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JOHANNESBURG, South Africa: With nearly 8,000 infected people on 7 May, South Africa has the most SARS-CoV-2 cases of all African countries, closely followed by Egypt, according to Johns Hopkins University. While the virus was slow to reach the continent compared with other parts of the world, the number of infections has grown rapidly. South Africa has been under strict lockdown for 35 days and measures were only eased a few days ago. Dental professionals have had to follow stringent regulations.
In a press release on 17 March, the South African Dental Association (SADA) recommended to oral health practitioners to consider postponing elective dental procedures until it would be safe to resume normal dental practice, in order to mitigate the spread of SARS-CoV-2.
“The South African Dental Association is deeply concerned about the health and well-being of the public and the whole dental team. The association also recognises the unprecedented and extraordinary circumstances dentists and all healthcare professionals face related to growing concern relating to this pandemic and it cannot, therefore, be business of dentistry as usual,” said Dr Renier Putter, board chairperson of SADA.
Consequences for non-emergency treatments during lockdown
On 23 March, the president of the Republic of South Africa, Cyril Ramaphosa, announced that the country would be under Level 5 lockdown—the highest level—from 26 March midnight until 16 April midnight. This 21-day lockdown was later extended until the end of April. The nationwide lockdown was enacted in terms of the Disaster Management Act 2002 and required all South Africans to stay at home, except for people providing services or products deemed to be essential. According to SADA, this caused some confusion as to whether dentists belonged to one of the categories that would be exempted. Before the lockdown was in effect, SADA confirmed that oral health practitioners were included in the category of essential personnel in the category of health workers in the public and private sectors. Therefore, dental professionals could choose to open or close their practices.
The association urged dental professionals to adhere to these rules because otherwise they could become subject to investigations by the regulator, the Health Professions Council of South Africa, for unprofessional conduct.
However, they were only allowed to perform emergency procedures during the shutdown. “What qualifies as an emergency is subject to a wide variety of opinions, but obvious examples are a patient in acute pain, or with an abscess, or swelling or excessive postoperative bleeding. As a guideline, any procedure that can be delayed for 30 days without, in the clinical judgement of the dentist, causing undue risk of harm to the patient, is non-essential,” commented SADA in a press release on 26 March.
The association urged dental professionals to adhere to these rules because otherwise they could become subject to investigations by the regulator, the Health Professions Council of South Africa, for unprofessional conduct. In addition, SADA warned its members that the association could not be of any assistance to them in such a situation.
Furthermore, the dental association recommended to dental professionals to conduct the initial contact with patients via telephone or messaging, to determine whether their condition warrants emergency treatment. The Health Professions Council of South Africa had permitted tele-consultations for emergencies for the lockdown period, restricted to established patients only.
Supply of dental material and financial relief
In a formal communication, SADA has been informed by the chairperson of the South African dental traders association, which represents 24 companies, that those dental supplies currently needed are available: “Our traders import a diverse range of consumable products and dental equipment, including new innovative high-tech ranges, e.g. CBCT scanners. We have had an incredible demand for the following products: face masks, gloves and disinfectants. I have confirmed that most of them can supply everything that is needed currently. Face masks are available but not all our members have stock.”
In a press release from the World Health Organization (WHO) concerning the COVID-19 situation in Africa, Dr Ahmed al-Mandhari, WHO Regional Director for the Eastern Mediterranean, commented on the current situation of healthcare workers: “We must protect our healthcare workers and ensure that they are appropriately equipped—they are on the front lines and need our unwavering support. We owe them a great deal.”
After the lockdown had been in effect for six days, SADA reported on 1 April that major insurers and other financial institutions would be making announcements on their offers in terms of temporary financial relief.
In addition, in light of the current situation, SADA has announced the cancellation of its Dental and Oral Health Congress and Exhibition. It was originally scheduled to take place from 28 to 30 August at the Emperors Palace Convention Centre in Johannesburg. The additional financial burden for exhibitors and dental professionals, aside from the financial losses caused by the lockdown, was mentioned as one reason for cancelling the congress.
Down to Level 4 for now
Since 1 May, South Africa has eased the lockdown restrictions somewhat, moving to Level 4. This has allowed more businesses to reopen, including some retail services, hot food delivery, mining and manufacturing. According to the Mail & Guardian newspaper, South African residents have to wear face masks in public and a curfew from 8 pm to 5 am has been put in place. However, South African authorities noted that, if the number of people infected with SARS-CoV-2 increases during Level 4, Level 5 restrictions will be initiated again.