modalities when social supports may be more limited than prepandemic. Feelings of isolation are reported to be increasing.18–21 Touch therapies have a substantiated record for supporting clients with these challenges.1,2,5,10,12 The Acceptance and Value in Multiple Populations The breadth of the potential applications is magnified by the value imbued in massage through multiple cultural practices and recent scientific advances. The roots of massage therapy’s hands-on treatment in diverse traditions around the world suggest that such benefits may be employable in multiple populations. In many cultures, the discipline developed out of religious practices and traditional healing and includes rubbing, cleansing, and anointing with oils.22 Research produced in recent decades has shown increasing evidence that manual techniques can aid in many conditions as discussed hereunder. Such evidence buoys the value these cultural traditions have already granted massage treatment. It also reframes the value in the United States where massage has been associated with luxurious lifestyles. Challenges of Acceptance, Value, and Access for Underserved Communities Before the pandemic, access to health care, including integrative medicine and massage therapy in particular, was recognized as significantly limited for nonwhite communities.23–26 According to research, the reasons are the perception of limited funds, fewer people of color in the profession of massage therapy that limits personal exposure to the service, and fewer known options in finding providers of massage.23,27 The pandemic has aggravated these disparities through its impact on disposable incomes, in addition to the forced suspension or reductions of practitioners’ work, as discussed hereunder. These historic circumstances and pandemic-related evidence suggest that access may be even more challenging for already underserved communities.23,25,26 Challenges Faced by the Massage Therapy Profession During the COVID-19 Pandemic Public policy after the outbreak of the pandemic varied significantly among integrative and hands-on professions. Massage therapy was initially deemed a nonessential personal service in the United States and an unnecessary burden on limited personal protective equipment [PPE] resources. It was thus suspended in both medical and community settings during the early stages of shelter in place.28 Yet other providers requiring close physical contact were authorized differently. Many, such as physical and occupational therapists, acupuncture and chiropractic providers, were only temporarily suspended for in-person visits. Most resumed within several weeks or could switch to remote sessions. Disciplines such as naturopathic medicine, nutrition services, and music therapy that were not dependent on physical touch were also able to pivot to remote delivery. In contradistinction, many jurisdictions completely closed massage therapy unless under the order of a medical doctor, osteopath, or chiropractor.28 In addition to the physical distancing, safety requirements, and the limited supply of PPE, the fact that treatment provided by licensed massage therapists is not generally covered by insurance may be a key reason it was not classified as essential health care and was slower to reopen even when other close contact professions were restarted with new PPE protocols sooner. Reopening happened in phases according to local authorizations. In some regions, massage practices resumed with few changes required. Others could only open with significant restrictions such as requiring sessions take place outdoors or for shorter duration. Compounding these challenges for massage therapists were the additional operational expenses of new PPE, disinfection, and ventilation protocols. Furthermore, the increased time needed to complete the disinfecting processes means fewer encounters in any given 468 TAGUE ET AL. Downloaded by 76.229.153.206 from www.liebertpub.com at 04/27/22. For personal use only. time period. Stated bluntly, practices have an increased cost of doing business with less income potential. The financial consequences to individual therapists and to the field as a whole will not be fully known for some time. The rate of attrition of providers due to both financial loss and personal safety concerns is yet to be understood. How the Massage Profession Adjusted to the Risk of SARS-CoV-2 Transmission Early on, leaders from several U.S. massage therapy organizations met to review the Centers for Disease Control and Prevention’s (CDC) recommendations for health care providers working in the emerging pandemic.29 They considered the limited published literature specific to transmission and consulted with scientists, administrators, and health care providers from other fields to determine if and how to safely practice massage therapy when resuming.29 Based on documents provided by the World Health Organization (WHO),30 the CDC,31 and the Federation of State’s Massage Therapy Boards (FSMTB),29 massage therapists returning to practice adopted significant changes in protocol to safely treat clients despite inconsistencies in local, state to state, and institutional requirements. Protocol adjustments affected hospital-based practices, both inpatient and ambulatory,