Written by: Dr Howard Holmes
President, Australian Society of Orthodontists (ASO)
Please describe how Covid19 has affected orthodontic practice in Australia?
The past 18 months have been particularly difficult for specialist orthodontists in Australia with fluctuating mandatory practice restrictions and enforced shutdowns. ASO members from Victoria (Melbourne) and New South Wales (Sydney), the states/cities with the most COVID cases so far, have been particularly disrupted by the pandemic but there have been virus outbreaks and periodic short lockdowns in all major capital cities around the country.
Orthodontic practices all over Australia are required to adhere to a range of mandatory measures including face masks, physical distancing and QR code check-in to reduce the risk and support contact tracing. In response to the current Delta outbreak, all dental practitioners in Victoria and NSW are limited to the provision of either essential or urgent/emergency dental care only. These restrictions obviously create some difficulties and confusion for orthodontists who still need to see their patients regularly to progress their treatment, but may find it hard to justify routine adjustments as “urgent” or “emergency” care. In these two states, patients in active treatment have inevitably seen their regular checks delayed and many new patients have been forced to delay the commencement of treatment due ongoing restrictions and clinical backlogs. In other states and territories where COVID related lockdowns have been much shorter, the impact has been less severe.
The uncertainty of this evolving environment, with restriction levels sometimes changing on a day-to-day basis, undoubtedly affects the morale and mental health of our members and their staff. With work conditions shifting from almost stasis during lockdown to a manic catch-up upon reopening there is certainly added stress and also financial uncertainty. However, under the circumstances, our members have so far coped very well. Patients and parents of young patients have also generally been very understanding of the importance of reducing public movements to bring local COVID outbreaks under control as quickly as possible. We are all looking forward to the time when our national vaccination rates allow for a return to something resembling the pre-COVID “normal”.
How have the members of your Society coped with the changes?
Despite the many challenges, our members have been working together and collaborating on our member social media pages to ensure safety and consistency in clinical practice. At the ASO we are grateful to many members who have offered support and information as we tried to keep up with the changing government announcements and what these meant for orthodontists. Many members have taken the opportunity to fast-track the implementation of digital technologies into their practices that allow for the provision of virtual patient visits and tele-consultations.
Regrettably, over the last 18 months we have had to abandon a large number of regular society events including the unfortunate last-minute cancellation of the 2020 ASO Congress that resulted in a significant financial loss for the ASO. We have subsequently moved state and federal member meetings plus our regular executive council and committee meetings to an online format. A limited number of face-to-face branch meetings of the ASO have been able to proceed during the periods when state lockdown conditions have been lifted.
The loss of face-to-face events has been very disappointing for our members. They have reported missing the networking and socialising opportunities of those events and are clearly starting to suffer “Zoom fatigue” with all CPD opportunities now transitioned to online formats.
We have worked hard to overcome the challenge of meeting and engaging remotely with our members and have successfully hosted a number of webinars and CPD events via Zoom in 2020/2021. Our last two AGM’s were also held online. We are very thankful for the support, resilience and flexibility of our members and volunteers who have participated in the various virtual ASO events.
What government support and guidelines have been implemented?
The Australian Federal and State governments have implemented a range of support measures, including “Jobkeeper” payments, rent relief and other incentives to help keep businesses afloat and keep employees in jobs - thus reducing the broader economic impact of COVID-19 on the country. Some of these measures have been more successful than others.
Dental health professionals in Australia have been required to adhere to new Federal and State infection control and prevention guidelines to help keep the public and their staff safe. The Australian Dental Association (ADA) last year released a guidance framework entitled ‘Dental Service Restrictions During COVID-19’ outlining which dental procedures were considered permissible under the various restriction levels mandated by state health authorities. The ASO also produced orthodontic guidelines to complement the ADA framework and made them publicly available on the ASO website.
How has your Society +/- Ministry of Health helped its members during this difficult period?
The ASO has been supporting our members to practise responsibly and professionally through this highly unpredictable and uncertain period. At the beginning of the pandemic, we launched a
COVID-19 Hub on our member website, with the latest Government, health, workplace and patient resources and updates all in one place.
The ASO has also been offering one-on-one member support via phone, email and direct response via our ASO Members Facebook Forum. This social media forum has been a very useful tool, especially during the lockdown periods, helping communicate urgent updates and also helping our members understand the changing restrictions and guidelines and how to implement them.
During the first half of 2020, the ASO changed the focus of our Public Education Program (PEP) from one focused on general education about orthodontics and consumer warnings on direct to consumer aligners, to one designed to support patients during an uncertain and difficult time. We created a range of COVID-specific assets and content that was made available for members to share with their patients and distribute on their own social media channels.
We also developed a live COVID-19 blog to inform the public about changes to health and safety measures in orthodontic practices and to provide them with the latest updates regarding dental restrictions across the country. A study on the ‘evaluation of the quality of information on the Internet about 2019 coronavirus outbreak in relation to orthodontics’ commended our communications efforts, and identified our website as being one of the top 3 most reliable and trustworthy in the sector.
How has Covid19 impacted the lives of Australians?
The initial COVID-19 outbreak in early 2020 massively disrupted all facets of life and work in Australia. However, through a combination of good governance, geographic isolation, domestic and international border closures, strict quarantine rules and a serving of good luck, Australia almost successfully eliminated the virus and by late 2020. By early 2021, most jurisdictions had almost completely reopened and there was complete freedom of movement across the country - barring occasional snap lockdowns due to leakages from hotel quarantine. Unfortunately, the Delta variant has put paid to these freedoms with significant spread through unvaccinated urban populations in recent months, particularly in Sydney. We expect areas impacted by these new outbreaks will remain in lockdown until such a time as the population vaccination rates reach a high enough level to make it safe to reopen. Orthodontists, like all health professionals, continue to do their part to help reduce the spread of the virus either restricting or stopping practice and increasing patient safety protocols.
Moving forward, how do you think orthodontic practice will change?
Tele-health/virtual consultations have already been adopted and embraced by both practitioners and patients and they are very likely to continue long term.
Hardship makes us stronger and more resilient, so whilst the recent turmoil is both inconvenient and problematic, paradoxically, it should also lead us all to technological innovations and new opportunities in the future.
Please write a message to all APOS members from ASO.
The last 18 months has been a steep learning curve for governments and the health sector around the world to get ahead of the virus, and orthodontists have been no exception.
My message to APOS members is to see this situation as an opportunity to try new approaches and technological innovations, and to work collaboratively with other health care providers so we can turn the pandemic into something much less threatening, reduce the impact of the virus on our families and our communities and hopefully resume our lives as quickly as possible. It also goes without saying that vaccination is our ticket out of this, so if you haven’t already done so – get the jab!