View from near the Frontline

I thought I'd pen a few lines as part of an insider view from near the frontline.

Mon 23rd March (First day of Lockdown)

All working as normal. 4 final year students arrive for a nearly fully booked clinic. By the afternoon any students with underlying medical conditions eg severe Asthma are advised not to be involved in clinical care.

Dentistry in the main is an 'Aerosol Generating Procedure' especially using the drill or scaler which is water-cooled ie the high-pitched whizzy ones.

The British Dental Association (BDA) and some of the other Professional Societies are voicing concerns and calling on the Chief Dental Officers (CDOs) for guidance. There are 4 of these one for England, Wales Scotland and Northern Ireland


Tues 24th March

This morning would have been our fortnightly GA list for treating our patients with special needs and learning difficulties. It has been cancelled, as has all elective surgery ie non-urgent operations.

In the afternoon we have 2 out of 3 student dental therapists attend to see patients. A few simple treatments that don't involve a drill or water-cooled scaler.

By the end of the afternoon we learn that all student clinical sessions at the Dental Hospital have stopped.

Management make the decision that routine care will now cease across our service. We will operate an emergency-only advice service, triaging over the phone and only see patients face-to-face unless they present with a facial swelling which may require anti-biotics. No 'Aerosol Generating Procedures' to be undertaken.

BDA are now getting very vocal on social media. The CDOs for Wales, Scot and NI are advising downing tools accept for emergencies. Not a dickie-bird from the CDO for Eng.



Weds 25th March

A busy day. Mainly phonecalls and emails. We have a large service, over 40 staff. Discussions are ongoing towards re-deployment to help other services. Each service within the Trust is asked to provide information for potential transferable skills. My health centre where I'm based has become one of the 'command' centres co-ordinating the community care. Being a senior clinician, I get to see first hand how the senior managers get to 'think on their feet'.

The RU Clear team (sexual health) were due to be disbanded at the end of March 2020 as their funding had run out. They are now the Community Swab Team. The plan is to run a service 7 days a week across Manchester to under-take Covid 19 swabs in peoples homes. I'm already thinking that swabbing is something that the dental team could help with. After all, we spend all day with full PPE on and are used to putting things in peoples mouths. We're also used to doing home-visits from time to time too. The clinical lead for our service is thinking on the same wavelength.

Stocks of PPE are being counted.

Finally we get notification from the CDO Eng that all routine and non-urgent dental care should be stopped. A remote 'urgent care' triaging service should be established. Those patients deemed to need care can be referred to the Local Urgent Dental Care System. Trouble is, there isn't one. Dental treatment is now deemed as high-risk. So essentially providing it will need the most protective PPE. This includes the special FFP3 masks. No one has been 'fit-tested' for the masks.

Before you can use a FFP3 mask you have to be 'fit-tested' for it. This involves putting the mask on, and then a special hood is then placed over your head and then some smelly substances is puffed inside the hood. The idea being that if the mask has a good seal it should filter out the smell and thus any virus particles. They are deemed as 99% effective.

You have to be 'fit-tested' for each make of FFP3 mask. There are numerous makes. Some will fit, some won't. For men with beards, these have to be shaved off as a seal can't be created.

I'm on a half-day today. I booked for someone to come and install some security cameras on the house. There'd been and an attempted break-in about 3 weeks back - broken padlock on side gate and an adjustable spanner left gripping one off the handles of the French windows. I ummed and ahhed about whether I should go ahead, but decided I could maintain the social distancing and given that my house would likely be the only vacant one in the cul-de-sac, it would be at risk.

4 cameras installed. With a good view of the back and front. If I hear a noise especially at night I can switch the TV on in the bedroom and check with out getting out of bed. When out of the house I can check via my phone, even has a notification system if something crosses a virtual line across the back garden.


Thurs 26th March

Another day spent refreshing the BBC news website. Emails read. Our service is planning to run with 2 sites (out of 8) offering emergency advice. A rota has been drawn up beginning from Mon 30th March.

Tidying out my office drawer I find my certificate for my FFP3 'fit-test' for 2009 in preparation for H1N1 (Swine 'flu). Re-read the government documents from the time regarding planning for an epidemic, mass deaths etc. Don't feel we're anywhere near where we were in preparation for H1N1 by this stage.

We've been skill-matched with the District Nurses. 10 of us have volunteered to be the initial trainees. A full day of training planned for tomorrow.

Fri 27th March 

Arrive at the training centre. Been a long time since I'd been at this particular health centre. When I first started the current job in 1998 we used to have a dental clinic here and I worked there 3 days a week until I moved full time to current Health Centre in 2001.

Full of admiration to the 2 District Nurse Matrons who have pulled together a training package for the dental team in less than 2 days.

An overview of wound care and dressings, injections and general medication. All bread and butter stuff to them but a real eye-opener to us especially the pressure-sore management.

Advise the trainers that I'd recently had experience of administering Heparin Injections for my Father (part of my Xmas trip duties). Admit that a bit nervy at first, got one a bit wrong but on the whole the patient tolerated it quite well.

Sat 28th March

A short local run. I'd set my bike up in one of the bedrooms on the turbo-trainer but haven't used it yet.

Sun 29th March

Catch-up phone calls with the family. 2/3rds have been on lockdown for 3 weeks now. The ones in France have to have a certificate to leave the house. Carers in Tenerife are looking after Ma & Pa very well, daily visit and doing the shopping for them.

Reflect with my Uncle (dad's brother, lives in Worsley) that cancelling the Cruise and selling the car are looking like 2 of the best things I have ever done. They would have been due back in Bristol on Tues 24th March. I was due to collect them from Bristol to bring them back to Bolton and then fly back to Tenerife on Sat 28th March.

One bonus, the 3 flights from Liverpool to Tenerife were cancelled by Easyjet. I'd written them off at Xmas but had left them booked just in case. A full refund acquired.


End of week 1 of Lockdown

At the end of the week, I reflect that it's all very surreal. I feel very privileged to still being paid a wage but want to feel that I'm doing something to help.


To be continued.........


ps if you want a 'fell' fix have a look at this programme that was aired on BBC4 on Mon 13th April at 7:00pm. You can get it on iplayer, called The Great Mountain Sheep Gather

https://www.bbc.co.uk/iplayer/episode/m000hb4r/the-great-mountain-sheep-gather

For the map nerds, I watched with my os map to hand

TF