The Centers for Disease Control and Prevention (CDC) reports that N95 respirators can be decontaminated and reused as protection against the virus that causes COVID-19, but the integrity of respirator fit and seal must be maintained.

The CDC analyzed four different decontamination methods for their ability to reduce contamination with infectious SARS-CoV-2 and their effect on N95 respirator function: 

  • Ultraviolet (UV) light (260 to 285 nm)
  • 70°C dry heat
  • 70% ethanol
  • Vaporized hydrogen peroxide (VHP)

For each method, the CDC compared the normal inactivation rate of the SARS-CoV-2 virus on N95 filter fabric to that on stainless steel. Using quantitative fit testing, the CDC then measured the filtration performance of N95 respirators after each decontamination run and two hours of wear for three consecutive decontamination and wear sessions.

VHP and ethanol yielded extremely rapid inactivation both on N95s and on stainless steel. UV light inactivated SARS-CoV-2 rapidly from steel but more slowly on N95 fabric, probably because of its porous nature, the CDC said. Heat caused more rapid inactivation on N95s than on steel, with inactivation rates on N95s comparable to UV.

Quantitative fit tests showed that the filtration performance of N95s was not markedly reduced after a single decontamination for any of the four methods. Subsequent rounds of decontamination caused sharp drops in filtration performance of the ethanol-treated masks and, to a slightly lesser degree, the heat-treated masks. The VHP-treated and UV-treated masks retained comparable filtration performance to the control group after two rounds of decontamination and maintained acceptable performance after three rounds.

VHP treatment had the best combination of rapid inactivation of the virus and preservation of respirator integrity under the experimental conditions. UV light killed the virus more slowly and preserved respirator function almost as well. Dry heat at 70°C killed the virus with similar speed to UV and is likely to maintain acceptable fit scores for one or two rounds of decontamination but should not be used for three rounds. Consistent with earlier findings, the CDC said, ethanol decontamination reduced N95 integrity and is not recommended.

All treatments, particularly UV light and dry heat, should be conducted for long enough to ensure sufficient reduction in virus concentration, the CDC said. The degree of required reduction depends upon the degree of initial virus contamination. The CDC said that policymakers can use its estimated decay rates (see file above) together with estimates of real-world contamination to choose appropriate treatment durations.

In times of shortage, the CDC said, N95s can be decontaminated and reused up to three times by using UV light and HPV and once or twice by using dry hear. Following nationally established guidelines for fit testing, seal check, and respirator reuse is critical, the CDC said. The CDC further recommends performing decontamination for sufficient time and ensuring proper function after decontamination using readily available qualitative fit testing tools.

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Healthcare workers including dental professionals in the United States have been facing the COVID-19 pandemic for more than three months. Stressors such as insufficient personal protective equipment (PPE), fears of infection, feelings of isolation from family, and harassment from the community for enforcing strict infection prevention measures are creating strains on them, which can interfere with providing adequate patient care.

To help healthcare organizations support their staff, the Joint Commission has issued Quick Safety guidelines on “Promoting Psychosocial Well-Being of Health Care Staff During Crisis.” The advisory shares information on how healthcare organizations and staff can remove barriers to seeking mental healthcare. It also provides safety actions to consider as well as strategies for healthcare workers to support themselves and their staff.

Healthcare staff must not encounter job-related barriers to receiving mental healthcare, the Joint Commission said. In some organizations, it is common practice to ask about mental health history during the licensing or credentialing process. As a result, the Joint Commission said, clinicians may not seek care out of fear of adverse effects on their career.

The Joint Commission advises organizations that it does not require them to ask about a clinician’s history of mental health conditions or treatment and supports limiting inquiries to conditions that currently impair the clinician’s ability to perform their job. The Joint Commission hopes that that this statement helps healthcare workers feel more comfortable seeking care.

The Quick Safety also recommends strategies that clinicians can use to support themselves:

  • Practice self-care and engage in healthy coping strategies.
  • Take microbreaks from patient care.
  • Practice good sleeping habits.
  • Partner with colleagues to cross-monitor each other’s well-being.
  • Stay connected with friends and family.
  • Check in with yourself.
  • Strive for resilience post-crisis recovery.

Strategies that managers and leaders can use to support staff include:

  • Communicate regularly.
  • Model behaviors that promote self-monitoring.
  • Encourage the sharing of concerns to build transparency and mutual trust.
  • Demonstrate the value of staff.
  • Orient staff to psychosocial resources and offer the basics on psychosocial first aid.
  • Proactively monitor mental well-being and provide active outreach.
  • Encourage peer support.
  • Share positive feedback.
  • Adapt staffing, such as rotating staff between higher-stress and lower-stress functions where possible.
  • Strive for resilience in post-crisis recovery.

“The mental, emotional, and physical strain healthcare workers are experiencing during these unprecedented times of COVID-19 cannot be understated,” said Erin Lawler, MS, human factors engineer with the Joint Commission.

“The Quick Safety advisory serves to support individual healthcare workers and organizations alike by providing recommendations for protective strategies and ways in which to build individual and institutional resilience during crisis. It is critical that we ensure healthcare workers have access to psychosocial resources and support now and in the future,” said Lawler.

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The National Dental Association (NDA) has issued a statement saying that it is “heartbroken” by the death of George Floyd as he was in the custody of the Minneapolis Police. The ADA, the American Association of Women Dentists, the Hispanic Dental Association, and the Society of American Indian Dentists also issued a joint statement noting that the dental profession is mourning Floyd’s passing.

“Like countless others across the nation and the world, we watched in horror as the video showed one officer with his knee placed on his neck and restrained by two officers while a fourth watched,” the NDA said.

The NDA also noted its own role in serving neglected communities across the country for more than 107 years and emphasizing their right to healthcare. These communities often are impoverished as well as deprived of economic and social justice, the NDA continued, adding its support for these communities as it calls for justice on Floyd’s behalf.

“We believe that every person should be treated as a human being without prejudice and racism. Our members have dealt with this since our inception and have actively been on the front line in the civil rights movement fighting for the rights promised by the Constitution of this nation,” the NDA said.

Additionally, the NDA said that it does not condone violence or the destruction of property, though it does understand the frustration at the root of the disillusionment of those who have not been heard in their call for justice and equity.

“We join the many organizations and groups around the world seen protesting this unspeakable tragedy to ensure that in the end justice will be served for George Floyd and others who have been deprived of a peaceful existence at the hands of those who have pledged to protect and serve their communities,” the NDA said.

“The ensuing outcry over Mr. Floyd’s death is not just about this singular incident, but instead a centuries-long history of discrimination and brutality against Black people and other communities of color. We add his name to the list of others’ whose lives have also been cut short under the heinous, yet enduring legacy of racial injustice,” the other groups said in their statement.

“We denounce the acts of racism and violence that have occurred across our nation. We stand with our colleagues who have been affected by current events, and with those whose longstanding fears and heartaches have been stoked once again,” the continued.

The ADA and its fellow organizations called upon dental professionals to “embrace diversity and inclusion not as buzzwords or intellectual exercises,” adding that it is the moment for the dental community “to live its values” and live each day with intention, integrity, and respect for fellow human beings.

“This is the moment to unravel from whatever personal biases we may harbor. To become allies. To have the hard conversations. To listen to voices that have long gone unheard. To speak up for those who have been disenfranchised. To commit to empathy and understanding. To be forces for change. To be agents of harmony. To call out wrong when we see it. And to do what’s right when we can,” they said. 

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A mobile app created by researchers at the New York University (NYU) College of Dentistry can help clinicians determine which COVID-19 patients are likely to have severe cases. It uses artificial intelligence to assess risk factors and key biomarkers from blood tests to produce a “severity score.”

Current diagnostic tests for COVID-19 detect viral RNA to determine whether someone does or doesn’t have the virus, but they don’t provide clues as to how sick a COVID-positive patient may become, NYU said.

“Identifying and monitoring those at risk for severe cases could help hospitals prioritize care and allocate resources like ICU beds and ventilators. Likewise, knowing who is at low risk for complications could help reduce hospital admissions while these patients are safely managed at home,” said research leader John T. McDevitt, PhD, professor of biomaterials.

“We want doctors to have both the information they need and the infrastructure required to save lives. COVID-19 has challenged both of these key areas,” said McDevitt.

Using data from 160 hospitalized COVID-19 patients in Wuhan, China, the researchers identified four biomarkers measured in blood tests that were significantly elevated in patients who died versus those who recovered: C-reactive protein (CRP), myoglobin (MYO), procalcitonin (PCT), and cardiac troponin I (cTnI).

These biomarkers can signal complications that are relevant to COVID-19, NYU said, including acute inflammation, lower respiratory tract infection, and poor cardiovascular health.

The researchers then built a model using the biomarkers as well as age and sex, two established risk factors. They trained the model using a machine learning algorithm to define the patterns of COVID-19 disease and predict its severity.

When a patient’s biomarkers and risk factors are entered into the model, it produces a numerical COVID-19 severity score ranging from 0 (mild or moderate) to 100 (critical).

The model was validated using data from 12 hospitalized COVID-19 patients from Shenzhen, China, which confirmed that its severity scores were significantly higher for the patients who died versus those who were discharged.

As New York City emerged as the epicenter of the epidemic, the researchers further validated the model using data from more than a thousand patients in the city. To make the tool available and convenient for clinicians, the researchers developed a mobile app that can be used at point-of-care to quickly calculate a patient’s severity score.

The app has been retrospectively evaluated in the Family Health Centers at NYU Langone in Brooklyn, which serve more than 102,000 patients each year as one of the nation’s largest Federally Qualified Health Center networks, NYU said.

“Real-time clinical decision support tools for COVID-19 can be extremely helpful, particularly in the outpatient setting, to help guide monitoring and treatment plans for those at risk,” said coauthor Isaac P. Dapkins, MD, chief medical officer for the Family Health Centers at NYU Langone.

After optimizing the clinical utility of the app at the Family Health Centers in May, the researchers aim to roll it out nationwide in the coming weeks. It is possible that the COVID-19 severity score could be integrated into electronic health records, providing clinicians with actionable information at an early stage for those diagnosed with COVID-19, NYU said.

“We hope this tool can help identify those at high risk for adverse outcomes and reduce the health disparities present with COVID-19,” said Larry K. McReynolds, executive director for the Family Health Centers.

The COVID-19 severity score leverages a model McDevitt previously developed to predict outcomes for patients with cardiac disease. Cardiac health is one of several priorities of his lab, which creates point-of-care diagnostic systems that can be programmed to test for oral cancer, cardiac disease, and now COVID-19 biomarkers.

The diagnostic system uses small, noninvasive samples such as swabs of saliva or drops of blood from a fingertip added to credit card-sized cartridges armed with bio-nano chips pioneered by McDevitt. The cartridge is inserted into a portable analyzer that simultaneously tests for a range of biomarkers with results available in less than half an hour.

Because the technology is currently used for research and informational purposes only, the app can be used with existing laboratory tests and requires oversight by an authorized clinicians. But over the next few months, McDevitt’s laboratory, in partnership with SensoDx, a company spun out of his lab, plans to develop and scale the ability to test a drop of blood for COVID-19 severity biomarkers and produce a severity score on the spot.

“With COVID-19, point-of-care testing, coupled with a decision support system, could improve how clinicians triage patients and potentially improve their outcomes, particularly for those who need more immediate and aggressive care,” McDevitt said.

In addition to McDevitt’s research group at NYU, the study involved collaborators from NYU Grossman School of Medicine, NYU Tandon School of Engineering, Zhongnan Hospital of Wuhan University, and Lathan BioPharm Group.

The app was developed by McDevitt’s laboratory and OraLiva, a company founded by McDevitt. The app is available for both Android and Apple devices. It is designated for use by authorized clinicians and is not intended for general use by patients.

The study, “Clinical Decision Support Tool and Rapid Point-of-Care Platform for Determining Disease Severity in Patients with COVID-19,” was published by Lab on a Chip.

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We have to do away with the notion that one part of our body isn’t connected to the rest of it. The body is an entity with many working parts that all work together. Now that maintaining the body’s overall health and balance is more important than ever, we must stop our antibacterial obsession and instead focus more deeply on cultivating a healthy microbiome.

What Is a Microbiome?

A microbiome is a complex network of bacteria, fungi, and, yes, even viruses that work 24/7 to keep us safe from foreign bodies. Bacteria in the body’s microbiomes have been linked with serotonin production, complex vitamin production, and hormone regulation.

In fact, your microbiome, not your immune system, acts as the body’s first line of defense against illness, infection, and disease. It is only when microbiomes have been compromised that the immune system needs to kick into gear.

Microbiomes exist in our gut, on our skin, in our eyes, in our nose and ears, in the birth canal, and, of course, in the mouth. And even though some major oral care manufacturers boast that their products kill 99.9% of all “germs,” the mass majority of bacteria that make up your oral microbiome are extremely good for you. When we start wiping out the bacteria in the mouth, we create an opening for a toxic overload that will impact your oral health as well as your whole body’s health.

Your mouth is like Manhattan—prime real estate for bacteria. When your oral microbiome is balanced and in its most natural state, 98% percent of its bacteria are protecting you from infection, inflammation, and toxicity. It’s crowded in there too, so there is little room for bad bacteria to move in.

But antibacterial oral care products are akin to atom bombs going off in your mouth. Antibacterial agents don’t discriminate, and there is no way to only target bad bacteria, so we lose the good residents with the bad.

Suddenly, lots of real estate is available, and you have no control over who moves in next. This leaves your mouth (and your oral microbiome) vulnerable, as it is now open to any and every bacterium, including dangerous superbugs.

To make matters even more worrisome, the next time you try and use an antibacterial product to eliminate those new inhabitants, they will have an even higher likelihood of surviving because there will be more of them than there were before. And on and on it goes.

Potential Preventive Treatment

Outside of antibacterial oral care products, the foods we chew and how well they are digested (thanks to healthy saliva) also play a part in our microbiomes and, thus, in our overall health.

One of my most exciting discoveries was the difference in gum inflammation (a sign of a compromised immune system) between patients who ate an organic, mostly plant-based diet and those who did not. I believe the key here is the lack of antibiotics, pesticides, and other harsh chemicals in their daily diets.

When inflammation is present in the body for long periods of time, the body’s immune system becomes taxed, and our viral load may be increased. Once a virus has become “active” in the body, meaning it has multiplied enough to become destructive, it can only go dormant from that time on and is then capable of being triggered active again at any time throughout its host’s life.

One of the best ways to avoid an increased viral load in the body is to minimize immune system engagement whenever possible. One of the greatest ways to do that is to protect our microbiomes and keep inflammation down. The best way to keep inflammation down in the mouth is to practice good oral hygiene, remove as many harmful chemicals from your diet as possible, and reduce day-to-day stress wherever you can.

When I first began my career in dentistry, I knew very little about the oral microbiome, and I certainly did not know about the extreme toxicity of most oral care products. As growing research surrounding probiotics’ benefit to the gut mounted, I began to think the same science may also be true for the mouth, which led me to years of research, product development, and several books on the subject.

One can improve the bacterial health of the mouth and the entire body through simple diet, product, and lifestyle changes. In improving and protecting the health of our oral bacteria, we can in turn strengthen our bodies’ defensive responses, increase energy levels, reduce inflammation, and return to a more natural state of whole-body health. No sanitizer necessary.

Dr. Maddahi is a board-certified dentist in Beverly Hills. After completing his dental degree at the University of Southern California School of Dentistry, he opened his practice in 1987 and has since had more than 15,000 patients walk through his doors. He is the founder of Luminuex Oral Essentials, the only certified non-toxic, microbiome-safe, and clinically proven line of oral care products backed by 50 clinical and laboratory studies. He also is the author of The Toxic Overload: The Truth About Your Body’s Natural Defenses and How to Experience Whole-Body Health

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The Perrigo Company is donating more than 160,000 toothbrushes to Camp Fire West Michigan, the StoreHouse of Community Resources, and Kids Food Basket. Valued at approximately $150,000, the donation will provide healthy oral care tools to those who have limited access to new toothbrushes or who are not performing routine brushing as a result of pandemic shopping challenges, Perrigo said.

The World Health Organization and the Scottish government have praised a rapid review of recommendations to reopen dental services led by academics from the universities of Dundee and Aberdeen in collaboration with the Scottish Dental Clinical Effectiveness Programme (SDCEP), NHS Education for Scotland, the University of Manchester, and Cochrane Oral Health.

The use of e-cigarettes, vapes, and mods has increased as smokers believe there are healthier than traditional cigarettes and have fewer side effects. These users also believe that these alternatives have less of an impact on bone fracture healing than traditional cigarettes, when the nicotine in all of these options can impede the healing process, reports the American Academy of Orthopaedic Surgeons (AAOS).

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