News / Publications

March 19, 2020

The WFC Advice Note on COVID-19, dated March 17, 2020, contained a key message that chiropractors should refrain from communications that make claims of effectiveness related to COVID-19 which infer that spinal manipulation / adjustment confers or boosts immunity or may enhance patients' recovery. Today, the WFC has published a rapid review of the relevant literature relating to spinal adjustment / manipulation and immunity, which has been compiled by the WFC Research Committee and informs our advice.

The WFC Research Committee comprises the world’s leading scientists in chiropractic drawn from Australia, Brazil, Canada, Denmark, Sweden and the United States. With hundreds of peer-reviewed publications between them, they have expertise in epidemiology, basic science, biomechanics, rehabilitation and clinical science.

At this time of critical challenges in global health, this review is consistent with the WFC’s #BeEPIC narrative and supports chiropractors in making informed decisions about the care they provide to patients and communities.

CLICK HERE TO READ REVIEW

March 17, 2020

PDF version

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.

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.

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.

March 12, 2020

WFC Public Health Committee

PDF version

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.

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
As at March 12, 2020, WHO is reporting 124,847 confirmed cases of COVID-19 in 118 countries. There have been 4613 deaths. China (80,981), Italy (12,462), Iran (9000) and the Republic of Korea (7869) account for 88% of all reported cases.

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

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.

Recommendations
- 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.
- 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.

According to WHO, the following measures are NOT effective against COVID-2019 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
https://www.who.int/emergencies/diseases/novel-coronavirus-2019 

Further information and resources

March 3, 2020

WFC Public Health Committee

PDF version

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."

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 thedisease. 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. 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 (e.g., high blood pressure, heart problems or diabetes) 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.

Recommendations for figure

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.

Recommendations
- 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.
- 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.

According to WHO, the following measures are NOT effective against COVID-2019 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.

Further information and resources

Report of an independent review by Safer Care Victoria

October 2019

November 1, 2019

For immediate release

 
Summary of outcomes and recommendations

As a consequence of concerns expressed by members of the public following the publication of a video showing the treatment by a chiropractor of a newborn infant in August 2018, the Minister of Health for the State of Victoria in Australia commissioned an independent review of the practice of spinal manipulation in children under the age of 12 years.

In March 2019 a panel was established to conduct this review. Panellists included medical experts in pediatrics, chiropractors, and regulators. It was chaired by the head of Safer Care Victoria, Professor Euan Wallace. The panel included Adjunct Professor Matthew Fisher, Chief Executive Officer of the Australian Chiropractors Association and Dr Wayne Minter, Chair of the Chiropractic Board of Australia.

The review included a public consultation, consultation with practitioners and regulators and a systematic review of the evidence by Cochrane Australia. For the purposes of the review, spinal manipulation was defined in terms of the application of a high velocity, low amplitude thrust beyond the physiological range of movement of a joint but within the limits of anatomical integrity. In Australia, the practice of spinal manipulation is limited to chiropractors, osteopaths, medical practitioners and physiotherapists.

Review of the evidence of harm

A search of the available literature was conducted by Cochrane Australia along with an analysis of patient complaints, practitioner notifications and an evaluation of insurance claims data from chiropractic insurers.

The review found very little evidence of patient harm for spinal manipulation in the treatment of children under 12 years. No patient complaints were identified and there were no practitioner notifications.

Three reports of serious harm were reported relative to spinal manipulation in children under 12 years. None of these events involved chiropractors, nor did they feature techniques used by chiropractors in Australia.

It was considered that there were 2 main reasons why evidence of harm was low:

- Spinal manipulation is rarely applied by chiropractors in the treatment of children under 2 years.

- Chiropractors utilise modified force techniques such that there is little likelihood of children receiving high velocity, low amplitude thrust spinal manipulation.

Despite these findings, the review states that spinal manipulation in children under the age of 12 years cannot be considered wholly without risk and that any risk of harm should be weighed against the evidence of benefit, especially in children under the age of 2 years.

Review of the evidence of effectiveness

Safer Care Victoria commissioned Cochrane Australia to undertake a systematic review of the effectiveness and safety of spinal manipulation in children under the age of 12 years.

The resulting systematic review concluded that the evidence base was very poor. It concluded that no strong evidence of effectiveness exists for the following conditions:

- Infantile colic
- Enuresis (bed wetting)
- Back and neck pain
- Headache
- Asthma
- Otitis media
- Cerebral palsy
- Hyperactivity
- Torticollis

Weak evidence was found for modestly reduced crying time in infantile colic and reduced wet nights in children with enuresis.

The review concluded that spinal manipulation cannot be recommended for headache, asthma, otitis media, cerebral palsy, hyperactivity or torticollis. It further concluded that the unlikely evidence of benefit versus the potential risks of harm should be considered in the use of spinal manipulation in the treatment of infantile colic and enuresis.

Public consultation

A public consultation resulted in 21,824 responses from people who had accessed chiropractic spinal care for children under the age of 12 years.

99.7% of respondents reported a positive experience of chiropractic care of children.

98% reported an improvement in symptoms following chiropractic care.

The panel noted a strong thread in the responses stressing the importance of the right of parents to choose the best care for their children.

The most common conditions for which chiropractic spinal care was sought for children under 12 years were as follows:

- Posture
- Colic
- Neck pain
- Breastfeeding issues
- Back pain
- Headache

0.3% of respondents reported a negative experience. Principal reasons cited included cost of care relative to perceived benefit, excessive use of x-rays, pressure to avoid medication or advice to avoid previously-consulted health professionals).

Health practitioner consultation

2735 responses were received from health care practitioners. Of the 85% of those confirming they provided spinal care for children, 99.5% were chiropractors.

Of the respondents, 80% stated they treated children aged 0-3 months, while 88% confirmed they treated children aged 0-24 months.

The most commonly reported benefits of care described by respondents were decreased pain, improved sleep patterns, more relaxed, improved breastfeeding and latching, and improved range of movement.

RECOMMENDATIONS

Improved safety

1. Spinal manipulation should not be provided to children under 12 for general wellness or for the management of the following conditions:

- Developmental or behavioural disorders
- Hyperactivity disorders
- Autism spectrum disorders
- Asthma
- Infantile colic
- Bedwetting
- Ear infections
- Digestive problems
- Headache
- Cerebral palsy
- Torticollis

2. National boards of those professions permitted to perform spinal manipulation should consider recommendation (1) when reviewing their policies in relation to the care of children.

3. Prior to treatment with spinal manipulation of children under 12, practitioner should provide written information setting out the proposed benefits and possible risks of care.

4. National boards should review notification data regularly to identify trends requiring modifications of policies, in line with the principle of risk-based regulation.

Improving quality

5. Practitioner groups permitted to perform spinal manipulation in Australia should urgently undertake research to develop an evidence base for spinal manipulation on children. The practice of spinal manipulation on children under 12 years should be ceased when there is the evidence shows no benefit. Ministers should consider whether funding should be allocated for the purpose of research.

6. Practitioner groups permitted to perform spinal manipulation in Australia must lead on developing evidence-based guidance on spinal manipulation of children for both practitioners and consumers, using National Health and Medical Research Council endorsed methods. This guidance material should form the basis of written information for parents in line with recommendation (3).

7. Consideration should be given by the Chiropractic Board of Australia to various models of advanced chiropractic training in pediatric care, particularly in spinal manipulation. Post-registration training on offer to chiropractors with a special interest in paediatrics should be assessed against the evidence-based guidelines.

Eliminating false advertising

8. Chiropractors should continue to be audited by regulatory authorities for their compliance with guidance relating to advertising.

9. National boards should consider whether prohibitive advertising statements are issued regarding spinal manipulation in children where there is evidence of no benefit.

10. Ministers should consider increasing penalties for advertising offences where a registered practitioner claim benefits of spinal manipulation in children that have no evidence base.

The full report is available at http://bit.ly/SCVpaediatric. It includes an Executive Summary, recommendations, a detailed description of the public consultation, and the systematic review undertaken by Cochrane Australia.