Responding to the COVID19 outbreak (take 2)
Advice for massage therapists
by Rebecca Barnett
Please note that, since the release of this article, AMT has escalated its advice to members. The advice below is no longer current.
When I originally started drafting this update, I was planning to write a nice authoritative, third person advice just like the one we published on this blog at the end of January. Then I went to the supermarket for a routine shop …
On the bright side I now know that, when the zombie apocalypse comes, the entire planet will be gorging on pasta, rice and beans while they wipe their suddenly exploding arses 628 times a day with increasingly rationed supplies of TP. TP will soon top oil, gold and silver in the global commodities market. Meanwhile a small nation state of paleo people will slowly emerge victorious, waving their carb contempt and constipation like a flag. Must eat brains? No problem. And who needs toilet paper when you can wipe your bum with bacon? (I am currently buying shares in bum gun manufacturing companies regardless).
This spate of panic buying shows two fairly depressing things: people don’t react to news in a rational manner and the public health messaging about COVID19 is failing miserably.
So I am going to use this blog to argue one main point which I hope gets some traction among the massage therapists who are a bit panicked about how to respond to COVID19 and those seeking guidance, direction and maybe a little bit of (qualified) reassurance.
Let’s just start with the slightly scary sounding bottom line – actual infectious disease and epidemiological experts are predicting that most of us are likely to get COVID19 sometime over the next few years. Most of us are also going to survive. The current containment policies being rolled out within Australia appear to primarily be aimed at buying the health system enough time to adequately prepare for a worst case scenario of patients requiring critical care in an already overloaded public health system.
There’s an awful lot that the experts and authorities don’t know yet and can’t predict because it is early days for COVID19. I suppose this uncertainty is the thing that freaks people out and drives irrational responses. However, the main risk that massage therapists face is proximity – you’re working more closely with clients than the recommended distance of 1.5 metres from infected people so you’re a bit more exposed to the risk of infection. However, if you are already following established policies and procedures for infection control and hygiene, you are unlikely to become more of a vector for disease transmission than anyone else in the general community.
So I am going to go out on a limb and say that, as a massage therapist in clinical practice, the single most important thing you can do right now – apart from following the standards that are already expected of you anyway and the advice we issued back on January 30 – is to become a vector for good public health information with your clients.
Rinse and repeat
Here was the list of actions we recommended in late January. These should still be at the core of your response:
- Apply standard precautions and transmission based precautions
- Instruct clients and any accompanying people to call ahead of an appointment if they have symptoms of any respiratory infection (cough, runny nose, fever, sore throat)
- Instruct clients to let you know if they have any symptoms of respiratory infection on arrival (or if they have recently returned from one of the identified hotspots)
- Provide instruction on hand hygiene
- Provide instruction on respiratory hygiene and cough etiquette
- Post visual alerts (signs, posters) at the entrance and in waiting areas providing clients with instructions about hand hygiene, respiratory hygiene, and cough etiquette. You can download and print the posters and resources provided by the Australian Department of Health
- Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand rub (ABHR), tissues, and no touch receptacles for disposal. (Update: you may be running out of ABHR due to the panic buying. Just supply plenty of soap and paper towels).
- Maintain a log book of all visitors who enter your clinic, including accompanying people.
Your COVID19 response checklist (Let’s say the above again in practical terms)
If you do nothing else:
- Read AMT’s infection control and hygiene standard then read and implement sections 2 and 3 of the NHMRC Australian Guidelines for the Prevention and Control of Infection. The most crucial parts of standard precautions that massage therapists need to be concerned with are hand hygiene; routine environmental cleaning; respiratory hygiene and cough etiquette; waste management; and appropriate handling of linen.
But you’re a responsible health care practitioner who aims to be a vector of good information and best practice so you are also going to:
- Become informed about COVID19 so you can communicate clear, informed messages to your clients. The Department of Health website provides an excellent overview. Read it.
- Monitor daily developments so you are aware of any outbreaks local to you. The Department of Health also provides daily alerts. This will help guide any decisions you make about your exposure to risks of either contracting the virus or becoming a vector for transmission in your clinic. Be aware of any updated travel bans and quarantine recommendations.
- Document your infection control policy and procedures. You should have one of these already written. If you don’t, do it now. It should literally only be a matter of documenting how you meet the standard precautions you just read about in the NHMRC guidelines. (Use headings and subheads: Linen – handling, storage, rotation of clean linen, handling of used linen etc). If you do this stuff properly, you just need to write the process down. It doesn’t have to be pretty, it just has to be documented.
- Consider making your infection control policy available to your clients. It could be one of the stranger opportunities for promoting yourself but mainly it could provide a lot of reassurance to your clients.
- Keep exceptionally good records and a log of all visitors to your clinic (not just clients) in case contact tracing needs to occur.
- Review your cancellation policy. If you currently leverage a fee for short notice cancellation, ditch it for the time being. You need to make it easy for clients to cancel if they have a sniffle etc and not penalise them. Yes, I get that this is painful.
- Add a placeholder message to your website / social media page / email distribution list reminding people to cancel or call ahead if they are unwell and asking clients to contact you before booking an appointment online if they have been travelling anywhere overseas. Instruct your clients to contact you if they are diagnosed with COVID19 and have recently attended your clinic.
- Check the department of health update every morning. Yep, I know that I have already mentioned this. If the infection begins to spread in the community around you, turn off online booking facilities so you can screen clients wishing to make an appointment. This screening is based on symptoms and risk profile of your clients, not race/religion/culture. While you have the right to refuse treatment, you do not have the right to discriminate.
- Be informed of who the most vulnerable populations are. At this stage, we know that this is people over 65, and those with existing respiratory and/or chronic disease.
- Download and print the Department of Health posters and display them prominently in your clinic. They are being updated and tweaked a bit as information comes to hand so it’s worth checking back at the resources page once in a while for updated and added resources.
- If you have an iPad or device playing content in your waiting area, play a handwashing clip on rotation or any of the segments from this excellent edition of the 7.30 report. But remember to follow NHMRC guidelines and product guidelines for cleaning the device!
- Buy a supply of single use paper towels. If you are currently using single use cloth in the clinic, replace with paper. It’s preferable.
- Wash your hands properly before and after each client. No, really properly. Show your clients how to wash their hands properly. There are so many fantastic resources and memes now that there is no excuse. This is one of the dull, factual ones.
- Cough and sneeze into the crook of your elbow. Show your clients how to do this.
- Get into the habit now of not touching your face with your hands. It is seriously freakin’ hard. I have been rudely awakened to the fact that I routinely touch my face about 180 times a day.
- Clean clinic door handles/knobs, light switches, tabletops, desks frequently. Read the labels and instructions for any cleaning products you use because there’s a reasonable chance you are not using them correctly. The NHMRC offers brilliant guidelines about cleaning the clinical environment, including risk assessment, frequency and cleaning product guidance. You will find this info in section 3.1.3 (page 55). Oh that’s right. You know because you have already read it.
- Make a financial contingency plan in case you have to close your clinic for a period of time
- Prepare for lean times (as above). There may be less work for a while.
- If you are an employer, make sure you know how to lawfully meet sick and personal leave obligations, and think about any other provisions you can make to support your workers. Be fair, reasonable and compassionate. Community support will be needed as much now as it was during the recent bushfires.
- If you are an employee or contractor, initiate a conversation with your employer/engager about what will happen in the event of a temporary clinic closure.
- Make a risk assessment of your own family and personal circumstances. If you have elderly, frail or vulnerable people you are in regular close contact with then your threshold for exposure is likely going to be higher and you may have to trigger more extreme isolationist measures in your professional life than the ones outlined above.
The final word
Massage therapy is a pretty unique intervention within the health care system in Australia. We generally spend more time with our clients than any other health practitioners. Although this proximity leaves us at slightly heightened risk of contracting illness, the risks of becoming a vector for transmission can be well managed with sound infection control policies and procedures.
There’s a lot of worry and uncertainty surrounding COVID19 so I would embrace the opportunity to become good citizens of healthcare and agents of public health: be the vector of informed, excellent advice and education for your clients. And if that means teaching a client how to wash their hands and cough/sneeze etiquette as a sensible alternative to TP stockpiling, go forth and lather.
About the Author
As CEO of AMT, Rebecca Barnett is excited by the opportunities that the massage therapy profession has to purge itself of persistent myths through evidence and education. Even though she has used the term “purge” in this bio, she does not have a stockpile of toilet paper.