ACHIEVING QUALITY DENTISTRY FOR LIFE

COVID-19 Update

​Dr. Lyford Introduces another layer of safety to Protect Against COVID
FOGGING
Applicable to everyone! everywhere!

Not Letting Your Guard Down (making lemonade from lemons-hypochlorous acid fogging):

Below are some relevant facts about the current  pandemic, which in the United States is far from over.  I believe that fogging is certainly relevant in a dental or medical environment, but I also believe fogging is applicable in schools, town, and city offices, especially where the public accesses spaces, and even at home.  I will provide links that anyone can access for supplies, fogging equipment, and sources for all.  Fogging is no replacement  for wearing a mask, washing hands, disinfecting surfaces, and social distancing, but it certainly makes sense as people will begin to get out more, kids go to school and other functions, and people travel more.

Important facts recently released in Medical and Public Health Publications:

Are symptoms predictive of who is infected and who is not?

These are samples from the United States:

Symptom                            Tested Positive                 Tested Negative

Fever                                                 27.74%                                  26.25%

Persistent Cough                              44.77%                                  41.24%

Shortness of Breath                        13.05%                                  12.03%

So, what is going on?

A large study of patients (805,703) from both the UK and USA using the above symptoms as a predictor of COVID-19 infection found that using these as a predictor for COVID-19 was wrong 82.57% of the time!

35% of patients infected with COVID-19 have no symptoms (CDC)

Need we worry about these patients if no symptoms are present in these patients?

In the journal Nature, there was a recently published finding by Chinese doctors that 57% of asymptomatic patients showed viral damage to their lungs based on CT scans.  A significant number showed viral damage to their kidneys, and there are now reports of previously perfectly “healthy” asymptomatic patients who develop Type I  diabetes as a result of autoimmune reactions to the pancreas induced by the “asymptomatic” infection of COVID-19.  This virus has the potential to cause chronic disease that could affect people for their lifetimes.   Furthermore, studies from Wuhan, China show that asymptomatic patients shed the virus longer than those with symptoms…this means they are potentially infective longer than those with symptoms that have the virus.

40% of COVID-19 spread occurs when patients are pre-symptomatic or asymptomatic…(CDC)

This virus is not just a threat to the elderly and infirmed…this virus is “taking down” healthy young people and those asymptomatic as well…

Aerosols and COVID 19Normal speech can transmit the virus.  A sneeze can transmit the virus more than 26 feet from the source.  Published in PNAS (Publication of the National Academy of Sciences, USA) recently was an interesting article by Stadnytskyi et. Al. (https://www.pnas.org/content/117/22/11875) that showed the virus is, in fact, in the air when infected individuals  speak normally, is in effect, and lasts for 16 hours

So, what do we do?  This is a 3-dimensional challenge to contain the virus, it is not just a blood borne surface issue, it is an aerosol control issue. The answer is hypochlorous acid fogging which we use in the rooms where we treat patients and greet patients.  And this is applicable in your work environment and home as well:

Hypochlorous acid is actually a natural defense produced by neutrophils of our immune system.  Neutrophils are part of our first line of defense against infection.  Hypochlorous acid is used in the  restaurant, grocery, and food preparation world as a non-rinse disinfectant.  It is a weak acid (pH 5.5-6.5), non-corrosive, non-caustic, evaporates rapidly leaving no residue, safe disinfectant.  It is skin friendly, eye friendly, inhalable, and ingestible.  Above 50 ppm Hypochlorous acid is virucidal.  At concentrations of 100-200 ppm it kills Norovirus and Avian Influenza Virus.  Uses of hypochlorous acid include:

At up to 20 ppm it is used as an eyewash (TheraTears)

At up to 60 ppm it is used as a no rinse sanitizer for food:  when you see vegetables being “misted or fogged” in grocery stores it is usually hypochlorous acid, not just water to increase the shelf life and keep the produce from degrading due to microbes like yeast , bacteria, and mold.

At up to 100 ppm it is used in plastic surgery to disinfect surgical wounds.

At 200 ppm it is an effective surface disinfectant with viral kill in less than one minute.

Effective fogging requires a small enough particle size to be suspended in the air long enough to kill microbes, in this case the ideal particle size is 20 microns.  It also requires a concentration of hypochlorous acid (200 ppm) at the correct pH (5.5-6.5) to effectively kill the virus and other pathogens.

This practice has  been adopted by commercial airlines, private jet owners, cruise ships, and hospitals around the world.  It has been in use for many years in restaurants, meat industry, and grocery stores.

Hypochlorous acid can be readily purchased, or tablets such as PurTabs can be purchased which can make an appropriate concentration of hypochlorous acid for about 50 cents a liter.  You can purchase hypochlorous acid generators (they look like a typical blender in your kitchen) and using non iodized salt (Kosher salt), water and a little white vinegar (to adjust the pH) to make hypochlorous acid in 15 minutes for about 9 cents a liter.  These generators will last 3-5 years per the manufacturer.

Proper fogging leaves no residue, does not leave floors damp, and takes a short amount of time.  We are fogging after each patient visit and twice a day in common areas.  This will not take the place of cleaning and disinfecting all surfaces and equipment and sterilizing all instruments, and the use of PPE (masks, gowns, eye protection etc.).  It is an adjunct to our Medify Air Filtration, universal precautions, and normal sterilization protocols.

I hope this information has been useful and reassuring…and I hope when you put all this information together you can appreciate:

The importance of wearing a mask whenever you are in public…it is NOT Rocket Science!  Care enough…then we all win…because we are all in this together…like it or not…

Links for fogging equipment and supplies:

Hypochlorous Acid Generatorhttps://store.ecoloxtech.com/ecoone

                All that is needed is non-iodized table salt (Kosher Salt) and white vinegar

Hypochlorous Tablets: 

Purtabs:  https://evaclean.com/products/evacleans-purtabs

                These are available on Amazon and Ebay as well.  Three different strengths are available, remember 200 ppm is the concentration desired for fogging.

          Brutab 6S: http://bhcinc.com/our-markets/healthcare/healthcare-programs/brutab-6s/

Fogging Machines: There are a myriad of resources out there.  Much of the tip technology comes out of the greenhouse world:

https://onlybestgoods.com/products/110v-handheld-ulv-fogger-machine-4-5-liter

https://www.amazon.com/fogger-machine/s?k=fogger+machine

I encourage you to search the web.  Keep it simple, you do not need electrostatic sprayers/ foggers.

For those of you that have a little “MacGyver” in you, I have built one for less than 200 dollars for use in the Practice.  I will be posting sources and will be collaborating locally with a tremendous resource that we hope to be able to make available foggers for use at home and work.  Stay tuned! 

May 2020 Reopening Protocol from Dr. Lyford

Dr. Lyford 

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