Today, I received the following from a friend who has a small physical therapy clinic in Seattle. 

Do you have advice for me as to whether my company should close? We are doing all we can to ensure the safety of our staff and patients including social distancing (except between you and the PT), disinfecting all surfaces, washing hands before and after every treatment, all the recommended procedures. We are small and have less than 10 at any time with more than ample space between people. The pressure is growing to close. I want to do the right thing, but also believe we keep people physically active which is good for their health and peace of mind. 


As Seattle area schools prepare to shut down, businesses around the city are faced with similar decisions. I thought my answer might be helpful to address the concerns and questions of workers and business owners around the city.

My friend, we’ll call her Karen, asked if I could give her a call to help her sort it out. When she answered, I could feel the concern in her voice. One of her employees, a woman with young children, was worried about picking up the disease from a patient and bringing it home to her children. Employees and patients with any sort of illness or cough were told to stay home. Patients washed hands on entering. All of the equipment and anything touched by a patient was cleaned with sterile wipes between patients. Still, the employee peppered her with scenarios by which someone could bring in the virus. What would happen, for example, if a patient went into the bathroom and, while in there, sneezed all over the wall. Someone could touch it and get sick. Even if you put a sign in there asking them to contact staff if they sneezed, they might just ignore it. How do you prevent that?

This staff member was extremely concerned that a patient with no symptoms could come in and spread the virus. To understand that risk, you need to understand the process. People cannot spread this disease simply by breathing in the same room as you. Transmission requires transfer of bodily fluids from the saliva or mucous of an infected person to the eyes, nose, or mouth of another. If someone is Not coughing or sneezing, the likelihood of transmission drops substantially. Unless you kiss or you share drinks or food with someone who is infected, your risk is low. It would require them touching their mouth or the inside of their nose, then touching something, then you touching the same object, then you touch your mouth, nose, or eyes. Anything that breaks up that chain of transmission will stop the spread. Wiping surfaces or either of you washing hands thoroughly eliminates the chain of transmission.

I asked her what guidance she had received from the CDC, the state, or the county. She said, none. I tend to give public health agencies slack, because they are routinely underfunded, but, in light of all the other closings in the city, this surprised me. These are hard questions to answer, even if you are trained in the field. After a long discussion, I suggested that she stay open, but give the staff and patients who were concerned the right to stay home after explaining the potential risks. Basically, informed consent. I would also make sure any elderly or chronically ill patients stayed home.

Bottom Line: The clinic is almost certainly far safer for patients to visit than a grocery store and is a safer place to work as well. Nonetheless, everyone has the right to make their own informed decision about this, particularly if they have some condition that makes them more susceptible to the disease.  No one should feel unsafe, but, in this case, they are probably safer than they think.