that were required of us. If we cut corners here, where else are we cutting corners?
SPEAKER_01Great points, Leslie. And I know that there is some pushback, I hear it from my clients all the time from patients who are vaccinated. I'm vaccinated, I don't have to answer these questions anymore. But one of the things that we found in dealing with the um delta variant is that it is much easier to spread. One of the things that the CDC shared with us um several months ago was that if you were vaccinated, you were very unlikely to be a spreader of COVID-19, even if you had a breakthrough infection. But because of the changes to the delta variant and the viral load being so much higher, like a thousand times higher, then it is much easier to spread. So information is king, and if we can help our patients understand the why, is exactly what you were saying, Leslie. Why are we doing it? Um, not only to create the safest environment, but because we're following regulations, which we hope they appreciate that we do. So, Linda, um the CDC also made a change to its recommendations for vaccinated individuals who may be exposed to COVID-19. Can you explain to us what that change is?
SPEAKER_03Yes, Mary. This was another one of the uh significant changes that occurred recently with the CDC. This uh change was published on July 28th of just this summer last month. And, you know, just kind of look thinking about some of the comments that you and Leslie and Olivia have made, so much of this information is just unfolding as we go. And it's almost like we're building the bridge as we go, and then we're gathering data from what's happening. I say we, the healthcare community, um, as we go along. So sometimes it can be frustrating to our listeners. I know for us we're taking a lot of time to sort out the information and learn it as well. So we we are all working on this together. So it's important that um we stay connected and that we stay informed. So I'd like to share that little piece of the change. And that was now the CDC has changed their recommendation for fully vaccinated people who have had a known exposure to someone with suspected or confirmed COVID, that that individual then needs to be tested three to five days after they've been exposed. And then they further need to wear a mask in public indoors to 14 days, which we know that's changed anyway, or until they receive a negative test. So obviously, if they test and they're positive, then they have COVID and they've got to go down that algorithm. So if we think about it from the perspective that there's just multiple scenarios, and each scenario has sort of a set of decision rules, if I can say rules or goes decision guidelines to follow. You know, before the vaccinations, uh, we were following either test-based or a symptom-based strategy for allowing workers to come back to work. So, in addition to that, um we're thinking now this is we're following this new section here, and that is the fact that if you're vaccinated, you have a different algorithm to follow. So if you're fully vaccinated and you get exposed to someone with suspected or confirmed COVID, then you need to be tested three to five days after the exposure, Mary.
SPEAKER_01Great, Linda. Thank you for that clarification. Because in the previous guidance from the CDC, we were told that if you were vaccinated and exposed, you did not need to be tested. So that is a big change. So, Olivia, um, since um vaccination of healthcare workers has become uh and to the general public has become a pretty hot topic, um, talk to us again about whether employees can require those vaccinations and again reiterate whether practices can ask their patients if they've been vaccinated.
SPEAKER_00So it's a tough question. Uh, it all depends on whether the employer has a mandatory vaccine program or a voluntary vaccine program. If a dentist is thinking about implementing a mandatory program, then we would have to take into consideration what the Equal Employment Opportunity Commission, EEOC, has to say. You know, there are federal anti-discrimination laws in place. Uh, however, it doesn't prohibit an employer from requiring employees to be vaccinated, but we do have to juggle different forms of laws. For example, we have to comply with the Americans with Disability Act, we must comply with the Civil Rights Acts of 1964, maybe some other laws that apply to our state. So we we would be in the position of having to address someone that declines the vaccine, maybe for a sincerely held religious belief or a disability. So if an employer wants to avoid an ADA claim, then there would have to be some policy statement that the individual shall not pose a direct threat to the health or safety of individuals in the workplace. Now keep in mind if there's a mandatory policy, that means if an employee is not vaccinated, they're dismissed. So that's where we want to tread carefully in case there's a disability claim made against that practice. So the employer would have the burden to show that the unvaccinated employee would pose a direct threat to the health and safety of the individuals in the workplace. And we understand that the meaning of the words direct threat means a significant risk of substantial harm that cannot be eliminated or reduced by reasonable accommodation. So the direct threat analysis involves you know, what is the duration of the risk? What is the nature and severity of the potential harm? What is the likelihood that potential harm would occur, and the eminence of potential harm? So, with those factors, we consider whether or not a reasonable accommodation can be made. This might not always be the case in a dental practice, but let's say the individual who's refusing does insurance all day long. Could that person work from home? That could be the accommodation that's made. Or let's say the person is pregnant, could they take a leave of absence from the workplace if they're refusing the vaccine? So basically, the dental practice would have to evaluate what the employee's job duties are, if there's something alternative that they can do, and how critical is it that they be vaccinated. Now, with religious accommodation, the law requires the employer to accommodate sincerely held religious beliefs. So it's not something that's just made up. It's sincerely held religious belief practice or observance, unless it would cause an undue hardship on the business. And so that's where you're doing a juggling act, trying to figure out if you could and you can roll out a mandatory program, but we encourage you to speak to your attorney because this might result in some claims, whether or not those claims are upheld or not. So don't be quick to implement a mandatory program because that does mean you would be terminating. Now we're running into dental practices that half the practice is not vaccinated. So if you had a mandatory program, that means half of the employees are dismissed. And so you may want to back up and think about uh what would be implemented that's reasonable for where you are practicing and to make sure you're in compliance with EEO laws and other laws. We do understand that California has a new state order that healthcare workers must show proof of the vaccine. And if they're not vaccinated, they're tested weekly. Uh, so you know, this is a very compromising position for employers to be balancing what the employee wants versus what the employer needs. But it does involve an individualized assessment of the unvaccinated employee to determine what their essential job functions are. And you can certainly ask for proof of vaccine. And the reason is, Mary, you know, if an employee is vaccinated, then there are certain things that would apply. So this new recommendation is if the employee is vaccinated and they're exposed to COVID, they don't go through quarantine, but now they're suggesting that they mask up for several days and be tested. So if they've got these vaccine cards, then we know how to deal with the exposures, whether quarantine or not quarantine, or simply mask up. Um so there's different things in place that we would have to follow. Now, once again, if terminating non-vaccinated employees, consult your attorney just to make sure that you're not violating any laws that could apply. And getting back to your other question, Mary, about the uh the patient, we can certainly ask for the patient's documentation as part of the medical history question. But that often results in the patient asking us, asking the dental workers if they're vaccinated. Now, let's not use HIPAA because HIPAA may not apply. You know, unless you're a pay patient in your own practice, being an employee is not going to trigger federal HIPAA, but it's still private medical information. So something that you might say if a patient asks for your vaccine status is just like we honor and protect the confidential protected health information of our patients, we treat employees' information in the very same manner. And you can assure patients that you are adhering to the very rigid infection control protocols. So I hope that's helpful to our listeners in a nutshell.
SPEAKER_01Oh, absolutely. Thank you so much, Olivia. Um, so it while it may seem to be very clear-cut, we can just create a policy that says, yes, you must be vaccinated to work here. It's not so much so. So that you need to consult an attorney, know what your state labor laws um say and require. In uh California, I'm sure we're going to see a lot of sort of test cases and information that um that comes out. So it's not just so clear cut. So as we go ahead, Olivia.
SPEAKER_00I I wanted to add, uh, employers should think about offering some incentives. And so if there's an incentive, such a bonus to be vaccinated, that might encourage people to participate in the program and make things more congruent.
SPEAKER_01Great suggestion and something that we talked about as a group a little earlier. If you incentivize the unvaccinated people to get vaccinated, then those who went ahead and voluntarily got vaccinated, you probably want to include them in that incentive program as well so you don't create resentment. So as we sort of wrap up this episode, um, Leslie, I think you suggested that you had some more tips for us on screening employees. So take it away, Leslie.
SPEAKER_02Well, uh, thank you, Mary. I did not mention employee screening when we talked about screening, and that's so important. I especially if we do have dental workers who are unvaccinated, we want to make sure that they don't report to work if they have are experiencing any COVID-like symptoms, have a fever of 100.0 or higher, or if they're waiting for results of a COVID test or have been diagnosed with COVID, obviously. But I believe that it's important to make sure that infection prevention and safety is not only expressed in our dental practice to our patients, but also to our team. We want you to be safe. You know, we understand if you're going to choose not to get vaccinated and we'll we'll deal with that. I know there's I we have another uh episode dealing with the California situation, but please make sure that you protect your uh your fellow worker and also our patients, because we want everyone to feel safe in the doors of our office. And one thing that I've had come up numerous times over the last 10 days is uh COVID cases among dental team members, multiple COVID cases. So we have to comply with CDC's uh recommendations for social distancing, for proper masking, for not uh getting into congregate situations like a lunchroom with unvaccinated employees. Uh yeah, and uh people I think maybe felt a little bit liberated by that mask announcement. And in dental practices, the result is we have uh I have three yesterday from a practice who uh couldn't they didn't comply, so they three people became infected on the team. You know, they're hobbling along trying to see patients. And uh then I had somebody last weekend that tested positive in a small group training, and the week before was a surgery center where they had a couple of employees that that disobeyed the the policy set for the unvaccinated individuals based on CDC guidelines. So let's uh all make sure that we express that importance to uh our coworkers and anyone in dentistry. So until we can get uh to a level of herd immunity and whatever level of vaccination we can, let's all be especially conscientious.
SPEAKER_01Great points, Leslie. And thank you so much for that. And you have to think about that. If you have a large group of team members that become COVID positive, it certainly doesn't instill a lot of confidence on the part of patients to come in that you're protecting them if you're not protecting yourselves. So thank you to all of our listeners for tuning in to this episode. If you do have questions, please submit them to support at thecompliancedivas.com. All of the resources that we talked about today, the changes to CDC, uh, mask requirements, the information about the outbreak in Provincetown Mass, and the COVID tracker, all of those will be on the support tab on the Compliance Divas website, thecompliancedivas.com. So thank you again for joining us, and we hope to see you on a future podcast.