The Governmental Orders by Layer
The orders that reached dentistry came from every layer of government and every class of authority the Suspension Clause names: the President and the federal agencies, the governors and State health officers, the State boards of dental examiners, the county and city health officers of the largest metros, the State occupational-safety agencies, the tribal governments and the territorial governors. In the spring of 2020 at least thirty States and the District of Columbia ordered dentistry closed to everything but emergencies by an instrument that named the profession; every other State confined the patient base to the home under a stay-at-home order while its dental board directed emergency-only care; every State that reopened did so on conditions written into an order; and in the third quarter of 2021 the federal workplace standard, the federal enforcement program, the health-care vaccination orders and the health-care masking rules, occupational-health and airborne-transmission controls, of the States and metros reached every operatory. This section inventories the instruments by layer; the tables on this page tabulate them.
The universe
Between March 1 and May 31, 2020, forty-two States and territories issued mandatory stay-at-home orders covering 2,355 of the nation's 3,233 counties.18 The American Dental Association's fifty-State workbook of June 26, 2020 records, State by State, a governor's, health department's or board's instrument limiting dental practice in every State, the District of Columbia, Puerto Rico and the Virgin Islands, and the American College of Surgeons' tracker of executive orders on "Dental, Medical, and Surgical Procedures" records the same regime from the surgical side.19 On July 2, 2021, thirty-five States had emergency declarations in force and nine had statewide mask requirements, airborne-transmission controls on every indoor public space; on September 21, 2021, twenty-five States had emergency declarations and eleven had statewide mask requirements.20 The Library's records for this industry are cited on this page for what each instrument says, never as a count of the orders that reached any employer.
The federal layer
2020
The President proclaimed a national emergency on March 13, 2020, and the Secretary of Health and Human Services had declared the public health emergency on January 31, 2020.21 The Centers for Medicare and Medicaid Services recommended on April 7, 2020 that non-emergent, elective medical services and treatment, "including dental procedures," be postponed, a recommendation the Governor of Florida recited as the premise of Executive Order 20-72 and that the States made mandatory in the instruments below.22 The Federal Emergency Management Agency's allocation rule of April 7, 2020 designated N95 filtering facepiece respirators, other filtering facepiece respirators, elastomeric respirators, surgical masks and surgical gloves as scarce or threatened materials, barred their export without FEMA's approval and subjected them to allocation orders; it was extended on August 10, 2020 and December 31, 2020 and ran to June 30, 2021.23 The Department of Defense postponed every elective dental procedure in every military dental treatment facility from March 31, 2020 for sixty days and permitted resumption facility by facility only from May 21, 2020; the Department of Veterans Affairs announced on March 27, 2020 that its COVID-19 Response Plan postponed elective and non-emergent procedures across its facilities, an announcement cited here as evidence of that postponement and not as an order.24 The Secretary's emergency-use declarations of March 2 and March 24, 2020 and the Food and Drug Administration's authorizations for NIOSH-approved and imported respirators governed the respirator supply on which every reopening order conditioned dental practice.25 The Office for Civil Rights' telehealth notification of March 17, 2020 and the Drug Enforcement Administration's telemedicine designation of March 16, 2020 were the federal predicates of the teledentistry triage the closure orders left in place of the visit.26 CMS's blanket waivers, retroactive to March 1, 2020, governed the Medicaid and CHIP dental programs' payment rules for the period.27 The Families First Coronavirus Response Act compelled paid leave from April 1 to December 31, 2020 for every employee under a quarantine order or caring for a child whose school an order had closed, a mandate that fell on an industry whose workforce is overwhelmingly women.28
2021, first and second quarters
The CDC's conveyance order imposed an airborne-transmission control, a mask on every person boarding, riding or waiting, on every conveyance and at every transportation hub from 11:59 p.m. on February 1, 2021, enforced by TSA security directives with civil penalties.29 OSHA's National Emphasis Program of March 12, 2021, DIR 2021-01, targeted inspections at the industries with the highest exposure, and its appendix named NAICS 621210, offices of dentists.30 FEMA's allocation rule ran to June 30, 2021, with additional exemptions noticed June 11, 2021.31 OSHA announced the COVID-19 Healthcare Emergency Temporary Standard, 29 C.F.R. part 1910, subpart U, on June 10, 2021 and published it at 86 Fed. Reg. 32376 on June 21, 2021, effective that day, with compliance dates of July 6 and July 21, 2021, binding every "setting where any employee provides healthcare services or healthcare support services," excepting "non-hospital ambulatory care settings where all non-employees are screened prior to entry and people with suspected or confirmed COVID-19 are not permitted to enter those settings"; its inspection directive, DIR 2021-02, issued June 28, 2021.32 The FDA revoked the emergency-use authorizations for decontaminated respirators effective June 30, 2021 and for imported non-NIOSH respirators effective July 6, 2021.33
2021, third quarter
The six-quarters section states the quarter in full: the Standard on every day; the revised National Emphasis Program of July 7, 2021, DIR 2021-03, again naming NAICS 621210; the conveyance order; the FDA's July 12, 2021 reissuance of the NIOSH respirator authorization withdrawing decontaminated and expired respirators; the Department of Defense's indoor-masking order of July 28, 2021, an airborne-transmission control on every person on every installation in an area of substantial or high transmission regardless of vaccination, reaching the contractors who staff military dental clinics, and its attestation-and-testing supplement of September 8, 2021; and the Department of Veterans Affairs' expansion of its vaccination mandate on August 13, 2021 to "volunteers and contractors who work in VHA facilities," reaching the contract dentists and hygienists of the veterans' dental program.34
The fifty States
The industry's regime
In every State the industry was reached first by an instrument of March 16 to March 31, 2020 that limited dentistry to emergency care, either a governor's or health officer's order naming dental practice, a general elective-procedure order the dental board applied to dentists, or a stay-at-home order that confined the patient base while the board directed emergency-only care; then by a reopening instrument of April 22 to June 8, 2020 that permitted resumption only on conditions of screening, protective equipment, capacity, fallow time and a written plan; then, in the winter of 2020-21, by re-tightening orders in the States that issued them and by the State occupational-safety standards; and then by the stepped expiry of the binding conditions between April 1 and July 1, 2021, after which the health-care masking rules retained by the reopening States (airborne-transmission controls that kept universal face coverings on every person in a health-care setting), the Standard and the August 2021 vaccination orders governed. Every date in this section is stated from the instrument's effective and end dates as the Library records them; the fifty-State table on this page carries every jurisdiction with dates.
The Northeast
New York directed hospitals to postpone elective procedures by Executive Order 202.10 of March 23, 2020 and, through the Department of Health's directive, limited dental practice to emergency care; the Empire State Development and Department of Health Interim Guidance for Dentistry, made mandatory for every practice by the Governor's Executive Order 202-series directives that essential businesses, "dentists and dental practices" among them, "comply with the guidance and directives for maintaining a clean and safe work environment issued by the Department of Health" and that every business reopened under New York Forward "must be operated subject to the guidance promulgated by the Department of Health," reopened dentistry statewide on June 1, 2020 on mandatory screening, protective-equipment, fallow-time and distancing conditions that ran to June 25, 2021; the Commissioner's Determination on Indoor Masking of August 27, 2021, an airborne-transmission control on every person in a health-care setting regardless of vaccination status, governed those settings in the third quarter of 2021.35
New Jersey suspended "all 'elective' surgeries performed on adults, whether medical or dental, and all 'elective' invasive procedures performed on adults, whether medical or dental," from 5:00 p.m. on March 27, 2020 to 5:00 a.m. on May 26, 2020 by Executive Orders 109 and 145, and permitted resumption only "in accordance with the policies and procedures" of the Department of Health and the Division of Consumer Affairs; Executive Order 242 of May 24, 2021 retained the health-care-setting face-covering requirement, an airborne-transmission control on every person in the office, when the general face-covering order ended.36
Pennsylvania's Department of Health directed on March 22, 2020 that "facilities ... cease all dental treatment except urgent and emergency procedures," a direction the Governor's business-closure orders carried until June 3, 2020; the Department's order of November 23, 2020 reduced elective procedures in regions with low acute-care capacity until its termination on August 23, 2021; the Department of State's dental waivers of April 24, 2020 ran under Act 21 to September 30, 2021.37
Massachusetts's Commissioner of Public Health ordered nonessential, elective invasive procedures postponed from March 18, 2020 and the Board of Registration in Dentistry directed emergency-only care; the Commissioner's orders of May 18 and June 24, 2020 permitted resumption on attestation and airborne-control conditions, with full dental reopening on June 8, 2020 under mandatory safety standards; the Commissioner's order of December 7, 2020 curtailed non-essential elective procedures again until its rescission on March 1, 2021; and the Commissioner's order of May 28, 2021 kept face coverings mandatory in health-care settings, an airborne-transmission control retained for every provider, staff member and patient, through the third quarter of 2021.38
Connecticut imposed mandatory Safe Workplace Rules on every open workplace, including every dental office, from 5:00 p.m. on April 7, 2020; Executive Order 12B ended its general business rules at 11:59 p.m. on May 20, 2021, and its Department of Public Health kept universal masking in health-care settings, an occupational-health and airborne-transmission control on every person in the office, by rule from May 19, 2021 and by order from August 7, 2021.39
Rhode Island's Department of Health postponed routine and elective dental care from March 19, 2020, reaffirmed the postponement on May 1, 2020, and permitted urgent, emergent and time-sensitive care from May 9, 2020; its emergency regulation of August 17, 2021 required every "health care provider" licensed by the Department, "including, but not limited to, a physician, dentist," to be vaccinated by October 1, 2021.40
New Hampshire's Governor and Board of Dental Examiners directed emergency-only care in March 2020 and reopened dentistry on May 11, 2020 under the dental guidelines made mandatory by the Governor's Stay at Home 2.0 emergency order, Emergency Order #40 (Ex. NH-050; Ex. SEC-03-057), which imposed workplace infection-prevention and exposure-control requirements on every practice: staff face protection, pre-appointment screening of every patient and patient masks.41
Vermont ordered "all clinicians in Vermont to expedite postponement of all non-essential adult elective surgery and medical and surgical procedures, including all dental procedures," from March 20, 2020, and reopened dentistry in phases from May 22, 2020 under Health Department interim guidance.42
Maine confined dentistry to urgent care from March 20 to May 18, 2020 and, on August 12, 2021, required "employees of Designated Health Care Facilities, Dental Health Practices, and EMS Organizations to become immunized to COVID-19."43
Delaware suspended elective and non-essential medical and dental procedures by the modifications of its State of Emergency from March 24, 2020 and permitted resumption from May 20, 2020 only on infection-prevention and exposure-control conditions: a two-week supply of protective equipment and face coverings on every provider, staff member and patient; the Department of Health and Social Services' emergency orders of September 8, 2021 imposed vaccination-or-testing conditions on free-standing surgical centers and office-based surgery practices from September 30, 2021.44
The District of Columbia's health department directed emergency-only dental care in March 2020; Mayor's Order 2020-053 of March 24, 2020 closed every business outside its exempt categories from 10:00 p.m. on March 25, 2020 and the Mayor's stay-at-home order of April 1, 2020 confined the patient base; Phase One on May 29, 2020 reopened dentistry under DC Health's dental guidance, revised June 22 and July 29, 2020; and Mayor's Order 2021-097 of July 29, 2021, effective 5:00 a.m. on July 31, 2021, restored indoor masking, an airborne-transmission control on every indoor public space regardless of vaccination status, for the third quarter.45
Maryland's Secretary of Health ordered elective and non-urgent procedures ceased from 5:00 p.m. on March 24, 2020 and, by the Amended Directive and Order of May 6, 2020, permitted dentists, dental hygienists and auxiliary personnel to resume at 7:00 a.m. on May 7, 2020 only on the infection-prevention and exposure-control conditions of a one-week supply of protective equipment, screening of every worker and patient and face coverings on every provider, on pain of immediate restriction to urgent care.46
The South
Virginia's Order of Public Health Emergency Two of March 25, 2020 prohibited non-essential surgery and dental procedures in "dental, orthodontic and endodontic offices" through April 30, 2020, as amended April 23; the Safety and Health Codes Board's emergency temporary standard bound every dental office from July 27, 2020, as a permanent standard from January 27, 2021 and as amended September 8, 2021.47
North Carolina's Board of Dental Examiners directed emergency-only care by statements of March 16, 18 and 20, 2020, the Department of Health and Human Services issued dental-setting guidance on March 20, 2020, and Executive Order 121 confined the patient base from March 30 to May 8, 2020; the Board's statement of April 30, 2020 governed resumption.48
South Carolina's "Home or Work" order confined the patient base from April 7 to May 4, 2020; its general orders ended on March 1 and 5, 2021 under Executive Orders 2021-11 and 2021-12, and its state of emergency lapsed on June 6-7, 2021 (Ex. SC-032; Ex. SC-036).49
Georgia's Board of Dentistry recommended emergency-only care from March 17, 2020, the Governor's shelter-in-place order confined the patient base from April 3 to April 30, 2020, the Governor's order of April 20, 2020 fixed the conditions of health-care practice, and the Economic Recovery State of Emergency (Ex. GA-041; Ex. GA-042) and Executive Order 08.19.21.03 of August 19, 2021 governed the third quarter of 2021.50
Florida prohibited "dental, orthodontic and endodontic offices" from providing "any medically unnecessary, non-urgent or non-emergency procedure or surgery" from March 20, 2020 to 12:01 a.m. on May 4, 2020, and permitted resumption only if the office met the protective-equipment conditions of Executive Order 20-112; the State Surgeon General's emergency orders governed licensure, renewal and examinations from March 16, 2020 to June 26, 2021.51
Alabama's State Health Officer delayed "all elective dental and medical procedures" from March 19, 2020, postponed "all dental, medical, or surgical procedures" from 5:00 p.m. on March 28, 2020, carried the postponement into the stay-at-home order of April 3, 2020 as paragraph 14 while making emergency dental care an enumerated reason to leave home, and permitted procedures to proceed from 5:00 p.m. on April 30, 2020 subject to revocation on protective-equipment grounds; the Board of Dental Examiners' protocols of April 3 and April 30, 2020 fixed the conditions of practice, and the Board's return-to-practice protocol remained a rule until April 9, 2021.52
Mississippi's Department of Health mandated the delay of non-emergency dental care from March 2020, extended by the Board of Dental Examiners to April 27, 2020 under Executive Order 1470; Executive Order 1477 permitted resumption from April 27, 2020 only "in accordance with the guidelines established by the Mississippi State Department of Health including conserving disposable personal protective equipment," with screening of every patient and capacity limits in every waiting room; Executive Order 1549 ended the general regime at 5:00 p.m. on March 3, 2021 and Executive Order 1551 lifted the arena and K-12 caps on April 30, 2021.53
Louisiana's Department of Health prohibited routine, non-essential dental visits, procedures and surgeries from March 18, 2020 by Healthcare Facility Notice Dental Provider-004, permitted time-sensitive dental procedures from April 27, 2020 under Notice/Order ALL-010 and the Allowable Procedures update, continued the regime by ALL-020 from June 5, 2020 and the July 2, 2020 extension "until further notice," and released the dental visit, procedure and surgery conditions only at 8:00 a.m. on May 24, 2021.54
Tennessee's Executive Orders 18, 25 and 31 barred non-emergency dental procedures from 12:01 a.m. on March 24, 2020 to 12:01 a.m. on May 6, 2020, one week after medical procedures resumed, and the Board of Dentistry's policy of May 4, 2020 governed reopening; Executive Order No. 82 of July 30, 2021 declared a limited state of emergency to facilitate recovery, and Executive Order No. 83 of August 6, 2021 governed health-care flexibilities in the third quarter of 2021 (Ex. TN-034; Ex. SEC-01-075; Ex. TN-035).55
Kentucky's Cabinet for Health and Family Services ordered that "ALL non-emergent, non-urgent in-person medical, surgical, dental, and any other healthcare practice or procedure must have immediately ceased effective close of business on March 18, 2020," and permitted Phase I resumption from April 27, 2020 with enhanced aerosol protections for dental offices, modified again on September 10, 2020; Executive Order 2021-386 of June 11, 2021 rescinded the general orders at 1:00 p.m. that day and kept masks mandatory in health-care settings, an airborne-transmission control on every person in the office, in force on July 1, 2021 and ended by the General Assembly's HJR 1 on September 7, 2021.56
West Virginia prohibited all elective medical procedures from April 1, 2020 by Executive Order 16-20, amended April 20 and terminated for all facilities from April 30, 2020 by Executive Order 30-20, with outpatient dentistry resuming under board guidance; Executive Order 77-20 imposed a workplace infection-prevention and exposure-control requirement on every confined indoor public space, face coverings on every person and a duty on every business to enforce it, from November 14, 2020 to June 20, 2021, and Executive Order 12-21 terminated the general regime at 12:01 a.m. on April 20, 2021 while keeping Executive Order 30-20's health-care provisions in force (Ex. WV-051; Ex. WV-063; Ex. WV-066).57
Arkansas's Department of Health directed dentists to suspend non-emergent dental care on March 23, 2020, permitted resumption from May 18, 2020 on screening, masking and aerosol conditions, infection-prevention and exposure-control requirements on every dental office, revised June 22, 2020, and kept its directives as guidance to February 26, 2021.58
Oklahoma ordered that "Oklahomans and medical providers in Oklahoma shall postpone all elective surgeries, minor medical procedures, and non-emergency dental procedures" from March 24, 2020, extended the dental postponement to April 30, 2020, and the Board of Dentistry's Resolution R-2020-1 of April 1, 2020 defined emergency and urgent treatment for the period.59
Texas's Executive Order GA-09 of March 22, 2020 required "all licensed health care professionals and all licensed health care facilities" to postpone every procedure "not immediately medically necessary," which the Board of Dental Examiners applied to dentists from March 23, 2020; GA-15 continued it from April 21; GA-19 of April 27, 2020 provided from May 1 that every licensed professional "shall be limited in their practice by, and must comply with," the emergency rules of their licensing agencies; and the Board's emergency rule 22 Tex. Admin. Code § 108.7 bound every Texas dental office from May 1, 2020 to June 18, 2021, readopted August 25, 2020 and amended February 19, 2021.60
The Midwest
Ohio's Director of Health ordered non-essential surgeries and procedures postponed from 5:00 p.m. on March 18, 2020, an order applied to dentistry, and dental offices resumed all care on May 1, 2020 under the State Dental Board's guidelines; the Director's amended order of June 2, 2020 governed non-essential procedures until April 5, 2021.61
Michigan's Executive Order 2020-17 required every dental facility to postpone cosmetic procedures and routine hygiene from 5:00 p.m. on March 21, 2020 until May 29, 2020, on pain of a misdemeanor; MIOSHA's emergency rules bound every Michigan workplace from October 14, 2020 to June 22, 2021; and Detroit's Emergency Order for Control of Epidemic of October 9, 2020 required every outpatient facility, "including dental offices," to screen every patient, mask patients, limit waiting rooms and appointments and use telehealth "to the greatest extent possible," workplace infection-prevention and exposure-control requirements imposed on every outpatient facility in the city.62
Indiana's Executive Order 20-13 of March 30, 2020 postponed elective procedures, dental included, from April 1, 2020, and Executive Order 20-24 permitted resumption from April 27, 2020 on protective-equipment and best-practice conditions; the Department of Health's control measures under 410 IAC 1, updated July 19, 2021, bound every provider to reporting in the third quarter of 2021.63
Illinois's Department of Public Health instructed dentists to postpone elective care under the stay-at-home order of March 21, 2020 and permitted resumption from May 11, 2020 under its Interim Guidance on Routine Oral and Dental Care; Executive Order 2020-09 governed telehealth; and Executive Order 2021-20 of August 26, 2021 named "dental offices" among the health-care facilities whose workers were to be vaccinated or tested weekly and imposed an airborne-transmission control, a mask on every person in every indoor public place in the State, from August 30, 2021.64
Wisconsin's Safer at Home order confined the patient base from March 25 to May 13, 2020, when the Supreme Court of Wisconsin struck it, and the Department of Health Services issued dental guidance on May 14, 2020.65
Minnesota's Executive Order 20-09 postponed "all non-essential or elective surgeries and procedures, including non-emergent or elective dental care, that utilize PPE or ventilators" from March 23, 2020 to 11:59 p.m. on May 10, 2020, and Executive Order 20-51 permitted resumption from that hour only on a written plan, an internal oversight structure and Department of Health guidance, in force until May 27, 2021.66
Iowa's proclamation of March 26, 2020 itemized the prohibited dental procedures and armed the Dental Board's investigators as peace officers; the proclamation of May 6, 2020 permitted resumption from 5:00 a.m. on May 8, 2020 only in compliance with the Board's Guidelines for the Safe Transition Back to Practice, with adequate protective-equipment inventories "without relying on state or local PPE stockpiles" and a conservation plan, and provided that "[t]he performance of any dental procedures except in compliance with paragraph A continue to be prohibited," a condition carried "until this disaster proclamation expires" through the proclamations of June 25, July 24, August 21 and September 18, 2020, November 16 and December 9 and 16, 2020, January 7, February 5, March 5, April 30 and May 27, 2021, to June 26, 2021.67
Missouri's Stay Home Missouri order confined the patient base from April 6 to May 3, 2020, the Dental Board recommended emergency-only care and the Division of Professional Registration closed to walk-in visitors from March 23, 2020; dentistry resumed May 4, 2020; the statewide Phase 1 order lapsed on June 15, 2020 without a successor, and RSMo 67.265, effective June 15, 2021, time-limited every local order thereafter.68
Kansas's stay-at-home order ran from March 30 to May 3, 2020 and its statewide face-covering order, a workplace exposure-control requirement that every business require face coverings of its employees, customers and visitors, from July 3, 2020 to March 31, 2021.69
Nebraska's directed health measures postponed elective surgeries from March 25 and April 3, 2020, the Board of Dentistry directed emergency-only care from March 20, 2020, and routine dentistry resumed statewide on May 4, 2020 under the Board's statement; the directed health measures of November 13, 2020 limited elective surgeries again.70
North Dakota's Executive Order 2020-05.1 governed licensure and telehealth from March 20, 2020, and its State Health Officer's face-covering and capacity orders, airborne-transmission controls paired with occupancy limits on every indoor business, governed every indoor business from November 14, 2020 into January 2021.71
South Dakota's Executive Order 2020-12 of April 6, 2020 postponed non-essential elective surgeries to conserve protective equipment from April 6, 2020 until Executive Order 2020-20 rescinded it on April 28, 2020 (by its terms it would have run to May 31, 2020).72
The West
California's regime ran through Executive Order N-33-20 of March 19, 2020, which confined the patient base statewide, through the county health officers' orders that confined it again and conditioned every open business, and through the Department of Public Health's and Dental Board's emergency-only directives; the county orders imposed written-protocol and face-covering conditions, workplace infection-prevention and exposure-control requirements, on every health-care facility from April 2020, the Department's guidance of April 27 and May 7, 2020 fixed the conditions of resumption, and Cal/OSHA's emergency temporary standards bound every dental employer from November 30, 2020, as readopted June 17, 2021; the State Public Health Officer's order of June 11, 2021, which requires every person to comply with the Department's Guidance for the Use of Face Coverings, made the July 28, 2021 guidance's rule of masks on every person in every health-care setting, an airborne-transmission control regardless of vaccination status, mandatory through the third quarter of 2021.73
Oregon cancelled "all elective and non-urgent procedures across all settings that utilize PPE, including but not limited to ... dental clinics" no later than March 23, 2020 by Executive Order 20-10, permitted resumption from May 1, 2020 by Executive Order 20-22 only "to the extent they comply with guidance or administrative rules issued by the Oregon Health Authority," an order that carried "the full force and effect of law" until its rescission on June 30, 2021, and in August 2021 adopted the Health Authority's vaccination rule for health-care providers and staff, its indoor masking rule and its health-care-settings masking rule naming "dental offices," airborne-transmission controls on every person in those spaces regardless of vaccination status, with Oregon OSHA's medical-removal rule from September 16, 2021.74
Washington's Proclamation 20-24 prohibited "dental, orthodontic and endodontic offices" from providing non-urgent care from March 19 to May 18, 2020; Proclamation 20-24.1 phased dentistry back in on protective-equipment and screening conditions; Proclamation 20-24.2 imposed requirements for non-urgent medical and dental procedures from December 3, 2020; WAC 296-800-14035 made every proclamation condition a workplace-safety rule from May 26, 2020 through the third quarter of 2021; and Proclamation 21-14 of August 9, 2021 required every provider in a "Health Care Setting," defined to include "Dental and dental specialty facilities," to be vaccinated by October 18, 2021.75
Alaska's Health Mandate 005 postponed all non-urgent or elective procedures for three months from March 19, 2020, Health Mandate 006 of the same day addressed elective oral health procedures in terms, Health Mandate 015 of April 15, 2020 permitted phased resumption from April 20 and May 4, 2020, and Appendix 03, Dental Hygiene and Dentistry, effective April 24, 2020 and revised August 5, 2020, required pre-appointment and in-office screening of every patient and testing before non-emergent aerosolizing procedures until Mandate 015 expired on November 15, 2020; the Addendum of September 21, 2021 to the Public Health Emergency Order activated crisis standards of care in the third quarter of 2021.76
Arizona's Executive Order 2020-10 of March 19, 2020 halted elective surgeries including dental from March 21, 2020, and Executive Order 2020-32 permitted resumption from May 1, 2020 only by exemption granted on universal symptom screening, enhanced cleaning and a protective-equipment supply obtained without the State's help, an order rescinded April 1, 2021.77
Colorado's Executive Order D 2020 009 ordered "the temporary cessation of all voluntary or elective surgeries and procedures," medical, dental and veterinary, from March 23, 2020, extended April 6 to April 26, 2020, and Executive Order D 2020 045 with Public Health Order 20-29 permitted resumption from April 27, 2020 on conditions amended thirteen times, the last on April 9, 2021.78
Hawaii's stay-at-home proclamation confined the patient base from March 25, 2020 and the Board's guidance governed reopening from May 1, 2020; the counties' orders and the statewide face-covering requirement, an airborne-transmission control on every indoor public space, governed 2021; that requirement ran through the Twenty-First Proclamation of June 7, 2021 and the Emergency Proclamation of August 5, 2021 to 11:59 p.m. on March 25, 2022 (reported as ending March 26, 2022), and Executive Order 21-05 of August 10, 2021 reimposed statewide capacity and spacing rules that ran to December 1, 2021 (Ex. HI-025; Ex. HI-054; Ex. HI-055).79
Idaho's stay-home order confined the patient base from March 25 to May 1, 2020; its Stage 3 and Stage 2 Stay Healthy Orders capped gatherings and conditioned every business statewide from October 27, 2020 to February 1, 2021, the Stage 3 Guidelines of February 2, 2021 ended the general restrictions, the Stage 4 Guidelines of May 11, 2021 carried the remaining health-care and workplace provisions through the third quarter, and the Governor's proclamations continued the suspension of licensing rules into the third quarter of 2021.80
Montana's stay-at-home directive confined the patient base from March 28 to April 26, 2020 and its licensing directive of April 21, 2020 governed health-care practice; the Face Covering Directive of July 15, 2020 imposed an airborne-transmission control, a face covering on every person, in every indoor public space to February 12, 2021, the Directive of November 17, 2020 capped gatherings and business capacity and hours from November 20, 2020 to January 15, 2021, the Directives of January 13 and February 12, 2021 ended them (Ex. MT-016; Ex. MT-018; Ex. MT-020; Ex. MT-021), and House Bill 702 of May 7, 2021 governed what every Montana employer could require of its employees as to vaccination status through the third quarter of 2021 (Ex. MT-072).81
Nevada's Board of Dental Examiners postponed elective dental procedures until at least April 30, 2020, the Governor's release of April 28, 2020 announced the resumption of limited dental procedures from May 4, 2020 while elective dental procedures remained suspended, Directive 011 of April 1, 2020 waived licensing rules and Directive 046 of July 20, 2021 continued them, Nevada OSHA adopted the Standard effective in Nevada July 1, 2021, and Directive 047 imposed an airborne-transmission control, a mask on every person regardless of vaccination status, in every indoor public space in the counties of substantial or high transmission from July 30, 2021, twelve counties on that day and sixteen of seventeen by August 24, 2021, Clark and Washoe throughout.82
New Mexico's Public Health Order of March 24, 2020 limited dental practice to urgent and emergency care from March 27, extended April 6 to April 30, and the Order of April 30, 2020 prohibited "dental, orthodontic and endodontic offices in the State of New Mexico ... from providing non-essential health care services, procedures, and surgeries, except under the conditions provided below," reopening dentistry on May 12, 2020 under the Department's guidelines; the Order of December 9, 2020 restricted non-essential surgical procedures to January 4, 2021; the order of August 17, 2021 reinstated indoor masking, an airborne-transmission control on every person regardless of vaccination status, from August 20, 2021 and governed the third quarter.83
Utah's State Public Health Order of March 23, 2020 postponed elective procedures, dentists and dental hygienists covered, from March 25, 2020, and the Order of April 21, 2020 rescinded it from April 22 on screening, protective-equipment and distancing conditions to May 15, 2020; Executive Order 2020-73 and the State Public Health Orders that followed it imposed a face-covering requirement, an exposure control on every indoor public space, statewide from November 9, 2020 to April 9, 2021, and House Bill 294 ended the mask requirement on April 10, 2021 and the Transmission Index on May 4, 2021 (Ex. UT-039; Ex. UT-043).84
Wyoming's Statewide Public Health Orders #1 and #2 of March 19 and 20, 2020 closed businesses and capped gatherings while the board directed emergency-only care, were narrowed by the Twenty-third Continuation of March 12, 2021, effective March 16, 2021, to school, child-care and large-event rules and were continued through twenty-seven continuations to May 31, 2021, and the Department of Health's guidance of April 24, 2020 governed the resumption of elective procedures.85
The winter re-tightening and the 2021 transition
Between November 13, 2020 and December 11, 2020, Nebraska (elective surgeries), Pennsylvania (reduction of elective procedures in regions with low acute-care capacity, November 23, 2020 to August 23, 2021), Massachusetts (order of December 7, 2020, effective 12:01 a.m. December 11, 2020, to March 1, 2021), New Mexico (December 9, 2020 to January 4, 2021), Washington (Proclamation 20-24.2, December 3, 2020), Indiana (hospitals, December 13, 2020) and Michigan (MIOSHA rules, October 14, 2020) re-tightened the health-care and workplace regimes that reached dentistry, and the Cal/OSHA standards took effect November 30, 2020.86 The binding dental conditions expired in steps: Arizona's exemption regime April 1, 2021; Ohio's procedures order April 5, 2021; Colorado's Public Health Order 20-29 April 16, 2021; Louisiana's dental regime May 24, 2021; Minnesota's Executive Order 20-51 May 27, 2021; Texas's rule June 18, 2021; Michigan's MIOSHA rules June 22, 2021; New York's Interim Guidance for Dentistry June 25, 2021; Iowa's proclamation June 26, 2021; Oregon's Executive Order 20-22 and Washington's phased framework June 30, 2021; Minnesota's peacetime emergency July 1, 2021.87 Where a State barred local orders (Texas from GA-34 and GA-38, Florida, Arizona from Executive Order 2021-06, Georgia from Executive Order 08.19.21.03), the State's own emergency instruments and the federal layer carried the 2021 quarters, and the Standard and the National Emphasis Program applied in every one of them.88
The largest metros
The local instruments
The county judges of Dallas, Tarrant and Denton Counties and the Mayor of Fort Worth (Dallas-Fort Worth) ordered on March 22 to 24, 2020 that "[a]ll elective medical, surgical, and dental procedures are prohibited" in their jurisdictions, and Galveston County (Houston) did the same on March 24, 2020; Dallas County's order of August 11, 2021 required "all commercial entities in Dallas County providing goods or services directly to the public," dental offices among them, to adopt a health and safety policy requiring "universal indoor masking for all employees and visitors" on pain of a $1,000 fine.89 The Delta-wave orders that follow in this subsection were of the same kind: occupational-health and airborne-transmission controls imposed on every indoor workplace open to the public regardless of vaccination status, several of them with an express duty of enforcement on the business that admitted the public.
New York City ordered every hospital and ambulatory surgery center to cease elective procedures within 96 hours of March 16, 2020 and reduced every non-essential in-person workforce by 100 percent from March 25, 2020; the Department of Health and Mental Hygiene's order of July 21, 2021 required vaccination or weekly testing of every staff member of the public hospital system and its own clinics by August 2, 2021.90 Los Angeles County's Safer at Home order of March 21, 2020 confined the patient base and its revision of April 10, 2020 compelled every open business, health care included, to adopt a written Social Distancing Protocol and to supply and require face coverings, workplace infection-prevention and exposure-control requirements on every open premises; its order of July 16, 2021 imposed universal indoor masking, an airborne-transmission control regardless of vaccination status, from July 17, 2021; and its Health Care Worker Vaccination Requirement of August 12, 2021 ordered every employer of a health-care worker at a "Clinics & Doctor Offices" setting, defined at paragraph a(x) to include "dental" practices, and at any "dental office" among the health care facilities the order recites, to document full vaccination by September 30, 2021, with Pasadena's parallel order of August 20, 2021.91 Chicago ordered every hospital to postpone elective procedures on March 19, 2020, kept masks mandatory in every health-care setting under the Phase 5 order of June 11, 2021, an airborne-transmission control on every person in the office, and required masks in every indoor public place from August 20, 2021, with suburban Cook County following on August 23, 2021.92 Philadelphia's Order No. 2 of March 22, 2020 closed every business not on its life-sustaining list and confined every resident; its Full Reopening Order of June 15, 2021 kept masks mandatory at every healthcare institution through the third quarter of 2021, an exposure control on every person in the office; its amendment of August 11, 2021 required masks in "[a]ny indoor setting" from August 12, 2021 and the Board of Health withheld the vaccinated-only exception from doctors' offices; and the Board's regulation of August 16, 2021 bound every institution providing "dental" services to the vaccination mandate, construed on August 25, 2021.93
The Fulton County Board of Health commanded every resident of Georgia's largest county to stay home on March 31, 2020 and Atlanta's stay-home order ran from March 24, 2020; Savannah's order of July 26, 2021 required a mask of every person entering a hospital.94 Maricopa County's (Phoenix) face-covering regulations of June 20, 2020, exposure-control requirements on the business and its patrons, bound every place of public accommodation, exempting a patient only while receiving dental services, and the Superior Court's order of August 4, 2021 required masks in every court facility from August 9, 2021; Tucson's proclamation of April 17, 2020 closed every business outside the exempt categories to April 30, 2020.95 The Boston Public Health Commission imposed universal indoor masking, an airborne-transmission control on every indoor business premises, from 8:00 a.m. on August 27, 2021, Cambridge from September 3 and Somerville from August 20, 2021.96 San Francisco's Health Officer ordered every individual to shelter and every business outside the exempt categories to cease on-site activities from March 17, 2020 and compelled every business permitted to remain open to "prepare, post, and implement a Social Distancing Protocol" from March 31, 2020; the Bay Area's eight health officers required masks regardless of vaccination status in every indoor setting from August 3, 2021, and San Francisco's Safer Return Together order required every business to screen personnel from June 15, 2021.97 Detroit's order of October 9, 2020 named dental offices; Oakland County's order of March 24, 2020 required every open business to screen every employee daily; Wayne County's order of March 26, 2020 did the same; and the Oakland County order of August 24, 2021 required masks in every school and day care in the county.98 King County's (Seattle) Local Health Officer closed bars, clubs, gyms and dining rooms and conditioned every retailer on daily employee screening on March 16, 2020, directed face coverings, an airborne-transmission control, in every indoor public setting from May 18, 2020 and ordered them from September 7, 2021.99 Minneapolis required face coverings in every indoor space of public accommodation as an exposure-control requirement on the business, with an express duty on "[a]ll employers of businesses that are spaces of public accommodation," from May 26, 2020 to June 1, 2021, and Saint Paul required masks on every City-controlled property from August 3, 2021.100 San Diego County's Health Officer ordered hospitals to delay elective procedures and every business to "make every effort to use telecommuting" from March 17, 2020, ordered every person to remain home and every business permitted to remain open to post a written protocol from April 9, 2020, and kept its isolation and quarantine orders in force through September 30, 2021 under the Limited Order of June 15, 2021.101 Denver ordered every resident to stay home from 5:00 p.m. on March 24, 2020; its order of August 2, 2021 required the personnel of care facilities, hospitals, "clinical settings" and "limited healthcare settings," defining "Clinical settings" to mean "ambulance service centers, urgent care centers, non-ambulatory surgical structures, clinics, dentist offices, doctor offices, and non-urgent care medical structures," to be fully vaccinated by September 30, 2021; Boulder County imposed indoor masking regardless of vaccination status in every indoor public space from 5:00 p.m. on September 3, 2021.102 St. Louis City and County ordered every resident home from March 23, 2020, the County re-imposed a Safer At Home order from November 17, 2020, and the City imposed indoor masking in every indoor public building from July 26, 2021.103 Clark County (Las Vegas) made every emergency directive of the Governor a licensing condition with a $1,000-per-day penalty from April 21, 2020, and the Eighth Judicial District Court required masks in every court facility from July 19, 2021.104 New Orleans closed every business outside the exempt categories and confined every resident from March 17 and 20, 2020, imposed indoor masking regardless of vaccination status in every indoor space from July 31, 2021, and Jefferson Parish imposed a parish-wide indoor mask requirement, an exposure-control requirement enforced by a $500 fine on the admitting business, from July 1, 2020 to April 28, 2021 and again from August 4, 2021.105 Honolulu's stay-at-home order of March 23, 2020, its Tier 5 order of July 8, 2021 and its Safe O'ahu Response Plan of September 22, 2021 governed every business on O'ahu, and Montgomery County, Maryland (the Washington suburbs) continued its stay-at-home order to June 19, 2020 after the State lifted its own and required masks in every indoor location accessible to the public from August 7, 2021.106
The sector regulators
The boards of dental examiners and the health departments
The Texas State Board of Dental Examiners' emergency rule is the paradigm: a licensing board's minimum standard of care, adopted under the Administrative Procedure Act's emergency provision at the Governor's direction, enforceable by license discipline and by the Governor's penalties, binding every dental office in the State for fourteen months.107 Iowa's Dental Board wrote the Guidelines for the Safe Transition Back to Practice on May 5, 2020 that the Governor's proclamation made mandatory from May 8, 2020, and its investigators enforced the proclamation as peace officers.108 The Oklahoma Board of Dentistry's Resolutions R-2020-1 and R-2020-2 defined emergency and urgent treatment and governed practice to December 31, 2020.109 The Alabama, Tennessee, North Carolina, Nebraska, Nevada, Ohio, Minnesota and Missouri boards directed emergency-only care and governed reopening by protocol, policy or statement, each binding on the board's licensees as the standard of care and enforced by license discipline.110 The State health departments of Florida, California, Maryland, Kentucky, Louisiana, Arkansas, Pennsylvania, New Mexico, Utah and Delaware issued the orders and directives already described, and the Florida State Surgeon General's and California Department of Consumer Affairs' emergency orders governed licensure, renewal, examination and continuing education for every dental licensee from March 2020 into the third quarter of 2021.111 The Massachusetts Department of Public Health's orders of August 20 and September 2, 2021 extended emergency licenses and opened the immunization registry to employers verifying employee vaccination.112
The State occupational-safety agencies
Virginia's Safety and Health Codes Board, Cal/OSHA's Standards Board, Oregon OSHA, Washington's Department of Labor and Industries, MIOSHA and Nevada OSHA bound every dental office in their States to written plans, screening, distancing, masking, exclusion and reporting rules carrying civil penalties, and Nevada OSHA and Oregon OSHA adopted the Standard as State law in the third quarter of 2021.113 The paid-leave mandates of New York, New Jersey, Colorado and Massachusetts compelled every dental employer in those States to pay quarantined and exposed employees not to work through September 30, 2021.114
The federal regulators
OSHA's Healthcare Emergency Temporary Standard and National Emphasis Program, FEMA's allocation rule, the FDA's respirator authorizations and revocations and CMS's recommendations and waivers are the federal sector instruments; each is stated with its dates in the federal layer above.115
The counterparties
Patients, laboratories, suppliers, hospitals, schools, transit
The stay-at-home, curfew and traveler-quarantine orders of every State and metro confined the patient base and are inventoried above; the winter stay-at-home orders of Los Angeles County, San Diego County, St. Louis County, Denver and the Bay Area, the Navajo Nation's four-month lockdown and the Puerto Rico curfews confined it again from November 2020 to January 2021.116 The dental laboratories that fabricate the crowns, dentures and aligners the practice seats were closed or capped by the elective-procedure orders that closed their customers and by the manufacturing and workplace orders of their own States, and the distributors' respirator inventories were governed by the FEMA allocation rule and the FDA authorizations.117 The hospitals and ambulatory surgery centers in which oral surgeons and pediatric dentists treat sedation cases were closed to elective cases by the orders of every State in the spring of 2020 and again in Pennsylvania, Massachusetts, New Mexico, Nebraska, Indiana and Mississippi in the winter of 2020-21, and were conditioned by New Jersey's ambulatory-surgery directives through the third quarter of 2021.118 The school-closure orders of the spring of 2020 and the remote-instruction and quarantine orders of the 2020-21 school year removed the industry's hygienists and assistants from its operatories, and the school-masking and quarantine orders of August and September 2021, infection-prevention controls on the classroom, governed their children in the third quarter of 2021.119 The conveyance order imposed an airborne-transmission control on every transit commute from February 1, 2021.120
The ecosystem
The mechanisms
Six mechanisms carried the orders to this industry, each an order in its own right: supply chain and borders (the FEMA allocation rule and export bar; the FDA authorizations and revocations; the land-border and entry restrictions on the foreign-trained hygienists and the Canadian and Mexican patients of the border practices); workforce, schools and child care (the FFCRA mandate, the school closures, the quarantine orders, the State paid-leave laws); travel and gatherings (the interstate quarantines that reached patients and the gathering limits that ended the continuing-education calendar); courts and public offices (the licensing boards' closures and the recorders' and clerks' counters); transit (the conveyance order and the transit agencies' rules); and health care as counterparty (the hospital and surgery-center orders and the health-care-worker vaccination orders from July 26, 2021).121 The meetings records on this page list the conventions, State association sessions, specialty meetings, continuing-education courses and licensure examinations of this industry that those orders cancelled, converted or conditioned in 2020 and 2021, with the venue jurisdiction's orders in force on the dates. The tribal governments acted in the same way: the Pascua Yaqui Tribe's Health Department announced on March 17, 2020, under measures the tribal government approved on March 13 and 17, 2020, that its dental program would see emergencies only (the release is cited as evidence of that suspension, not as an order); the Navajo Nation's orders locked down its businesses on sixteen weekends in 2020 and for four months from November 16, 2020; and the Mescalero Apache Tribe's executive orders required a face covering of every employee, agent and contractor of every tribal enterprise from May 12, 2020 and again, regardless of vaccination, from August 20, 2021, an exposure-control requirement on every tribal workplace; the territorial governors closed Puerto Rico's dental clinics in April 2020 and imposed vaccination-or-testing conditions on the health sector from August 16, 2021, and the Service itself confirms that territorial employers are eligible employers.122 Foreign orders, including the national lockdowns that closed the offshore laboratories from which aligners and prosthetics are sourced, are facts and circumstances stated by category.
The standing duties
Beneath the emergency orders lay a fourth layer that bound every dental employer on every day of the six quarters: the standing statutes commanding every person to prevent and control communicable disease and every employer to furnish a safe and healthful workplace, the offenses punishing disobedience of health and emergency orders, and the liability shields protecting only the complying business. Each is an order from an appropriate governmental authority, and the pandemic directives gave each its content. It is stated here for eight principal States (Texas, Florida, Arizona, North Carolina, California, Ohio, Utah and New Jersey); the fifty-one-State table is at /duties.123
The first layer is the orders' own condition of operating, and the verbs were commands. Texas's GA-19 provided that every licensed health care professional "shall be limited in their practice by, and must comply with," the emergency rules of the licensing agency, for dentistry rule 108.7, May 1, 2020 to June 18, 2021 (Ex. TX-012; Ex. SEC-03-017; Ex. DUT-TX-012). Florida's Executive Order 20-112 of April 29, 2020 permitted a dental office to resume "only if" it met its capacity and protective-equipment conditions (Ex. SEC-03-043). Arizona's Executive Order 2020-32 permitted elective dentistry from May 1, 2020 only by exemption on proof of "a universal symptom screening process for all staff, patients, and visitors prior to entry" (Ex. SEC-03-029), and from May 16, 2020 every Arizona employer "shall develop, establish and implement policies based on guidance from the CDC, Department of Labor, Occupational Safety and Health Administration (OSHA) and ADHS" (Ex. AZ-019; Ex. AZ-020; Ex. DUT-AZ-013). North Carolina's Executive Order 141 of May 20, 2020 named the actions "which establishments open to the public under the terms of this Executive Order must follow," and California's Cal/OSHA standard, 8 C.C.R. § 3205, commanded that "Employers shall establish, implement, and maintain an effective, written COVID-19 Prevention Program." Texas's orders incorporated the DSHS minimum standard health protocols with "should" (GA-18, GA-28 and GA-32; Ex. TX-011; Ex. DUT-TX-020), and GA-34 converted the clause to "strongly encouraged" from March 10, 2021; the protocols are recorded as a recommendation, compulsory through Labor Code § 411.103, the general duty clause and Civil Practice and Remedies Code § 148.003 (Ex. DUT-TX-013; Ex. DUT-FED-001; Ex. DUT-TX-015), the instruments that incorporated them by operation of law.124
The second layer is the standing law. Texas states the duty on the person: "The state has a duty to protect the public health. Each person shall act responsibly to prevent and control communicable disease." (Health and Safety Code § 81.002, Ex. DUT-TX-001.) Knowing refusal of a control measure is a Class B misdemeanor (§ 81.087, Ex. DUT-TX-006), and Labor Code § 411.103 commands that "Each employer shall" provide "a place of employment that is reasonably safe and healthful for employees" and use "methods of sanitation and hygiene" (Ex. DUT-TX-013). North Carolina: "All persons shall comply with control measures ... prescribed by the Commission," on pain of up to two years, and the Commission's rule made the CDC's "Guidelines and recommended actions" "the required control measures," a recommendation made compulsory by the rule that incorporated it (Ex. DUT-NC-001; Ex. DUT-NC-007). Ohio: no person "having charge of a public conveyance or place of public accommodation, amusement, resort, or trade" may "negligently fail to take reasonable measures to protect the public from exposure to the contagion," a second-degree misdemeanor (Ex. DUT-OH-007; Ex. DUT-OH-005). California: refusal "to conform to, any rule, order, or regulation prescribed by the department respecting a quarantine or disinfection" is a misdemeanor (Ex. DUT-CA-003). Florida: violation of "any requirement adopted by the department pursuant to a declared public health emergency" is a second-degree misdemeanor (Ex. DUT-FL-001; Ex. DUT-FL-008). Arizona: knowing refusal "to obey any lawful order or regulation issued as provided in this chapter shall be guilty of a class 1 misdemeanor" (Ex. DUT-AZ-007). Utah: violation of "lawful orders of the department or a local health department" is "a class B misdemeanor," and from November 9, 2020 "every employee shall be required to wear a face mask while that employee is at work," one of that winter's workplace infection-prevention and exposure-control requirements (Ex. DUT-UT-003; Ex. DUT-UT-018). New Jersey: the Governor's orders "shall be binding upon each and every person within this State" (Ex. DUT-NJ-006). Over every State stood the general duty clause: "Each employer ... shall furnish to each of his employees employment and a place of employment which are free from recognized hazards" (29 U.S.C. § 654(a)(1), Ex. DUT-FED-001), enforced by general duty clause citation from September 2020 (Ex. LAW-487; Ex. DUT-FED-073) and, under the Act's respiratory-protection standard, 29 C.F.R. § 1910.134 and § 654(a)(2), against an office of dentists on April 15, 2021 (Ex. DUT-FED-018), and from June 21, 2021 by the Standard (Ex. FED-080).125
The third layer is the liability shields, whose premise in every form is that compliance was what a dental practice owed. Texas protects a business unless it "knowingly failed to implement or comply with government-promulgated standards, guidance, or protocols intended to lower the likelihood of exposure to the disease" (Ex. DUT-TX-014; Ex. DUT-TX-015); Florida immunizes only a defendant that "made a good faith effort to substantially comply with authoritative or controlling government-issued health standards or guidance" (Ex. DUT-FL-012); Arizona presumes good faith only for a business that "adopted and implemented reasonable policies related to the public health pandemic" (Ex. DUT-AZ-010). North Carolina, Utah and Ohio set a culpability floor without a compliance clause and are stated for what their texts say: North Carolina commands "reasonable notice of actions taken by the person" to reduce transmission (Ex. DUT-NC-006); Utah's immunity preserves the Utah Occupational Safety and Health Act (Ex. DUT-UT-013; Ex. DUT-UT-014); and Ohio's Am. Sub. H.B. 606 provides that "A government order, recommendation, or guideline shall neither create nor be construed as creating a duty of care upon any person that may be enforced in a cause of action" (Ex. DUT-OH-020), so Ohio's compulsion lies in R.C. 3701.352, 3701.81(C) and 4101.11 and the orders' conditions. California enacted no shield and presumes a failure of due care from violation of "a statute, ordinance, or regulation of a public entity" (Ex. DUT-CA-013); New Jersey shielded health care professionals only, for acts "in support of the State's response" (Ex. DUT-NJ-007). A dental office that screened, distanced, cleared its operatory, fitted respirators and masked its staff did what these commands required; each is an order from an appropriate governmental authority, whatever its source.126