Massage in the ‘New Normal’ The Covid Era: For the Healthy, a needed service.

Massage in the Covid Era is still a needed service. If a provider sees patients clinically, for injuries or pain management, then massage therapy enters a bit of a grey area, where it may be deemed essential in the same way as Physical Therapy and Chiropractic. But even if a patient is seeking relief from the stress of living under new circumstances, working from home, with children at home, and needing the comfort and reassurance that massage therapy brings, it is vital, and can’t be understated. So Let’s be very clear that Massage Therapy MAY be safe to practice, if special provisions are universally made and kept. Provisions that are for HEALTHY PEOPLE. These provisions are not fun or convenient, and many people have observed that people find it very challenging to comply with the practice of social distancing, masking, and sanitation all of the time. With July seeing 60,000 new cases daily in the US by mid-month, it is clear that the spread of Covid-19 is not easy to prevent, and people are still failing at the challenge.

Here is how we intend to make Pains End Massage Therapy Clinics a place where we are playing to win: the goal is no infections in the office ever.

NEW PRACTICES AT PAINS END:

Major changes have been made in the Ballard Studio Works office, to provide sanitary environs for patients. We’re working to replace all furniture with new furnishings that can be fully sanitized. When you come into suite 470 now, you can be assured that very potent, very aggressive measures have been taken to ensure that the space is truly clean and safe.

Here is a list of new things that you’ll notice

Temperature Check: 65% of people with Covid have symptoms of the disease, and nearly all (varying percentages, but typically over 80%) of symptomatic and pre-symptomatic patients have fever.

A Touchless Forehead Thermometer shall be used for each patient to have a temperature check prior to their entering the treatment room. The Temperature should be recorded on their Consent to Treat Form – Pandemic Questionnaire

Pandemic Questionnaire: Each person should newly answer the 4 tracking questions on the Pandemic Consent to Treat Form and sign it. Patients are asked to show willingness to have their session rescheduled – despite the real disappointment any of us would feel – if they cannot answer all four safety questions regarding isolation & social distancing, travel, and symptom tracing.

Swiss Cheese Method – The Swiss Cheese Analogy is used to describe Fail-Safe provisions in many engineering applications. The idea is that a slice of swiss cheese is not a very good patch for a leak. But if you add another slice, it starts to cover some of the holes in the first slice, and the leak gets a little better. An additional slice may all but block the leak, and by the time 4 or 5 layers are present, there is nothing able to leak through. This is a good Fail-Safe analogy for a virus. We don’t want it getting through any of our layers of protection, but the more layers we can design and provide, the more secure our system.

- Sanitize the massage room: This comprises 4 layers of our Swiss Cheese safety system:

o Air scrubbing using active filtration during occupancy of the room: HEPA Filtration.

o Air Sterilization using High Intensity UVC lamps when the room is unoccupied

o Air Sterilization using Ozone while the room is unoccupied.

o Surface Sanitization using Hydorgen Peroxide Fog (30nm) and Disinfectant – The table and all surfaces and even the walls and floor are fogged between sessions, and damp mopping 1x to 2x daily.

o Improved Linen management: All used linens (and now blankets) are removed from the room along with practitioner clothing (scrubs) after each session.

- Hand Washing and Sanitation – Patient and Practitioner wash hands thoroughly upon entering the room, and as needed (or utilize sanitizer) throughout the session.

- Masking:

o Provider is masked using N95 respirator while in the room (the only exceptions are when administrative times will be followed by a nighttime UVC & Ozone sanitization cycle and at least 40 minutes time before the next person is entering the room.

o Patient is masked in the room. A significant exception is when the patient is lying prone on the massage table, where it may be impractical for most patients to wear a mask. Systems for filtered air supply and some containment for the face cradle (head rest) of the massage table are in place to cover this very significant potential for increasing infection risk, but the patient will be breathing out through fabric that separates their breath from the room and receiving air delivered through a filter.

o Provider will be masked and wear a shield when working on the body above the waist when the (masked) patient is supine (face up) on the treatment table.

o Clothing Change – Provider will change clothing (scrubs) after each session

False Alarms & Self-Monitoring – Patients also, but particularly practitioners should be honing the practice of self-monitoring. This includes maintaining a log of morning and bedtime body temperatures, and watching for any instances of unusual readings (even mild fever should be considered a strong alarm to cancel or reschedule appointments – pre-symptomatic infected people as of July 1st 2020 are emerging in studies at some of the most infectious people with the virus.) Patients should be willing to have their appointments rescheduled – even for a false alarm. This is going to be the way this works for some time to come. The disappointment anyone feels when not receiving a massage they anticipated IS REAL, but it may be more commonplace going forward, and it is a sign that people are taking special and appropriate care.

It’s ALL Rehearsal - These protocols are designed to reduce the likelihood that anyone coming for care can become infected in this office. They are clearly more impactful when they are always practiced, and never neglected. This is the real game in this pandemic. The Blue Ribbon will go to anyone who does not get sick with this virus, whether they have to protect themselves for another 6 months, or 6 years.. The winners will all be the ones with the smoothest practices, who are most diligent and most automated. It is all rehearsal. Realizing that there is little chance your neighbor is infected when you speak with them, even if someone forgets to keep safe social distancing momentarily is not a bad insight. But keeping crisp practices, and becoming better and smoother at these over time is what is going to prepare us - rehearsal for the one day when we have live Cornoa virus in front of us, and of course we don’t realize. How we design our practices, and how well we train ourselves to faithfully carry them out will be telling in the long run.

Universal Precautions: We know what Universal Precautions are in hospitals: these are the set of practices used to contain infections diseases in hospitals and health care settings, where it is known that a patient is infected, and the infection must be reliably contained within the treatment room, without spreading to the people who come and go from that room to provide care, or to the physical spaces beyond the room. Universal Precautions generate a great deal of infectious medical waste, and the hazards and costs associated with these protocols make them ill suited for massage practice. But we can borrow some of the key concepts of sanitation that will very greatly limit transmissibility in the massage setting. By designing systems that use disinfectants, laundering, rest, and sanitization, and by adding these to practices of diligent masking and hand washing, we CAN make it very difficult for the virus to spread.