A Health Inequalities Impact Assessment of the surveillance of COVID-19 in asymptomatic patients attending dental settings in Scotland.

INTRODUCTION: A key aspect of the public health response to COVID-19 in Scotland was enhanced community surveillance, including testing in dental settings. Across Scotland, dental settings offered patients over 5-years-old the opportunity to participate in community surveillance of COVID-19. METHODS: A Health Inequalities Impact Assessment (HIIA) was conducted to understand the differential impacts the programme would have on the population and to improve the accessibility of the programme. HIIA is a tool to allow the assessment, understanding, and mitigation of impacts on people of a proposed policy or practice. It fulfils an organisational duty to meet the requirements of the Equality Act and Fairer Scotland Duty. The HIIA was conducted rapidly in parallel with the programme development. An action research approach included an online workshop, consultation, review of population data and a literature search. RESULTS: Adjustments were required to improve the programme's accessibility. Stakeholders, including dental teams from across Scotland were involved in the consultation and brought their front-line experience in different settings. Common issues identified included digital literacy and access, language and cultural barriers to participation, and issues relating to the implications of a positive COVID-19 result. Literature indicated limited evidence on the acceptability, accessibility, and equity of asymptomatic COVID-19 surveillance. CONCLUSION: This HIIA was conducted during the COVID-19 pandemic. As an example of good practice in tackling inequalities in access to programmes it should represent the benchmark for other similar initiatives.

Implementing a Curriculum on Disaster Behavioral Health in a Psychiatry Residency Program

Background: Disasters are broadly defined as “encounters between forces of harm (hazards), and a vulnerable human population in harm's way, that create demands exceeding the coping capacity of the affected community,” (Shultz, 2014). Disasters predictably produce behavioral and psychosocial consequences;in fact, more survivors are affected psychologically than are harmed physically. Type of disaster event, severity and duration of exposure, geographic scope, and extremity of resource losses contribute to distress and diagnosable psychopathology. For persons currently undergoing treatment for disease, injury, or life-changing medical condition, exposure to a disaster may complicate their care, exacerbate their condition, threaten their survival, and trigger psychological reactions. The ongoing COVID-19 pandemic has increased baseline population prevalence rates of common mental disorders worldwide, thereby compounding risks for psychopathology among persons whose communities are affected by disaster. The current era, marked by layered stressors, creates a compelling impetus to train upcoming psychiatrists on skills to support disaster survivors, including those with special needs. We are designing and implementing a curriculum to teach the principles of disaster behavioral health to our psychiatry residents based aligned with national guidelines (Flynn and Morganstein, 2020). Method: An electronic survey was distributed to psychiatry residents to assess their current knowledge and skill levels for performing key actions when dealing with disaster survivors, post-impact. Residents were asked to rate their current knowledge regarding disaster behavioral health principles, their confidence for providing psychological support to disaster survivors, and their interest in evidence-based disaster behavioral health training, grounded on national recommendations. Interested residents will participate in an expert-led lecture series that will include pre- and post-training assessment of disaster behavioral health knowledge and skills. Results: The initial interest survey garnered a 40% resident response rate. Apart from rating their ability to “gather information in a disaster situation” at 4-of-5, most residents rated their current knowledge levels and confidence in their skills to provide support to disaster survivors at 2-of-5 or below. Regarding interest in a disaster behavioral health lecture series, 86% indicated they would be interested. Pre- and post-training assessment are pending the delivery and completion of the lecture series. Discussion: Initial resident survey results demonstrate limited knowledge of disaster behavioral health principles, low levels of confidence in skills to support the psychological needs of survivors, and strong interest in receiving training. Conclusion: We will proceed to develop a robust disaster behavioral health training curriculum for our residents, starting with a lecture series featuring experts in the field and rapidly expanding to skills training and real-world disaster deployment/response opportunities. References: 1. Flynn BW, Morganstein JC. Curriculum Recommendations for Disaster Health Professionals: Disaster Behavioral Health, Second Edition, 2020. 2. https://www.usuhs.edu/sites/default/files/media/ncdmph/pdf/ncdmph_csts_revised.pdf 3. Shultz JM. Perspectives on disaster public health and disaster behavioral health integration. Disaster Health. 2014;2(2):69-74.

SARS-CoV-2 Positivity in Asymptomatic-Screened Dental Patients.

Enhanced community surveillance is a key pillar of the public health response to coronavirus disease 2019 (COVID-19). Asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include preappointment and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centers across Scotland invited asymptomatic-screened patients aged over 5 y to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardized Viral Transport Medium-containing test kits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/email with appropriate self-isolation guidance in the event of a positive test. All positive cases were successfully followed up by the national contact tracing program. Over a 13-wk period (from August 3, 2020, to October 31, 2020), 4,032 patients, largely representative of the population, were tested. Of these, 22 (0.5%; 95% CI, 0.5%-0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. To our knowledge, this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing infection prevention control and PPE vigilance, which is relevant as health care team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.