The AAPD has been regularly updating membership regarding on this page regarding Small Business Administration (SBA) loan opportunities, both the Economic Injury Disaster Loan (EIDL) and the new Paycheck Protection Program (PPP). The PPP officially opened on April 3, 2020.
 
Unfortunately, interim guidance released by the SBA concerning EIDL and PPP prompted the ADA to send out an Action Alert.

This latest SBA guidance appears to indicate that small businesses will now be ineligible to apply for a PPP loan if they received EIDL dollars after April 3, 2020.  Many small businesses that have applied for the EIDL were under the impression that they could also apply for PPP loans in the future if they chose to do so.  All of the guidance from the various Congressional committees and other sources have stated that a small business can apply for both, with no deadline beyond the covered period in the legislation. The guidance also seems to contradict legislative language from the CARES Act. Further, the SBA has been accepting the EIDL applications with no caveat that it might make someone ineligible for PPP. 
 
The AAPD also sent the ADA Action Alert to our Grass Roots Network yesterday urging a response. 

THERE IS GOOD NEWS TO REPORT THIS MORNING FROM THE ADA:

Thank you for your interest in sending a grassroots alert on this issue. Due to the overwhelming response from ADA members across the country, SBA reached out this morning to inform the ADA that they will be clarifying the rule. Until we receive that clarification, we will be holding off on sending any additional communications to regulators and legislators. Thank you again for being an advocate!

~ The ADA Grassroots Team 

If you have any questions contact COO and General Counsel C. Scott Litch at 312-337-2169 ext. 29 or slitch@aapd.org.

New PEDO Teeth Talk Episodes regarding COVID-19 are now available.

Leadership, Ethics and Managing through a Crisis that we Never Imagined Would Happen
This inspiring and informative podcast with Professor Timothy Feddersen of the Kellogg School of Management guides us through the steps for right actions in managing the pandemic.  You will learn protocols for managing today, as well as planning for the future, with empathy and “lean out” leadership.
 
One Pediatric Dentist’s Observations and Actions to date in early response to COVID-19
In this interview with Dr. Ron Hsu of Vancouver, WA, you will hear how one practitioner respondedin a location hit early and hard by the COVID-19 crisis. With experience in DSOs and private practice, Dr. Hsu discusses his strategic actions throughout the crisis, from the beginning until today.

Subscribe to Pedo Teeth Talk so you don’t miss any COVID-19 specific episodes being released. Listen on aapd.org.
 
Dentist Volunteer Opportunities During Pandemic
The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a federal program created to support states and territories in establishing standardized volunteer registration programs for public health emergencies. As a pediatric dentist, your time and expertise could be invaluable. To volunteer, you can register online with ESAR-VHP and be ready to serve. Since volunteer registration differs from state to state, visit this site here and click on your state of residence.
 
SBA PPP Loan Program Opens Today
See our update from earlier this week on April 1, 2020 and the PEDO Teeth Talk Podcast Episode featuring Mike Graham, the ADA’s Senior Vice President for Government and Public Affairs, as he quickly and simply breaks down the meaning of the CARES Act for dentists and their practices.  He explains the different loans/grants and the timing for application, what may come next, and clarifies some of the confusion regarding the meaning of the CARES Act. Mike is connected to the pulse of activity in Congress regarding this package and conversations regarding future possible funding. Listen here.

The American Dental Association (ADA) issued a new interim recommendation that dentists limit their practices only to urgent and emergency procedures until April 30, in keeping with the recent recommendations from the U.S. Centers for Disease Control and Prevention. Learn more here.

ADA New Interim Guidelines for Minimizing Risk of COVID-19 Transmission

CDC Guidelines

According to the statement, “The ADA recognizes that existing and future local or state government mandates supersede ADA recommendations. In addition, state dental associations may best understand local challenges being faced and make recommendations appropriate to members in their areas.”

ADA’s interactive state-by-state map with regulations, recommendations and mandates regarding the safe practice of dentistry during the COVID-19 pandemic and number of cases in each state.

The recommendations encourage individual dentists to “exercise professional judgment and carefully consider the risks outlined in the ADA’s interim guidance and weigh those risks against any possible benefit to the patient, the practice employees, the community at large, and the practitioner.” The recommendations also emphasize the high risk of transmission for dentists, staff and patients due to the proximity of individuals during dental procedures, and the critical importance of the availability of appropriate personal protective equipment (PPE) during emergency and urgent care.

The Coronavirus Aid, Relief and Economic Security (CARES) Act, a $2 trillion stimulus package designed to help citizens, states and businesses nationwide devastated by the pandemic, was signed into law on March 27, 2020. The CARES act includes a significant increase in funding of $349 billion to the Small Business Administration (SBA) to guarantee loans to small businesses to help alleviate economic injury directly caused by the coronavirus. These loans may be used to pay for employees’ COVID-19-related sick leave, mortgage or rent, and other overhead expenses. Businesses will need to apply through banks and credit unions. The bank holding your business account is a good place to start. For more information on Small Business Interruption 7(a) Loans under the CARES Act, click here.

It is important to understand that Under the CARES Act, the SBA COVID-19 Economic Injury Disaster Loan (EIDL) received an additional $10 billion and is now available to employers in all U.S. states, Washington D.C., and territories. Since the EIDL 7(b) loans are awarded on a first-come, first-served basis, online applications should be completed promptly. You will find the updated EIDL Application page here.

If the SBA website is overloaded, the ADA recommends it may be best to apply after 9 p.m.

The CARES Act also created a new Paycheck Protection Program (PPP) Loan. Starting April 3, 2020, small businesses and sole proprietorships can apply for and receive PPA loans to cover their payroll and other certain expenses through existing SBA lenders. Understanding these options and determining what is best for your practice can be confusing. We strongly encourage that you review this fact sheet prepared by the ADA and Academy of Dental CPAs. Also note that on the evening of March 31, 2020, the SBA released the loan application for the PPP plus an information sheet containing loan guidelines.

Any information you may have seen suggesting that both EIDL and the PPP Loan cannot both be applied for is incorrect. A former draft of the CARES Act would have prohibited this, but last minute negotiations changed that prohibition.

Further, the ADA understands that you can roll your EIDL loan into the PPP loan. An EIDL grant/advance of up to $10,000 will be deducted from any loan forgiveness someone receives if they roll the EIDL into the PPP, but not the full EIDL amount. ADA encourages dentists to get both and then roll in the EIDL for better loan terms on any of the remaining balance from the combined loan after receiving assistance. The immediate cash infusion of  $10,000 from the EIDL should be very attractive to many pediatric dentists right now. As noted, you would then take the up to $10,000 deduction from any loan forgiveness you might later receive.

The U.S. Chamber of Commerce has also provided a Coronavirus Emergency Loans Small Business Guide and Checklist, which can be accessed here.

The AAPD continues to strongly recommend that you should also contact your main practice lender bank for other sources of relief from current loan payments such as deferred payment, interest-only payments, and/or short-term low interest loans. Pediatric dentists have reported favorable outcomes utilizing this approach. 

In keeping with our attempts to apprise our membership of important changes and clarifications in the midst of the COVID-19 pandemic, we want to provide the latest from the CDC. Our previous communications have tried to advise members to look to reliable sources for information and advice. The CDC continues to represent the best information, derived from national and international surveillance and analysis by our country’s best epidemiologists and dental analysts. 

Also in keeping with the AAPD’s position, we encourage members to seek current information from local and state authorities that may more directly affect efforts in your location. Because of the changing nature of this pandemic and strategies to address it, regular scrutiny of reliable resources will be the best way to provide for patients, insure their safety and protect you and your staff.

The Centers for Disease Control and Prevention (CDC) released Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response on March 26, 2020. These guidelines offer worthwhile direction to pediatric dentists nationwide and may serve to influence state-level decisions regarding the safe practice of dentistry during the pandemic.

Recommendations Summary

Postpone Elective Procedures, Surgeries, and Non-urgent Dental Visits.
Services should be limited to urgent and emergency visits only during this period of the pandemic. 

Stay at Home if Sick.
Ask employees to stay home if they have symptoms of respiratory infection and send staff home if they develop symptoms while at work.

Contact Patients Prior to Clinically Urgent/Emergency Dental Treatment.
Call all patients before their scheduled appointments and screen for symptoms of respiratory illness over the phone. If the patient reports signs or symptoms of fever or respiratory illness, dental and medical providers should work together to determine the appropriate facility for emergency treatment.

Know Actions to Take if a Patient Has Suspected/Confirmed COVID-19.
Clean and disinfect the room and equipment according to the Guidelines for Infection Control in Dental Health-Care Settings. Clean, disinfect, or discard the surface, supplies, or equipment located within 6 feet of symptomatic patients, and use EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program from use against SARS-CoV-2. 

The AAPD urges its members to review the newly posted guidelines in their entirety, found here. 

Additional information from the AAPD on Infection Control can be found here.  

Information on the COVID-19/Coronavirus changes almost daily and the American Academy of Pediatric Dentistry urges its members to keep current on the evolving science and best practices to protect themselves and the families they care for. The fast spread of this illness and the world’s inexperience with it make staying current even more important:

1. Keep abreast of changes in understanding and addressing the virus. This means following the course of the virus every day. Government and professional health organizations provide the most up-to-date and accurate information. Some sites you may find useful are:
   • Centers for Disease Control and Prevention (CDC)
   • American Dental Association
   • American Academy of Pediatrics
   • U.S. Department of Education
2.  Avoid claims and information from non-mainstream and non-reliable or unverified sources which may provide erroneous and even dangerous advice or recommendations. 
3. Evaluate the need for precautions and changes in your personal behavior based on sound information. Work, travel, meeting attendance, and other potential sources of exposure are usually addressed in guidance by reliable sources. AAPD will advise its members of changes and precautions related to meetings and other events, based on sound science and best practices in advance. We are looking to the CDC and WHO to provide recommendations on travel. At this time, there are no bans or suggestions not to travel within the U.S. Learn more here.
4. Practice-related precautions should follow the advice of recognized authorities. Members should keep abreast of recommendations at the local, state, and national level that relate directly to their individual circumstances. State and county health departments are good sources of information relative to local circumstances.
5. This virus has demonstrated the need for personal responsibility in controlling its spread. This means attention to your own risk status, current health, and the health of your family. This is especially important for those who are at greater risk of infection, such as the elderly and those with weakened immune systems. Taking recommended steps to minimize spread of infection while ensuring that you seek and receive the appropriate care is the best advice. Your personal physician and local health authorities remain the best sources of information should you have questions about or require care for suspected infection.

AAPD will closely monitor information as it emerges and when necessary, advise members of changes and recommendations that will protect them, their families and their patients, and help them plan for future events.