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CORONAVIRUS: Advice for chiropractors April 17, 2020

April 17, 2020

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On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). As of April 17, 2020, there have been over 2.075 million confirmed cases in 213 countries, areas or territories. There are currently over 140,000 confirmed deaths. 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. In many countries around the world chiropractors have ceased providing direct, hands-on care to patients in response to governmental or health policy 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 April 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 current, 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. Chiropractors must comply fully with all government directives in relation to the COVID-19 pandemic, which may include ceasing the provision of direct-contact patient care.

5. COVID-19 may be transmitted from person to person and may be contracted from surfaces on which the virus is deposited. Where they are continuing to provide essential services to patients, it is of critical importance 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, physical distancing, sanitization of all equipment and surfaces and appropriate use of personal and protective equipment (PPE).

6. 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. Multiple nations and regions of the world are now subject to special measures including enforced physical distancing.

7. 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.

8. 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.

9. WHO recommends that those with mild signs and symptoms of COVID-19 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.

10. 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 17 Apr 20

What is COVID-19?

Coronavirus disease-2019 (COVID-19) is the infectious disease caused by the recently discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 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.

washhands 2020 03 26

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. Shaking hands may transmit the virus and should be avoided.

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

As of April 17, 2020 there have been 2.075m confirmed cases of COVID-19 in 213 countries, areas or territories. There have been over 140,000 deaths. USA (632,781), Spain (182,816), Italy (168,941), Germany (133,830) and France (107,778) account for 59% of all reported cases.

WHO is publishing current figures via its Covid-19 Situation Dashboard at www.covid19.who.int

There has been a rapid escalation in national and regional 'lockdown' measures, with enforced restrictions on social distancing, closure of schools, colleges and universities and widespread cancellations of social and sports gatherings. Despite these measures, 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. A loss of sense of smell and taste has been reported. 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. Masks are effective only when used in combination with frequent hand cleaning with alcohol-based hand rub or soap and water. Cover both the mouth and nose and make sure there are no gaps between your face and the mask. Avoid touching the mask while using it; if you do, wash your hands with alcohol based hand sanitizer or soap and warm water. Replace the mask with a new one as soon as it becomes damp and do not re-use single use masks. To remove the mask, remove it from behind (do not touch the front of the mask), discard immediately in a closed bin and clean hands immediately.

who usemask


According to WHO, the following measures are NOT effective against COVID-19 and can be harmful

- Smoking
- Wearing multiple masks
- Taking self-medication such as antibiotics. Antibiotics do not work against viruses, such as COVID-19.

Treatment

To date, there are no specific antiviral treatments or vaccines currently available for COVID-19. People with COVID-19 should receive care to relieve symptoms. People with serious illness should be hospitalized. Most patients recover due to supportive care. Possible vaccines and some specific drug treatments are under investigation and are being tested through clinical trials.

A healthy lifestyle will make all bodily functions work better, including immunity. Eating healthy diets, with plenty of fruit and vegetables, keeping physically active, quitting smoking, limiting or avoiding alcohol intake, and getting enough sleep are key components of a healthy lifestyle.

WHO Strategic Objectives

WHO's strategic objectives for its response to the COVID-19 outbreak are:

- Interrupt human-to-human transmission, including reducing secondary infections among close contacts and health workers, preventing transmission amplification events and preventing further international spread*
- Identify, isolate and care for patients early, including providing optimized care for infected patients.
- Identify and reduce transmission from any animal source.
- Address crucial unknowns regarding clinical severity, extent of transmission and infection, treatment options, and accelerate the development of diagnostics, therapeutics and vaccines.
- Communicate critical risk and event information to all communities and counter misinformation.
- Minimize social and economic impact through multi-sectoral partnerships.

*This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in health care settings, implementation of health measures for travelers, awareness-raising in the population and risk communication.

COVID-19 and domestic violence

The COVID-19 pandemic and measures being taken to address it, such as lockdown measures which enforce staying at home, may exacerbate the risk of family and domestic violence. The United Nations Secretary-General has indicated that the rate of violence against women and girls has risen sharply following the imposition of lockdown measures during the pandemic. Chiropractors seeing patients, either in person or virtually in the form of telehealth consultations, should be mindful of the potential for non-accidental injuries and direct physical violence being related to presenting complaints. A WHO information sheet on this subject with advice for the health sector is available at https://www.who.int/reproductivehealth/publications/vaw-covid-19/en/

Stress

Due to measures that are being implemented around the world to combat the spread of COVID-19, many people are experiencing symptoms of stress, anxiety, confusion or anger. WHO has developed a helpful infographic which sets out symptoms and measures that can be taken to manage stress during the pandemic.

WHO coping with stress

Myth-busters

- 5G mobile networks DO NOT spread COVID-19
- COVID-19 can be transmitted in ALL AREAS, not just those with hot and humid climates.
- Cold weather and snow CANNOT kill the COVID-19 virus.
- Taking a hot bath DOES NOT kill the COVID-19 virus.
- COVID-19 CANNOT be transmitted through mosquito bites.
- Hand dryers ARE NOT effective in killing the COVID-19 virus.
- Ultraviolet lamps SHOULD NOT be used to sterilize hands or other areas of skin.
- Thermal scanners CANNOT detect people with COVID-19 unless they are displaying signs of fever.
- Spraying alcohol or chlorine WILL NOT kill the COVID-19 virus once it has entered your body.
- Pneumonia vaccines DO NOT protect against the COVID-19 virus.
- Rinsing your nose with saline DOES NOT protect against infection with COVID-19.
- Eating garlic DOES NOT protect against infection with COVID-19.
- COVID-19 DOES NOT just affect older people: young people are also susceptible.
- Antibiotics ARE NOT effective in treating or preventing COVID-19.
- There are NO specific medicines to prevent or treat COVID-19.
- Catching COVID-19 DOES NOT mean that you will have it for life.
- Drinking alcohol DOES NOT protect against COVID-19

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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