Getting back to Work during COVID-19, Part 1: Essential or Non-essential?

This is a 3-part post covering topics relating to re-opening our bodywork practice. Thanks to Cinny Burrell for prompting me to write this!

Essential but not Emergent:
Over the past month, I’ve been thinking a lot about this designation “essential” or “non-essential” as it has been handed down through our public health system. I understand and deeply appreciate the difference between what we do and the kind of medicine that doctors and their teams offer in hospital settings. On a regular day; let alone during an emergent crisis. What I want to share in this post are thoughts about a wider sense of medicine and healing — one that we can more easily embrace once the curve is flattened and isolation orders are being lifted.

Because LMTs in WA state are listed as health care providers, and therefore ‘essential,’ we are authorized to continue working. Even though this is the case, most of us have closed or significantly diminished our practices during this time. Some of us decided to close our practices out-right for a considerable time (a month or more); others have had enough cancellations that their practices are only marginally operating.

Practice Guidance from the State:
On April 6th, the WA State Board of Health has given those of us still working with clients some guidance:

• Only provide massage to patients with urgent medical issues.
• Cancel non-urgent massage appointments.
• When treatment is medically necessary, screen patients for symptoms of respiratory illness (e.g., fever, cough, difficulty breathing)…If a patient has respiratory symptoms, do not provide treatment. Instead, refer the patient.
• Consider instructing patients to implement self-care measures such as rest, hydration, light stretching, light or moderate activity and self-massage.
• Make sure patients practice social distancing of six feet in waiting rooms and other areas.
• Closely follow CDC Guidelines for hand hygiene and clean equipment and facilities between patients.
• Remind sick employees to stay home.
• Consider wearing a face mask or cloth face covering when providing massage and when within six feet of another person. Provide face covers and request use by clients when close proximity is necessary.

I will write about the practicalities of implementing these guidelines in my next post.

A New Normal:
Here I want to speak to the underlying perspectives about massage/bodywork that this Health Alert reveals. These underlying issues hold within them some of the keys to how we can decide which patients to work with and when. This is especially important because, experts agree, we will not emerge from this public health strategy of social distancing all at once. We will emerge slowly, over time. In all likelihood that means we all will be practicing at a middle-ground level: more than now, less and differently than before.

There will be many versions of acceptable practice during this time. Most of us work with relatively healthy people (not the kind of challenges seen in an emergency room), who are looking to amplify their well-being. Working with health gives us MORE options, not fewer — this is a good thing. But it also demands consideration on our part. I’d like to speak to how we can figure out what’s best for our own circumstances.

What we do:
• Consider the kind of work you do. If there is a spectrum of general to technically specific, where does your work fit? How unique is this skill set (can a PT do it, an OT, a trainer)?
• What are the consequences of NOT doing your work with clients? For example, if you practice manual lymphatic drainage, your hands on work is a primary treatment for people’s edema, one that can’t be replicated easily. Not receiving your care could leave clients with long term lymphedema.
• Can it be replicated at home? If so, consider doing tele-health sessions with your clients — teaching them self-care massage, the simple things. This can empower them in the meantime and build a bridge with them for the future. They know you’re out here and thinking of them.

Who we work with:
• Do you work with a specific population? Kids, elders, athletes, tech workers, cancer patients, construction workers, etc.
• How is COVID effecting them? Some may be sitting idle for the first time in their lives; others might be working overtime under unusual stress, physical, emotional or psychological.
• Do you have a steady private practice, with on-going clients relationships, or do you work in a more generalized setting: a clinic or spa that handles all the scheduling for you, chair massage at events or public venues?
• This matters because the ‘new normal’ of mutual disease precautions might be easier to implement with people you know (or with people you don’t know). If you work for a company, making sure the managers have your back about what to do if clients don’t want to be screened or use precautions is key for your own sense of safety.

When is our work necessary:
Current phase of social isolation/COVID emergency:
For acute challenges: orthopedic/soft tissue injury, lymphatic, neural, physiological, psychological, etc… Consider shorter sessions during this time. Just enough to keep people out of the ditch and/or from having significant side issues. Can they ‘get by’ with 1/2 hour every 2 weeks, even though they want 1 hour every week?

For example, I’ve been working with babies who are having significant breast feeding challenges. Waiting 4 weeks is really long for an infant, and usually the sessions can be short and spaced far apart. I’ve also been working with a couple of clients who have significant anxiety/depression; this COVID time has become such a risk factor for their overall health that their counselors are telling them to get care.

Middle phase of COVID emergency: coming out, but not all gone:
As the curve is flattened for a longer time, we can start considering people with significant challenges that will require more time to treat. Those that need weekly appointments and/or challenges that they can partially tend on their own, but having your care once a month really helps.

In this category I’ll also put the many, many workers who are overextending themselves right now. Tech workers working long hours at home with poor ergonomics; first responders of all kinds; parents and teachers – oh my!; store clerks and delivery people. There are a lot of people who could use our support in the near future. I’m considering a reduced rate for front line health care providers for a period of months this year.

All clear (and/or between this time and the next time):
When I feel afraid about being self-employed and not working on anyone for yet another week, I try to breathe and remember this: touch heals. Touch helps our immune system, our sleep, our sense of connection and well-being. Touch helps relieve the effects of cumulative stress: achyness, stiffness, poor sleep, impaired digestion. Touch can help reduce the effects of psychological and physical isolation, including depression and anxiety. All the reasons people have been coming to us for years are present now. One of the ways to move fully from trauma to health is to move beyond fear and pain, and recover our ability to perceive pleasurable sensations and emotions.

This is where I find myself coming up against the clinical assumptions in the Health Alert — essential/non-essential. These categories fit for an emergency situation, however, if all we ever have is emergency medicine, our health will suffer, our quality of life will suffer. Alternative methods tend to stress fostering health rather than fighting disease. When the dust has settled and it is more reasonable to be moving about with fewer precautions, the work of alternative care providers, like us, will be sorely needed. My hope is that this extreme time with COVID-19 gives us many (oh so many!) insights into how we can improve our health care system, including an appreciation for how alternative care can be complementary care.

My next post will look at how practically to implement the practice guidelines.