Why I'm choosing not to reopen my massage therapy practice in phase one.
Updated: May 26, 2020
Dear clients, I am writing to address the press release from Governor Kate Brown yesterday 5/7/20 that released the phase one guidelines for reopening. Our county must meet certain requirements to apply for phase one reopening, though since Hood River county is small and has had a smaller number of COVID-19 cases I believe we may soon meet these requirements for phase one reopening. Massage therapy has been included under the ‘personal services’ category which will be ‘allowed’ to reopen in phase one with these guidelines. This inclusion is fairly complicated and I have a lot to say on the matter, but I will do my best to summarize. In short, I will not be reopening my practice by May 15th if Hood River county is approved for phase one reopening. The reason I'm making this decision is the same reason I decided to close my practice on 3/14 well before the state mandate to close non-essential businesses: to protect the safety of my clients, myself, and our community. Nothing has changed about the inherent risks of giving and receiving massage therapy during this pandemic except that we now better understand more of the risks directly associated to COVID-19 and massage therapy. Will the guidelines keep me safe?
These guidelines are written in such a way that they aren’t mandated guidelines as much as suggestions to providers in the personal services category. The liability is shifted from the state to the individual choosing to practice, with no recourse whatsoever if the provider is unable to meet all of these guidelines. They offer no real protection to you as the public or to the providers. The guidelines themselves are flawed and full of contradictions and continue to not take into account the asymptomatic spread of COVID-19 which is the main reason we chose or were told to close our practices initially. Symptom and temperature screening will not prevent asymptomatic COVID-19 positive people from passing those initial tests and getting on the massage table potentially exposing the therapist and making them a vector for any other clients they see long before they would exhibit symptoms.
The state's suggested guidelines for providers ask that we provide disposable masks to our clients and “medical” masks for ourselves, face shields, gloves,
gowns to change between every client, and EPA certified disinfectant products, all during a time when these supplies are difficult to come by due to being back ordered and come at a premium cost. This upfront cost to the individual who will also have to lessen overall client load to meet these physically distanced guidelines will come at a time when personal service providers have been out of work for up to 8 weeks and many have yet to even receive a single unemployment assistance payment. Folks who work in personal services are struggling to meet this demand as many simply do not have the capital available.
Will a mask keep me safe? Even with the suggested use of masks for clients and providers “to the extent possible” per the guidelines, aerosolized virus simply from regular breathing is still a risk, which is why physical distancing measures have been implemented across the country to limit the spread of this aerosolized virus. As providers, the guidelines tell us to maintain 6ft physical distance at all times between ourselves and clients--except for when the service we perform prevents us from doing so. The spread of aerosolized virus is a greater risk when you are within 6ft of someone, even if you are both wearing masks and particularly if you are within 6ft for longer than 15 minutes. Obviously the high contact nature of massage therapy being performed in small rooms for an average of 60-90 minutes means that it is impossible to abide by 6ft physical distancing guidelines and puts both client and therapist at a higher sustained risk of exposure.
Are there other risks related to COVID-19 and massage therapy?
The last thing I need to address with regards to massage therapy being included in phase one is the risk of blood clots and COVID-19. There is mounting evidence that shows blood clotting is a symptom of COVID-19 and can present even when no other symptoms have. This is particularly relevant as it relates to massage. Patients are presenting with deep vein thrombosis who otherwise wouldn’t. The risk of stroke and pulmonary embolism is so much higher. DVT is one of the more serious contraindications for massage and also harder to screen out before treatment if a client doesn’t know they have it. In fact, the muscle cramping and pain from DVT might be what actually makes someone seek out massage therapy in the first place. Even if we follow the state guidelines to have clients screen themselves for symptoms like cough, difficulty breathing, taking temperature, they could show no other signs of symptoms and still be presenting with blood clots which massage could potentially dislodge and could result in death. Many massage therapists echo these same concerns and disagree with having been placed in phase one of reopening, despite our industry representatives in the state work groups voicing these concerns and urging that we not be included in phase one. We are concerned for our clients safety as well as our own.
At the risk of overloading you with information I want you to be informed of what is happening in the massage therapy industry and with these state guidelines so that you can proceed with caution, understand the risks involved and know that these ‘guidelines’ go against what many in our industry have asked for in protecting public health. These guidelines are not agreed upon by industry professionals, yet some providers will open with varying degrees of compliance. We have not been approved to work yet by our state licensing board and they have essentially deferred all actions and accountability/liability to the state/governor, so our own state licensing board has no power here.
What about providers who are technically allowed to return to work, but who understand that to do so constitutes a risk to public safety?
So far, the state’s official stance remains unclear as to whether or not providers who--citing personal and public safety concerns--choose to remain closed during phase one, will lose their unemployment assistance, PPP or EIDL funding. Many of whom have yet to see a single payment from any CARES act assistance program. It’s important to understand that this amounts to providers having to decide between upholding their responsibility to do no harm, and their personal livelihoods. This is not a position we should be putting people in and it’s not what’s best for public health. Final thoughts:
I want this to be public knowledge so that people can inform themselves that these state “guidelines” for personal services offer no guarantee of public safety or the safety of these providers. If you choose to seek out personal services at this time, know the personal risk involved, please act accordingly and in addition, support these industries if their stance is to remain closed despite pressure from the state. The risk of performing massage therapy at this time remains the same as it did in mid March, as does my commitment to do no harm. So until we have more information regarding this virus and its lasting effects particularly as they pertain to massage, I will remain closed to not risk public and personal safety.
Please understand I do not make any of these decisions lightly and it is only after much research, tears and deliberation that I come to this understanding. I hope that this information and perspective proves useful to you and please don’t hesitate to reach out to me privately if you have any questions. *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.