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Dr. Neal Rogol and dental assistant Stephanie King perform a dental procedure on their patient Sole Sheibav last week.

On March 17, 2020, the Rhode Island Department of Health informed Dr. Neal Rogol that he, like countless other small business owners around the state, had to close down. “It was a forced vacation that wasn’t a vacation,” Rogol, a family dentist whose office is at 24 Salt Pond Road in South Kingstown, said.

Dentistry has always been on the forefront of infection control, according to Rogol. Viruses that have beset civilization throughout the last several decades have compelled medical professionals to wear more personal protective gear – such as gloves, scrubs or some other barrier to cover clothing and masks, so he sensed what changes COVID-19 would herald. When his practice reopened at the end of May, 2020, the Rhode Island Dental Association instructed all dentists to wear “a heavier filtration mask,” and it distributed them to dentists for emergency situations.

“The dental association really came to bat,” Rogol said. “The association distributed hand sanitizers for all the offices, a certain number of high-filtration masks, and disposable gowns. We implemented the use of N95 masks, which have the highest filtration rate possible.” Rogol also procured face shields because, he explained, “When you’re using drills, you’re creating aerosols, and the coronavirus is spread through aerosols, or droplets.”

There was also equipment that dentists were instructed not to use, such as the ultrasonic cleaner, which is used to clean heavy deposits of hardened tartar, known in his profession as “calculus.” These machines also produce aerosols. Rogol’s hygienists had to perform “hand scaling” until the restrictions eased; they became more knowledgeable about the virus, and people were vaccinated. “At one point, many offices were not even doing cleanings,” Rogol said. “We weren’t even polishing.”

Gradually, dentists started polishing and resumed the use of the ultrasonic cleaner again when the Centers for Disease Control gave them permission to “do everything that we wanted to do,” according to Rogol. Presently, Rogol’s office is a bulwark against the disease. All surfaces are cleaned with an antiviral hydrogen peroxide-based barrier. At an out-of-pocket cost of roughly $5,000, Rogol purchased two air filtration machines, which use active pure technology, and three “extra-oral evacuation” (outside of the mouth) machines that evacuate aerosols and contain three layers of filtration.

Rising inflation and the supply-chain crisis have made the N95 masks both more expensive and difficult to purchase. “Hospitals told their staff they had to use the same masks over and over again, but I didn’t want to do that, so I stocked up as much as I could.” Initially, he also followed the advice of putting the masks in sealed Tupperware containers until the masks became more readily available. The gloves, which Rogol said, once cost $6.99 a box, shot up to $24.99 a box. They’ve returned to a reasonable $8.99 a box, but the initial expenses were significant.

Rogol instituted other precautions as well, including restricting the number of patients who could sit in the waiting room. At one point, some of his patients had the option of waiting in their car to be called in for their turn. “We’re still requiring all patients to wear masks in the office until they sit in the chair. It’s very controversial, because the state has lifted the restrictions, but in a health care setting, masks are appropriate,” Rogol said. “We are screening all staff members, and we take the temperature of all patients when they come in. We make sure they are healthy and haven’t knowingly been exposed to anybody with a virus.”

Part of this screening process involves patients completing a COVID questionnaire, and all patients, prior to treatment, have to rinse their mouths with a hydrogen peroxide solution. “We’re trying to protect everybody, and patients understand and appreciate that.”

Rogol says things may never be the same as before the pandemic.

“I don’t know if it will ever be the way it was before,” he said. “I still have patients who won’t come in unless they have discomfort or pain. The phobia of the virus sometimes outweighs the need for preventative care. Dental care is tied to overall good health, so it’s more important than ever to maintain good health.”

Stephanie White, the owner of Optimal Wellness Therapeutic Massage at 24 Salt Pond Road, has been a massage therapist for 10 years, and the trials and tribulations of being a small business owner were never more pronounced than they have been the past two. In March, 2020, when COVID-19 was spreading rapidly, she was forced to shut down her business for four months, which put her and her family in an economic bind.

She had no income for a couple of weeks until she became eligible for pandemic unemployment insurance, which covered, she estimated, about 70% of the income she received in pre-COVID times. In the interim, White said, “I still had overhead, and we had to forgo a lot of bills at home. One was the mortgage payment. You spend 10 years building a business, then all of a sudden…”

White’s business expenses were adding up as well. “The majority of people who work in this industry (massage therapy) are independent contractors, so we were not eligible to receive PPE (Personal Protective Equipment) as (Internal Revenue Service form) 1099 employees.” White explained. When the Rhode Island Department of Health informed White on that last day of May, 2020, that she could reopen in June, she and her staff were unprepared. “We couldn’t open right away because we had to buy things we needed. We had to buy all sorts of air filters, and we had to follow all kinds of cleaning protocols and have different types of equipment to be compliant,” White explained.

She was able to re-open Optimal Wellness on July 1, but she and the other therapists had to get accustomed to the post-COVID adjustments the virus imposed on all sectors of society. “We had to take fewer clients because we needed more time to clean; plus we had to screen all of our clients to make sure everybody was healthy and following the rules” she said. “And laundry is more expensive, the cleaning supplies, the air filters, all the equipment is more expensive. We now employ professional cleaners instead of doing our own cleaning.”

White herself caught COVID in November 2020, but credits her protocols for ensuring that none of her clients reported getting sick.

“Somebody in my family tested positive, so I immediately got tested,” White said. “I had been at work because I didn’t know I was positive. I called every client that I had seen that week, and not a single person got sick, because we followed all the protocols. After that, a lot of people didn’t want to come in because I got COVID. It made me more comfortable with the precautions I was using because not a single person ended up getting it.

“That was probably the worst thing, telling people they were exposed,” White added. “I called everybody for the week, maybe about 15 people. We followed strict protocols, and obviously it paid off.”

More strict protocols and mitigating measures followed as the Omicron variant began to spread. In October, 2021, the Department of Health mandated that anybody who held a license with its agency had to be vaccinated. Two of her staff did not want to comply, so Optimal Wellness is down to three massage therapists.

As the Omicron variant appears to have peaked, and Gov. Dan McKee has relaxed his masking and vaccination mandates, White is more optimistic about the future. “I think people are more comfortable doing a one-to-one activity as opposed to being in a large crowd,” she said. “Everybody’s been pretty good about not coming in when they don’t feel well. One week we had 10 cancellations from people who either weren’t feeling well or who tested positive, but lately, we are in a good phase. We haven’t had any cancellations in the last two weeks. The problem is having to pivot with all the different changes. The cost of everything goes up, and you look around and see all these other businesses closing. It is just exhausting having to keep up.”

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