Latest / The SHEA Podcast / Dentistry and COVID-19 with ADA

Transcript

Dentistry and COVID-19 with ADA · The SHEA Podcast

• 0:11
  SPEAKER_00: Welcome to the We're All in This Together COVID-19 Allies and Infection Prevention Podcast Series as part of the Society for Healthcare Epidemiology of America Rapid Response Program.
• 0:23
  SPEAKER_00: I am Dr.
• 0:24
  SPEAKER_00: Michael Durkin, Assistant Professor of Medicine at Washington University School of Medicine in St.
• 0:29
  SPEAKER_00: Louis, and I will serve as your SHA moderator and speaker.
• 0:32
  SPEAKER_00: I am also happy to welcome Mal Tompi, Manager of Clinical Practice Guidelines, and Dr.
• 0:38
  SPEAKER_00: Alonso Carrasco Labra, Senior Director of the Department of Evidence Synthesis and Translation Research at the American Dental Association.
• 0:47
  SPEAKER_00: Discussion on the podcast does not reflect SHA or ADA perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:59
  SPEAKER_00: Today's episode will focus on collaborations between healthcare epidemiology and dentistry and how we as a team can work together to address the most important questions surrounding the COVID-19 outbreak.
• 1:12
  SPEAKER_00: We'll start with formal introductions of our participants.
• 1:16
  SPEAKER_00: Dr.
• 1:16
  SPEAKER_00: Alonzo Carrasco Labra is the senior director of the Department of Evidence Synthesis and Translation Research at the American Dental Association and an adjunct professor at the University of North Carolina at Chapel Hill School of Dentistry.
• 1:31
  SPEAKER_00: He also has a master's in clinical epidemiology and a PhD in health research from McMaster University in Canada and a Doctor of Dental Surgery from the University of Chile.
• 1:42
  SPEAKER_00: He has extensive experience working with the American Dental Association in outcomes methods research and using grade methodology.
• 1:51
  SPEAKER_00: He also collaborates with several other countries and other research groups.
• 1:57
  SPEAKER_00: He's also an author on more than 100 peer-reviewed publications in medicine and dentistry.
• 2:03
  SPEAKER_00: Mala Vika Tampi is the manager and lead epidemiologist for the evidence synthesis and guideline development team at the American Dental Association and the Research Institute Center for Evidence-Based Dentistry.
• 2:16
  SPEAKER_00: She has an MPH from the University of Michigan School of Public Health and is a member of the grade working group and a young ambassador on the Chicago Council on Global Affairs.
• 2:26
  SPEAKER_00: Question number one.
• 2:28
  SPEAKER_00: Please describe what you and organized dentistry, specifically the American Dental Association, are doing to address COVID-19.
• 2:36
  SPEAKER_01: Thanks for the question, Dr.
• 2:37
  SPEAKER_01: Durkin.
• 2:38
  SPEAKER_01: I can take a stab at this one.
• 2:40
  SPEAKER_01: When the ADA learned about the emergence and looming devastation of what has played out with COVID-19, we really prioritized the convening of a rapid response team from not only the Science and Research Institute, but the Practice Institute, the Health Policy Institute, and the communications and marketing team.
• 2:57
  SPEAKER_01: Our major goal was to not only collect whatever questions and concerns the dental community had, but responding to as many of them as we possibly could.
• 3:06
  SPEAKER_01: And we knew we needed to approach this as a very, very collaborative effort, not only between administrators, but researchers, clinical experts, and communications experts.
• 3:16
  SPEAKER_01: As you can imagine, between March and April was a highly critical time in mounting our response.
• 3:20
  SPEAKER_01: And our first order of business was to establish internal processes and then together build what we now call a digital COVID-19 center.
• 3:28
  SPEAKER_01: What we needed to do was adapt our standard methodology for creating guidance to this very accelerated time frame.
• 3:36
  SPEAKER_01: We had a small amount of time to create this guidance, limited evidence, and it was really, really important that we adapt to that reality and act.
• 3:44
  SPEAKER_01: For any of those listening who are interested in seeing our content, the website can be found at Ada.org backslash virus.
• 3:51
  SPEAKER_01: We wanted to ensure that our members, the greater general community, were abreast of not only the latest scientific information and guidance, but also had access to pragmatic and skilled resources to use in their practices and with their patients as well.
• 4:04
  SPEAKER_01: We really wanted to ensure dentists kept the lines of communications open with their patients and this wasn't just a standstill type of situation.
• 4:12
  SPEAKER_01: Additional efforts included working with digital graphic designers, data visualization experts to again ensure that all of our communications tools were really just well done and created to help the patient and the dentist to have meaningful, valuable conversations around COVID-19.
• 4:31
  SPEAKER_01: One example of this, very, very simple and quick, is instead of saying SARS-CoV-2, we were incorporating language like the virus responsible for COVID-19 in our dissemination materials.
• 4:43
  SPEAKER_01: And all of this being said, the ADA we really approached this hand in hand with the CDC to ensure that we weren't working in a silo.
• 4:50
  SPEAKER_01: And we felt that we were really able to remain highly interconnected with the greater healthcare community in the midst of this pandemic.
• 4:59
  SPEAKER_00: That's fantastic.
• 5:00
  SPEAKER_00: To my knowledge, this has been the most comprehensive resource in dentistry to date.
• 5:05
  SPEAKER_00: I imagine that this resource expans beyond outside of the US and it has significant implications in terms of international dentistry as well.
• 5:14
  SPEAKER_00: Can you discuss the reach of the American Dental Association and the impact of this guideline in terms of international dental practice as well?
• 5:23
  SPEAKER_02: The ADA was contacted by a number of organizations outside from different countries requesting the translation of the material to different languages.
• 5:32
  SPEAKER_02: And it was very interesting to see the prompt approach that my colleagues at the ADA had facilitating all these processes and also making sure that in people who are translating these different content were aware of the nuances in relation to the US system that may work in different ways in other healthcare systems outside the United States.
• 5:54
  SPEAKER_02: So those translations were happening as the pandemic was progressing, and we find out that somehow the pattern of translation was following the wave of COVID as well.
• 6:05
  SPEAKER_02: So some of the material that at some point for us, when we move along from March and above, was in a way updated and replaced with new material, the previous material was still relevant for other settings in the world.
• 6:20
  SPEAKER_02: And the ADA was collaborating and sharing that material in a timely fashion, depending on the specific situation that those regions were addressing.
• 6:29
  SPEAKER_02: In general, our material focus in the US, specifically in our members, for some of the recommendations, I would say for many of the recommendations, honestly, issues of generalizability of the data are not really that relevant.
• 6:42
  SPEAKER_02: It's more an aspect of adjusting the recommendations to local resources.
• 6:46
  SPEAKER_02: What would have probably been the adjustment that organizations and other ministries of health or governments would have need to do on the face of the guidance that the ADA put out?
• 6:57
  SPEAKER_00: That's fantastic.
• 6:58
  SPEAKER_00: Certainly there's a lot of limitations creating a single document that would be comprehensive in all resource settings.
• 7:05
  SPEAKER_00: There's a lot of other challenges I'm sure your group have encountered as well.
• 7:09
  SPEAKER_00: In your mind, what has been dentistry's biggest challenge around COVID-19 and how has the American Dental Association handled it to date?
• 7:18
  SPEAKER_02: So I would say that if you think about the dental community and the professionals that work in it, the entire dental team, the different dental settings vary dramatically from one to the other.
• 7:30
  SPEAKER_02: So if you think about from rural areas to more urban areas, dentistry that is executed in hospitals, in private clinics, there is a lot of diversity on that regard.
• 7:42
  SPEAKER_02: And that diversity is exactly, as you said, Mike, difficult to reflect in these recommendations.
• 7:47
  SPEAKER_02: Recommendations that are difficult to implement in many settings are simply useless and probably problematic rather than actually something that clinicians and patients can use to make better decisions.
• 7:58
  SPEAKER_02: We have that aspect of the variability that is necessary to be reflected.
• 8:03
  SPEAKER_02: We also knew at the beginning that dentistry can stop.
• 8:07
  SPEAKER_02: It's interesting that at some point we saw some ethical dilemmas that the ADA was presented to.
• 8:12
  SPEAKER_02: I would say the entire dental community was presented to, when in some cases, from some leaders, it was proposed that dentistry can just stop and it would be okay.
• 8:23
  SPEAKER_02: That's something that the dental community overall responds very strongly, making sure that essential dental care is provided on a timely fashion, not only because that's what patients assert, but also because, in the context of the pandemic, we want to make sure that emergency departments are not flooded with dental emergencies that otherwise would have better been treated in a dental setting.
• 8:45
  SPEAKER_02: So there is a dual role there that entities has been played during the pandemic, making sure that those numbers remain under control and making sure that those emergencies are treated appropriately.
• 8:59
  SPEAKER_02: They also face challenges in relation to the upgrade of our PPE.
• 9:04
  SPEAKER_02: Dentistry, in general, if you look at the literature, the dentistry is pretty good and have done a pretty good job in terms of infection control.
• 9:12
  SPEAKER_02: Now this is a new challenge.
• 9:13
  SPEAKER_02: And we are basically now, we can say, very happy to see that dentists are taking this very seriously and actually quickly adapted to the new reality for the enhanced PPE that is necessary to minimize the transmission of the virus.
• 9:28
  SPEAKER_02: So we saw that response strongly and very responsively, which is something that we truly appreciate and see that massive response from the dental community.
• 9:38
  SPEAKER_02: Things that we think that we can do better, definitely a better interaction with emergency departments.
• 9:43
  SPEAKER_02: In particular for the aspects in relation to dental care focus exclusively on the emergency and urgent care.
• 9:51
  SPEAKER_02: And hospitals were also dealing with COVID-19.
• 9:54
  SPEAKER_02: It might be nice to have a better interaction between these two systems so it can be better organized in thinking probably future pandemics, hopefully not, but it's likely that that may happen.
• 10:05
  SPEAKER_02: And in case that happened, we hope to have a nicely orchestrated response between these two systems.
• 10:11
  SPEAKER_00: That's fantastic.
• 10:12
  SPEAKER_00: You mentioned use of PPE in dental settings.
• 10:15
  SPEAKER_00: Unfortunately, PPE still is somewhat of a limited resource in the US, and then some of the other readers, ADA readers that are following your guidelines too.
• 10:25
  SPEAKER_00: Can you touch on some of the ethical dilemmas related to use of PPE in dental compared to medical settings as well?
• 10:34
  SPEAKER_02: So, in relation to this problem, you see that as healthcare professionals, dentists have a responsibility for patient care and they are committed to their patients.
• 10:44
  SPEAKER_02: Many of the relationships patients establish with their dentists are fairly close in a way that there is a commitment to make sure that the oral health of their families are covered and their needs are secured.
• 10:56
  SPEAKER_02: So somehow, dentists, when you think about the need for PPE in medical settings and the need for PPE in dental settings in the context of the pandemic again, right?
• 11:06
  SPEAKER_02: When we have, let's say, March, April, there was a big discussion.
• 11:10
  SPEAKER_02: Some groups were suggesting that dentists would better donate the entire PPE as a way to support the medical aspect of management of COVID-19 and reduce the number of PPE available for the dental settings.
• 11:26
  SPEAKER_02: And that creates that dilemma.
• 11:28
  SPEAKER_02: On one hand, and this is the classic dilemma that we always see between the greater good, right, versus the most individual component.
• 11:34
  SPEAKER_02: So a dentist committed to treat their patients would feel a strong responsibility to have the available PPE for the patients that need urgent care at that time and avoid them, imagine exposure to go to an emergency department.
• 11:50
  SPEAKER_02: The tension there is real.
• 11:52
  SPEAKER_02: What do you do with that tension?
• 11:54
  SPEAKER_02: Do you prioritize PPE, certain number of PPE for dentists, or dentists should donate their PPE to physicians, nurses, and other health care professionals in hospitals?
• 12:05
  SPEAKER_02: I would say that through the pandemic, this dilemma was in a way sold towards acknowledging the relevance that dental care has.
• 12:13
  SPEAKER_02: And we actually were towards receiving additional support in terms of PPE for dental clinics, which is great.
• 12:21
  SPEAKER_02: And I believe that hopefully that will minimize or mitigate the impact of not providing routine dental care during such a long time, months, minimizing the impact that that will have in our population moving forward.
• 12:34
  SPEAKER_02: Impact that probably we'll be able to see in the months to come.
• 12:38
  SPEAKER_02: I also believe, in a way, that somehow this is an important discussion that should happen at a high level when dentistry is re-evaluated in its relevance, not only from the professional perspective or from dentists, but mostly from patients.
• 12:53
  SPEAKER_02: I don't know if you remember that early in the pandemic there was an article in New York Times when a famous comedian was saying that one of the scariest things that can happen to him during the pandemic would be to need dental care.
• 13:05
  SPEAKER_02: And it explains a lot about what it means when you have a dental need that cannot be met under the typical circumstances and importance that it has for people.
• 13:15
  SPEAKER_02: So we do expect that moving forward, there will be a more fluid dialogue, and probably issues in terms of the donation of PPE will not be that big of an ethical dilemma as it was at some point in the past.
• 13:28
  SPEAKER_00: Certainly some of the PPE decision making is based on a combination of need for health care in terms of emergencies versus routine care.
• 13:36
  SPEAKER_00: And then some of those decisions are based on availability of data and safety of procedures, too.
• 13:43
  SPEAKER_00: I think one of the limitations that COVID-19 has brought up is limited data about PPE and aerosol generating procedures in dentistry.
• 13:54
  SPEAKER_00: Would you like to touch a little bit more on some of those limitations?
• 13:59
  SPEAKER_01: COVID-19 has been a huge challenge for people like me, people who develop clinical practice guidelines and policies and synthesize evidence to inform these policies.
• 14:10
  SPEAKER_01: One comparison I've heard being made is the similarity between SARS-CoV-2 and the HIV epidemic of the 80s and 90s.
• 14:18
  SPEAKER_01: And really, you know, where that comparison starts is this virus jumped from an animal reservoir to human beings and then spread.
• 14:25
  SPEAKER_01: And what this means is that this is novel, this is new, and we really didn't understand this at the beginning because it was so new.
• 14:33
  SPEAKER_01: And so I think really where we focused our energy in April and March was to understand what evidence we should be identifying, what it says, and moving forward with that evidence.
• 14:46
  SPEAKER_01: And what we saw was that there really wasn't much evidence in the context of this specific virus and how it moved within the population and how it moved specifically within a dental clinic.
• 14:56
  SPEAKER_01: Ideally, when we were creating our policies and guidelines, what we would have are a wealth of evidence.
• 15:03
  SPEAKER_01: So we would have systematic reviews with really robust methodologies to inform our guidelines and policies.
• 15:09
  SPEAKER_01: But of course, we didn't have that and we needed to say something.
• 15:12
  SPEAKER_01: Dentists need to know how to proceed.
• 15:14
  SPEAKER_01: They need to know what patients to see, they need to know how to minimize transmission risk within their practices.
• 15:19
  SPEAKER_01: And these were the questions that we were asking ourselves and really digging through all of the evidence to find answers to.
• 15:26
  SPEAKER_01: Something we really focused our energy on, and you touched on this, Mike, was the aerosol generating procedures.
• 15:32
  SPEAKER_01: So in dentistry, we generate a lot of aerosols.
• 15:35
  SPEAKER_01: Quite previously in dentistry, we were focused on as long as had splatters or bigger particles than those that are found in aerosols.
• 15:42
  SPEAKER_01: And so our PPE was designed to minimize transmission of infectious diseases based on these splatters and not necessarily aerosol generating procedures.
• 15:52
  SPEAKER_01: And therefore, we really needed to dig into not only dental literature of which there was not much evidence in regards to this issue, but also from other fields, including anesthesiology.
• 16:02
  SPEAKER_01: And that evidence is what really informed our recommendations for PPE and infection control, specifically for COVID-19.
• 16:12
  SPEAKER_01: As with all evidence, new evidence allows us to update our knowledge and it goes on and on and on.
• 16:17
  SPEAKER_01: So as more evidence is collected and disseminated, we'll have a stronger confidence in our estimates of effect and be able to really stand behind our recommendations more and more and more.
• 16:27
  SPEAKER_01: And obviously, as close epidemiologists and policymakers, what we really want is a wealth of evidence.
• 16:32
  SPEAKER_01: And so it's encouraging to see researchers and medical professionals working together to collect this so that we can really have the most robust policies moving forward.
• 16:43
  SPEAKER_00: I think those are great points.
• 16:44
  SPEAKER_00: Certainly, guideline documents can be generated but aren't always followed.
• 16:48
  SPEAKER_00: Do you think that any of the recommendations you have have have changed dental practice?
• 16:53
  SPEAKER_00: What do you think has driven some of those changes?
• 16:56
  SPEAKER_00: And on a day-to-day level, what do you think dentists are doing differently now as opposed to before?
• 17:03
  SPEAKER_02: In our latest surveys conducted at the ADA, there's a description of a large endorsement of these recommendations.
• 17:11
  SPEAKER_02: If we start looking at some data at the moment, there's no fully documented outbreak of COVID-19 in dental clinics.
• 17:21
  SPEAKER_02: Somehow that is giving us a sign that after three months of reopening, studies are coming out now, providing accurate estimates and some data, but basically preliminary observations suggest that that transmission may be extremely minimum, which is a good news.
• 17:37
  SPEAKER_02: If you need to think about what are the potential reasons for that, and you cross that with the survey suggesting that dentists have PPE available and actually having implemented many of the measures, I would say that probably the measures that are implemented at the moment seem to be effective.
• 17:53
  SPEAKER_02: Of course, this is observational data.
• 17:54
  SPEAKER_02: As you know, we have data from approximately 2,000 and something clinics.
• 17:59
  SPEAKER_02: I think it's 22,500 clinics overall.
• 18:03
  SPEAKER_02: At the moment, it seems that these measures are working.
• 18:06
  SPEAKER_02: And I think that's a great news in general.
• 18:08
  SPEAKER_02: We also see, which is another irrelevant aspect, all these different measures, screening over the phone, for example, which is something that was not done in the past necessarily in the dentistry in the way it's done now, screening for COVID-19, triaging different procedures according to the urgency that is attached to them.
• 18:28
  SPEAKER_02: Those are things that, compared to what happened in the past, is definitely a change in practice.
• 18:33
  SPEAKER_02: How the entire dental clinic, the workflow to desinfect and cleaning between patients is also something that has changed compared to some of the aspects of what was done in the past.
• 18:44
  SPEAKER_02: And it has to change quickly.
• 18:46
  SPEAKER_02: The CDC is changing its recommendations relatively frequently.
• 18:50
  SPEAKER_02: New evidence is emerging over time.
• 18:52
  SPEAKER_02: And you see that overall in all these webinars that discuss issues of infection control and the latest evidence, the audience is always massive.
• 19:01
  SPEAKER_02: And I personally feel very happy to see that.
• 19:04
  SPEAKER_02: It means that clinicians truly care and they really will try to implement this evidence as soon as possible.
• 19:11
  SPEAKER_02: The hard data suggesting that the outbreaks of COVID-19 in dental clinics is minimum to none seems to corroborate with hard numbers that that might be the case.
• 19:21
  SPEAKER_02: I think there was no choice here as to whether you want to change your practice according to emerging evidence.
• 19:27
  SPEAKER_02: That is not a question anymore.
• 19:29
  SPEAKER_02: Now it's a matter of how that can happen and how healthcare agencies and professional organizations can help clinicians to implement that knowledge faster and in a more efficient manner.
• 19:41
  SPEAKER_00: I'd like to emphasize one point in particular.
• 19:44
  SPEAKER_00: You're absolutely right.
• 19:45
  SPEAKER_00: There haven't been any substantial outbreaks of COVID-19 in dental settings.
• 19:49
  SPEAKER_00: Sometimes the absence of data or negative studies is hard to publish, but I think it's very important to emphasize that to the public and the general dental community.
• 19:59
  SPEAKER_00: Certainly, I think a lot of the current publications that get the most press are related to whether or not something generates aerosols or if COVID-19 is airborne.
• 20:09
  SPEAKER_00: But the studies that show that appropriate PPE really reduces the risk of transmission are generally underreported as well.
• 20:16
  SPEAKER_00: So I hope that data is published or shared or disseminated widely so that we can reassure dentists and the general community, because there's certainly a lot of anxiety even among patients about going to see their dentist as well, to tell them that, listen, if you have a dental emergency or you need additional dental care, you should still see a dentist.
• 20:38
  SPEAKER_01: You bring up a great point, Dr.
• 20:39
  SPEAKER_01: Durkin, specifically related to preventive dental care.
• 20:43
  SPEAKER_01: I think something that we have incorporated into our guidance is the need for prevention of dental carry specifically to continue during the COVID-19 shutdown.
• 20:54
  SPEAKER_01: And that really, really shouldn't be forgotten.
• 20:57
  SPEAKER_01: I think public health and dentistry are working very closely together at the moment, and we're really encouraged to see that.
• 21:03
  SPEAKER_01: And this includes not only the application of sealants in children and those who need it in other age groups, but also interventions like silver diminish fluoride and non-restorative procedures that really move us away from using hand drills and hand pieces to more, again, non-invasive, minimally invasive treatments.
• 21:21
  SPEAKER_01: And one final point I want to make is that about our latest guideline on antibiotic therapy for urgent pulpal and periapical conditions.
• 21:29
  SPEAKER_01: And in common uh language, what that means is everyone gets a toothache and their mouth swells.
• 21:35
  SPEAKER_01: And that's what I mean when I say pulpal and periapical.
• 21:37
  SPEAKER_01: And what we recommended for that guideline was to not describe antibiotics for immunocompetent patients unless there was a risk for the infection spreading.
• 21:48
  SPEAKER_01: One priority that the ADA had when releasing our COVID 19 guidance was to emphasize not only preventive treatments like sealants and SDF, but also minimize the use of antibiotics to.
• 22:00
  SPEAKER_01: The care of patients.
• 22:01
  SPEAKER_01: That in the pursuit of stopping one public health crises, we didn't want to start another one.
• 22:06
  SPEAKER_01: So that was also worked into the guidance that we put out.
• 22:11
  SPEAKER_00: Yeah, Mal, that's that's fantastic because certainly there are numerous opportunities for dentists and physicians to work together to handle both the pandemic in terms of long-term and short-term issues, as well as handling and making sure we stay focused on other collaboration opportunities too, including antimicrobial stewardship.
• 22:31
  SPEAKER_00: What additional opportunities do you see for collaboration in dentistry and other healthcare settings?
• 22:37
  SPEAKER_01: I think the pandemic in the short and long term has lent an enormous light to the research and public health communities.
• 22:43
  SPEAKER_01: And I'm so excited to see real influence being handed to the public health communities.
• 22:48
  SPEAKER_01: I hope to see that continue.
• 22:50
  SPEAKER_01: And I also want to shed some light into how dentistry has really taken this opportunity to be more and more connected with the medical community and the research communities and evidence-based communities.
• 23:01
  SPEAKER_01: I think we're really pushing to make sure that we're as evidence-based, as research-oriented as possible.
• 23:07
  SPEAKER_01: And I also wanted to add, this is a great opportunity for researchers at every level.
• 23:11
  SPEAKER_01: So this includes young researchers, mid-careers, senior researchers, and there are so many mentorship opportunities available if we seek them and we offer them to those under us.
• 23:22
  SPEAKER_01: I think this pandemic has really highlighted the importance of science, the importance of working together.
• 23:29
  SPEAKER_01: And really, my last thought is that when and if the next pandemic comes, it's and it's primarily respiratory disease, we at the ADN and Dentistry have a much more organized and collaborative way of proceeding.
• 23:41
  SPEAKER_01: And that gives me a little bit of solace amongst all of this difficult stuff.
• 23:48
  SPEAKER_00: That's great.
• 23:48
  SPEAKER_00: In closing, for individuals that are interested in learning more about coronavirus resources provided by the ADA Mel or Alonzo, would you like to share the website or additional links to evidence-based practice guidelines at the ADA?
• 24:05
  SPEAKER_01: Sure, Mike.
• 24:06
  SPEAKER_01: The website, our digital platform for all of our COVID-19 resources, can be found at ADA.org backslash virus.
• 24:15
  SPEAKER_01: And our library of systematic reviews and clinical practice guidelines can be found at cbd.ada.org backslash evidence.
• 24:25
  SPEAKER_00: Thank you very much to our speakers, Malavika Tampi and Alonzo Carrasco Labra for joining us today and sharing your perspectives and experiences.
• 24:34
  SPEAKER_00: And a sincere thank you from Shay and to all healthcare personnel for all that you are doing to respond to COVID-19.
• 24:42
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 24:51
  SPEAKER_00: You will also find additional resources such as recorded webinars, healthcare facility outbreak preparedness, and SHA COVID-19 town halls, and the additional podcast series COVID-19 update, What Do We Know Now, which is released every Thursday.
• 25:08
  SPEAKER_00: That concludes this episode of the Allies and Infection Prevention Podcast Series.
• 25:13
  SPEAKER_00: Thank you for tuning in.