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CORONAVIRUS: Advice for chiropractors. June 15, 2020

June 15, 2020

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On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization (WHO). As of June 14, 2020, there have been over 7.69 million confirmed cases globally. There are currently over 427,000 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 updated advice note is current as of June 14, 2020, based on WHO source material and has been produced with advice and guidance from the WFC Research Committee and WFC Public Health Committee.

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.

MASKS - UPDATED ADVICE

The World Health Organization (WHO) updated its advice on masks on June 5, 2020. It advises that masks should be worn as one part of a comprehensive strategy to suppress transmission and save lives. Masks are not sufficient on their own to prevent transmission and other measures, such as hand-washing and physical distancing, are equally important. Full WHO guidance on the use of masks can be found here.

Medical (surgical) masks*

Medical (surgical) masks can stop people becoming infected as well as preventing others from becoming infected.

The following groups should wear medical masks:
- Health workers
- Anyone with symptoms suggestive of COVID-19
- People caring for people suspected of or displaying symptoms of COVID-19

Medical masks are also recommended for these at-risk people when they are in areas of widespread transmission and cannot guarantee a distance of at least 1 meter from others.

- People aged 60 years of over
- People of any age with underlying health condition

*In the absence of aerosol-generating procedures (AGPs), WHO recommends that health workers providing direct care to COVID-19 patients should wear a medical (surgical) mask (in addition to other PPE that are part of droplet and contact precautions. In care settings where AGPs are performed (e.g. COVID-19 intensive and semi-intensive care units) WHO recommends that health workers should wear a respirator (N95 or FFP2 or FFP3 standard or equivalent)

How to put on a medical (surgical) mask

- Before touching the mask clean your hands with an alcohol-based hand rub or with soap and water
- Inspect the mask for tears or holes. DO not use a mask that has previously been worn or is damaged.
- Verify which side is the top - it is usually the side with the metal strip
- Identify the inside of the mask, which is usually the white side
- Place the mask on your face covering the nose, mouth and chin, making sure there are no gaps between your face and the mask.
- Pinch the metal strip so that it molds to the shape of your nose.

Do not touch the front of your mask while wearing it to prevent contamination; if you accidentally touch it, clean your hands.

How to take off a medical (surgical) mask

- Before touching the mask clean your hands with an alcohol-based hand rub or with soap and water
- Remove the straps from behind your head or ears, without touching the front of the mask
- As you remove the mask, lean forward and pull the mask away from your face
- Medical masks are for single use only. Discard the mask immediately, preferably into a closed bin.
- Clean your hands after touching the mask
- Be aware of the condition of the mask; replace it if it gets soiled or damp.

Non-medical, Fabric masks (general public, non-health workers)

For areas of widespread transmission, with limited capacity for implementing control measures and especially in settings where physical distancing of at least 1 meter is not possible - such as on public transport, in shops or in other confined or crowded environments - WHO advises governments to encourage the general public to use non-medical, fabric masks. They should be handled carefully, not shared with others and washed frequently.

WHO is actively studying the research on the wearing of fabric masks. New research has identified the following preferable types of fabrics, number of layers and composition of fabric masks:

- An inner layer of absorbent material, such as cotton
- A middle layer of non-woven material such as polyproplylene
- An outer layer of non-absorbent material, such as polyester or polyester blend

Remember that the use of a fabric mask alone is not sufficient to provide an adequate level of protection. Maintain physical distancing and frequently clean your hands.

MYTHBUSTING: The prolonged use of medical masks when properly worn DOES NOT cause CO2 intoxication nor oxygen deficiency

howtoweramedmask

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 and the wearing of face coverings on public transport and in confined, crowded environments.

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.

11. There are currently no drugs licensed for the treatment or prevention of COVID-19. While several drug trials are ongoing, there is currently no proof that hydroxychloroquine or any other drug can cure or prevent COVID-19. The misuse of hydroxychloroquine can lead to serious side effects and illness and even lead to death.

MYTHBUSTING: Drinking ethanol, methanol or bleach does not prevent or cure COVID-19 and can be extremely dangerous.

 

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.

GENERAL INFORMATION ABOUT COVID-19

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.

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.

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.

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 stress infographic

MYTHBUSTERS

- Spraying and introducing bleach or another disinfectant into your body WILL NOT protect you against COVID-19 and is highly dangerous
- 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
- Adding pepper to your soup or other meals DOES NOT prevent or cure COVID-19
- COVID-19 IS NOT transmitted through houseflies.

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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