Issue link: https://www.massageandbodyworkdigital.com/i/1276187
46 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 2 0 This article will cover some complications related to SARS-CoV-2 infections as we currently understand them. This isn't a comprehensive discussion that will cover every possible situation. Instead, I have chosen conditions that are common enough to be reported in the medical literature, and that are most likely to impact massage therapy clinical decisions. This discussion is informed by what we understand as of early summer 2020. Because virtually everything about COVID-19 is a moving target, I will look forward to revisiting this topic later, to see how (or if ) post-COVID complications continue to affect patients. The list of resources that accompanies this article provides input from physicians and scientists whose job it is to try to unravel all the ways COVID-19 affects human function. However, what we see in the technical literature seldom captures the immediacy of human experience. So I also want to voice my gratitude to the many members of Survivor Corps (www.facebook. com/groups/COVID19survivorcorps), a Facebook page specifically for COVID-19 patients to share with and support each other as they recover. The descriptions of their experiences shine an important humanizing light on the technical information. Further, this community shows us that we don't yet know very much about how to help people who survive this infection. Their long-term experiences have not yet been studied or pursued for treatment, so in many ways they are very much on their own. Our clients who are recovering from COVID-19, hospitalized or not, are sailing in uncharted waters. Massage therapy could be a supportive and life-affirming part of the recovery process—with the caveat that it must be done with great care and in incremental steps toward pre-COVID levels of intensity. Until we and our clients know what their resilience is like, we must offer our gentlest work, post-COVID, and be diligent about checking back for any unexpected responses or reactions. COVID-RELATED COMPLICATIONS When we look at COVID-related complications organ by organ, or system by system, we see that a combination of factors is probably at work. • Viral attack: A direct viral attack on cells with ACE-2 receptors (the target cells of the SARS-CoV-2 virus) is responsible for some damage. These cells are found in the alveoli—often an early site of attack—and also in the capillaries that wrap the alveoli. Damage here interferes with lung function and blood oxygen levels and may lead to collapsed alveoli and acute respiratory distress syndrome. • Immune system response: A normal immune system response prompted by viral invasion of various tissues can cause more cellular damage. In other respiratory tract infections, like cold or flu, immune system activity causes most of the symptoms: our white blood cells and antibodies are set up to kill infected cells and their neighbors as we try to get control of an aggressive viral infection. • Exaggerated inflammation: On top of an aggressive viral infection (along with a normal, healthy, but similarly aggressive immune system response), some COVID-19 patients experience outsized and prolonged inflammatory reactions that cause much more tissue damage than would otherwise occur. The combination of these three factors—viral invasion, immune response, and exaggerated inflammation—gives rise to a host of potentially life-threatening consequences. Following are some of the most relevant ones for massage therapists.