Getting back to work during COVID-19, Part 2: Practical Considerations

On April 6th, the WA State Board of Health gave us guidance about how to work with clients while the COVID-19 public health isolation protocols are in effect. Some of us have shut down our practices completely, some of us are seeing a few clients. One thing is for sure: when we begin practicing again at more usual levels, we’ll be using precautions that are new.

Here are my current thoughts about how we’ll be navigating those new parameters. (The bulleted sentences in bold come directly from the health alert. My thoughts are added in the following sentences.)

Scheduling sessions:
• Only provide massage to patients with urgent medical issues. In my previous post, I discussed how we can think about what qualifies as urgent. On a practical level, I’ve also been relying on clients to decide this for themselves. For some, their need is great enough that it surpasses the risk of coming in. With regular clients, I honor that they know what my work does for them and that they need it; that’s good enough for me. The only new clients I’m accepting at this time are babies in distress. (I could also see accepting new whiplash clients — shouldn’t there be no accidents right now?! Sheesh.) Needless to say, anyone not willing to use precautions doesn’t get an appointment.

• Cancel non-urgent massage appointments. So far, most clients are self-isolating — canceling their appointments when they know they can wait. When we start to open up again, we’ll likely need to have a way of screening clients’ level of need. At first, I’m considering offering shorter appointments and/or working on fewer people. To give myself and others a chance to get used to things during this unusual time.

What I don’t want to do is go back to work behaving as if we haven’t been through this extreme time. I won’t know ahead of time what my needs are, so I want to give myself permission to take it slowly. (My next post will be about how to take care of ourselves when we re-open our practices.)

• Remind sick employees to stay home. Being self-employed, you’d think this is a no-brainer. But I am grateful to COVID-19 for teaching me a deeper lesson of taking care of myself and not pushing through my own mild symptoms. I hope I can retain this lesson as life returns to ‘normal.’ I’m hoping we’ll all be more willing, in months to come, to wear masks when we get the sniffles, to stay home and rest, and to not judge others for doing so themselves.

Consider your practice set-up:
• Make sure patients practice social distancing of six feet in waiting rooms and other areas. This is pretty self-explanatory. A few weeks ago, it felt strange to have that extra space between us. Now, we’re getting used to it at the grocery store, the post office, bank, etc. So it doesn’t feel so odd, though I still need reminding sometimes.

• Closely follow CDC Guidelines for hand hygiene and clean equipment and facilities between patients. Here, I’m leaving 15 minutes between clients in order to wipe things down, clean and then dry with a second towel. When wiping down, I’m not just focusing on door handles and the like. Lots of people now are not touching the handle itself, to avoid germs, instead touching all over the door.

I’m considering posting a sign that says, “Please only touch the door handle–so I know where to wipe!” In the meantime, I’m asking them to let me open and close the door for them.

I’m also asking that people consistently leave their shoes outside the office. Because I often get down on the floor for assessment or working with kids, I don’t want shoes tracking in…whatever.

Screening clients and mutual protection:
• Screen patients for symptoms of respiratory illness (e.g., fever, cough, difficulty breathing). “Cough and difficulty breathing” are symptoms we can ask about. Checking for fever requires measurement; the guideline relative to COVID-19 is a temp of 100.4 degrees or more.

We’re using thermometers on ourselves, and soon will use them on clients as we all start to move around more. (There will be a phase when case rates are expected to go up, but hopefully only a little. Herd immunity requires that we do move as a herd, after all. So we’ll be taking that moderate risk together soon.) We have 2 kinds: an ear thermometer and an infrared thermometer.

The infrared thermometer allows us to take someone’s temperature while maintaining social distance. Aim the light beam at their forehead to get a reading. The Kinsa ear thermometer tracks our readings over time, and sends that data to their company’s mega-database. Usually I resist participating in meta-data, but this time, it’s a great idea. Information they’ve gathered has been successful in predicting overall disease trajectory and therefore public health modeling. Check it out! (Currently sold out of the ear model; have an oral model for all ages.) Clearly, if they have symptoms, refer them to their PCP or a nearby clinic.

• Consider wearing a face mask or cloth face covering when providing massage and when within six feet of another person. There are so many options here. Youtube is your friend. One thing worth noting: this virus is relatively fragile. Washing your cloth mask (and sheets) in the washing machine at a regular setting, regular detergent, even cold water is enough to kill it.

You don’t need to use bleach to clean your linens/cloth masks — in fact, Clorox is discouraging it. My sister in law happens to work for Clorox, so got the low down recently. BTW: if you’re wondering why Costco still doesn’t have palettes of Clorox products, it’s because they are prioritizing hospitals and elder care facilities. Just saying.

• Provide face covers and request use by clients when close proximity is necessary. Most of our clients are bringing their own, however we made an extra dozen or so cloth masks to be used by clients and washed each time. Again, easy to do now that we’re all becoming more accustomed to this simple measure.

Using on-line platforms or phone for sessions:
• Consider instructing patients to implement self-care measures such as rest, hydration, light stretching, light or moderate activity and self-massage. We have been partners with our clients in these recommendations already. I keep my expectations simple for these sessions.

Sometimes it’s just reminding them of the exercises that I’ve already shown them. Other times, I guide them through a simple self-massage routine. It might be as simple as breathing or stretching together — helping them take time out to pay attention to their health, to listen to their body.

I acknowledge that this is new to me and I’m willing to improvise in helping them. People are grateful for the support and happy to pay. Because it feels a bit less focused or reliable than our time together in person, I’m not charging my full rate for these sessions.

Placebo response? Bring it on!
I appreciate that a big portion of the benefit is the connection we have. I want to give a big shout out for the role of placebo in healing. In standard clinical culture, placebo is either ignored or disparaged because it doesn’t link with an external, clearly identified “mechanism.” What gets lost through this analysis is that there are measurable, physiological changes–placebo responses, not effects–that bring greater health and well being (sometimes greater than the drugs/treatments being tested!). Rather than being a sham, placebo responses represent ways that the body-mind connection can be stimulated toward health.

Often alternative/complementary medicine is also disparaged as being overly influenced by placebo dynamics. I say, Bring it on! If there are ways that I conduct my practice such that the client’s body is engaged and stimulated into healing, I’m glad for it.

It may be a little counter-intuitive, since our work is fundamentally about touching, but I’ve had good success with the few e-sessions I’ve done. If your clients are open or interested, I hope you give it a try. See how your knowledge can translate across a new kind of connection!

My next post will look at how we take care of ourselves during this time of isolation and the coming phases of opening up our practices.

See earlier posts relating to COVID-19 by filtering to Announcements.