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Coronavirus Disease 2019. Advice for chiropractors March 17, 2020

March 17, 2020

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On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). Chiropractors are primary contact health care professionals and to protect themselves, their patients and their communities they must stay current with the latest scientific evidence, information and advice. The global situation regarding COVID-19 is evolving daily and advice may change over time pending developments and emerging scientific knowledge. This advice note is current as of March 17, 2020 and has been produced with advice and guidance from the WFC Research Committee and WFC Public Health Committee. 

Key messages
1. The WFC acknowledges the service of chiropractors around the world in contributing to the health of nations. We recognize that this is a challenging time and that we are in unprecedented territory with regard to the global outbreak and spread of COVID-19. As a worldwide community, the WFC understands that there are many questions being asked of chiropractors and that the situation varies from country to country. In order to support the global efforts of our fellow health professionals it is of critical importance that chiropractors communicate information to their patients and communities that is scientifically accurate and comes from authoritative sources.

2. Advice communicated to patients by chiropractors and their staff should be based on advice from WHO and official national public health agencies in their country.

3. There is no credible scientific evidence that chiropractic spinal adjustment/manipulation confers or boosts immunity. Chiropractors should refrain from any communication that suggests spinal adjustment/manipulation may protect patients from contracting COVID-19 or will enhance their recovery. Doing otherwise is potentially dangerous to public health.

4. COVID-19 may be transmitted from person to person and may be contracted from surfaces on which the virus is deposited. It is vital that chiropractors, their staff and all visitors to their facilities are scrupulous about personal and clinic hygiene, including the practice of hand washing, respiratory etiquette, social distancing, sanitization of all equipment and surfaces and appropriate use of personal and protective equipment. Chiropractors must comply fully with all government directives in relation to the COVID-19 pandemic, which may include closing clinic facilities.

5. Current evidence is that the elderly and those with co-morbid health conditions are particularly at risk.Care must be taken to minimize potential spread of COVID-19 to these special populations. In areas ofconfirmed outbreak this may take the form of suspending provision of office-based care to vulnerable individuals in order to prevent transmission. While most fatalities have occurred in the elderly population, it is now known that young people, including children, have died from COVID-19. Those not exhibiting symptoms can still carry and transmit the virus.

6. Chiropractors and their staff should ensure they are familiar with information about COVID-19, which is set out below. They should monitor the WHO website, government directives, advice and guidance from regulators and official sources of public health advice in their respective nations, states and provinces.

7. The elderly and people with underlying conditions must be prioritized. WHO recommends that those with mild disease are isolated and cared for at home. It is important that care-givers take all necessary precautions to protect themselves. This means that the patient and the care-giver should wear medical masks. Patients should sleep in a separate room and use a separate bathroom. One care-giver, who is in good health, should be assigned to care for the patient, and should practice rigorous hand-washing and sanitization procedures as set out below. These measures should continue for 2 weeks after patients have stopped exhibiting symptoms.

8. COVID-19 is spreading to low income countries. It is not known at this stage how it will affect communities with a high HIV-positive prevalence or who are malnourished. Chiropractors working in these communities should be particularly mindful of measures that will help prevent transmission.

Recommendations for patients and health professionals
- Regularly and thoroughly wash your hands with soap and water or alcohol-based hand
cleaner.
- Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
- Avoid touching your eyes, nose and mouth.
- Follow good respiratory hygiene. Cover your mouth and nose with your bent elbow or
tissue when you cough or sneeze. Dispose of the used tissue immediately.
- Clean surfaces with disinfectant.
- Avoid unprotected contact with farm or wild animals.
- Within health care facilities, enhance standard infection prevention and control practices
in hospitals, especially in emergency departments.
- If you feel unwell, stay at home and isolate for at least 14 days.
- If you develop fever, cough and difficulty breathing, seek medical advice promptly as this
may be due to a respiratory infection or other serious condition. Call in advance and tell
your provider of any recent travel or contact with travelers.
- Stay informed on the latest developments about COVID-19. Follow advice given by your
healthcare provider, your national and local public health authority or your employer on
how to protect yourself and others from COVID-19.

What is COVID-19?
COVID-19 is the infectious disease caused by the recently discovered novel (new) coronavirus. Several coronaviruses are known to cause respiratory infections in humans. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. On January 30, 2020 the International Health Regulations Committee of the World Health Organization (WHO) declared the outbreak a "public health emergency of international concern" and on March 11, 2020 it was officially declared a pandemic.

What is a pandemic?
Declaring a pandemic has nothing to do with the characteristics of the disease but is instead associated with concerns over its geographic spread. According to WHO, a pandemic is declared when a new disease for which people do not have immunity spreads around the world beyond expectations. Once a pandemic is declared it becomes more likely that community spread will eventually happen, and governments and health
systems need to ensure they are prepared for that.

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How does COVID-19 spread?
People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales if one breathes in these droplets. Another way is when these droplets land on objects and surfaces and one touches these surfaces, then touch their eyes, nose or mouth, they can catch COVID-19. WHO is assessing ongoing research on the ways COVID-19 is spreading and will continue to share updates.

How long is the incubation period for COVID-19?
The "incubation period" means the time between catching the virus and beginning to have symptoms of the disease. Most estimates of the incubation period for COVID-19 range from 1-14 days, most commonly around 5 days. These estimates will be updated by WHO as more data become available.

Spread of COVID-19
In recent days, there has been a rapid escalation of cases of Covid-19. As at March 17, 2020, WHO is reporting over 180,000 confirmed cases of COVID-19 in 148 countries. There have been over 7000 deaths. China (81,077), Italy (24,747), Iran (14,991) and the Republic of Korea (8236) account for 77% of all reported cases.

WHO is publishing current figures via its COVID-19 Situation Dashboard.

There has been a rapid escalation in social distancing measures, closing schools and canceling social and sports gatherings. However, WHO is concerned that there has not been enough testing, contact tracing and isolation, which are the key elements of the response.

What are the symptoms of COVID-19?
The most common symptoms are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don?t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems (particularly high blood pressure, heart disease, diabetes, chronic respiratory disease and cancer) are more likely to develop serious illness. About 2% of people with the disease have died. People with fever, cough and difficulty breathing should seek medical attention.

Should I wear a mask to protect myself?
People with no respiratory symptoms, such as cough, do not need to wear a medical mask. WHO recommends the use of masks for people who have symptoms of COVID-19 and those caring for individuals who have symptoms, such as cough and fever. The use of masks is crucial for health workers and people who are taking care of someone (at home or in a health care facility).

WHO advises rational use of medical masks to avoid unnecessary wastage of precious resources and misuse of masks. Use a mask only if you have respiratory symptoms (coughing or sneezing), have suspected COVID-19 infection with mild symptoms, or are caring for someone with suspected COVID-19 infection. A suspected COVID-19 infection is linked to travel in areas where cases have been reported, or
close contact with someone who has traveled in these areas and has become ill.

According to WHO, the following measures are NOT effective against COVID-19 and can be harmful
- Smoking
- Taking traditional herbal remedies
- Wearing multiple masks
- Taking self-medication such as antibiotics. Antibiotics do not work against viruses, such as COVID-19.

Treatment
There are no specific antiviral treatments or vaccines currently available for COVID-19. People with COVID-19 should receive supportive care to help relieve symptoms. For severe symptoms, treatment should involve care to support vital organ functions. People who think they have been exposed to COVID-19 should contact their health provider immediately.

WHO information
WHO information about COVID-19 can be found at WHO information WHO information about COVID-19 can be found at https://www.who.int/emergencies/diseases/novel-coronavirus-2019

WHO advice for Healthcare Providers
Recommendations for the workplace
Health Care Worker information
WHO situation reports

WHO advice for the Public
Advice for the public
MythBusters information for the public
Three videos about COVID-19 here, here and here.

Global research on COVID-19
WHO has posted links to research on COVID-19 from around the world, which can be accessed at
http://bit.ly/COVID19_research.

 
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