By Ruth Werner
We have recently marked the sad first anniversary of the appearance of COVID-19 in this country, and we have surpassed a half-million deaths. We have been frightened and angry, sad and frustrated . . . and now maybe with the advent of three safe and effective vaccines and falling infection rates, we can be a little hopeful. In addition, we have learned a lot about this virus and how it moves from one person to another, and some of that has been unexpected.
Given this evolving information, some massage therapists have quite reasonably begun to question the heightened level of hygienic precautions we undertook when it became feasible to open our practices again.
I was honored to be part of the task force that worked with the Federation of State Massage Therapy Boards to create some practice guidelines that focused on hygienic precautions in hospitals, private practice, spas, and school settings. We used the best information available at the time (May 2020) to provide the safest recommendations we could offer. I hope that project helped massage therapists all over the country make good decisions that involved extensive hygiene audits and upgrades in their workplaces to keep themselves and their clients safe.
Many of the recommendations we made then are still very much in play. Others were probably not emphasized enough. It was an interesting experience to go over that document again from the perspective of this year of practical application and prognostication.
Here, I will offer a few of my thoughts about hygienic practices in massage therapy settings during this transition period as some of the most immediately threatening aspects of the pandemic appear to be receding, at least for the moment. (By the way, a blog on the virus variants will be coming soon, so don’t get TOO comfortable!) Note: If your state or local ordinances have guidelines that are more stringent than the ones I offer here, FOLLOW THEM. This document is purely from my own limited perspective and point of view; it is not meant as definitive guidance.
One of the main variables to consider about COVID-mitigation actions is local positivity rates. From the beginning of the pandemic, public health officials have suggested a community can be considered to have low risk when the local positivity rate (that is, the percentage of tested people who are positive for the virus) is under 5 percent. There have been times when some regions of the country have seen positivity rates at 20 percent and higher, and those are areas where the virus is rampant and new infections are common. Right now, the positivity rate for the entire US is at 3.03 percent, so we have definitely seen a good downward trend—but it is always wise to know what your local rate is. Your state probably has a public health website with that information. For instance, as of today the positivity rate in my state is 4.7 percent: not bad, but higher than the national average. If your local positivity rate is low, then the risk of being exposed or exposing others to the virus is also lower than it otherwise might be, and this might influence some of your choices.
Another variable is your own health and that of people close to you. If you are someone at high risk for illness and you have not yet been vaccinated, that should raise your level of caution in how you enact hygiene choices. This is also true if someone in your close circle is vulnerable to whatever pathogens you might carry home with you.
These are the points of focus that I think are most important for massage therapists at this moment in time. I want to emphasize one more time: This is my own perspective. I am not a doctor or public health policy expert. What I offer here is simply the thoughts of a well-informed well-wisher.
One of the most important findings about COVID-19 communicability is that it is spread most commonly by way of airborne particles, and NOT by way of droplets that contaminate surfaces. (Although this is still possible, and it is important to keep our surfaces clean, they are not the teeming source of infections we once thought.) In other words, an infected person doesn’t have to cough, or sneeze, or laugh, or yell—all they have to do is breathe, and new virus will enter the room.
This finding means that good air turnover is critical to lower the risk of spreading the infection. Many massage rooms don’t have great ventilation or windows that open. Compound this with seeing five or six people a day, plus minimal turnover time, plus no air movement or filtration. Now you have a veritable gaseous stew of exhaled microorganisms: not great for the practitioner or clients. Guidance for how to manage massage room air quality and humidity is provided in a wonderfully helpful article by Julie Tudor in Massage & Bodywork magazine.
Mask or No Mask? (Also, Eye Protection)
Mask, definitely. Both client and practitioner should continue to use masks throughout the session. Even if one or both have been vaccinated. In fact, it is now recommended to use double masking against the B.1.1.7 variant (that’s the one first tracked in the UK), because it is found to be much more transmissible than the standard version, and it is spreading rapidly through the US and is expected to be the dominant version of the virus by April or May of this year.
I heard on my favorite public health policy podcast, In the Bubble, today that new research (prepublished, and not yet peer-reviewed) suggests that vaccinated people might NOT carry viruses in their nose, mouth, or throat—but that is not yet settled science. And until it is, we must use masks, and we must avoid massage around the mouth or nose—vaccinated or not.
In fact, in addition to using masks, while this virus is still in our communities, I recommend protective eyewear as well. Some studies suggest that people who wear glasses have a lower risk of infection, and since we now know that the virus is spread through tiny airborne particles, it seems likely that eye exposure is a possible route of infection. Using goggles or a shield provides even greater protection than eyeglasses.
Beyond the question of masks and eyewear, what is necessary in terms of clothing? In the early days we recommended having a set of work clothes, including shoes, that were kept and laundered separately from the clothes we wore at home. Nowadays, I propose that this might be overkill. I have always been in favor of changing whatever clothing a client touches for every session—this means changing a shirt or apron with every client. But the whole top-to-toe disposable PPE rig is probably not necessary . . . unless you or someone you are close to is very vulnerable to being ill and they haven’t been vaccinated, then these precautions may still have good benefits.
Cleaning Surfaces: Definitely
The fact that COVID-19 is not always spread by way of contaminated surfaces does not mean we can skip that step of hygienic practice. Remember, those airborne viruses will land sometime, especially if humidity is appropriately high. This is good—they’re easier to remove from surfaces than from the air. Hospital-grade disinfectants with appropriate contact time on tables, face cradles, and hard surfaces that clients touch (e.g., doorknobs, light switches, bathroom fixtures, and so on) are still an important part of client care.
To Glove or Not to Glove?
The issue of gloves has always been an open question for me. People I respect come down on both sides of this subject. Some localities mandated the use of gloves since the onset of the pandemic, and I don’t know if those rules have changed. Since the virus is mainly airborne and not surface-borne, it’s fair to say that the use of gloves where skin is healthy and intact may be unnecessary for COVID-19 mitigation.
Hand Hygiene: Keep It Up
While the need for gloves may be overstated, the need for good hand hygiene is not. Obviously, this applies to our preparation for working skin-to-skin with clients, but it applies to all the other things we do with our hands, like handling soiled linens, typing on grody keyboards, using the bathroom, and cleaning up our workspaces. We must wash or sanitize our hands after any of these activities. Is that harsh for your skin? Absolutely. Which means if you haven’t already, it’s time to find a moisturizer that works for you to keep your skin healthy and hydrated.
Other New Habits
It is possible that the pandemic influenced some other choices massage therapists make, and these can carry us into a healthier future. Closed laundry hampers and foot-operated trash bins can outlast this crisis with benefits for general hygiene in the future. Using a paper towel to turn off the taps in the bathroom and to open the door where many people go through on a daily basis—that’s just good practice in general. What other new habits have you adopted that you anticipate will outlive COVID-related precautions?
Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (available at BooksofDiscovery.com) now in its seventh edition, which is used in massage schools worldwide.
“COVID-19-Related Coagulopathy” by Ruth Werner
“Questions for Clients Who Have Had COVID-19” by Ruth Werner
“A Conversation with a Hematologist” by Ruth Werner
The Contagion Myth
May I question authority?
I’m reading The Contagion Myth, an interesting book byThomas Cowan, MD and and Sally Fallon Morell. They raise the question of isolating a virus — it has never been isolated. They challenge virology methods developed by the allopathic medical industry. They remind us of all the microscopic organisms that are in our guts to keep us healthy and not be feared. Terrain theory, as it’s known, seems to have become accepted today universally, except for when an industry sees windfall profits from manufacturing vaccines that the industry is free from liability.
I don’t accept the idea of a virus that’s never been isolated as a germ to fear. I believe it’s a fraud.
Thanks for reading my comment.
A well-informed well-wisher?
This article was a disappointment. Two issues:
1) Identifying yourself as merely "a well-informed well-wisher" puts the validity of your suggestions into doubt. I've been relying on the information you're shared via ABMP about COVID-19 and felt slapped in the face when I read that sentence. It still stings. Why bother earning your living publishing books, articles and podcasts if you feel it necessary to disclaim your recommendations smack in the middle of making them? Wishy washy advice I'd say...
2) As a professional who still makes my living as a massage therapist, I'd like to know exactly when it "became feasible to open our practices again." I didn't get that memo. My practice is re-opening after being closed for over one year because I will be fully vaccinated. No other reason has been convinced me that my clients and I would be safe from infection. The Hippocratic Oath states our first obligation is to "Do no harm" - trustworthy advice.
Thanks Ruth for your update! Common sense hygiene and being careful during a pandemic is a protection and shows respect For others in my eyes.
Your well-researched guidance has been indispensable during this pandemic and for so many years before that. No one has all the answers in the case of COVID and what we do as massage therapists will look a little differently for many of us. The information and opinions you share are vital to the field. Thank you!
outcalls or in-home work
I closed my office for good and now, post-vaccine, am thinking of doing just a couple of massages a week, for vaccinated clients only, either at their homes or possibly (for a few who are also close friends) in my one-room apartment. Any precautions specific to these situations? Or just DON'T?