The uncertainties of COVID-19 spikes and a second wave, and economic and social uneasiness present challenging moments as we attempt to unlock our acupuncture practices safely. Guidelines are in abundance. I asked the Medical Acupuncture editorial board for advice about reopening practices. Herein, I summarize some of the interesting responses.
Advice and Guidelines
Im Quah-Smith, MD, reported the instructions that she uses in Australia:
Guidelines for the Staff
• Wear gloves and masks.
• Sanitize treatment spaces (bed and equipment trolley, laser devices, laser goggles) between patients.
• Laser therapists (spending 30+ minutes in the same space as each patient) need gloves, masks, and plastic visors.
• Light switches, door handles, benchtops, table tops, should be all sanitized 3 times a day.
Guidelines for Patients
• The large sign at the front door glass states: “NO ENTRY if you have/might have signs of a respiratory infection or COVID symptomatology.” (I am a subspecialist, so I do not have to take on these cases.)
• The sign also says to use the sanitizer gel upon entry.
• Your temperature will be recorded upon entry by the clinical assistant.
• You have to wear the mask provided at all times.
• The reception/front desk has a barrier to maintain social distancing, so keep 1.5 meters between patients and the receptionist. (She is masked as well.)
• You have to sanitize before you leave.
• Each treatment room also has a sanitizing device.
• All magazines and unnecessary items in the waiting lounge have been discarded.
• The cleaners use disinfectant in their cleaning process.
• Until recently, we had all rooms aired (windows opened), but the weather has become rather chilly now, so the air conditioners are on.
Ikuro Wakayama, MD, reported the Japan Society of Acupuncture and Moxibustion Guidelines:
Guidelines to Prevent Infection by SARS-CoV-2 (Coronavirus) in Acupuncture Clinics in Japan
(1) Take your body temperature every day. If you have low-grade fever or coldlike symptoms, such as cough or nasal discharge, you will not be allowed to practice.
(2) Avoid 3Cs (closed spaces, crowded places, and close contacts) in the waiting and treatment rooms. Confirm the mobile phone numbers of patients just in case you need to trace them to reduce a COVID-19 cluster.
(3) Ventilate the waiting and treatment rooms. Open the windows and doors regularly. Use a ventilating fan.
(4) Measure the temperatures of patients and ask them whether they have coldlike symptoms or dullness, and record these symptoms. If a patient has a low-grade fever or any related symptoms, avoid acupuncture moxibustion treatment. Disinfect the thermometer applied to the patients each time if it is a contact-type thermometer.
(5) You and your patients must wear masks during medical interviews and practice, considering that there exist asymptomatic patients.
(6) You must wash your hands, using soap, or disinfect your hands, using 80% alcohol, before and after practice. Try to wear disposable medical gloves during practice. In this case, wash your hands again after taking off the gloves.
(7) Change precleaned towels and linens between patients or use disposable towels and linens.
(8) Disinfect desks, chairs, doorknobs, handrails, toilets, etc. regularly. Disinfect pillows, beds, and physical therapy equipment between patients.
(9) Check whether first-visit patients have underlying conditions, such as chronic heart diseases, chronic pulmonary diseases, diabetes mellitus, etc. For revisiting patients with such chronic diseases, the necessity of acupuncture treatment should be reviewed and coordinated with the patients' primary physicians.
(10) Follow each guideline when practicing in hospitals or other medical institutes.
Claudie Terral, MD, from France, reported her recommendations:
(1) Reduce the number of patients to 2–3 only in the morning.
(2) Practice distancing without a mask.
(3) Talk from a distance and do no talking close to the patient.
(4) Use the usual protocol for cleaning hands and contact surfaces.
Conditions in a Practice
Ali Safayan, MD, (a non–board member) reported from the United States:
I am using maximum PPE [personal protective equipment] in my office when examining and treating patients in all clinical settings, including general physical examinations, acupuncture, and prolotherapy. Patients have to fill out a COVID-19 questionnaire 24 hours before their arrival indicating totally asymptomatic status. At the entrance of the office patients must be wearing masks and get forehead thermal scanning to make sure that there is no temperature. Patients are led to the bathroom to wash their hands and do not touch anything on the way out. Finally, patients are guided directly into the exam room for their particular procedures.
All of our once-comfortable “egg crate” foam table covers with soft cloth sheets have been removed, and the patients now enjoy the cold, firm linoleum exam and massage tables with a subtle hint of diluted Clorox® bleach. These once beautifully adorned exam tables are now covered with very crisp, bleached, white exam-table paper cover sheets that makes a lot of noise when a patient gets up on a table, and the paper tears very easily as you change the positions of your patients. There is also a disposable face cradle cover. Finally, our once-soft pillowcases have now been replaced by similarly stiff paper pillowcase covers that Pam, Linda, and I have been fluffing up for decades.
Our soft cotton-cloth gowns have also been replaced by lovely blue paper gowns held together by plastic belts. These gowns have little-to–no value whatsoever. Once a patient gets ready to position him- or herself on the table the gown rips nicely down the front or the side exposing much of the flesh that the patient is attempting to cover. I then enter the room looking as if I'm examining the remnants of the melted main reactor core at Fukushima. I have a disposable smock down to my ankles, plus a standard face-mask, glasses, and a face-shield. My ensemble is completed by a pair of nonpowdered, nonlatex, dark-blue, disposable, nu-skin nonsterile gloves.
Although the temperature in the room is a pleasant 75°–80°, based on the patient's desire, my core temperature by now is well over 100°. I'm perspiring profusely, and my glasses and my face shields have now completely fogged up. It is in this state that I then attempt to deliver an acupuncture treatment. The needles stick to my fingers as if my gloves were made of Velcro.® It's just as bad with the ITO box wires. It's taken a number of acupuncture treatments to get comfortable putting in needles and hooking up electricity.
Two board members from the United States reported that they had been closed until July and that it was time to retire.
We are challenged in our profession to safeguard ourselves and patients. Most importantly, acupuncturists are loving professionals and are kind to their patients. Practicing is an art, and we have to adjust to current circumstances. There exists a wealth of information about COVID-19 to assist us during these challenging times. If you feel this is difficult, just put yourself into the place of the patient needing care; it is even more perplexing. I was a patient and had a virtual medical consultation. Although it was not hands-on, I rejoiced not having to battle the Washington, DC, congested traffic.
COVID-19 Journal Articles
Journals are experiencing an almost overwhelming submission of articles dealing with COVID-19. Unfortunately, the information is not very accurate in many articles. Authors may be taking shortcuts or even using questionable methodology. There are increasing reports of plagiarism taking place. Articles submitted to Medical Acupuncture are being scrutinized substantially. Any article that suggests acupuncture cures COVID-19 or mitigates the course of the virus is rejected without a randomized controlled clinical trial. Private communications and internet articles suggest that herbs might be helpful to reduce viral symptoms. This will require appropriate review and research. Whether it is a combination of acupuncture, herbs, dexamethasone, antibody treatment, or a vaccine to ward off the virus, let us acknowledge that Eastern and Western medicines may offer significant benefits as combined therapies. It could help us change the world for the better.