Why I am not in the Office:
1. Telehealth is zero risk of infection and transmission. John Hopkins Public health risk analysis calculator and flow chart. In office sessions are “moderate” risk of infection and transmission: Here
2. Droplet transmission. The 6ft social distance rule only applies to interactions under 10 min. Since therapy is 60-90 minutes. There’s no way to reasonably reduce risk with social distancing. Masks do reduce risk, however, no clear research on the duration of mask wearing that is reasonably effective in an enclosed space.
"The World Health Organization (WHO) recommendations for social distancing of 6 ft and hand washing to reduce the spread of SARS-CoV-2 are based on studies of respiratory droplets carried out in the 1930s.[...] However, when these studies were conducted, the technology did not exist for detecting submicron aerosols.[...] Increasing evidence for SARS-CoV-2 suggests the 6 ft WHO recommendation is likely not enough under many indoor conditions where aerosols can remain airborne for hours, accumulate over time, and follow air flows over distances further than 6 ft."
"Given how little is known about the production and airborne behavior of infectious respiratory droplets, it is difficult to define a safe distance for social distancing. Assuming SARS-CoV-2 virions are contained in submicron aerosols, as is the case for influenza virus, a good comparison is exhaled cigarette smoke, which also contains submicron particles and will likely follow comparable flows and dilution patterns. The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols. In an enclosed room with asymptomatic individuals, infectious aerosol concentrations can increase over time. Overall, the probability of becoming infected indoors will depend on the total amount of SARS-CoV-2 inhaled. Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure (10). For these reasons, it is important to wear properly fitted masks indoors even when 6 ft apart."
I do not have windows or ventilation in my office. The office suite shares the building with many other businesses and shared bathroom spaces, which are increased risk areas that I can not control.
3. CDC, State of Ohio, APA all say to utilize telehealth whenever possible. Current clients that do not have a high risk need for face to face, NASW says clinicians do not legally or ethically have to resume in person sessions even if the client insists. Source
4. Protection for clinician - My family has members whom are high risk, keeping them safe is my responsibility. By staying home I keep him safe and don't put burden on clients to keep them safe.
Creating an environment for clinicians to be exposed and placing the clinician and their family at risk for their job when other zero risk options are available is negligent. Whatever choices clinicians make in their real life is up to them, but as the leader it is important to protect clinicians' lives in the best possible way with the decisions made.
5. PPE - Must provide masks, sanitizer, cleaning products, etc. The State of Ohio has made it a requirement for employees to wear facial coverings while at work. Doing therapy in a mask negatively impacts treatment, making it difficult to read body language and engaged clients. Many folks do not have any or have any access to PPE due to shortages. There are other medical facilities that need the PPE and should have access since mental health practices have the ability to be exclusively telehealth.
6. Contact Tracing
Contract tracing from the health department would impact client confidentiality and safety of the office space. I take your confidentiality seriously, which is why I am not in the office at this time.
1. Breaching client confidentiality to provide The Health Department with a list of clients who were potentially exposed in your office.
2. Keeping detailed logs of who has entered and exited your building and at what times to provide to The Health Department is cumbersome and challenging to execute.
3. If exposed, the clinicians and clients who were in the building will need to quarantine for 14 days and will have to continue telehealth during quarantine, thus telehealth is a necessary option.
4. From an ethical client focused perspective, a counselor's office is often one of the few truly safe places for clients, at this time it is potentially dangerous and threatening to the client’s physical and mental wellbeing. The counseling space should not be a space that can create a traumatic experience for clients. Further, a client cannot effectively reprocess trauma and reduce symptoms if the environment they are sitting in is a possible threat. Client will maintain sympathetic nervous system activation throughout the session creating a significant barrier to the therapeutic process. Additionally, having the therapist and The Health Department contact the client to tell them that they were exposed at counseling and will have to quarantine for 14 days will have a significant negative impact on their mental health.
7. Liability insurance is very vague at this time and most likely won’t cover and COVID19 related issues for clients What is clear is that you will have to document “meaty” medical necessity for each client to return to in office versus telehealth. Liability and renters insurance related to clinicians exposed to COVID19 is equally vague. There are also questions related to how worker’s compensation and/or group health insurance policies will respond to a clinician exposure and illness in the workplace .Source