PERSPECTIVES
J Oral Maxillofac Surg
Protecting Ourselves During the
COVID-19 Pandemic
Elie M. Ferneini, DMD, MD, MHS, MBA,* and Steven Halepas, DMDy
The current coronavirus disease of 2019 (COVID-19)
pandemic has run rampant on our healthcare system.
At the time of writing this, 3 resident physicians have
died, 1 of whom was in our field.1 These young doc-
tors had their entire careers ahead of them; they
were working long hours, relying on their hospitals,
their government, and their healthcare system to pro-
tect them. These residents are by no means the only
victims within the healthcare system. This virus has
claimed the lives of attendings, nurses, and other
essential healthcare providers.
When 1 of us (E.M.F.) was training to be an emer-
gency medical technician, he would be tested on
different scenarios. However, each was an automatic
failure if he did not ask the same first questions ‘‘BSI
(body substance isolation) and is the scene safe?’’ It
was drilled into our brains to worry about scene safety
above all else. We were taught that the most important
point was to ensure you were safe, your partner was
safe, and then to worry about the patient. We do not
let firefighters run into buildings without the proper
equipment; it follows that we should not let doctors
and nurses tend to the ill unprotected. When we
took the Hippocratic Oath, we agreed to run into a
burning building for the sick, but we did not agree
to do it naked. Without protecting our healthcare
workers, our healthcare system will fail.
Private practices across the United States are re-
maining open to serve their community for emergency
treatment to relieve stress on hospitals and emergency
rooms. Throughout this pandemic, oral-maxillofacial
surgeons (OMSs) have been providing treatment to
life-threatening conditions such as head and neck
*Director, Beau Visage Med Spa, Cheshire; Surgeon, Greater
Waterbury Oral & Maxillofacial Surgeons, Associate Clinical
Professor, Division of Oral and Maxillofacial Surgery, University of
Connecticut School of Dental Medicine, Farmington; and Associate
Clinical Professor, Department of Surgery, Frank H Netter, MD
School of Medicine, Quinnipiac University, North Haven, CT.
yResident, Department of Oral and Maxillofacial Surgery, New
York Presbyterian –Columbia University Irving Medical Center,
New York, NY.
Conflict of Interest Disclosures: None of the authors have any
relevant financial relationship(s) with a commercial interest.
1
-:---, 2020
infections and facial trauma. ‘‘As COVID-19 threatens
to overwhelm our healthcare systems, oral-
maxillofacial surgery practitioners are charged with
reducing the burden placed on other emergency cen-
ters and, if necessary, lend our unique experience and
training in anesthesia and intensive care unit care to
other medical and surgical services.2’’ At hospitals
across the United States, oral-maxillofacial surgery res-
idents and faculty have been redeployed to intensive
care units to care for patients with COVID-19. In the
darkest days, residents were given a single N95 mask
to hold onto, carrying it around in plastic containers
between shifts, to ensure they had a mask the next day.
Our scope of practice places us in a high-risk cate-
gory because our procedures generate virus-
containing aerosols. SARS-CoV-2 has been demon-
strated to remain aerosolized for up to 3 hours.3,4
Working intimately in the oropharynx means that
OMSs must take all precautions very seriously. Viral
shedding can occur in asymptomatic and presymp-
tomatic patients and is greatest in the nasopharyngeal
region. Many of these private practice offices do not
have the proper personal protective equipment
(PPE) to provide care to patients in today’s environ-
ment. Surgeons have been calling every distributor
they can think of and ordering masks and gowns
whenever possible, with many of the major distribu-
tors on backorder.
We live in unprecedented times when federal and
state governments are fighting with hospitals for
PPE. Andrew Artenstein, the chief physician executive
and chief academic officer at Baystate Hospital,
recently reported a correspondence explaining how
Address correspondence and reprint requests to Dr Ferneini: Di-
vision of Oral and Maxillofacial Surgery, University of Connecticut
School of Dental, Medicine, 263 Farmington Ave, Farmington, CT
0603; e-mail: eferneini@yahoo.com
Received April 24 2020
Accepted April 28 2020
Ó 2020 American Association of Oral and Maxillofacial Surgeons
0278-2391/20/30455-9
https://doi.org/10.1016/j.joms.2020.04.047
2 PROTECTING OURSELVES DURING THE COVID-19 PANDEMIC
he had attempted to buy PPE for his hospital. He went
with trucks to try to execute the purchase. However,
before he could wire the funds, 2 Federal Bureau of
Investigation agents arrived and started to question
him. The Department of Homeland Security was trying
to redirect the PPE that the hospital was trying to pur-
chase. It took the intervention of their Congressional
representative to allow the hospital to keep the PPE.5
It is the duty of OMSs to provide emergency
coverage for our patients. It is essential for govern-
ments to classify OMSs as critical first responders to
allow us access to the PPE we need to provide urgent
care safely. We also need the ability to administer rapid
COVID-19 testing in our facilities and clinics to expand
testing within our communities. If a vaccine becomes
available, we will need to be allowed to administer that
vaccine to provide immunity as efficiently as possible.
Our healthcare system is failing us, and the days of
being driven by profits and administration need to
be behind us. The US healthcare system administration
costs have increased exponentially. Our healthcare
system has let our providers down. OMSs are on the
front lines of this battle, both in our private practices
and in the hospital settings. Governors and other state
officials have called on us to donate our PPE to hospi-
tals but still expect us to see emergency patients in the
private setting to reduce the strain on the emergency
system. We must not waste the lessons learned in
this crisis. We should use it as an opportunity to
become better integrated and recognized as a vital
part of our healthcare system and help strengthen it.
References
1. Wayne State University School of Medicine News: COVID-19
claims member of class of 2018 Chris Firlit; 2020. Available at:
https://today.wayne.edu/medicine/news/2020/04/07/covid-19-
claims-member-of-class-of-2018-chris-firlit-36783#.XqIhov9j-kE.
link. Accessed April 23, 2020
2. Ebben S, Hussain R, Miloro M, Callahan N: The UIC COVID proto-
col: A technical note for pandemic oral and maxillofacial surgery
call coverage [e-pub ahead of print]. J Oral Maxillofac Surg,
https://doi.org/10.1016/j.joms.2020.04.004. Accessed April 23,
2020
3. van Doremalen N, Bushmaker T, Morris DH, et al: Aerosol and sur-
face stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl
J Med 382:1564, 2020
4. Ather A, Patel B, Ruparel N, et al: Coronavirus disease 19: Implica-
tions for clinical dental care. J Endod 46:584, 2020
5. Artenstein AW: In pursuit of PPE. N Engl J Med 382:e46, 2020