Why I am not re-opening any time soon

Since my last “letter to my clients” post I have been watching as other therapists purchase and prepare and plan and get their practices re-opened with all sorts of new policies, procedures, and preventive maintenance in place (alliteration intended).

The state of Kansas allowed massage therapists to re-open “appointment-only” on May 18th. Some people chose to forge ahead and re-open; a lot of people did not. I am in the latter camp, as are many of my most trusted peers. I had thought maybe I would be able to start home calls some time this summer; at this point, however, all home calls are advised against by authorities because the therapist cannot control the sanitation of a home-call location.

I’ve watched, read, queried, listened, and researched how re-opening could possibly be something I could do sooner rather than later, once I am able to secure a new workspace and all the right supplies. I’ve spoken with colleagues in the field, I’ve looked at official documents put out by our states, our professional associations, and the overarching Federation of State Massage Therapy Boards (see link, below). I’ve searched my own soul, too. And, of course, I’ve looked at my dwindling bank account (no pandemic unemployment or small business assistance has made it my way, yet).

I’ve found myself optimistically making a list of the vast quantities of new supplies and PPE that I would have to purchase before even thinking about putting my hands on anyone besides my husband and my pets. (I like lists, and sometimes shopping is fun.) The list is very long, and it includes a lot of expensive, hard-to-get items that I mostly haven’t been able to find, or, when I can find them, can’t yet afford (e.g. one impermeable medical-grade sanitizable cover for a face cradle pillow — $50).

All these logistics aside, right now there are a number of issues that, to me, are absolutely insurmountable to my re-opening at this time, or, possibly, even this year.

One: I do not have a suitable office space. This could be overcome by either 1) building out in my garage (at an expense, but home improvements are worth it, as would be creating a space that is entirely isolated from our living space) or 2) continuing to search for an office to rent that meets certain criteria, then securing that office with a deposit and perhaps a number of months of renting it without occupying it (something that I would consider ONLY if it were the absolutely perfect space, and is something that I was unable to do to keep my previous space).

The second is something that caught my eye in the FSMTB publication put out this last week: “Each massage practice will have its own time frame for returning to work based on the state’s stay-at-home orders, supply of personal protective equipment (PPE), funding for massage programs, availability of COVID-19 tests, COVID-19 testing rates, and stable or falling COVID-related hospitalization rates for two weeks or more.” (emphasis mine). I’ve already touched on the lack of availability of PPE at this point, and I’ll mention something about it further in a bit.

Third are the case studies of how the virus has spread in different situations, shown in this continually-updated post by this author, Erin Bromage. Thankfully, her writing makes me stop and think about the multitude of factors that would still lie outside of my control, even were my office perfect (impossible), my sanitation 100% complete every time (also impossible), My PPE, hygiene, and personal practices immaculate (I’m good, but, also, this is impossible), and I stayed as personally isolated as I could outside of work so I could provide massage without risks coming from anywhere else (impossible, and also not fun).

The fourth is something we aren’t even TALKING about in massage therapy right now, but it was the VERY FIRST THING that made me pause and then stop my practice way back in the second week of March: SOCIAL/PHYSICAL DISTANCING.

Last, but not least, and likely the MOST important thing that, again, is NOT being talked about in re-opening massage practices is EXTENDED CONTACT TIME.

Let me address each of these in turn.

Office space: Tabling the idea of building out at home for the moment, I am looking for a new space that meets certain requirements, but nothing is coming up that works for me. I chose not to continue renting the wonderful yet poorly-ventilated basement space with no windows that I had been in since November, 2018. I am going to let this subject lie until I have some sort of positive update and am no longer mourning letting go of what I thought would be my “forever home until I retired from massage.” (Damn you, Sars Co-V 2!)

That phrase from FSMTB’s publication: Go re-read that bold bit one more time. It is the last bit that gets me: “…stable or falling COVID-related hospitalization rates for two weeks or more.” That stopped me in my tracks. Wait? Where can I find this number? How do I relate this number to my practice? What does it mean if this number is going up? I don’t have the answers to this question at this time.

I believe, however, that what we are going to see in this area is that number trending upwards through June. Note that I said “believe” — I have no data to back this up because I wasn’t even told I should be LOOKING for this data in order to decide when and how to re-open my practice. WOW!

Not to mention I have NO idea what the testing availability and rates are for my area. I am naturally a risk-averse person; I like to know about potential risks, and I like to minimize them, whatever it takes. This entire ten-week period that I haven’t been working, all I have heard is we don’t have enough tests, we don’t have a high-enough testing rate, and we don’t know the real infection rate in any community for this disease because of that. And, now, I also don’t know if the hospitalization rates are trending up or down.

Let me move on to the third thing. If you’ve read those two posts by Erin Bromage and understood what she is describing, one of the things that hit me the hardest was the issue of indoor ventilation. It looks like when people gather in indoor spaces, whether large or small, ventilation patterns can contribute significantly to the spread of the virus.

Spending extended time one-on-one with someone who is outside of my “chosen contact pool” in an enclosed room, even with a good air purifier and open windows during/after a session, seems like it would increase the risk not only for both of us, but everyone else we would subsequently have contact with in our lives.

Even if we both “believe” that we are not carrying the virus and that we haven’t been doing activities where we could risk contracting it, we still WOULD NOT KNOW, because widespread testing is NOT available — and sometimes testing isn’t even reliable! We also could not be assured that if both of us had previously tested positive and recovered from COVID-19, that either one of us had actually developed an immunity to the virus and were no longer active spreaders.

On to social/physical distancing and extended contact time. These are important guidelines that are still in play when we are out and about in the world, even as stay-at-home orders are lifted and other restrictions are easing. The recommendations for distancing and contact time have not gone away, no matter what those folks out at the lake are doing today.

Massage therapy is performed over an extended amount of contact time in an enclosed space without social/physical distancing and with someone who would normally be outside of your contact pool/family.

Please read that again.

NO amount of sanitation or masking or prayer or airing out a room is going to change these facts.

Massage therapy is performed over an extended amount of contact time in an enclosed space without social/physical distancing and with someone who would normally be outside of your contact pool/family. 

Yep, I repeated that intentionally.

This is what keeps me up at night when I think about going back to practice. I can have the best sanitation practices, have all of the new protocols in place, air out my room after every session, run an air purifier 24/7, clean every high-touch surface with the right, EPA-approved cleaners and the right contact time, change clothes and shoes after every session, wash my linens properly, wash my hands properly, wear masks and change them out every time I needed to, and still… my client and I would be in an enclosed room, not physical distancing, sharing the same air, even with masks on, and spending contact time that exceeds the continued current recommendation of 10 minutes.

When we choose to have an extended contact time (even with masks) with someone who is not in our family, we are casting our lots into the same contact pool. We are basically becoming one big, extended family for a short period of time (basically the two-weeks of self-isolation that it would require were either of us to test positive). We could hope that neither one of us had previously picked up the virus from someone else and was carrying it into the session, and we could also hope that nobody else who had come into the office that day before our own session had been actively carrying the virus. But we cannot know any of this for certain, because this is the nature of the current crisis.

All of the sanitation and hand washing in the world could not protect us from the people and spaces we have had contact with in the wider world that we are bringing with us right into the massage session into the enclosed space for an extended period of time.

Now, let’s pause here. What I have just said above is true at all times in any massage session. There are always risks inherent because of the close nature of our work. During cold and flu season, I up my sanitation and disinfection game dramatically. In my 30 years of practice, there have been fewer than a half-dozen times that I believe I may have picked up a cold from a sick client, and even fewer times that a client believes they got sick from coming into my office. So, we might decide that the risks of spreading this new virus would remain as low as the common cold or the flu as long as we were doing everything else properly.

The truth is, though, we cannot know this at this time. Especially with asymptomatic spread (up to 40% of carriers last time I checked), the risks of spreading and contracting this virus are much, much higher than the common cold or flu. Symptoms don’t come on as quickly or in the same manner as cold and flu, either. Some people never have symptoms and are still carriers. We also don’t yet know all of the iterations of this disease and how it commingles with existing health issues. I believe that we just may not yet have enough information about the disease to begin to take the risks inherent in practicing massage therapy.

Let me put these thoughts into real terms: I do NOT want to be responsible for endangering someone else or their loved ones because I turned out to be an asymptomatic carrier and they then carried the virus on to their family. The converse is also true; I am also trying to protect MY parents by limiting my contacts and my activities as much as possible so I can run essential errands for them.

Well, what about upping the PPE game and making everyone in the office wear N-95 masks at all times? Sure. Both the client and I could wear N-95 masks. Worn and used properly, they actually do protect the wearer and other people in the room from virus transmission.

I promised myself I wasn’t going to rant about the unavailability of good PPE, but I will rant about this: N-95 masks are for healthcare workers and first responders, NOT FOR MASSAGE THERAPISTS. We are NOT essential workers. PPE is in short supply all over the world. Were I to magically get a box of N-95 masks, whether I bought them or was gifted them, I would hand them over to frontline workers in the healthcare field or else to my husband’s frontline co-workers (bus drivers). I WOULD NOT DO MASSAGE IN THEM. I am not that selfish. My business can wait.

So, there you have it. My very long-winded and deeply thought about opinions as of this moment, May 22, 2020, on why I cannot go back to practice right now or in the coming weeks and still feel like I am doing the utmost to protect my clients and their loved ones. I will watch as the brave folks who have returned to practice wade through the new protocols and make them second nature. I will keep an eye on the testing and hospitalization rates in my city, county, and state. I will hope that PUA and SBA money will finally find me. And, I will continue to learn, change my mind where needed, and think continuously about what I can do to help people, whether or not it is via massage therapy.

Here is the tl;dr that sums up why I believe I cannot reopen at this time; 1) I need a space with windows and washable surfaces; 2) local hospitalization rates need to be stable or dropping for at least 2 weeks; 3) proper ventilation of the room and the office needs to be controllable and achievable; 4) wider social/physical distancing rules need to be lifted; and 5) personal contact time needs to be extended by authorities to long enough to permit massage.

So, looks like I’ll see you all in 2021, unless something miraculously changes. That could be my thinking, or it could be the world. We just don’t know yet.