Ep 23 - The State of PPE in Massage with Zeel's Alison Harmelin and Amir Hemmat

00:00 Kristin Coverly: Anatomy Trains and the Laboratories of Anatomical Enlightenment are excited to invite you to Dissection Livestream, a regional and layered journey through the human body with Tom Myers and Todd Garcia. New dates coming soon. Student Jan Ball who attended the last dissection says, "The whole livestream dissection course was truly a unique educational experience. It was profoundly moving. I gained so much from it. It was one of the most valuable educational opportunities that I've had. I'm truly grateful to Tom, Todd, and the whole team of people involved who made this unique opportunity available." This experience will be delivered through Zoom webinar with high quality audio and video, multiple perspectives, and time for questions. Visit anatomytrains.com for dates and details.

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01:00 Darren Buford: Welcome to The ABMP Podcast. My name is Darren Buford. I'm the Editor-in-Chief at Massage & Bodywork magazine and Senior Director of Communications for ABMP. I'm joined by my co-host Kristin Coverly, licensed massage therapist and Director of Professional Education for ABMP. Our goal is to connect with luminaries and experts in and around the massage, bodywork and wellness profession in order to talk about the topics, trends and techniques that affect our listener's practices.

01:27 DB: Our guests today are Amir Hemmat and Alison Harmelin. Alison Harmelin is Co-Founder of Zeel, a high-growth technology startup and the nation's largest platform for on-demand wellness services. Prior to Zeel, Alison spent 15 years as a broadcaster for CBS News. Alison's work as an anchor and field reporter included coverage of the aftermath of the September 11th attacks, the London bombings, Hurricane Katrina, and Superstorm Sandy. In 2003, Alison was nominated for an Emmy for her investigative series on child sex trafficking. A philanthropist and former model, Alison lives in New York City with her husband and Zeel Co-Founder, Samer Hamadeh, and their three children.

02:06 DB: Amir Hemmat is the current Senior Director of Public Health and Workplace Safety for Zeel. Amir has focused on the procurement and supply chain management of PPE supplies over the past two decades, beginning with his service as a Health Policy Consultant to the California State Legislature in 2001. He is a long time advocate for, and policy advisor to federal and local governments for affordable and accessible healthcare and equipment. Amir is also a Senior Advisor for the healthcare and manufacturing and supply chain practices for consulting strategy firm Monarch Global Strategies. Hello, Amir and Alison.

02:45 Alison Harmelin: Hello.

02:45 Amir Hemmat: Hi, great to be here.

02:47 DB: Hello, Kristin.

02:48 KC: [chuckle] Welcome, hi everyone. Hi listeners.

02:50 DB: Amir, tell us a little bit about your background and involvement with PPE procurement and the work you did with the State of California.

03:00 AH: Sure, absolutely. So again, my name is Amir Hemmat. I attended medical school, and then not too long after, joined work at the California State Senate Health and Human Services Committee. And during that time, among my responsibilities, I was assigned to handling the administration of federal and state funds for the procurement of what was then largely referred to as medical supplies or now, PPE, and in support of the federally qualified health centers, which tend to consist of the non-profit hospitals and clinics throughout California. It was a very different environment at the time, as you can imagine, this was about almost 18 years ago, and the level of demand was nowhere near what it is today. But it did give me an inside track into understanding where reliable supply for the various PPE were available both domestically as well as internationally.

03:58 AH: I have to say that along with me at Zeel, I have our Senior Advisor, Michael Camunez, who is a former US Assistant Secretary of Commerce and also a White House Counsel. Michael focused specifically on international trade, and so he's been a great support in overseeing some of the international transactional challenges that come about when it comes to PPE procurement, and supply chain management. And of course, our CEO at Zeel, actually comes from a background in chemical engineering. His undergrad was at Stanford University, he also did a master's in chemical engineering. And so collectively as a team, I've been very fortunate enough to have a strong mindshare in this space and be able to support one another, challenge one another because of some real interesting new normals that exist in the marketplace, that I'm sure we'll dive into, that we're having to work through. But certainly, my ability in the past to be able to actually travel to manufacturers and oversee production lines of various PPE, as well as handle the laboratory and non-laboratory testing of the product is certainly something that's been useful during this period of time.

05:11 KC: Amir, how would you summarize the state of PPE procurement right now at your level, sort of the big Zeel level, but also down to the individual practitioner trying to do the best they can for their practice?

05:24 AH: Sure, and this is coming from someone who has had experience in this space. I mentioned I went to medical school, I have a background in public health with a master's in that category and applied physiology. And I mentioned that really to try to communicate that even with my background, this is a space that is really, really challenging in terms of, I'd say the three Fs, there's fraud, fear, and frantic activity happening. That's really the way I think about it. We're looking at a marketplace because there is such enormous demand and opportunities for commercial transactions to take place. You've seen overnight PPE suppliers and brokers come into play, and so with that, a lot of fraudulent activity that is occurring. We're seeing a lot of fear, both at the consumer level as well as the organizational level.

06:19 AH: Consumers are having to navigate all the noise and information that they're receiving. Commercial entities are having to figure out how to either rearrange an existing procurement group that they may have had, that was largely focused on items like soaps and towels, and now having to think through the need of different PPE for their organization. Or, in many cases, don't have any prior procurement experience whatsoever, and having to figure out where they can turn to, to figure that out. And then, of course, we've all heard the news on how frantically purchases are occurring, and this is top-to-bottom again, with consumers as well as corporations who are having to meet the demands and concerns, and moving very quickly to make pretty large purchases of international supplies, and dealing with the challenges that come with that. So, it's the three Fs that keep coming up, as we're navigating through this, the fraud, fear and frantic activity.

07:20 DB: Kristin and I were talking before the podcast in ABMP, and I'm sure just in general massage practitioners out there. There are a range of MTs who are already practicing, who've gone back to practice, and then there's MTs who have yet to practice, specifically in the State of California. So it's really all a wide variety of what's going on. And my question is, how do consumers and purchasers know who to trust? And that could be those who are already purchasing material, versus those who have yet to begin.

07:51 AH: Sure. So, we're in an environment where part of the concern is that many of the regulatory entities that we historically have depended on to advise us, and to watch out for us, as consumers, are themselves overwhelmed. We have to realize that even FDA investigators, who traditionally are overseeing some of the states, many of them have never been to Asian countries, let alone been into a PPE factory. And so, you can imagine the level of education that's going on there, in each of the professionals that we're depending on. Now, there is a lot of effort going on there, and they are making progress. But meanwhile, the consumer is left to have to figure out how to navigate all of this on their own. And it's quite overwhelming.

08:42 AH: If you take some time to review CDC or FDA websites, a lot of information and jargon that the average consumer is not gonna be very familiar with and credit to a lot of people, they're spending the time to educate themselves. But I think ultimately what we need to depend on today is our common sense tactics, right? It's not realistic or practical for any one of us to earn a PhD in PPE overnight. Utilizing brands that you're familiar with, working with partners that are able to take some of this pressure off of you, and looking to be sure you're working with folks who have some kind of transactional history in the space, so that you're reassured that you're working with a legitimate supplier, and that the product you're receiving is safe to use.

09:29 AH: In particular, with the audience we're speaking of today, in our therapist community, we wanna be extra-sure that the equipment that they're utilizing in the human-to-human interactions that they're having are solid, and that they can rely on that. And so, there's really no room for error. Nothing is 100% foolproof when it comes to PPE, that's something people should realize. It is ultimately a approach of you risking big situations and scenarios that you're in and minimizing risk to yourself, as a consumer. It is common sense that can help us avoid some of the issues we're hearing in the market. In particular really concerns me, the level of fraudulent and counterfeit product that's being put into the market to meet some of the demands, as we've scaled up so rapidly.

10:19 KC: And I think that's a concern for a lot of people, is how do they navigate this field. As you're saying, with your background, it's still a challenge. So we have people jumping in for the first time as individuals, trying to figure that out too. Can you tell us a little bit about the FDA's EUA, Emergency Use Authorization list? And does that feel like a good step for people to use? Do they still need to be asking questions, even if a product or a company is on that list? How do we use that as a tool?

10:47 AH: Sure. So, the EUA is a authorization that the FDA and our government agencies here in the US have allowed for during this pandemic, so that we could qualify more manufacturers to provide supplies to the US consumer, given the level of demand and the challenges of accessing product in a market scenario like this. And so, approach is one where these manufacturers have had to qualify and meet certain criteria to be listed, and therefore meeting those requirements make them a safe option for purchasers. Know that, as consumers, we've seen the FDA evolve this list. And so, we've started with a much longer list, and since then, we've identified some challenges, and things are moving very quickly.

11:39 AH: And so, on the one hand, I do wanna say that we're fortunate that we were able to ramp up. We have a EUA list that gives us some more reassurance? Absolutely. And it's been great to be able to resolve some of the supply and demand issues with that list. But, again, I have to let everybody know, you do need to be your own advocate. Although it can give the average consumer some idea of what products have been approved, we would still encourage you to work through a third-party partner that's accessing product, versus handling a lot of the international transactions that would be required if you're gonna go direct to the source that's listed on the EUA. So, ultimately, most of the consumers are gonna be going online, or going into a retail location to make a purchase. And I would encourage that, versus the alternative of getting creative with the international purchases, because of the number of things that can go wrong, beyond whether or not someone legitimately qualified for that EUA list or not.

12:40 KC: Where are we in supply? How close are we or how far away maybe is more accurate, [chuckle] are we from supply catching up to demand and prices normalizing? What do you think about that?

12:51 AH: So I think we're still a ways off for a number of reasons. When I get asked this question, I really think about the totality of the supply chain that exists and what challenges come up across the board. So it's one thing to talk high level about are we producing enough masks to fulfill the needs of the world. And the reality is, is that is still very much in motion, because as soon as you catch up with raw materials being produced and masks or other supplies being produced at a strong enough level, you have larger buyers coming into the market or you have issues such as the packaging or shipping that needs to be addressed to meet up with the production levels that are being produced. So I was in a recent conversation where the producers of Nitrile gloves were starting to ramp up effectively, in terms of production of the gloves, but they were struggling to get their printers to work fast enough with the boxes that they need to put together for those gloves.

13:55 AH: So there's all sorts of pieces of the supply chain that are evolving. It's fascinating to watch how the world is getting this flywheel going, but it's still very much in process. We're still learning a lot. You should expect some erratic pricing to continue in the various categories. And inevitably we're gonna run, especially where we're seeing the surge of the pandemic in some places resulting in higher needs of supplies. So we do expect to continue to see some volatility. It's certainly have not normalized or standardized either on pricing or supply at the moment, but hopeful. I think we're ultimately having to see a big shift to a new normal in the PPE space. I don't expect us to see things return back to pre-pandemic times, at least in the next three years, but we are seeing all the pieces come together and improve more rapidly every month. So I'm hopeful that we'll start to see in next year, some normalizing. It's just that normalizing will be at a new normal versus the pre-pandemic normal.

15:07 DB: It's such an interesting situation right now. How can practitioners prepare for short-term procurement versus like a long-term strategy regarding over or under-purchasing? That seems like something, if I was a massage practitioner, I would certainly be considering purchasing too much or under. I know some of it's access to materials, but is there any kind of guidance you can give MTs on that?

15:33 AH: I think one of the keys is not to think too short-term. So it's best to really plan about a month out, at least, if possible. You don't wanna find yourself in a situation where you need supplies overnight. And that consists of both understanding what supplies are going to be useful to you, considering the budget that you need to set aside to purchase those products, and to give yourself enough time that should you need to get new supplies, you've got enough leeway to be able to allow for any shipping challenges that could occur.

16:10 KC: And when we're talking about purchasing planning, let's dive in a little bit even more specifically and talk about what are we buying. So what kinds of face coverings are we talking about? So we have a lot of options, as people just living in the world, but also specifically as massage therapists and what we think might be best to use in our practice. What we wanna use ourselves, what we wanna ask our clients to wear during a session. So when we're talking about all the different options from a cloth mask all the way to an N95, what do you recommend for a massage therapist, practitioners and clients?

16:43 AH: First off, something is better than nothin. So let's be clear about that. We wanna encourage everyone to have some kind of face covering, preferably a respirator of some sort, but any mask covering should be in place. You can follow the CDC guidelines for the minimal needs. When it comes to our recommendations, we really want to educate community members who are interfacing with other community members on a regular basis within the social distancing space to have a medical grade or at least civilian grade respirator available to them. And so that's typically an N95 or KN95 mask. At the very least, a 3-Ply surgical mask can provide two-way protection. So what's the usual approach is that a fabric mask is helpful for scenarios where you're either outdoors or indoors, but with enough room to maintain proper six feet social distancing on a regular basis from other individuals that you might be interacting with.

18:00 AH: In a scenario, especially work scenario where you are providing some kind of massage therapy or other types of interactions of that nature, you wanna have something that not only protects the customer, but protects yourself. And one of the reasons I worked with Zeel is because they're really thoughtful about putting the therapists first, in their thinking and their approach as a company. And so part of that, and why we've taken this step into PPE is we wanted to arm our members with both the education as well as the supplies to work in this current environment. And what that requires is to ensure that there is some kind of respirator in place that allows that our therapists to be able to conduct their work with the knowledge that they are protected, as well as they're protecting their customers. And when you wear a KN95, or a 3-Ply mask, or an N95, what that does for you is not only protects your customers, depending on anything that might be exposing them, and also protects yourself should you be exposed to any harmful scenarios.

19:14 KC: And there's been some confusion too, about whether or not N95 and KN95 masks are reusable. Can you address that?

19:23 AH: Sure. There are some studies now, and some methodologies, none of which... Personally, I would encourage the general consumer to utilize the masks that we're talking about today are generally meant to be disposable. They do have written instruction on sort of how long they can be used for and what environments, for what periods of time, and so I would adhere to those things available on CDC or FDA websites. And yes, although there have been studies, and in particular in environments, clinical environments in particular, where there's high demands and there's a need for reuse, they've had to take those chances. But generally, for the consumer, I would encourage that those masks be used as instructed, and disposed for something new.

20:17 KC: PPE has become such a stressful topic for so many therapists, whether they're at the clinic and spa owner level, and they're doing more bulk purchasing, or even down to the individual therapist just trying to do the right thing for their practice, and theirselves, and their clients. What are some of the top tips you have for how a massage therapist can choose and procure PPE, to try to help reduce that stress level a little bit?

20:44 AH: Well, my number one recommendation is that they really look to find a partner that has experience in this space, that's allocating resources and is educating appropriately, and has a brand that they can generally trust and rely on. Obviously, at Zeel, we're doing quite a bit to educate communities, and to handle quality control, supply chain management and procurement of product, and so we love to be a partner where we can be. But we're not the only ones, and we're happy about that, because there's a need for a large audience out there to work with the right partners in this environment, to identify the right products. And so, what I would discourage is for any consumer or therapist who doesn't have previous experience with PPE to try to do the education overnight, for becoming PPE experts. There are people who can help, who want to help in this space, and we should use our capacities to identify those right partners, and that will lead us to the right products, ultimately is what I would suggest in this fast-moving environment, where there's a lot of unknowns and concerns.

22:05 DB: And what do you see as the future of PPE use? Is this something that is gonna become the norm, from here on out? Or certainly for a year, two years, several years? Or, honestly, could this be something that we see ongoing now? Because once we've adopted to this, once we've become used to it, does it bring like an extra layer of safety for clients and for practitioners, regardless, once we move past COVID and just normal flu season? It's just something that you've seen, or we've seen, frequently, in Asia for years, because of other pandemics, or just because of safety concerns, or pollution in general.

22:43 AH: Yeah, it's a question I've gotten a lot, over the last several months is, what's the future of this market and/or utilization of PPE supplies? I think we have to come to embrace that we are in a new normal now, and having been through this pandemic, we are all shifting our social norms to some degree. And certainly, when it relates to masks or other PPE supplies, I think we are much less hesitant, as a society, to utilize these products and resources. Certainly, we can look over to Asia countries for behaviors over there that might influence how we think about approaching these things here in the US. What you've seen is a period of time where people are more intensely utilizing PPE, and then ebbs and flows, as things are more secure and safe.

23:47 AH: What I would argue is, if you look at either the trends in Asia, or even the historic trends around the Spanish Flu, and how we were able to come back to some baseline, that didn't necessarily look like everyone walking around all day with masks and face shields on, but did shift to a place where there was much less hesitation to grab that mask, or use those gloves, or stock up the hands sanitizer more so. And so, I do think the needle has moved, and that piece is more permanent, but I also think that we're in a acute period, with a greater need, that we all hope will not exist for the long term, but certainly something we're navigating right now together.

24:46 DB: If you don't mind, we'd love to transition and ask a few questions about Zeel, specifically, 'cause I'm sure our listeners will have questions about... Can you... About mobile massage, right now, in this environment. What can you tell us about mobile massage for Zeel, and did you have a period where you shut down and reopened? And can you just tell us about adjustments that practitioners and clients have had to make?

25:12 AH: I could take that we indeed did have a period where we shut down. We chose to shut down, actually, prior to most states mandating that that happen for both mobile massage and massage in spas and hotels. We have re-opened state by state according to guidelines, so as you can imagine, we are still not open in California at all, and also not open in New Jersey where spas are open for massage but at-home massage is still not allowed. We have been very cognizant of the fact that our therapists have been out of work for months. We understand, of course, that PPE has been helpful, but that there is a real desire to get back to work and that's one of the reasons that this PPE division of Zeel has become so front and center in the work that we do because the most important part of getting back to work is getting back to work safely. And that means for our therapists network of 11,000 licensed therapists around the country as well as for our valued customers who trust us and trust that the people that we are sending into their homes are the very top, top, top of their craft.

26:27 KC: In addition to the PPE requirements, what other protocols have shifted and changed as you're starting to reopen and people are going back out and visiting people's homes and hotels and public spaces?

26:39 AH: So there's a two-fold answer to that because both the protocols have changed and as a result and that's the interesting part about being a tech platform because we really are a tech company as opposed to a massage company, we've changed our tech to rise to meet the occasion. So if you are a customer on the Zeel platform and you are booking the massage in a state where massage has been reinstated, is now allowed, you're going to see a pop-up when you are booking through the app that asks you whether or not you travelled, whether or not you've been running a fever, whether or not you're showing symptoms of any illness, no less just COVID-19. And on the other side of that, we have an app, as you probably know, that is specific to our 11,000 therapists. So in the therapist's app, there is another pop-up that does a similar set of... It's almost a checklist to remind people that two years ago, if you got up with a little fever, many folks still would have gone into work and now what we're saying is, times have changed, if you get up with a little fever, you text in and you give up the appointment and we move on to another therapist in the network who is going to be able to safely bring that massage therapy to our customers.

27:51 AH: And it's interesting 'cause I heard you mention earlier, frontline workers, and we think of frontline workers, we think about doctors and nurses and folks working in hospitals who've been literally putting their lives in line for us. But I also think about folks who are working at Amazon round-the-clock to get us food and supplies we need, to live safely and comfortably at home, and I would put massage therapist into that category as well, and here is why. I think that the mental health crisis that has only been exacerbated by COVID and the sheltering in and the isolation that so many folks feel, I think that in that itself is its, its own crisis that needs to be addressed. The massage therapists in that way are frontline workers because massage therapy is a non... People will take sleeping medications, people will take narcotics, people will take whatever it is that they need to feel better and I'm not gonna get into psychopharmacology, it's certainly a valid choice.

28:52 AH: Massage therapy is a way that many, many people use a very safe modality to manage their stress, to sleep better, to function better, to parent better, to work better, so we can get those folks back into the field and I consider that a front line of sorts. We have laid out a number of recommendations that follow CDC guidelines, state guidelines, recommendations through you at the ABMP certainly. And what we're asking our therapists to do, keep in mind, when I say our, I mean therapists on our platform, so the therapists in the Zeel network are 1099'ers, they're independent contractors, and they're their own small businesses and we actually take a lot of pride in supporting their small businesses. We make recommendations to them but cannot necessarily mandate to them in a way that we could have if they were employees.

29:43 AH: So here are the recommendations. We start with the check, which before they even leave their homes, they've checked themselves at a real level to make sure that they are showing no signs of illness. We then promise the customer that they will be wearing a mask and we cannot promise a KN95 or N95, but as Amir was saying earlier, a 3-ply surgical mask is certainly a very valid form of PPE. While cotton masks or home-made masks are somewhat less protective, they are something that some folks are choosing to use. We prefer the 3-ply surgical but again, we cannot mandate the 3-ply surgical. We're also asking therapists if they are going to multiple appointments in one day, to entirely wipe down their equipment, that includes their table, their headrest, etcetera, with Lysol or any product that is known to be safe for a customer but also to kill bacteria, viruses or other germs that might be transferred from, say, a table to a human being.

30:52 AH: And we're asking people, the customers to do what is comfortable for them in their homes but obviously if they are in any way feeling ill, they're to cancel that appointment and then frankly wait for two weeks before they try to book again and the tech will meet that. So when we have a therapist or a customer that calls in to cancel appointment because they are not feeling well or someone in their home is not feeling well, that actually triggers the system and that allows us to know that those folks should not be re-booking for 10 days to 14 days. Now, interestingly as I'm sure you're aware, the CDC has recently shifted between feeling ill or positive COVID test and being clear to go back to work. So like everything else in this rare time, we are trying to move as fast as we can to make sure that our customer base and our therapist community are as safe as possible.

31:50 KC: And I think that's what everyone's trying to do their best, to navigate this new situation, to do our best for the therapist and the client, and that can be challenging day by day... Everything's changing day by day.

32:01 AH: I like to think of us all as ducks in the water. We seem pretty serene and unruffled but we're paddling like hell underneath.

32:07 KC: And wearing a mask above the water.

32:10 AH: That's correct.

[chuckle]

32:12 AH: At all times.

32:13 DB: I wanna thank our guest, Amir and Alison today so much for joining us. Where may listeners find out more information about Zeel?

32:20 AH: Www.zeel.com. We also have a wonderful blog, this hashtag... /blog, that has a lot of this information about PPE, including many of Amir's words of wisdom and expertise, and we do a twice monthly letter that goes out to all of the therapists on our network. There's provider newsletter and one of the most popular subject matters that we've been covering with PPE, how to procure PPE, how to utilize PPE, even how to test PPE. There's a really fantastic blog post on the Zeel blog about testing PPE, because there are ways to test at home to know that what you've purchased is actually of quality and is actually working. So please check out the website and let us share some of the expertise that we have in-house through Amir and his team.

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33:15 DB: Thank you so much for joining us today.

33:17 AH: Thank you.

33:18 AH: Thanks for having us.

33:20 KC: Thank you, both.

33:25 Speaker 5: This has been a production of Associated Bodywork & Massage Professionals. ABMP is a leading association for massage therapists and body work professionals in the United States and beyond. From liability insurance to Professional Advocacy, award-winning publications to the world's largest continuing education library for massage to this podcast, no organization provides more for its members and the profession than ABMP. ABMP works for you.

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