Almost daily, Myopain Seminars receives inquiries about when we will resume teaching in-person courses. Because of the COVID-19 pandemic, all courses have been postponed on a monthly basis similar to how other post-graduate continuing companies are handling the current situation. Throughout the US, lockdown rules are being relaxed even when nationwide, the number of people infected with the coronavirus cases continues to increase. A few course programs have announced recently that they will start teaching courses again as early as June.
Even though, the number of confirmed new cases is down (as of May 30, 2020), how can any (course) organization determine whether it is indeed safe enough to conduct live courses when rapid diagnostic tests (RDT) are not yet readily available?
Confining even a limited number of students to an indoor classroom environment over several days will likely increase the risk of infection, given that the risk of indoor infections may be as much as 19 times greater than the risk of outdoor infections. It takes only one asymptomatic student to infect an entire class. According to XI et al., 44% (95% confidence interval, 25–69%) of secondary cases were infected during the pre-symptomatic stage. Even after an infected person has no more symptoms, in one study, half of the patients continued to be virus-positive up to 8 days, while another study demonstrated that some survivors demonstrated viral shedding for 37 days!
An epidemiological study of a COVID outbreak in a call center in South Korea showed that on one floor, the attack rate was as high as 43.5%. According to the researchers, this study showed that a high-density work environment can become a high-risk site for the spread of COVID-19, which probably is not all that different from a 3-day hands-on manual therapy or dry needling course where social distancing is not really feasible. Can healthcare providers knowingly assume this kind of risk and create potentially a source of further transmission of the virus? The Korean study showed that, most likely, the duration of interaction (or contact) was the main facilitator for further spreading. How can any course provider reduce the infectious dose in a course environment, since with prolonged exposure, as would be the case in a 2 or 3-day course, higher inoculating doses will result in higher viral loads? The viral load reflects the number of viral particles present in an individual. The Centre for Evidence-Based Medicine at the University of Oxford reports that the evidence of a relationship between viral dose and disease severity is limited by the poor quality of many of the studies, the retrospective nature of the studies, small sample sizes, and the potential problem with selection bias.
A local dental office in the Washington DC area proudly announced that they had installed “HEPA hospital-grade room purifiers, UVC and ozone disinfectants as appropriate, and germicidal disinfecting fogging.” It is tempting to implement similar measures during live courses, but none of these measures have been shown to control the spread of the coronavirus effectively. If courses are starting up again, what kind of preventive measures would be needed to minimize the spread of the virus?
Prior to a course, all students should confirm that they have implemented safety measures, such as wearing a mask in public and social distancing, are free of COVID symptoms, have not been exposed, have not recently traveled outside the country, etc. Ideally, RDTs are given maybe an hour before a course begins. With a response time of 30 minutes, all students would be notified whether they can attend the course.
Once in the classroom environment, students and instructors should wear a face mask and gloves at all times. Do you need a protective shield when practicing how to perform a cervical manipulation or dry needling of the sternocleidomastoid muscle? Is that even possible? Airing the room should be done regularly, but with temperatures already soaring to well over 100 degrees Fahrenheit in some regions of the country, logistically, that may be a challenge by itself! Does it suffice to have students sign a release and conduct the course anyway and assume the risk of infection? Since most patients survive the disease with about 5% of individuals who have died from coronavirus, it that an acceptable risk?
As a side note, it is kind of worrisome that according to Kathleen Carley, a professor in Carnegie Mellon University’s School of Computer Science’s Institute for Software Research and director of the Center for Computational Analysis of Social and Organizational Systems (CASOS) and Center for Informed Democracy & Social – Cybersecurity (IdeaS), about 45% of the Twitter account discussions around stay-at-home orders and reopening the country is being fueled by misinformation campaigns that use bots. Carley would not confirm that these bots originate in Russia and China, but “it definitely matches the Russian and Chinese playbooks, but it would take a tremendous amount of resources to substantiate that,” she said.
Listening to epidemiologists, it does not seem to make much sense to return to the classroom at this point in time, but we are interested in your thoughts on the subject. Leave us a message to let us know your thoughts