- Hannah Hulett
COVID-19 Practice Update: Vaccines, Variants, and Antibodies—Oh My!
Hello, my friends. I know it’s been awhile since I updated here, and with the rollout of COVID-19 vaccines, I just wanted to give a little update on the status of my practice. With the arrival of the vaccine, hope is on the horizon. In Oregon, massage therapists are eligible for the vaccine under Phase 1a as allied healthcare providers. The data on both the Pfizer and Moderna vaccine is very promising for reducing illness and hospitalizations from COVID-19 with around a 94% efficacy rate, and I am very hopeful that we are one step closer to reaching a new normal toward herd immunity. That being said, I am continuing to follow the research as it unfolds regarding all things COVID-19 so that I can move forward from an informed foundation with which to make decisions for the safety of my clients, myself, and the community at large. Though the research thus far has shown that both the Pfizer and Moderna COVID-19 vaccine generate an antibody immune response which dramatically decreases illness caused by COVID-19 inflection, there is not yet enough data to show whether the vaccines can prevent asymptomatic transmission of the virus to others not yet vaccinated. We also do not know how long the duration of protection may be for those already vaccinated. As we wait for more data regarding COVID-19 immunity and transmission post-vaccination, it has been advised by OHA, CDC, and local public health departments to remain vigilant with standard precautions such as mask-wearing, physical distancing, and limiting indoor gatherings. Public health officials suggest that herd immunity is reached when somewhere between 70-80% of the population is vaccinated. Until we have more of the public vaccinated, COVID-19 will continue to be transmitted in our community, and it’s possible that even vaccinated folks can still be vectors. With the hope that comes with the vaccine, there also comes information regarding some newly identified variants of COVID-19: B.1.135 (South Africa), B.1.1.7( UK), P.1.(Brazil), and CAL.20C (California). Scientists are currently researching the B.1.1.7 UK variant to determine whether there is an increased risk of mortality. Some studies are already beginning to suggest that may be the case. So far this variant appears to be 50-70% more transmissible. This means that even with all prevention precautions taken, there will be a significantly higher risk of transmission than before. Higher rates of transmission mean more cases, which ultimately leads to more deaths and overloading our healthcare systems and workers, which are already reeling in some places after the post-holiday surge across the nation.
Though we are so close to such promise with the vaccine, we are also at a very tenuous place with experts projecting that the higher transmissible B.1.1.7 UK variant will be the dominant variant in the United States by mid-March. Now more than ever we must be vigilant with our precautions so that we don’t continue to spread the virus and its new variants. The more opportunity the virus has to spread, the more opportunity it has to mutate with the possibility of new variants that might compromise the efficacy of the current vaccines. One such variant, B.1.135 (South Africa), is so far showing some level of antibody resistance. Although it appears the vaccine will likely still be protective against both B.1.1.7(UK) and B.1.135 (South Africa) variants, vaccine efficacy may be slightly reduced. One study shows a 6.4-fold reduction in neutralization ability for the B.1.135 variation, which may lower the efficacy of the vaccine to some degree. As a precaution, Moderna is already exploring the possibility of adding a third booster shot to its current two-shot regimen to boost immunity to newly-emergent strains. These variants are also particularly concerning for those who have already been infected with COVID-19, who may have gained sufficient antibodies to offer some level of immunity for an unknown length of time, but may not be resistant to this variant and may be at risk for reinfection. Many of these people may have a weakened immune system or may still be dealing with COVID-19 “long haulers” symptoms from their first infection and may not be able to win the fight against a second variant. As more people become infected with COVID-19 globally and produce some level of antibodies and/or become vaccinated, more infectious variants will emerge to keep the virus thriving. While it does appear that the mRNA vaccines are adaptable to the new variants, the successful and timely distribution of additional (adapted) vaccine boosters will be a challenging task. With more variants circulating and mutating, herd immunity requires our sustained vigilance. All of this to say that although the vaccine brings hope for herd immunity, it is currently a race between the vaccine and new variants. The best thing we can do to help slow the spread of new variants and buy ourselves a little bit more time for more of the population to get vaccinated is not to start taking more risks but instead doubling down on our precautions. Wearing high-quality masks, limiting indoor gatherings, and staying physically distant from those not inside your bubble whenever possible are the best tools we have to reduce transmission. What does this mean for reopening my practice:
With so much up in the air, I haven’t selected a date for reopening, as new data continues to emerge at the present pace. I am researching religiously and eager to get back to practice. However—in order to do so in the safest way possible, for clients, myself, and our community—I am waiting for a few things:
(1). A higher percentage of our local population to get vaccinated to get closer to herd immunity locally,
(2)More information regarding transmission post-vaccination and newly identified variants, and
(3) For our local case numbers/test positivity rates to be low and sustained.
We have learned so much about how transmission risk can be reduced for the massage therapy setting when precautions are taken by both client and practitioner, including risk mitigations like wearing high-quality masks, exposure/symptom screening, and HEPA air filtration and/or open windows. Nonetheless, massage therapy in my office likely remains somewhere in a ‘medium risk’ category as demonstrated in the image below (based on low occupancy, wearing face coverings, contact for prolonged time in a somewhat poorly ventilated setting (no outdoor airflow) while silent or speaking. This chart does not take into consideration the newly-emergent, highly-transmissible variants, which would further increase risk level even with these precautions followed to a T. Image source.
So in a race of variants against vaccine, the best decision I feel I can make for my practice and our community with the information that is currently available is to remain paused so as not to risk any further transmission when it is so crucial that we prevent the spread of these new variants and limit the opportunity for the virus to further mutate while awaiting vaccine distribution. This decision is what feels right for me based on my own assessment of the information, risks, and the specs of my office, but I am not a doctor, scientist or epidemiologist. I look to these experts to help decipher the vast sea of ever-evolving research. Your mileage may vary in the decision to receive massage therapy at this time. Every space, situation, and person has different levels of risk based on many factors. With that said, I truly hope that you all know how much I deeply miss providing the healing supportive care of massage therapy and connecting with all of you to help you find ease in body and mind. None of these pandemic-related decisions have come easy to me and I continue to try to lead my decision making by the ethos of “do no harm” as I weigh the risk vs. reward of returning to practice. I know remaining paused comes at the high cost of you not being able to receive this care at a time when we are all struggling and I hope to honor that by continuing to stay informed and put safety above all else. I truly feel that we are in the homestretch and I am hopeful and closer than ever to getting back to practice and am so looking forward to seeing your smeyes (smiles with your eyes) and getting everyone some much-needed bodywork. I will continue to give practice updates closer to a reopen as the situation evolves. I will also be gradually updating my website with all COVID precautions and protocols I will be taking when I do reopen so keep an eye out for that. Stay strong and stay safe out there my friends! *disclaimer* This information is not to be taken as legal or medical advice as that is out of my scope of practice. As this unprecedented situation continues to unfold the research and data cited may be variable to change. The intent of this letter is simply to inform you of my opinion and perspective as a licensed massage therapist and to recognize the true risk of receiving massage therapy at this time is unknown and thus has informed my cautious decision to keep my practice closed.