The first cases of Covid-19 illness were detected in our countries late in February (in Finland in January), and within a few weeks it was evident that the pandemic situation was a reality also here. All our governments have met the situation with strong hygienic advices, rules for social behavior and more or less daily updating of the situation, but with varying degree of regulation, restrictions and prohibitions. The number of infected and sick people varies a lot between the countries, and so does the number of dead persons. Pr. 100.000 inhabitants is the number of deaths so far (13th of May) for Iceland 3, Norway 4, Finland 5, Denmark 9, and Sweden 36.
Norway
As many other countries Norway was not prepared for an epidemic like this. We started with advices of thoroughly hand hygiene, social distancing, early detection and contact tracing. On March 12, the government decided to close all kindergartens, schools, universities and public facilities like theatres, museums etc. All larger cultural and sport events was cancelled, and social gatherings were limited. “One-to-one treatments” were restricted; physiotherapists, hairdressers, beauty salons etc. had to close, also dental practices for regular treatment. People returning from abroad had to stay in home quarantine for two weeks. We were all encouraged to stay at home if possible. Hospitals changed routines from normal health care to increase the capacity for acute help. Many temporary clinics for testing and care for corona sick people was established. The main reason for all this was the fear of overloading the Norwegian health system capacity, and time has showed it has been successful.
Dentists were allowed to do only needed acute treatment, and if patients showed sign of fever or possible covid-19 illness, they should be referred to one of the public clinics which were established for this reason. This resulted in postponement of many planned and ongoing treatments, to the discomfort and problems for the patient. Many dentists, hygienists and dental nurses came on leave, and of course the profession has had a huge loss of income. Via the Norwegian Dental Association many dentists gave parts of their stock of face masks to the medical hospitals, which were in lack of different protective equipment.
From the end of April, the Norwegian society has carefully and gradually “opened up” again. Kindergartens and primary school started, and now the closed businesses can start again, but with strict rules for behavior, equipment and infection control. Cinemas, theaters, restaurants and bars can reopen, but not for more than 50 persons.
Dental practices and clinics have reopened, but the treatment capacity is reduced because of the expanded rules for disinfection, distance in the waiting room etc. And I think some patients will still be afraid and postpone their treatment.
This pandemic has been a suffering for most people, and a catastrophe for some, both medical, social and economic. The sick and the families with sickness and dead have been under great pressure and sorrow. The economic costs for individuals and for society have been enormous. Despite the Norwegian governments more than 40 billion Euros support package to aid businesses and people suffering from the economic slowdown, many people will feel these costs as a big problem in time to come.
Ivar Hoff (Regent District 3)
Covid-19 dental situation in Sweden May 2020.
In Sweden the situation concerning dental care, during the spring of 2020, have been different if you compare private offices and Folktandvården (i.e. the government funded dental care – NHS like).
The private offices have been more or less opened during the covid-19 pandemic. One of the largest companies Praktikertjänst AB (approx. 1100 dentists out of 1800 company owners) made all dental personnel, dentists/nurses/dental hygienists, partly redundant and the offices have been working 40%, with economic contribution from the government paying for their income up to 92%. Smaller private businesses have also, later in the process, been given the opportunity to have the same economic contribution.
Folktandvården, on the other hand, have been working all the way from full time down to a 100% lock down. The reason for the 100% lock down has been to have mouth guards, gloves and other disposable items given to the health care workers. Notice, Sweden have not had enough stockpiles. Some dental nurses from Folktandvården have also been transferred to the hospitals to give an extra hand.
Of course, patients 70+ and those with covid-19 symptoms have not been treated. Special offices have been set up for treating those with symptoms in need of emergency care.
Nothing dramatic reported, so far so good.
Anders Skoglund (Vice Regent Sweden)
Covid-19 in Denmark
The Corona crisis has been a tough time. In reality it has been much tougher economically than disease wise. We have a relatively low number of dead – not like Norway, but certainly in the lower end of the scale. But as I said it has had an incredibly high cost for the Danish economy – in almost every aspect.
Denmark closed down on the 17th of March and was initially supposed to stay closed until the 8th of June. With the exception of dentists, who initially was forced to close down until the 30th of June. We had to send nine employees home on a salary compensation – one of the government’s many financial aid packages, which in this case gives 30.000 DKK per month per employee. In addition, we also have an employee, who is on long-term sick leave, so we were only two clinic assistants and two dentists/owners left to work at the clinic. The dentist clinics in Denmark were only allowed to stay open to perform emergency treatments that could not be postponed. Our revenue dropped from 100 % to 0.25 % from one day to another. The Danish Health Authority put up some very strict restrictions and guidelines for our work, which changed almost hourly. We had to call and move all our patients for seven practitioners. We tried to be optimistic and moved patients up until early May. In the meantime, an enormous amount of time and money was spent on getting protective equipment. Due to the shortage of protective gear some clinics have had to be very creative.
When you could start to see that it was beginning to go better in regards to the infection pressure and the epidemic curve began to deflect, the government decided to begin the first part of an opening of the country from the 20th of April. We were informed about this on the 18th of April. It was hopeless conditions. Dentists were not allowed to use the three-function syringe, turbine or ultrasound unless the patient was able to show documentation of a current negative COVID-19 test. Furthermore, there has to be a 10-minute break between each patient used for prober cleaning and venting. Fortunately, the Health Authority has eased the original demand of a negative COVID-19 test, so it is no longer a requirement for attending regular treatment. It is only still a requirement if ultrasound is needed. We spent the first week on getting both us and the clinic ready. We were also very concerned about whether the patients would be too afraid to come to the clinic. Fortunately, this has not been the case. The patients have been almost happy to come.
We still have two employees at home and two on/off. The clinic is well occupied, so now it can only go forward. However, it is a burden with the 10 minute break on each side of the patients and the amount of time we need to spend on getting into the protection equipment – we look like a bunch of pandemic frontlines, when we are all dressed up.
On top of COVID-19, we also have an ongoing conflict between the Dental Association and HK, which is a professional organization/union for the clinical assistants. HK is very aggressive, and they have exhibited dentists in the media, for example by exposing clinics that do not meet the standards and requirements. But their hetz is hitting the entire dentist industry, which is very frustrating. Worst-case scenario is that HK might soon call the clinic assistants to strike. That is certainly not something we need right now.
Anyway – it is overall going forward – though with certain challenges.
Per Bjoerndal (Vice Regent Denmark)