The CDC: Straight from the source

Who writes the federal guidelines for the beauty industry? Why does the CDC consider PPE the last line of defense for beauty pros? How can we improve ventilation in our salons? What steps should be taken if COVID-19 exposure happens? Our guest Dr. Cherie Estill from the CDC’s National Institute for Occupational Safety and Health answers our questions and we discuss the implications.

Show Notes

Resources:

Centers for Disease Control (CDC) Guidance:
COVID-19 Employer Information for Beauty Salons and Barbershops

What Beauty Salon and Barbershop Employees Need to Know about COVID-19

COVID-19 Employer Information for Nail Salons

What Nail Salon Employees Need to Know about COVID-19

CDC COVID Data Tracker

NIOSH Hierarchy of Controls

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Edited for length and clarity.

EPISODE TRANSCRIPT

JAIME: Before we get started, we want to announce that we’re the featured educators in a virtual learning event. A Slice of Pro Beauty scheduled for Sunday, October 11th and Monday, October 12th is open to all license types.

ASHLEY: And if you’re a cosmetologist or nail technician in Illinois, you’ll be able to satisfy eight hours of your CE requirement. Bonus! Visit outgrowthpodcast.com/slice for more info and to register. Seats are limited. Now on with the show. 

JAIME: Welcome to Outgrowth: A Slice of Pro Beauty with your hosts Jaime Schrabeck.

ASHLEY: And Ashley Gregory. In early June, the Centers for Disease Control issued guidance for nail salon employers and workers. More recently, the CDC did the same for the rest of the beauty industry to include hair and skincare services, even massage.

JAIME: To learn more, we welcome our special guest, Dr. Cherie Estill from the CDC’s National Institute for Occupational Safety and Health. Let’s grow together. 

JAIME: Welcome, Dr. Estill. Thank you for joining us on Outgrowth.

DR. ESTILL: Thank you. Thanks for having me.

JAIME: The function of the CDC and NIOSH within the federal government and its impact on state governments. We have lots of questions because we might not have paid much attention to the CDC or even known what NIOSH was before the pandemic. Can you tell us how the CDC recommendations influence state guidelines?

DR. ESTILL: Sure. So NIOSH is the National Institute for Occupational Safety and Health. And we are part of the Centers for Disease Control and Prevention. We’re a federal institute, and our job is to conduct research, and make recommendations for preventing work-related injuries, illnesses, and deaths, but we’re not regulatory agency or an enforcement agency. So our mission is just to transfer knowledge, research knowledge, into practice for occupational safety and health.

JAIME: To follow up on that, this guidance that comes from the federal government that comes in the form of recommendations rather than requirements or laws, is that correct?

DR. ESTILL: That’s correct. Yes. We recommend. That’s our job is to make recommendations based on the best science.

ASHLEY: So the qualifications of the individuals that are responsible for writing those guidelines obviously have different areas of expertise. What contribution do experts that are in the beauty industry make to this process?

DR. ESTILL: So many people were involved in writing the CDC guidelines. Of course, much of the guidelines is for what everyone is doing that revolves around COVID-19 and then there’s many things that are specific to the salon industry. The authors that drafted these guidelines, 

they do have backgrounds in exposure assessment and infection control. And three people that are connected with the hair/beauty industry did review the guidelines as part of the CDC review process.

JAIME: And to give our listeners more information about your particular expertise, could you explain that?

DR. ESTILL: Sure. I have a master’s and bachelor’s degrees in engineering and then a PhD in environmental health which is part of the college of medicine. I have done a number of research studies that have to do with chemical exposures in industry and the nail salon industry is one of those that I have looked at and that’s why I have been involved with this industry, the salon industry, because of my background with the nail salon industry.

ASHLEY: Well, I think that makes you, of course, Dr. Estill, uniquely qualified to speak to guidelines in general for the beauty industry, with this added layer of COVID on top. I guess what I’d love to know is when the CDC compares risks posed by beauty services to risks in let’s say other industries like manufacturing or industrial, where do we really belong on that hierarchy and why?

DR. ESTILL: Sure, so think about dental offices and those are seen as much higher risk because they have droplets that can come from a patient’s mouth and patients are not protected by wearing masks. So the beauty industry is not seen to be as risky as that, but It’s riskier than some others. It has to do with being in close contact, which of course you need to do. You need to touch the other person. So you need to be in close contact with them. And then the second thing to look for is time. How long are you with the person? You have probably a similar amount of risk as other industries that come into contact with people, close contact, but you’re also with them for more extended amount of time. For instance, a clerk at the grocery store is not going to be with you for more than five minutes, but you’re going to be with your client for 15 minutes, and could be much more than that. Also there’s occasions and there could be potential to remove a mask, which we don’t recommend to do those procedures right now, but there is that potential. So those three things being in close contact, extended amount of time, and potential remove a mask would be things that put the industry at a higher risk than some of the other industries that are facing the customers or the general public.

JAIME: For some of the states that were slower to allow services to resume inside beauty salons, the role of this study that was done in Missouri with the hairstylists, we’d love to know what role that particular study played in the development of the guidance for beauty salons and barbershops, and if there are any comparable studies underway focusing on different services other than just hair.

DR. ESTILL: So that Missouri hair salon study, it was conducted by the Centers for Disease Control as part of an outreach to that location. It actually gives a lot of information about the transfer of the disease. If you think about that as there’s a hairstylist that has a COVID-19 and she, she did not infect all of those people that she was with. The other stylist was infected, but she considered that her close contact and was engaged with that person without a mask.

But it does show that the mask wearing during all that time, eight days or something that she was infected, she did not transfer it to other people. So it made us very confident in putting into place the cloth face mask in this salon as something that can prevent COVID-19 at this time. I’m not aware of any other similar studies being worked on right now, but that doesn’t mean that there aren’t any. I just am not aware of any right now.

ASHLEY: You mentioned earlier or alluded to the prevalence or the option, I guess, in our services and service protocols, that masks can be removed just by the nature of a beauty service. What’s recommended when a service does require working directly on the client’s face without them wearing a face covering?

DR. ESTILL: Okay. So I’m saying that people might remove their masks, but we don’t recommend it at all. We don’t recommend that the beauty care workers are engaged with the public without masks, but because it is seen as a very high level of risk, you would be exposed to because you have to be so close to that person. You would be exposed to the droplets and aerosols coming from their face. If somebody does want to go ahead and do procedures like that, there are no-strap or stick-on face coverings if the problem is the strapping. Those do exist and I have heard of people using those. I guess we would recommend those before you would go to just taking off your mask.

JAIME: We’ve learned so many new terms throughout this pandemic, and one certainly is PPE. Recent guidance expands greatly on cloth masks while many in our industry wear disposable surgical masks, and I think our listeners may be interested to know that cloth masks aren’t considered PPE, and what about additional protection like wearing visors, or glasses, or goggles?

DR. ESTILL: We have a hierarchy of controls, which is something that is very, that’s always used in the occupational safety and health. Hierarchy of controls puts things in place, one, two, three. The very first thing is to eliminate or substitute. The second thing would be engineering controls such as putting ventilation or barriers, and then finally administrative controls and personal protective equipment. Personal protective equipment is things that protect the actual wearer, which would be the higher level respirators, like N95s. And those we prefer to save at this time for the healthcare industry because the healthcare industry and the medical first responders need those. But, at the same time, we are recommending that if beauticians, barber salons, nail salons, if they used certain respirators before the pandemic, they should continue to wear those respirators because that was something that was needed before their job. Maybe they’re exposed to certain chemicals. In the nail salon industry, many people wear respirators or face masks for applying acrylic nails. So those items should still be worn. If they didn’t wear a respirator before, they should wear the cloth face covering, which is more so protecting others around you as opposed to protecting yourself, which a personal protective equipment protects yourself. It’s kind of hard wording to understand, but the cloth face covering is protecting others so that you are not breathing out droplets and aerosols onto other people. 

JAIME: As far as the hierarchy of controls goes, that’s where we get into issues of creating barriers and that kind of thing, right? The plexiglass that we’ve talked about or the other ways to.

DR. ESTILL: Right. 

JAIME: Separate ourselves from our clients so that we’re not sharing as much air. 

DR. ESTILL: Right. The hierarchy of controls. So it’s, the first is the eliminate or substitute, which in the case of COVID-19 is difficult. And the way you would do that is keeping sick people out of the workplace so that it’s not there to begin with. That is eliminating or substituting. The second thing is engineering controls. So if you can’t get rid of the whatever it is that people could be exposed to, how can you design by engineering means or physical means changes? And so ventilation, which can, you know, if the air changes a whole lot, then there’s less of that around the workers or barriers, so making actual physical changes. And then after that the things that are less protective are administrative controls and personal protective equipment because they rely on the system of the people in that area to follow specific administrative rules and procedures. Also the personal protective equipment requires them to wear something. It could be hot. It could be in their way. So those type of things are considered to be less protective than engineering controls.

ASHLEY: Now, Dr. Estill, I know that your work previously has focused in general with nail salons and air quality. Is there a specific reason that nail salon guidance was released separately and quite a bit sooner than the balance of the beauty industry?

DR. ESTILL: Yeah. So there’s not really a particular reason that it was really first, other than me and others had more expertise in the nail salon industry because they use so many more chemicals. We had recently done some studies in that industry so we had a general knowledge. So that was done first and then the beauty barber one was done after that. So that’s really the only reason.

JAIME: For anyone in our audience who has not had the opportunity to do a comparison of the two different sets of guidelines, what would you focus on as being the primary difference, or is it more similar?

DR. ESTILL: They are very similar. If you can think about what was happening in the US in the end of May, beginning of June when the nail one came out and then the more recent one was put out, I don’t know, maybe three, four weeks ago, some of the CDC language definitely changed and some is more specific and more refined. We also were able to benefit from the other CDC guidance on businesses and offices. So those type of procedures and ventilation and things like that were added in. We are definitely focused on aerosols, and air, and droplets, a little bit less focused on surfaces. So a little bit changes like that, but for the most part, there’s an awful lot of similarity. If you own a beauty salon or a nail salon, many of the procedures are the same. First, think about how does it spread? What are my procedures? How can I separate people from each other? What do I say to clients and what do I have them do? You know, so many of the procedures are very much the same.

ASHLEY: Along with that shift from focusing on surfaces and a renewed focus on ventilation and air quality, how does someone measure that? What if you have things like ceiling fans in your salons, and then, if you were to extrapolate that out, what effect does that have on the safety of blow drying hair and other salon activities that can be detrimental, or just have an effect, on the air in a space?

DR. ESTILL: Sure. Yeah. So I think ventilation is very important. Each salon should think about their ventilation and typically, they would be talking with their building’s maintenance personnel.   That would be the first place to start and assure that there’s a high level of air changes and good filtering. So the building maintenance personnel will know how to do that, but what you need to do is make sure you’re telling them we need to go to the highest level of air changes that the system will allow. So we’re not recommending a specific level because the building stock in this country has variety. You need to just put in place as good as you can and good filtering and making sure that the filters, they fit. They don’t leak, things like that. So the maintenance personnel should be taking care of that. And you want to increase the amount of fresh air to the extent that the ventilation system can, while you’re still keeping your building at a comfortable temperature and between 40 and 60% humidity. As far as blow drying, we consider blow-drying uncontrolled ventilation. So if air is blown over a client’s face, it could be propelled toward another person’s face. So that is really the problem with it. If you have other fans in the facility, the high-speed directed fans for comfort, those are also problematic. If you have fans, I think you alluded to ceiling fans. Those are usually not high speed, and they’re mainly stirring the air around and I wouldn’t see those as problematic. For blow-drying, if you have many workers and clients in one room, that is more of a problem than if you have like separate rooms for one client and one beautician. Then there’s probably more care in how the blow dryer is used.  

JAIME: Because I work in a building that’s more than 50 years old, and does not have air conditioning, and I would question just how well done the ventilation was, I am so grateful to hear what you’ve said about ceiling fans. 

DR. ESTILL: Right, and that, if you can open windows, but I know that you also need to think, is it safe to do so with the many wildfires that are going on, if that’s anywhere near you?

JAIME: It is near me or at least it was, and the air quality outside certainly has been a concern   throughout this entire summer. Let me ask you this about air quality. When I ask about measuring the air quality, rather than just deferring to our landlords who may not really know, is there a way to have OSHA, or some other agency, or even a private entity come into your space and tell you by doing some measurement, what the quality of your air is?

DR. ESTILL: So they wouldn’t measure quality. They could measure air changes per hour and  NIOSH and OSHA would not do that. You probably have a local fire marshall or somebody like that who would be saying here’s the requirements. Not during COVID, but just during regular time, these are the requirements for an operation to be running. So kind of with the like ASHRAE guidelines, which are the main air and heating and refrigeration engineers put out some guidelines, but other than paying for a consultant, you could definitely do that to see what your air changes per hour are. But there’s not really, other than building codes and guidelines, there’s not really like, here’s exactly what it needs to be. We don’t have that right now. You would want to just put it to the extent that you can. You want to have a pretty well ventilated space, which is measured by air changes per hour. How much air is coming in? How much is going out versus how much is in the facility?

ASHLEY: Well, since we’ve touched on California, and their fun, little peccadilloes and things that they’re doing differently than other states, California did make news by limiting most salons to providing services outside only. Does the CDC offer or plan to offer any guidance about this option, especially if we are facing down a potential second wave which would force more states to in turn restrict indoor services?

DR. ESTILL: So CDC does state in many locations that activities are safer if they’re held outdoors. So because of the higher ventilation of, you know, wind speed, it’s definitely higher ventilation. It is safer.  But that being said, I don’t see us recommending that beauty salons only conduct their business outdoors. Instead, we recommend that if people are indoors with less ventilation, it is more risky and it’s harder to keep people apart when they’re indoors because there’s only so much space. Again, we’re recommending good ventilation. I can give you some other recommendations on good ventilation. Again, talking to your facilities management, seeing if they can adjust the ventilation system and the maximum amount delivered to that space while still keeping good humidity and temperature. Reevaluate the position of supply and exhaust diffusers and dampers. So putting the fresh air over where the workers are and having that exhaust from maybe a location where people enter and exit, or if people are waiting, and then using natural ventilation as much as possible. We do have, besides the beauty salon guidance,   we have guidance on building ventilation systems you could look at or send your maintenance people to look at.

JAIME: Turning to this issue of contact tracing, is there a reason why the guidance doesn’t address the issue of recording the client’s contact information? Because we think that would be useful for authorities who needed to find individuals who may have been exposed in a salon setting.

DR. ESTILL: Sure. This would be a voluntary measure, and would be up to the states and local jurisdictions to implement contact tracing. And contact tracing is considered for close contacts, people within six feet for more than 15 minutes. So those are the people that you would want to trace and a client stylist relationship would entail that. It would be a good measure for stylists to get contact information of clients in the case that they became positive. But again, it would be a voluntary measure and up to the state and local jurisdiction if you wanted to enforce it in any way.

ASHLEY: So then when states limit things like salon capacity or the duration of a service time, can you give us some insight into how that’s supported by the data you’re seeing?

DR. ESTILL: So the local jurisdiction, states, cities, counties, they are monitoring the pandemic within their communities and so most of those guidelines are reflective of the monitoring or the rates that they have seen within that community. Limiting the number of people that enter a facility, or limiting time with any one person, it does reduce the risks, but the reason for those guidelines of limiting capacity are definitely reflective of local rates or local hotspots.

JAIME: And as members of the public, not privy to that information, we’re trusting our health officials to make those decisions on the different sectors in our economy.

DR. ESTILL: So you have that data by the county level. If you go to the CDC COVID data tracker, you would be able to see rates and the cases at the county level. So you would be able to look at the county that you live in and determine what those levels are.

JAIME: I wish we had that by industry because I know in California, there are just small number of counties who are actually reporting the circumstances under which someone might be exposed. So, for example, they might call, call out that a gym was a source, or a spa. And what we don’t see, as a member of the public, is of course what the health officials are seeing, which has all that information from behind the scenes. Even in my county, what’s getting reported as the case count is higher than it should be, where people live rather than where they work. Even though in my county, a number of those people live in one part of the county, but work in another and the place where they work has low case rates.

DR. ESTILL: Well, each jurisdiction is doing the tracking so they would be tracking that. We do agree that it would be, as far as my organization doing research on occupational safety and health, that would be one of our goals is to systematically track cases by occupation. As it currently stands, healthcare personnel are singled out and are reported in this CDC COVID data tracker. You can look separately at health care personnel, but other types of occupations are currently not stratified right now in the data, the federal data, that everyone can see that’s on the county level.

ASHLEY: Switching gears slightly, worst case scenario, if an exposure does happen in a salon business, what steps should a salon take?

DR. ESTILL: Immediately separate that worker from the other workers and the clients. That is very important. You may need to even arrange for private transportation home. If that worker generally carpools with another worker, or takes the subway, or something like that. And that ill person needs to self isolate and contact their healthcare provider. As far as what you need to do at your facility for cleaning and disinfection, you need to look at your facility and if there’s been someone that’s suspected or confirmed to have COVID-19, then you need to clean and disinfect that area. That’s everywhere that that suspected or confirmed case would be, such as offices, bathrooms, common areas, shared equipment and focus especially on frequently touched surfaces like light switches. If other workers don’t have to have access to the area where the sick person is, then you should wait 24 hours before doing the cleaning. But if you need to clean it right away, you can, just you would want to be careful. The workers who test positive for COVID-19 should immediately notify their employer, making sure that you’re notified. Sick workers should follow CDC recommended steps to self isolate and seek care. They should not return to work until they’ve completed the discontinue home isolation, and consult their medical providers to assure that they are in agreement with that. And you also need to determine which employees may have been exposed, so which employees or clients may have been exposed to that person, and so they may need to take additional precautions. You would inform those employees that there is a possible exposure of COVID-19, but at the same time, you need to be sure to follow the American with Disabilities Act and maintain confidentiality. Most workplaces would follow the public health recommendations for community-related exposure and in doing so would recommend that those close contacts that have been potentially exposed would stay home for 14 days and self monitor for symptoms.

ASHLEY: Knowing what we know now and how this situation is obviously evolving daily, should we expect significant updates to industry-specific guidance in the future from the CDC?

DR. ESTILL: Well, they will update the guidance as needed and as additional information comes available. I can’t speak to whether they will specifically update the beauty and hair nail salon guidance. But if parts of it changed in the larger CDC picture, then these will follow suit and be edited to follow the same guidance and wording. And you’ll notice a number of places in this guidance where we link to other guidance and that’s because as things change, then that other guidance can get changed without actually making changes to every single one of these industry-specific fact sheets.

JAIME: Links have never been so useful.

DR. ESTILL: Right.

JAIME: We can’t let you go without asking a question that’s more specific to the nail industry   and it’s about the increased popularity of products that are actually made from methylene chloride intended to remove gel polish products. Is there anything that you want to share about your understanding of those types of products and the dangers that they pose to both professionals and clients?

DR. ESTILL: The studies I’ve done on methylene chloride were on furniture stripping. It’s a very powerful chemical for furniture stripping, but it’s also a chemical carcinogen, meaning it causes cancer. So I would be wary of those, but I can’t say anything in particular about those products cause I haven’t researched those.

JAIME: We can send you many links. They’re being sold everywhere, even to consumers through sites like Amazon, and they’re being called magic gel removers. And of course it looks pretty impressive if you see a video time lapse of that product being applied and then this product that would otherwise take 10-15 minutes to soak off with acetone seemingly just miraculously starts peeling off. But unfortunately based on some pretty shady looking safety data sheets that likely don’t list all the ingredients accurately, many people are unaware of what the actual ingredients are. We’ll send you some information.

DR. ESTILL: Great. I will look it over.

ASHLEY: Yeah, it’s concerning, for sure. Well, Dr. Estill, thank you so much for your time and your insights into what this process looks like from the other side. I know a lot of our listeners will be very appreciative of understanding what does actually go into making these guidelines   and the fact that so much thought is put into it.

DR. ESTILL: Great. Well, I appreciate being asked to participate in this podcast.

JAIME: Thank you so much.    

ASHLEY: Well, Jaime, that was an action packed episode. I’ve learned so much in the past 30 minutes. We really packed in a lot of questions.

JAIME: We did pack in a lot of questions and what’s so interesting about this is in those questions, we have even more questions to ask in the future. We need to know where we are right now and understand a bit about how we got here and I think that’s why Dr. Estill was the perfect guest because she already has expertise in our industry.

ASHLEY: I really enjoy hearing from experts outside of the beauty industry itself and the perspective that comes with a ton of knowledge about occupational safety and what we can actually learn from someone who may not have the mechanical knowledge of what goes into a beauty service and how to perform that. But I really enjoy the objective perspective of Dr. Estill just wanting again to keep everyone safe, workers, clients, et cetera.

JAIME: Knowing that she and her colleagues are studying different aspects of the safety of our work, and producing research, and then publishing articles on that research, I’m really excited to learn in the future, what is it that they’ve been focusing on even before COVID? And now going forward, I imagine their studies will take on new importance and we may be exposing our audience to this material that they otherwise would not even think to research themselves.

ASHLEY: Oh, definitely. I was really happy to learn that there are industry members that are consulted before these guidelines and industry-specific guidance is issued by the CDC. I for a long time was of the opinion that it was someone coming from, you know, an industrial safety background or coming from an epidemiological background, and not really knowing a lot about how our industry works, and then just kind of issuing these blanket guidelines. To know that and really kind of get a peek behind the curtain helps me understand number one, the big picture, and secondly, why the guidelines are the way that they are.

JAIME: It could be different if we were part of a different sector, and we’ve heard more recently that if the guidance were actually produced outside and then presented to a government agency, that’s more like lobbying. That’s not the way the process should work. The process should be generated from within the government using the science, using the resources of these individuals with all this expertise. The data, I mean, just the data alone, the things that we’ll never get to see, those are all things that would go into these guidance documents and even then, they’re just still recommendations.

ASHLEY: Exactly, and I know there’s a lot of discussion around that happening right now in other industries and the guidance that’s been issued for them. What I really am taking away from this is that official documents like this are even still evolving behind the scenes. And our circumstances as they’re ever changing through COVID, and when we kind of get back to more normal times, it just shows that we need to be very flexible, but we also, as beauty service providers, need to be really on top of what’s happening. Is there new guidance? Because I know a lot of our listeners have never heard of CDC industry-specific guidance or taken the time to look at this because they didn’t know what existed. And so that’s why I’m so thankful to Dr. Estill to not only help us spread the word that there is this documentation and these guidelines out there, but what actually goes into creating them. The fact that nails has been separated I know has been kind of a hot button issue for you and I in the past, but I think the explanation of that helps me understand that we’re not being singled out. Really the consideration is extra special for us just because of the nature of the products we use.

JAIME: And Dr. Estill pointed that out specifically, the chemicals that most would expect to find in nail salons, even though my particular business doesn’t use those chemicals. It’s one of those things where they’re trying to address the broadest and most likely scenario in our industry. And if they can look at a hundred different salons and 98 of them are using similar chemicals and I might be one of two that’s not, the guidance needs to be written for the 98 and apply to me as well, obviously.

ASHLEY: The other part of our interview that I think I’m going to be going back to and listening over again and again is that specific study of the hairstylists in Missouri ,and the fact that the CDC was there it sounded like for other reasons, really to kind of aid and maybe do a field investigation, but they took that opportunity to release those results and help other people in our industry understand what the risk factor is when proper protocols are followed. Because that’s information that could have just died on the vine in that county or in the state of Missouri. The fact that it became an actual study and it was shared is something that I think is very valuable for our industry worldwide to help clients feel safer, to help salons understand the importance of PPE and all of the other conditional factors. But I believe the data from this time period in history is going to be studied for years, and years, and years. And  we may even get more information about industry-wide breakdowns like you mentioned versus, you know, just health care workers, but getting really granular with that data and finding out where the actual kind of hotbed industries were.

JAIME: That’s why I’m hoping that additional studies will be done focusing on different parts of our industry so that if in the future, we need to go through this process again, and I do not want that to happen, but if we can anticipate that it might, we could make better decisions and have more confidence in those decisions as they’re being made because we do have this data.

ASHLEY: And we also have what sounds like an action plan and marching orders really. I never really thought about doing a measurement of the air quality or the air rate of turnover.  I think that’s something that’s very accessible to the lay person to be able to hire someone in to do that, indoor air quality experts. And I think that’s all just good information to have in general, as we move forward, knowing that this is going to be our reality for the next year or more. What other data points or layers of protection can we offer not only to our clients but to ourselves?

JAIME: And the layers of protection, most of us, at least I’ve seen this in social media, are pointing immediately to the PPE and the point that she made about the hierarchy of controls makes it clear that the PPE is actually the last line of defense after you’ve eliminated other opportunities for people to behave in ways that would affect the outcomes. So the other types of controls that she described those are more of the surroundings so that it wouldn’t matter how people behaved if you eliminated the opportunities for the virus to pass between people, or to be in the air and be circulated.

ASHLEY: And that’s something that I’ve learned today. That PPE is really as zoomed in as you can get, and we need to zoom out a little bit more and start controlling our environment, or at least maintain a level of control over our environment so that PPE doesn’t have to be the last line of defense. It’s just something that’s good to have and we know that there’s other protocols in place that are keeping the environment safer for us. I’m not saying don’t wear PPE, oh my gosh. But just knowing that that shouldn’t be the only thing you’re relying on, it’s really good to think about. It’s good to understand how those things all work in relation with each other and helps me realize that what we can control is bigger than just our own personal protective equipment.

JAIME: Don’t you think though it’s a bit ironic that the factor that’s considered most important, the ventilation, is the thing that we can’t readily point to and say, unless you have some sort of certificate on the wall or something that said it’s been rated to change over at this rate? We can see dividers. We can see people wearing PPE. But in terms of whether or not you can walk into a space and understand whether or not there’s enough ventilation happening there, that’s not something that’s as easily measurable. I’m worried that a number of bad actors will try to, as they have already, try to sell very expensive equipment to salons claiming that it’s not only circulating the air properly, but that it might be cleaning the air and ridding the air of COVID.

ASHLEY: It’s essentially UV sanitizers for the air. You know, we’re moving into that level now. These foggers and all of these other things that I have a little bit of experience with just based on the fact that my dad is in the commercial cleaning industry and disaster restoration. Indoor air quality in our country is notoriously terrible, and that can be just from lack of ventilation, circulating air, mold spores, If you aren’t hiring someone that is specifically certified or specializes in air quality management, you’re not getting anything. There’s these ozone machines that are, they look like a little old Hi-Fi speakers and there’s these machines that are asking you to put liquid disinfectants in them, and then aerosolizing that which is just incredibly dangerous. And I know Leslie talked about and touched on that in our Clean Hands, Safe Salon series. But buyer beware, do your research. Knowing that we now need to focus on air quality, ventilation, circulation of air, and do everything that we can to get more fresh air into the mix. Just understand that if it’s being sold to you in a Facebook ad, it’s probably not going to do what you need it to.

JAIME: I have some phone calls to make. I’m looking forward to actually having someone come in and do the measurements that would be necessary to figure out exactly how the ventilation is functioning absent any of the products.

ASHLEY: Well, and you have a baseline, which is something not a lot of people have. You had a previous Cal/OSHA study done on your specific space and on your person to know are you breathing in noxious fumes and things that are dangerous, and the results of that were very surprising.

JAIME: They were, and I had that done because I was concerned that, instead of just assuming there was a problem and spending the money on equipment, I wanted to make sure I understood the scope of the problem, and was fortunate enough to realize that Cal/OSHA, which is California state’s OSHA equivalent, was offering the opportunity to have a study done at no cost. And when I had that study done, we made sure it was a really busy day. We had everyone working. We were booked back-to-back like we normally would be. This is of course pre-pandemic, and we were monitored individually as service providers and each space in our salon where we worked was monitored. And this whole study took 10 hours. It was a very full day. And when the results came back, I was thrilled because not only was it not even close to being a cause for concern, I will say this again. I work in a really old building. The ventilation, as far as I’m concerned, is not that great. We don’t have air conditioning, for example, but maybe the ventilation is better than I think it is. Maybe I need to give it more credit, but I do need to go back and have the air circulation measured again because I do want to know what’s happening now, especially that I did install ceiling fans as a means of helping to control the temperature and move the air in lieu of not having air conditioning.

ASHLEY: And given where you’re located, just geographically, opening the windows isn’t always an option, given wildfires and just extreme temperatures and things like that. And you have magnetic door locks on your salon. It’s not like you would just have the front door open all the time and you only have one entrance or exit that opens to the outdoors. We’re all kind of in different situations and trying to make the best of it, but I did want to ask Dr. Estill, and it’s I’m sure a pretty touchy subject at the CDC and NIOSH right now, but just why some of these recommendations have such conditional language and the things that we’ve talked about in the guidelines and, or regulations, or recommendations, the if possibles, the if feasibles. Just knowing that, again, everything kind of comes back to us as beauty professionals or as salon owners to follow the recommendations, I know that they’re based in several data points, and studies, and fact, but nothing is set in stone. Nothing is being required uniformly of all of us and I understand that conditional language is required so that people don’t think that this is a law. But then again, what’s wrong with having a law that says you have to wear a mask if you’re going to be up in somebody’s face doing waxing or a haircut or whatever?

JAIME: These recommendations at the federal level would certainly give state-level authorities the, I don’t want to use the word ammunition, but I’ll go ahead and use it, the ammunition to make this a law for their particular jurisdiction. But even going back to this idea of the ventilation,   the windows that I do have in my salon, they don’t open. The only way to get air in and out, other than what is built in, is by opening the front door, which does open to the outside. And then, as you mentioned, the other door actually opens onto a hallway, which approximately 25, 30 feet from there, does open to the outside, but that door isn’t open, normally speaking. That door is closed for security reasons. So this whole idea of being told this is what you have to do, that would be another conversation to have with a landlord. And I’m sure the landlord would come back with, well, if you want to pay to change the windows to make them accessible, to make them open, by all means, go ahead and pay and have that done.

ASHLEY: Yeah, it’s a sticky situation I know to have blanket regulations like that and I’m kind of reconsidering the statement I just made. You know looking at states like New York that are requiring new salons to open with ventilation systems at each station installed. It’s incredibly cost prohibitive, but again, not all salons perform and offer the same services, or use the same products. So when you have to regulate kind of to the lowest common denominator, there’s going to be people that get tripped up in that net. That they don’t necessarily need that because of what they offer, the products they use, but because it is required by law, everybody sort of just has to comply, and then it’s another barrier to entry conversation. So I understand, I guess, a little better. I just like talked myself out of it, why these can’t be regulations and our recommendations. Looking at it from the other side, it makes quite a bit more sense now, which is why I’m so glad we had this interview because it’s really given me a new perspective on what the CDC is capable of. And to be quite honest, as an industry, we don’t even follow the regulations that are on the books anyway. So I don’t know why I would expect this to be any different.

JAIME: And if the CDC were to be able to issue laws and regulations, then I would expect, they’d be responsible for enforcement, and we know that’s not going to happen.

ASHLEY: Right. Well, I mean, enforcement equals money, time, and manpower. And I don’t think the CDC should have to be tasked with that when they’re keeping us from very scary diseases coming from other places or food. So I’m glad that there is someone on the federal level looking out for industry and offering this guidance. I guess it’s up to us to decide what we do with it, and how we really get our arms around it, and bring it into our daily practice.

JAIME: As always, the more we can apply ourselves and comply with what’s recommended and what’s required the safer we’ll be.

ASHLEY: Exactly. Well, I think that’s a fabulous note to sign off on. But again, many thanks to Dr. Cherie Estill from the National Institute of Occupational Health and the CDC. Her time is super valuable and we appreciate that we were able to get some of that today. Please subscribe, rate, and review Outgrowth on your favorite podcast platform. It helps new listeners find us, and we really appreciate that.

JAIME: If you’re enjoying Outgrowth, please head to Apple podcasts and leave us a review. We may read your review on our next podcast.

ASHLEY: And as always, you can follow us and comment on recent episodes on Instagram at @outgrowthpodcast.

JAIME: I think I need to head over to the CDC website and do some more reading.

ASHLEY: You and me both, lady. Well, until next week.

JAIME: Be safe.

ASHLEY: Be smart. 

JAIME: Bye.

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