On March 19, Newsom issued a statewide stay-at-home order. Since then, dentistry has worked with state and local public health leadership to ensure the provision of emergency services, conserve personal protective equipment, and limit virus transmission, Nagy said.
On April 7, the state Department of Health directed dentists to limit services to dental emergencies only. On May 7, the department updated its guidance for emergency and urgent services. However, Nagy said, local health departments continue to issue conflicting guidance, including directives that are more stringent than the state’s and directives that essentially would prohibit dental practices from opening until rapid COVID-19 tests are available on-site.
“Ultimately, it is crucial that your administration ensure that local guidance is clearly communicated to all levels of government prior to publishing and that any protocols that are more restrictive than your Department of Public Health’s are based on the needs of a particular region and are consistent with the state’s protocols for establishing local differences,” Nagy wrote.
This lack of clarity regarding how offices can reopen, what protective measures must be implemented, and which services they can provide has left dental professionals unsure if they can go back to work while leaving patients uneasy about receiving care, including urgent care, said Nagy.
The letter noted directives issued in Los Angeles, Ventura, Sacramento, Kern, and San Francisco counties and added that in each instance where conflicting local directives were issued, there was a clear lack of communication between the various levels of government.
Nagy conceded that varying infection rates across the state will warrant different preventive measures. However, he added, any guidance that is more restrictive than the state’s should not be an artificial barrier to care even in areas where community transmission rates are higher.
Further, Nagy called out restrictions such as San Francisco’s directive requiring patients to be tested for COVID-19 prior to aerosolizing or surgical procedures as misleading and confusing considering the current status of testing processes and access to PPE.
“Until a streamlined process that mandates how local guidance is issued, misaligned orders will continue to disrupt the provision of healthcare and exacerbate the unfound uncertainty of whether healthcare services can be safely obtained and, in many cases, will encourage patients to seek their care outside of these counties, eroding the value of the orders themselves,” Nagy said.
“It is for these reasons that I respectfully urge your administration to develop and immediately implement a standardized process by which local public health directives are vetted for alignment with current policy,” Nagy said. “I also urge that when more restrictive orders are deemed necessary, those orders reveal in plain language the supporting rationale and do not conflate the real issues at hand.”