26 Aug 2020

I've recently received a lot of requests for referrals to piercers who are open during the pandemic.These requests are from people who are seeking to get pierced right now, and they're located in areas where "non-essential" businesses are still shut down. (Of course many of us find piercing to be "essential" but that's not really what's up for discussion at the moment.) Apparently, some piercers are working even though regulations require them to be closed.

My response has been: if your local government feels there's so much viral spread present in your community that piercers must be closed, then the best thing to do is wait until it is deemed safe! Any piercer (or body artist) who is working in an area that has a mandated shut-down is someone who does not care if they break the law. That is not the type of ethics you would want for someone who is breaking your skin. If they don't care about working when they shouldn't, they may not care about whether their implements are sterile, or other critical safety aspects. Just wait. There's no harm in waiting, and there is potential harm in seeking piercing when it is forbidden. I've done a lot of piercing problem consultations lately from people who have gotten pierced during the pandemic by piercers who are not supposed to be working. They are doing a concentrated amount of really low-quality, hack work!

Another discussion that's come up a lot lately is whether it is a good idea to get a nose piercing (nostril or septum piercing) or an oral piercing (tongue or lip piercing) at this time. Most liklely, the answer is no. It is certainly not acceptable in areas that have mask mandates. Below is an article from the monthly Q & A column I write for Pain Magazine on the subject. It answers a question from a piercer, and the response was written to piercers, but it certainly contains relevant information for anyone who is seeking such a piercing while mask-wearing is so prevalent. And remember your nose should never "go commando" when you're wearing a mask. The virus can enter and leave through the nostrils, so the mask must always cover both the mouth and the nose!

Here's the article:

Dear Ms. Angel,

Do you think it is OK to do nostril piercings right now if their mask stays over their mouth, and I am off to the side? (Today’s headline was “U.S. reports record single-day spike of 60,000 new coronavirus cases,” and we just passed 3 million confirmed.) I was thinking that septum and oral piercings might be more risky because of where I stand and the direction the client breathes? I don’t know how to decide what is safe and my health department is nowhere to be found. Thanks! C.
 

Hi C.,

There is debate within the industry about the safety and appropriateness of doing “below-the-mask” piercings during the Coronavirus pandemic. In many areas, oral and nasal piercings (and jewelry changes) have been suspended due to regulations intended to control the spread of COVID-19. And in others—like yours—no guidance has been provided. The number of cases varies considerably by region and over time, so your particular circumstances must be taken into account when making decisions if no restrictions have been imposed.

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Wearing a mask while healing might cause a bump!

Experts say distancing plays the primary role in reducing the spread of COVID-19, but of course, it is not possible to maintain physical separation while piercing. Fortunately, piercers are already familiar with using personal protective equipment (PPE) and taking measures to ensure the health and safety of ourselves and our clientele. So, we should be capable of carrying out any changes needed to make our practices as safe as possible.

Cases are currently rising in many localities—and massively exploding in others. If you’re in a zone with a large or increasing COVID-positive population, it would be wise to decline to pierce the nose or mouth and require every client to remain fully masked while on your premises. It is safest for you to wear a mask whenever people (patrons or coworkers) are in the building, even if it is not mandatory in your location. 

I would also encourage piercers to wear a face shield or goggles—especially if you’re working on the nose or mouth. An international research team that analyzed 44 studies from 26 countries reported that eye protection could reduce the risk of infection from 16% to 6% compared to those not using the safeguard.[i]

Research has also shown that the virus can linger in the air for longer than was previously believed. A widely disseminated open letter to the W.H.O. was signed by 239 scientists. It states: “Studies by the signatories and other scientists have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure at distances beyond 1 to 2 m[eters] from an infected individual.” The researchers also noted that the problem of virus-carrying respiratory microdroplets in the air is especially acute in indoor and enclosed environments, particularly if ventilation is inadequate or exposure periods are extended. When a viable virus is suspended in droplets smaller than five microns, they are termed aerosols. For perspective, a human hair is about 50 microns wide.

Since air quality is critical, every piercer should have a HEPA filter in the piercing room. Depending on local circumstances and the quality of your facility’s HVAC system, it may also be appropriate to place a HEPA filter in the retail area.

I discussed the matter of below-the-mask piercings with over 50 colleagues. I found that even in locations where no prohibitions exist, many practitioners are not working on those parts of the body at this time. Others who are not forbidden will pierce the nostril but not the septum, or the nose, but not the mouth.

Like you, a number of piercers believe that the direction in which clients breathe relative to their own position makes certain procedures safer than others. There’s obviously no specific research on this, but it seems relevant to know that aerosols float, move with air currents, and can stay suspended for hours.[ii]

Most who are performing nostril piercings believe that they are safer than oral piercings, which they’re declining. Given that swabs are commonly placed in the nose to test for the virus, it is unclear if this is accurate. The coronavirus is spread from the mouth and nose when infected individuals talk, cough, or breathe.[iii] Yes, normal breathing—including from the nose—can release the virus into the air. Piercers commonly guide clients to take slow, deep breaths during the procedure. While this practice is helpful to calm and relax the piercee, it is now potentially dangerous if their mouth and/or nose is unmasked.

If the client wears a mask except for the marking, cleaning, and piercing, then puts the covering back in place after you complete the procedure, there’s still a risk of releasing virions (infectious viral particles) into the studio environment. Evidence shows that face coverings are better at preventing others from catching an infection from the wearer,[iv] so allowing masks to be removed in the shop elevates potential risks.

Extended contact is another factor for COVID-19 transmission. So, to diminish the amount of in-person time you spend interacting with patrons, provide access to an aftercare video with all of the information you routinely impart during your in-studio speech. It is also helpful to use an online release form that clients can fill out in advance.[v]

An additional concern is the prevalence of “silent infections.” Pre-symptomatic carriers (who are sick but have yet to develop signs of illness) can be exceptionally infectious.[vi] Asymptomatic individuals who test positive but never feel ill also represent some risk of transmission. The most conscientious pre-screening and temperature-taking still can not eliminate these individuals from your client pool. We must assume that every piercee can transmit the virus and behave accordingly.

Yet another consideration is whether frequent (or constant) mask-wearing over a fresh piercing will cause irritation and healing complications. 

Our understanding of the SARS CoV-2 virus remains limited, and research is ongoing. As more is discovered, it will likely become easier to make sound decisions. Meanwhile, contemplate the information above, your own situational factors, and use your best judgment. (Be safe!)


[i] https://www.webmd.com/lung/news/20200608/eye-protection-could-decrease-covid-19-spread

[ii] https://www.nytimes.com/2020/07/06/health/coronavirus-airborne-aerosols.html?action=click&module=RelatedLinks&pgtype=Article

[iii] https://www.avert.org/coronavirus/about-covid19?fbclid=IwAR3Yu0cKSPV23qPcdMBM0ZbZt6HElwG8cQoKKT4eXATVIV_S2sinSpmnGEw

[iv] https://www.npr.org/sections/health-shots/2020/06/21/880832213/yes-wearing-masks-helps-heres-why

[v] https://www.signnow.com/ (for example)

[vi] https://www.pnas.org/content/early/2020/07/02/2008373117

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