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COVID-19 Guidance for Acupuncturists
March 20th, 2020
To whom it probably does concern,


The board members of the Oregon Association of Acupuncturists are as concerned as you are for the health of our patients, our families, our friends, and ourselves. Many of you have closed your clinics during this time and are justifiably concerned about what that means for your continued ability to eat and pay rent.

We are not advocating for clinic closure at this time in Oregon, partly because we are an important part of the medical ecosystem for our patients. We also recognize that those of you who are remaining open are taking every precaution possible to keep everybody healthy using social distancing and sanitizing, as well as keeping high risk patients away for now (and using proper screening). In addition, based on the guidance from the ASA below and elsewhere, we are advocating for keeping non-essential visits and group treatments off of your schedule for now. We are encouraging you to also remain socially distant in your interactions outside of work. This translates to a decreased likelihood that you will get and pass along the virus to anyone, but especially to your patients, who you are obligated to do your best not to harm. We're not ignoring Governor Brown's executive order 20-10. It doesn't apply to us because we're  not using much (if any) personal protective equipment. Please simply act as if you have Covid-19 and so does everyone else with whom you interact.  Please see below for more details around how to treat with as much safety as possible and be otherwise healthy right now.  More guidance is coming out all the time from different bodies and the situation is clearly fluid.

Stay healthy, 
Your Oregon Association of Acupuncturists Board of Directors

What is the National Guidance?

What is Proper Personal Protective Equipment for Acupuncturists?

What Does Social Distancing and Sanitation Look Like in an Acupuncturists Clinic?

Should you choose to remain open, be sure to practice universal precautions listed below from the ASA Guidelines here.

  • Avoid close contact with people who are sick
  • Avoid touching your eyes, nose, and mouth with unwashed hands
  • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains 60%-90% alcohol if soap and water are not available. COVID-19 can transit through both respiratory droplets and via stool, so careful handwashing is critical.
  • Cover coughs and sneezes with a tissue, then throw it in the trash can. Cough or sneeze into your elbow and not your hand if you do not have a tissue available. If you contaminate your hand and then tough other objects, you will spread the virus.
  • Pre-screen patients for recent travel to affected areas, fever over 100

Language from Illinois state guidance

Even if cleaned with hospital grade wipes, infection control teams recommend not using the room for three hours after someone who is infected.  We don't know everyone who is infected or carrying at this time.  We believe it is our responsibility as a profession to reduce risk and practice preventive medicine for the safety of the entire community.
 

Some Examples of Social Distancing and Sanitizing in Clinic

Some of these examples might seem extreme to you.  Some may seem like we’re underestimating the virus.  Take the advice you want and leave the rest behind!

Social Distancing - All patients go straight into a treatment room to remove the ability of people to wait together in a lobby.  Massage services are suspended entirely.  Avoid talking during palpation and tongue diagnosis (including patient and provider).  Stand/sit as far apart as the room size allows for during the interview, then don't converse during needle insertion. Make patients aware that this is not a judgement on them, but instead a safety precaution for their sake and for the sake of your other patients. Reduce the number of chairs in the lobby so there's no way patients can be within six feet of one another. Ask patients to breathe through the nose during palpation, needling if face up or seated. Have patients complete any paperwork at home and bring in.  Have patients pay co-pays in the rooms or from home/vehicles.  Scheduling can happen online or in rooms.  Reducing the patient's time in the lobby is very important.

Pre-screening Procedures - Call patients to make sure they aren't sick. If they're doing well, tell them to stay home.  If you're sick with an amorphous URI, tell them to stay home and possibly use supplements/herbs.  Ask if they're traveled outside the state or country lately.  Ask if they've had contact with a sick person within the past two weeks.  Meet them at the door with a thermometer whether they're sick or not.  Keep the door locked and have them wait in their cars if that's practical for your setting. Take your own and any other clinic worker's temperatures before the start of your shift.
 
Cleaning Procedures
- Wash/sanitize hands on entry to a room.  Repeat before exit. Disinfect all surfaces at the beginning and end of the day, as well as between each patient.  These might include the treatment table, door knobs, chairs, tables, bolster, shelving, counters, and instrument trays.  Consider discontinuing water/tea/coffee service until further notice. Change all linens between patients. Get rid of the table warmer and/or fleece covering for tables and face cradles until further notice, as these can't be sanitized.  Clean clinic clothing between shifts, maybe even if you just go to the store at lunch, and this includes lab coats/scrubs.  Maintain clean fields and prevent cross-contamination.  Disinfect thermometers after use. Place pillows and bolsters under the top sheet.
  
Refamiliarize yourselves with CNT : 
    

From Sharon Weizenbaum’s blog post on a classical perspective on facebook.

  • Coach patients on lifestyle and prevention
  • Consider offering set "office hours" via phone so patients can talk over their concerns
 

Lifestyle Guidance

Diminishing social life - get introverted - go to work and go home, walk the dog, and don't party. This is for the safety of our patients, our families, and especially the more at-risk members of our communities and the world.

 

How Long Will This Last?

We understand that any closure (or keeping away a large percentage of lower need patients) is an immemse burden for small business owners. There are resources from the Small Business Administration for compensation for small business owners and employees, and we will alert our members as more relief and resources are made available. The federal government may send us checks as well.Small Business Administration 

See Tomas Pueyo's post to understand numerically the projection of daily transmission rates for our country. We can expect a doubling of cases every six days, according to several epidemiological studies in the Lancet. That means we are possibly looking at about 1 million US cases by the end of April: 2 million by May 7; 4 million by May 13; and so on. Here's the source from Statnews.

It has been demonstrated that a 14 day  self-containment is effective in identifying those who may be incubating the virus but are currently experiencing NO symptoms and capable of spreading it. Also, it has been shown to live on surfaces for a number of hours so consider a deep cleaning of your home and office.

Click here to view the John Hopkins Coronavirus COVID-19 Global Cases Map or up to date stats on Worldometer. 

 

What About Telehealth?

This is an opportunity for us as a profession to shine! In the process, we can support and educate our patients in a number of ways:

  • Phone consultations for a fee
  • Be available for a certain window of time each day so patients can talk over their concerns
  • Mail herbs or supplements so patients can get ahead of the curve by treating symptoms as they appear and make adjustments as they progress. Chinese medicine is powerful medicine

Language from HHS:
" A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationawide public health emergency.  This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19."


Training from Unified Practice

By simply adding "telemedicine" as a room and service option, you can continue to provide care to your patients in a safe environment. Check out our detailed guide on how to set up your clinic for telemedicine appointments.

How Can Chinese Medicine Help?
 

 

What To Do if You Get Sick?

Perhaps schedule a telemedicine visit with your local healthcare practitioner. Refer your patients to get tested for COVID-19 if they are presenting with the following symptoms: fever, dry cough, or shortness of breath. Encourage your patients to self-quarantine at this time for a minimum of 14 days as well. Visit the CDC website for more up to date information or contact 211.

 

Other links:

 

Be Part of the Conversation in Oregon!

  • We are hosting the OAA COVID-19 Education Series by Zoom conference call starting on Wednesday, March 25th at 4:30 pm. See your email and our FB for details and login information.
    • The first in the series is all about learning from your fellow acupuncturists in small groups via Zoom about one another's practice in terms of keeping their clinics open or going for telehealth integration.  
    • Facebook page: https://www.facebook.com/OregonAAOM/
    • Board meetings - Third Thursdays, 7-9 pm (by Zoom invitation for now - let us know if you want to "attend")
       
  • Join the Oregon ECHO Network, the Oregon Health Authority, and County Public Health Officials starting Thursday, March 19, at noon for weekly interactive virtual sessions on the COVID-19 virus and the Oregon healthcare community response
    • The sessions will provide the latest information on best practices in clinical management, clinical practice safety, testing, and the community public health response.
    • The sessions will provide the latest information on best practices in clinical management, clinical practice safety, and the community public health response.
    • All Oregon clinicians are encouraged to register
    • To connect to the sessions, go to https://zoom.us/j/575366462

 
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