Updates 03/15/2020 – There is a Federal Bill that has passed the House and now has gone to the senate that will provide help for everyone in the US who is affected by the virus or self quarantine.
HR 6201 states:
SEC. 601. Definitions.
(1) EMERGENCY LEAVE DAY.—
“(A) IN GENERAL.—The term ‘emergency leave day’ means, with respect to an individual, a calendar day in which the individual is not able to engage in employment due to any of the following reasons:
“(i) The individual has a current diagnosis of COVID–19.
“(ii) The individual is under quarantine (including self-imposed quarantine), at the instruction of a health care provider, employer, or a local, State, or Federal official, in order to prevent the spread of COVID–19.
“(iii) The individual is engaged in caregiving for an individual who has a current diagnosis of COVID–19 or is under quarantine as described in clause (ii).
“(iv) The individual is engaged in caregiving, because of the COVID–19-related closing of a school or other care facility or care program, for a child or other individual unable to provide self-care.
“(1) IN GENERAL.—Subject to paragraph (2), the amount of the emergency paid leave benefit to which an individual is entitled under subsection (a) for a 30-day period shall be an amount (not to exceed $4,000) equal to 2/3 of the individual’s average monthly earnings.
Update 03/15/2020 – Social Distancing This weekend, the call for social distancing became much stronger. Many states and the Federal Government and many individuals like Jason Warner (FB post) are calling for stricter social distancing. This brings up many financial fears for most but hopefully the bill above can help. Many massage therapists live day to day or week to week making it difficult to stay home and not work.
What is the Corona or COVID-19 virus?
It is NOT a flu virus. It is one of the enveloped viruses, meaning they are one of the easiest types of viruses to kill with the appropriate disinfectant product. It is SARS-CoV-2 RNA similar to infection with MERS-CoV and SARS-CoV. The virus that causes COVID-19 and the one that causes Severe Acute Respiratory Syndrome (SARS) are related to each other genetically, but they are different. SARS is more deadly but much less infectious than COVID-19. There have been no outbreaks of SARS anywhere in the world since 2003. It is a zoonotic virus meaning it spreads from animals to people and people to animals making it more difficult to control.
There are several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19. WHO – https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
Spreading of Virus:
What we know so far:
It is NOT airborne like the measles but it is contracted by the droplets in the air from a person coughing or breathing so the recommended course is to be 6 feet away from others to avoid picking up the virus from surfaces or in the air. So far, available evidence suggests it can be transmitted less easily from soft surfaces than frequently-touched hard surfaces, such as a doorknob or elevator button. https://www.health.harvard.edu/blog/as-coronavirus-spreads-many-questions-and-some-answers-2020022719004#q1
An airborne virus stays in the air and is spread through the air. It is unknown at this time for sure if it is not airborne.
There is contradictory information out there about the spread of the disease and some are saying you can be contagious way before you have symptoms.
People who are at higher risk are the elderly, immune compromised and also people with heart and lung diseases or issues.
Symptoms: Fever, DRY cough, shortness of breath. It is specifically a respiratory virus. The big difference is the DRY cough and shortness of breath. Differences between flu, cold, COVID-19, norovirus graphic.
Why is this happening?
Personally, I really don’t get it – why the extreme measures to control this if 80% of the people who get it have very mild symptoms that they recover from? I just heard the best answer today in a communication from Italy that the reason is because those who are sick and require hospitalization are overwhelming the healthcare system. I am not sure if there is more to it than that.
Should you continue to work?
The answer to that is highly individual. You will have to make the best decision for YOU.
- Can you afford not to work? How will this affect your family and your business?
- Do you have underlying health issues like lung problems, immune system disorders for starters or are unhealthy in general or does a family member that would make them more susceptible ?
- Have you or a family member come in direct contact with an infected person (within 6 feet for over 10 minutes)?
It is also a good time to slow down a bit so that could bring new people in who are stuck at home and need stress relief. Our communities need more help with stress relief and I really wish there was a way to give them massage at the fire houses and emergency centers but the added risk may be too much. I don’t know if we are immune to this virus after we have it either.
If you are an employer of other massage therapists you have more to deal with. You will need to keep your employees safe and help them through this. You will need to create strict policies and help your employees enforce them safely for all involved. if your employee has the slightest sign of being sick, you need to send them home which will mean you will have to cancel appointments or have backup therapists to fill the appointments. You will also need to have flexible policies to accommodate employees who have to stay home because of sick family members or schools being closed. More info — https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html
Should you wear gloves?
It is up to you, but so far if you are washing your hands and cleaning your office and don’t have anyone coughing on your table, my guess is that you will be fine.
Here is information on wearing gloves that will help you to learn how to use them correctly. I also recommend that you wear gloves when cleaning your room so they can be disposed of after EACH client.
Should you wear a facemask?
Surgical masks only protect YOU from spreading germs if you have the virus.N95 masks protect you from getting the virus when it is in the air around you. Masks need to be disposed of after every interaction with an infected person or when it becomes so used that it does not fit your face tightly.CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html
WHO recommendations on face masks.
- If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
- Wear a mask if you are coughing or sneezing.
- Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
- If you wear a mask, then you must know how to use it and dispose of it properly.
Facemasks are already in short supply and are not available in stores around Seattle or online and need to be saved for people on the front lines.
How to work with clients.
I started becoming aware of every move I make in the office and on the way to the office. I started thinking about clients and how they get to the office – having to touch door handles to enter the building and my office and touch elevator buttons etc.
Wash Your Hands
One easy thing to do is when people walk in your door, have hand sanitizer or offer them a sink (in restroom or with my situation, I have a sink in my office) and show them how to wash their hands according to the WHO – Print out one of these hand hygiene handouts:
WHO — https://www.who.int/gpsc/5may/resources/posters/en/
CDC hand washing guide – https://www.cdc.gov/handwashing/when-how-handwashing.html
CDC – using hand sanitizers – https://www.cdc.gov/handwashing/pdf/hand-sanitizer-factsheet.pdf
Popular brands like Purell and Germ-X sometimes use benzalkonium chloride instead of alcohol, which is less effective at killing human coronaviruses than alcohol.
Homemade hand sanitizers – There is a bit of controvercy over the correct recipe for making your own hand sanitizer. The general recipe is:
- 2/3 cup rubbing alcohol (isopropyl alcohol) or ethanol
- 1/3 cup aloe vera gel
- 8 to 10 drops essential oil, optional
The problem is that there are many different dilutions of rubbing alcohol. The best recipe should have 99% ethanol (grain alcohol) or isopropyl alcohol (rubbing alcohol). Many of the brands are only 70% alcohol. Also, if you use a product that contains a lower percentage of alcohol (e.g., 70% alcohol) then you need to increase the amount of alcohol in the recipe or it won’t be as effective. (Rubbing alcohol and aloe vera gel are out of stock everywhere too now…so Just Wash Your hands.)
Don’t Touch Your Face
The other part of this is to stop touching your face. The virus lives on surfaces of all kinds and you never really know if you touched something that is contaminated. Think of all the things you touch — the doors, handles, keys, glasses, phone etc etc. Touching your face brings the virus to your face where it could get into your nose or mouth and transfer the virus to you.
Ruth Werner said – “CDC /OSHA recommends 10% bleach for surfaces (mixed up at least weekly). For laundry, wash on high heat, dry on high heat. Use detergent. This virus has a coat that melts with soap pretty easily, so that doesn’t seem to be a problem (yet). Good antimicrobial action is achieved at 71-77* F, 21-25*C. If you add bleach the water must be much hotter for the bleach to be effective: 135*F. Bleach should be added at 50-150 parts per million. (Frankly I don’t think this is necessary for coronavirus.)”
Using the intake process to properly screen clients to lessen your possible exposure to the virus is essential. Start by asking them if they have been in contact with anyone who has the virus–anyone at home or work? It started out as being something that was only found in people who had traveled to China, Japan and Italy but has since changed.
People are being really up front with this anyways. I assume that people have not if they are out and about. As I started to talk to people, I realized that everyone knew someone who knew someone…and the connections started falling together. If they are not showing symptoms, we do not know without a doubt that they do not have the virus. Upping your sanitizing routine is the only way to be most certain, but even then there is a risk. Shaking hands has turned into toe tapping or elbow tapping, but I have stayed with hand shaking and then follow up with the offer to wash their hands or handrub with sanitizer after that.
- Have you had the flu or any cold/sinus/congestion illness in the past two week or so?
- Has anyone in your family had the flu or cold in the past few weeks or currently home sick with a cold/flu like illness?
- Have you had anyone at your office or church or immediate community that has been diagnosed with the COVID-19 illness now or in the last few months?
I am also asking them when they leave to let me know if they happen to get sick in the next 7-14 days although it would be difficult to tell where they got it from but just and added measure.
Facemasks are in short supply and are not effective unless you have the virus or are handling people that have the virus.
Why the run on TP and bottled water?
This one I don’t get but one checker in Trader Joes said that in China there was such a shortage of facemasks that they started using toilet paper and that caused TP to run out there. I am still looking to confirm that.
What are the best cleaners to use for your massage table, room, door etc.
Cleaning your table and other surfaces in your office are crucial to stopping the spread of this virus.
We currently do not know how long the virus stays alive on surfaces. Use gloves for cleaning your office after each client and throw them out in a covered receptacle. CDC recommendations – https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html
EPA recommended cleaning products – https://www.epa.gov/sites/production/files/2020-03/documents/sars-cov-2-list_03-03-2020.pdf
Alternate business plans.As health departments suggest social isolation and businesses send their workers to work from home, you may need to make adjustments in the way you do business. I am changing my hours to work earlier in the day to accommodate people who might want to get in earlier in the day. If you have a niche practice in a hospital where people are being treated for the virus, think about changing to an outcall business or a chair massage business.
Your cleaning awareness will go on steroids. EVERYTHING YOU touch and the client touches needs to be cleaned AFTER each client…the door knobs, the clothes hangers, your phone or tablet that you use for credit card processing. Some companies are limiting taking cash because of the added risk of the virus being passed on the money.
I started thinking about how clients breath on my shoes and pants when laying on the table with their face in the facerest! What about the carpet under their noses? The wood on the end of the table? EVERYTHING!
We still do not have enough information on things like how long this lives on surfaces. We do not have accurate data on how many people actually have the virus because we don’t have enough test kits. We don’t know how long this will last. Plan as you would for any other emergency situation.
- Have 6 months to a year in savings.
- Have alternate sources of income
- Have a plan for being flexible with things like no shows and last minute cancellations. There is just so much happening and it is happening so quickly, charging cancellation fees will make people really mad which is a risk for bad reviews and people not coming back. Yes you will lose money, but there are other things you can do to keep people coming in and coming back during such a pandemic.
- Think about learning to bill insurance for massage therapy sessions. When you bill insurance your payments come 2-4 weeks later making it so you have income each week. Some car accident related cases will take a bit longer to pay. People who come in with their insurance paying tend to come in more often and they are usually in more pain so they are more motivated to continue their sessions.
- Be flexible with your schedule to accommodate clients
- Connect with your local community for information and support
- Have a plan to help your employees through this. Create flexibility with sick policies and days off.
- Practice good self care
- Stay calm
- Purchase cleaning supplies like Babarcide Wipes, Chlorox wipes, alcohol based wipes, hand sanitizer, soap, paper towels and laundry detergent
- Make sure your website is working the best it can to make sure clients keep finding you and coming in. Learn how to create a website that works.
- Start selling package deals to people coming in and to your regular clients to get some money in the bank
- Sell gift certificates to be used when this is over to build up your cash reserves.
- Be prepared to stay home the minute you feel like you are getting sick and stay there until you are better –no matter what type of illness you have.
What to tell your clients and potential clients about Covid-19
Here in Seattle, people coming in already understand it for the most part. They want to know that you are cleaning your office and are aware of the guidelines for contact and cleaning.
Look at some of the emails coming to you for examples of what to say. I just got this one from Lens Crafters that I really like that could be really adapted for massage therapists.
Help is coming
The first signs of health are showing up in the Seattle area. The city of Seattle has set up a grant for very small businesses under 5 people.
Unemployment benefits are being opened up for employees affected by layoffs. This will help separate the independent contractors from
Find your State’s Department of Health office and Follow them on Facebook and other social media sites – https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html
Find Your County health department and follow them on social media or sign up for news.
Ruth Werner’s – Massage therapists guide to COVID -19 https://www.facebook.com/MassagePracticeBuilder/posts/10156554056532271
Report from WHO task force in China- https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/
I live 5 miles from the Life Care facility where the virus was first detected and now has spread in the US. The last few weeks has been crazy with people buying out Costco, other big box stores, drug stores and grocery stores of hand sanitizer, face masks, disinfectants, bottled water and toilet paper…why I personally don’t understand and I guess I have more faith in our system. My office is in the heart of downtown Seattle in the business district where most of my clients work in some tech capacity nearby. Last week on Wed, everyone came in and said their office told them to go home and work from home until April, 1 or some were just until the end of March. Social distancing is what they are using to keep people from spreading this.
All of a sudden my business went from a regular 15 people a week down to 2 for next week. I am deeply saddened by the effect this will have on all small businesses and the world. I do have a plan B after a few days of fear and wondering what will happen. My schedule has been so full that some of my regulars who just come every few months or so have not been able to get in. I will start with contacting them. I am also putting up a page on my website and writing up a policy in an attempt to keep people calm and make sure they get the right info. (I have a local FB chat group where I was asking if anyone found hand sanitizer and one person posted yes with a picture of two big bottles only to look closely to find it is only soap. People don’t even know what they are shopping for!)
My guess is that many people who had the flu in Jan and Feb might have had this virus and not the flu. They were only testing people who had traveled to China and only a few days ago opened up the testing to include anyone with the specific symptoms but still do not have enough test kits.
Update 3/11/2020 – Things are moving really quickly. I first thought I was just going to be extra careful with cleaning and screening but found that most people have had SOME contact with this virus but most is very remote like they worked in the first building that got shut down for cleaning or was at a conference where someone had it. We still do not accurately know the incubation period and they think it is 2 -5 days and some sources are saying 2-14 days. Everything in downtown Seattle is being shut down. Hotels are empty. Conventions are postponed. The Governor just announced that any event with over 250 people is cancelled and anyone with events with any amount of people need to comply with the guidelines for cleaning and sanitizing.
I have been searching for the reasons why this is happening since it did not happen with H1N1 and also 80% of people who get it have mild symptoms and recover easily. I finally saw this video from the Leader of Italy saying how overwhelmed their hospitals and health care systems are. That makes sense but I was hoping/thinking that ours are better. This afternoon I found this website www.flattenthecurve.com and there is says:
In the USA, our health care capacity is under 1 million staffed beds; this is not adequate to accommodate the number of hospitalizations we are expected to see (4-8 million). Johns Hopkins University did a 3-year global survey of pandemic preparedness. Although the USA ranked at the top of the countries, even the US only scored a 42 out of 100. We simply don’t have the equipment, training, or messaging in place and we need to ramp up fast. No one does. That is why your choices today matter so much.
Things that made me feel better this last week (03/09/2020): I found out first hand that Bill Gates is personally working on this full time and has donated over 10 million to the state for testing and creating vaccines and testing. His foundation has donated 5 million. The WA DOH is in constant contact with our Governor and they are teaching him everything about this virus so he can make the most informed decisions he can.
The University of WA is working to unravel this virus with a game – https://fold.it/portal/
Kaiser is already testing a vaccine and looking for volunteers (not a live virus or any virus in the vaccine.) https://corona.kpwashingtonresearch.org/?fbclid=IwAR2Jv41po-UuuQ9oeEPqaij_1RVo2SfAi6pQG_3_vEeNasnhmRnJ1k9trbE
The Federal Gov is giving WA 11.5 Million– https://www.king5.com/article/news/health/coronavirus/washington-state-federal-funding-combat-coronavirus/281-4ad88793-7e1c-4300-a61d-980ede5b891e
WA State is already talking about how to support the small businesses and communities – “Our taskforce is also working with large bankers, financial associations, telecoms, utilities and major employers to discuss what they can do to provide relief for companies and workers negatively impacted by COVID-19. We are working to compile a list of these resources, including favorable credit terms for firms that encounter cash flow problems; debt and late penalty forgiveness for workers; and deferring bills, waiving fees, and providing discounts and no-interest loans. My office and our emergency management team will continue to amplify this corporate support.” https://www.governor.wa.gov/news-media/special-covid-19-message-washington-state-businesses-and-workers-governor-jay-inslee
Bill Gates and the Gates Foundation is creating a test that can be done at home. News report.
If you live in the United States, you are currently much more likely to catch the flu than the new coronavirus. A big part of this is the fear of the unknown. There are no vaccines or medications but only 80% of the people who get the virus hardly have any symptoms and recover quickly. Currently it has a higher mortality rate than the flu but I really think that it is due to the lack of testing which is because of the shortage of test kits. (The Life Care Center where it all started here still has only tested 45 of their 120 residents https://www.king5.com/article/news/health/coronavirus/life-care-center-kirkland-coronavirus-patients-moved-treatment/281-079da2ce-5a61-438c-a266-a5af399e2a7)
COVID-19: Approximately 102,472 cases worldwide; 340 cases in the U.S. as of Mar. 7, 2020.
Flu: Estimated 1 billion cases worldwide; 9.3 million to 45 million cases in the U.S. per year.
COVID-19: Approximately 3,491 deaths reported worldwide; 14 deaths in the U.S., as of Mar. 7, 2020.
Flu: 291,000 to 646,000 deaths worldwide; 12,000 to 61,000 deaths in the U.S. per year.
Stop the Panic. Stop the Spread. Stay informed. Stay Calm. Be flexible. This whole situation changes minute by minute. I predict that in a few weeks we will know a lot more as we see how social distancing will change things.
Eat right. Sleep good. Get your immune support vitamins and herbs going. If you get sick you have to stay home of course and remain there at least 72 hours or 14 days. If you think you have been exposed it is best to self quarantine.
For the profession to think about.
03/15/2020 update – where are our professional associations?
Call to action
Dear AMTA & ABMP leaders,
We are Licensed Massage Therapists and Bodyworkers, and we would like to express our growing concern about your lack of action and communication in the wake of the COVID-19 pandemic.
In this time of crisis, we need leadership in the form of communication, guidance, protocols and best practices for Licensed Massage Therapists and Bodyworkers.
What if we had (thanks Laurie Lyons):
- A Dedicated full-time infection prevention practitioner to work on infection prevention aspects of the preparations, including education, training, and exercises.
- Designate a medical director to work closely with the infection prevention practitioner.
- A pandemic preparedness committee (or use an existing emergency management committee) that includes representatives of all clinical and support departments as well as senior administrators. ( applies to larger clinics, spas etc..)
- Participate in a local healthcare coalition, which includes neighboring clinics , local public health agencies, and emergency management. Members of multi-clinic health systems should integrate system-wide planning with local planning with other local clinics.
Changes that may happen and are happening as a result of this:
The air pollution over China has been reduced significantly – https://www.accuweather.com/en/weather-news/china-pollution-levels-fall-during-coronavirus-outbreak/693879
Companies are sending everyone home to work and some may stay home even after the outbreak leading to less traffic congestion and less pollution. Innovation and collaboration will thrive to help get us through this.
No it doesn’t make sense in some ways but it is what it is. The Coronavirus is spreading like wildfire around the world along with the fear and misinformation about what this is and what it isn’t.
See also: Surviving and Thriving During COVID-19
Thank you so very much on your article and input. I have to agree with you very much on Don’t Panic people. Yes, it’s hard being in our field of business. A lot of fabulous reminders. Again thank you for this fabulous post!
Ellen Byrne says
I fear that you are possibly passing out bad advice. Can you at minimum list your updates at the top of your blog? This reads as if you are basically labeling Corona Virus as a bad form of the flu. No discussion of what constitutes high-risk patients. No discussion of passing the virus along while being asymptomatic or having a mild case of the virus. No discussion of how the virus shed may live in cloth/ rugs and how we clean these materials. No respect to the current policies of asking people to social distance. No mention of interviewing clients for recent travel or possible symptoms of fever or cough. You “think” bleach isn’t necessary to clean massage linens in the case of Corona Virus. We are in the face of the unknown. There is the possibility of over-reacting. There is also the responsibility we have to be conservative and to not risk spreading disease.
Julie Onofrio says
I have clearly stated that it is not the flu. I have a list of screening questions. travel does not matter anymore – it is whether or not people have any kind of sickness or have been in contact with anyone who is sick. The social distiancing just became a big thing this weekend. Bleach ruins the sheets. thanks
I think it’s past time … shut it down. ‘Do No Harm’ is more important than your making ends meet if you’re in the medical profession! You may have no symptoms and still give to your clients! Wake up!
Julie Onofrio says
Yes read my other more recent posts on this –