COVID-19: Pakistan’s dental fraternity and industry face unprecedented challenges

In a matter of days, Pakistan’s own COVID-19 tally has soared past 1,200 cases, mirroring the exponential growth in new infections seen in Italy. The worsening situation has prompted all four of the country’s provinces as well as Azad Jammu & Kashmir and Gilgit-Baltistan to impose considerably strict lockdown measures.

While some in the country, particularly in the federal government, have criticised the provinces’ preventive steps as premature and overkill, official data on healthcare and quarantine facilities and conversations with members of the medical fraternity reveal why Pakistan can ill afford to repeat Italy’s mistakes.

With such situation in backdrop, the question arises whether the dental community is ready to face this pandemic.

Many dentists have proactively limited their practice to emergency procedures only. Though this step was taken purely on voluntary basis, but no proper guidelines have been circulated by Pakistan’s Dental Authorities.

According to the Centers for Disease Control and Prevention, it is advised to limit patient inflow and take proper measures. The patient’s history should be taken thoroughly, including travel history. Make sure that the patient is not accompanied with attendants, if possible. After every procedure hand-piece should be replaced, the chair, trays and area in 1-feet radius should be disinfected. A gap of at least an hour between each procedure.

“We are potentially looking at a total disaster if we fail to take precautions now,” warned Dr Tahir Shamsi, who heads the National Institute of Blood Diseases. “Our healthcare system is already in shambles, struggling to handle routine workload much less COVID-19 patients.”

The dental practice may change altogether once this virus is gone.

“If we don’t take steps to contain it now, we may end up seeing patients lying in our corridors, streets and footpaths,” he said. “More than 170 COVID-19 patients fighting for each intensive care unit bed. Not to mention those suffering from other diseases will be deprived too,” Dr Shamsi added.

With 132,227 beds and 7,697 health facilities across Pakistan the challenges are huge. Sindh has the highest number of health facilities with 3525 HCEs and many field hospitals are underway to fight the menace.

Experts recommend to make sure that only non-invasive procedures are carried out. Emergency and pain relief to be the only focus. Use of hand-pieces be discontinued for the time being. The waiting area should be ventilated properly and encourage time difference between appointments so that there are least number of patients waiting.

It is advised that dental community take proper measures to keep themselves safe by wearing masks, gloves and clean clothes. Those having industrial set-up, should put workers on rotational basis and educate them on social distancing. Non-essential staff should be allowed to work from home. Due to certain external factors, the prices of protective face masks have been escalated. The stakeholders should ensure the provision of these protective gears to their staff.

Pakistan’s renowned dentist Prof. Ayyaz Ali Khan says that it is time to only do the emergency procedures while Prof Mahmood Haider recommends consultation and pain management only. Dr Awab Alvi said that the fight against the coronavirus can only be succeeded if everyone in dental practice, maintain good protection protocol. Especially in regard to the protective equipment, dental fraternity needs to assist each other and consider the financial constraint imposed with it.

“[…] it is time that dental industry prepares itself for the unprecedented challenges once this is over”—Liaqat Humayun, President of the Dental Trade and Manufacturers Association

The dental practice may change altogether once this virus is gone. Dentists may have to adopt stricter measures like face visors and better protective gears, commented Dr Awab.

Dr Mahmood Shah, the President of Pakistan Dental Association termed the current scenario as the biggest challenge the community has ever encountered.

Talking to the president of the Dental Trade and Manufacturers Association, Liaqat Humayun, he termed the situation as a complete economic meltdown. “The impact we are seeing is huge. With institutions closed and the prices of consumables soaring it is time that dental industry prepares itself for the unprecedented challenges once this is over,” he said.

“The prices of masks alone have gone up by 400 times and same is the case for surgical gloves. Import has come to a standstill, staff has been relieved in some cases and the business carried out is based on stock available,” he concluded.

The industry stalwarts like Idrees Qadri and Ashraf Ghauri also said that the dental industry stands to suffer the most in the healthcare sector and must brace itself for challenges in the post COVID-19 era.

The industry faces acute cash-flow shortage with no payments coming and the whole business cycle is halted with clinics going for emergency/consultation only and in many cases closed.

Even in such dark times, there is a light of hope. A student based initiative called ‘Agahi For Corona’ has been started to help the community. The campaign, headed by Dr Talha M.Siddiqui, Vice Principal, Baqai Dental College, Baqai Medical University and Dr M.Ainul Haq, Assistant Director and Head Department of Medical Education, Baqai Dental College, Baqai Medical University, includes students, House Officers, doctors, dentists, pharmacists, physiotherapists and paramedics

The only redeeming feature at this point in time is that the whole world is adversely affected.

It is true that the dental industry is badly hit with the catastrophe, but the collective efforts can resuscitate the community back.