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On the morning of Monday, March 16, the number of COVID-19 cases and deaths was growing exponentially in the state of Washington, where I work at a facility-based outpatient department for a critical-access hospital and rural medical clinic.

With initial business closures just beginning, our rehab department was still seeing patients and scheduling new evaluations, albeit very reluctantly. When the stay-at-home recommendations went into effect that afternoon, the flood of cancellations began. As the Rehab Department director, I was struggling with how to have my staff of three physical therapists (myself included), one physical therapist assistant, one occupational therapist, one rehabilitation aide, and two front office coordinators abide by the recommendations to decrease exposure.

How were we to keep the six-foot distancing in place during our direct patient care without any PPE other than surgical masks? I faced an ethical dilemma. By asking my staff to continue with outpatient treatments, I risked potentially exposing them and our patients. Was it more harmful to keep the doors open or close them?

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