In light of current worsening COVID-19 numbers in BC, CMTBC reiterates the public health expectation that all persons wear masks in shared indoor areas, and that these be three-layer masks if at all possible. While the decision regarding mask use in the treatment room is a matter for the professional discretion of the RMT in communication with the patient, CMTBC strongly recommends that both the RMT and their patient wear masks, unless there is a clear medical reason not to do so.

On November 4, 2020, the Ministry of Health (MOH) issued a policy communiqué entitled Mask Use in Health Care Facilities During the COVID-19 Pandemic. The communiqué was addressed to “Health Authority CEOs” and outlines “Ministry of Health Requirements for mask use by health care workers, non-clinical staff, patients and visitors”. The masks referred to in the communiqué are “medical grade face mask[s] that meet ASTM International or ISO (or equivalent) performance requirements for bacterial filtration efficiency, particulate filtration efficiency, fluid resistance, pressure differential, flame spread, skin sensitivity and cytotoxic testing.”

A number of RMTs have contacted CMTBC to inquire whether this policy communiqué applies to them. The answer – at least at this point in time – is that the communiqué does not apply to RMTs. The communiqué applies to public health care facilities, and not to contexts in which health care is provided by practitioners who work outside the public health care system.

This does not mean that RMTs cannot or should not wear masks. On November 4, 2020, CMTBC updated the FAQs to its Interim Guidelines for Return to Practice and included the following:

It sounds like masks are mandatory now, is that correct?

CMTBC follows the guidance and direction of public health authorities; in BC, that means Dr. Bonnie Henry and her team at the Office of the Provincial Health Officer, and the BC Centre for Disease Control. Dr. Henry stated in late October 2020 her “expectation” that people wear masks in indoor places. Dr. Theresa Tam, Canada’s chief public health officer, indicated on November 3, 2020 that masks and face coverings are an area of “evolving science”, and recommended people wear three-layer masks indoors. Again, context is important: as outdoor temperatures drop and people move indoors, the knowledge and use of masks will continue to evolve. CMTBC recommends that people follow Dr. Bonnie Henry’s expectation that masks are worn indoors. The College understands that masks cannot be worn in every situation in the treatment room. RMT discretion is required, as is communication and agreement from the patient about when, where, how, and why masks are to be used.

Update on masks and face coverings

Since the release of the Interim Guidelines in May, RMTs have had the option of requiring their patients to wear masks during treatment, provided that this requirement is communicated to the patient in advance.

RMTs are reminded that their treatment facilities, and communications with their patients, make them different from public health facilities. From the outset, the Interim Guidelines stressed the critical importance of patient pre-screening, both 24 to 48 hours in advance, and at the time of the patient’s arrival for their appointment.

It is RMTs’ pre-screening of patients in accordance with the Interim Guidelines, and the relationship of trust and of open and honest communication between RMT and patient, that provide the critical initial layer of protection against viral transmission. That protection can be further enhanced by mask use, but it cannot be replaced. Pre-screening is vital, now more than ever.

RMTs are asked to do the following:

1. Follow all of the recommendations the Interim Guidelines rigorously, and ensure that their safety plan is fully consistent with the Guidelines,
2. Review the Interim Guidelines and FAQs if they have not done so recently,
3. Follow the guidance provided in Section 6 (PPE and mask use)of the Interim Guidelines, and the guidance provided by public health authorities regarding mask use, and
4. Consider that while mask use is not mandatory in the treatment room, the default should be that masks are used.

The COVID-19 pandemic continues to be a fluid and evolving situation. CMTBC will update guidance to registrants as the situation evolves, and as new public health and Ministry of Health guidance is provided.