Letter to Practitioners on COVID-19

03/15/2020

Dear fellow practitioners,

We are taking a moment to address the many questions that have come to us from members of the East Asian medicine practitioner community. First, we want to say that during this difficult time, there are no simple answers nor are there answers that will suit everyone. Second, we know how hard these choices are, especially given the intensity of the impacts: economic, social, and personal.

It is our understanding that at this point in the spread of COVID-19, social distancing, hand washing, and covering coughs are critical elements of the plan to interrupt the spread of the virus. Many public health specialists stress that effective hand washing for at least 20 seconds may be one of the most important elements of this effort. However, the issue of social distancing, another important element of this strategy, directly affects our clinics. In thinking through the decision to close the school teaching clinic for at least two weeks, which we did on March 12th, 2020, we considered many different issues. We have highlighted below some issues that we think are relevant to our colleagues in private practice.

Given the fact that testing at this point is very limited, it will be extremely difficult to know a patient's status with any degree of certainty. Furthermore, according to the latest available data, patients are contagious prior to being symptomatic. The exact amount of time is unclear at this point, but estimates range from several days to about two full weeks. As such, the possibility of unwitting exposure to an infectious patient is very high. We thought about the consequences of closure as set against the consequences of remaining open. Closure would mean economic hardship for us and a significant disruption to having a consistent flow of patients through our clinic. It would also deprive our patients of treatments at a time when many of them are experiencing anxiety and significant disruption of their lives. 

Ultimately, we decided to take the preliminary measure of closing our clinic for the next two weeks because we did not want to unwittingly become a center of disease transmission in our community.  Despite our significant efforts to make the school and clinic as safe as possible, we, like most small medical facilities, are not equipped to test or to isolate patients with this virus.  And while our treatments are critically important for many of our patients, we are not generally offering treatments that are life or death. For our patients, missing treatments for several weeks or a month will certainly disrupt their lives, but if it helps to interrupt the spread of COVID-19 in our community, we believe that the disruption will have been worthwhile. 

This difficult decision is one that each practitioner will make on the basis of personal circumstances, patient population, access to testing, ability to identify and to isolate sick patients, and personal health status. We offer these thoughts simply as an example of one way to think through the complex issues involved, not as a rule for anyone. 

In that we spirit, we hope that these ideas are helpful and we welcome constructive dialogue about the steps that practitioners are taking.