Chiropractic and Corona virus, what do we really know?

COVID Mode of transmission:

Early reports suggest person-to-person transmission most commonly happens during CLOSE exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs or sneezes. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity. The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. Airborne transmission from person-to-person over long distances is unlikely, but the virus does live on hard surfaces for extended periods, therefore cleansing surfaces is also important. (4)

Epidemiologic factors and testing:

Please realize there are guide decisions about COVID-19 testing and that only suspected cases are tested. You can’t simply request a test and expect for that to happen, but as more test kits become available, this may become easier. Documented COVID-19 infections in a jurisdiction and known community transmission may contribute to an epidemiologic risk assessment to inform testing decisions. Medical clinicians are strongly encouraged to test for other causes of respiratory illness (e.g., influenza) before considering any COVID-19 testing.

Mildly ill patients are encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management, but this is strictly supportive care unless significant breathing issues arise. Patients who have severe symptoms, such as difficulty breathing, should seek care immediately. Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness. (5)

Hand Hygiene:

Health care professionals (HCP) should perform hand hygiene before and after patient contact, or contact with potentially infectious material. HCP should perform hand hygiene by using 60-95% alcohol or washing hands with soap and water for at least 20 seconds. Integrity Chiropractic has ensured that hand hygiene supplies are readily available to all personnel as well as patients in every care location. (6) The same information applies to you and your family … wash, wash, wash! By the way, we have hand washing stations in every treatment room, in our rehab bay, and in all 3 office bathrooms, there is no reason not to have clean hands at Integrity Chiropractic.

Disinfection and Prevention:

At Integrity Chiropractic we ensure that environmental cleaning and disinfection procedures are followed consistently and correctly. Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings. (7) This is exactly what we are doing at Integrity Chiropractic. Tables, counters, door handles, door surfaces, computer screens and keyboards are all disinfected multiple times throughout the day. We additionally utilize a cleaner with surfactant that works for 24 hours to not allow bacterial or viral attachment to the surface.

SO WHY CHIROPRACTIC?  --  Can that help and if so how?

It is important to state that we do not have enough quality evidence to support a specific causal increase in systemic immune function following chiropractic care at this time. However, there is published evidence that this does occur in specific immune cells. We just need more quality studies to be performed to properly understand and verify the chiropractic – immune connection. Here’s some research in the meantime.

Interleukin-2:

One of the very best ways to prevent and fight any virus is to have a strong and healthy immune system. Research from 2006, 2008 and 2010 determined that patients who received Chiropractic adjustments showed increased levels of a specific signaling molecule in the body called Interleukin-2. IL-2 regulates the activities of white blood cells which are responsible for immunity. The molecule impacts the body's natural response to microbial and viral infections and helps the body recognize and create specific responses that neutralize foreign invaders. This protein molecule was found to be higher in those who received Chiropractic spinal adjustments when compared to those who did not. (8,9,10,17)

Polymorphonuclear Neutrophils:

Another type of immune system cell, (PMNs), showed increased biological activity after chiropractic adjustment. PMNs are the most abundant circulating blood leukocytes. They provide the first-line defense against infection and are potent effectors of inflammation. (11) Researchers found a significant difference in the respiratory burst of PMNs in response to a particulate challenge, depending on the time of blood sample collection. The response of PMNs isolated from blood collected 15 min after manipulation was significantly higher than the response of cells isolated from blood collected 15 min before. (12)

Cluster of Differentiation 4

An important study was performed at the Sid E. Williams Research Center of Life Chiropractic University. Researchers took a group of HIV positive patients and adjusted them over a six-month period. What they found was that the “patients that were adjusted had an increase of forty-eight percent (48%) in the CD4 cells (an important immune system component).” These measurements were taken at the patients' independent medical center, where they were under medical supervision for the condition. The control group (the patients that were not adjusted) did not demonstrate this dramatic increase in immune function, but actually experienced a 7.96% decrease in CD4 cell counts over the same period. (13)

Another study showing the positive effect chiropractic care can have on the immune system and general health was performed by Ronald Pero, Ph.D., chief of cancer prevention research at New York's Preventive Medicine Institute and professor of medicine at New York University. Dr. Pero measured the immune systems of people under chiropractic care as compared to those in the general population and those with cancer and other serious diseases.

In his initial three-year study of 107 individuals who had been under chiropractic care for five years or more, the chiropractic patients were found to have a 200% greater immune competence than people who had not received chiropractic care, and 400% greater immune competence than people with cancer and other serious diseases. The immune system superiority of those under chiropractic care did not diminish with age. Dr. Pero stated: “When applied in a clinical framework, I have never seen a group other than this chiropractic group to experience a 200% increase over the normal patients. This is why it is so dramatically important. We have never seen such a positive improvement in a group…” (14)

Musculoskeletal Considerations of Coronaviruses:

Myopathic and neuropathic complications in patients diagnosed with SARS have been reported in the clinical literature previously. (15) This is an important consideration because SARS-CoV-2 is the virus that causes COVID-19. Muscular changes are frequently associated with severe acute respiratory syndrome. After the acute phases of initial care, these can present to chiropractic offices due to muscular weakness, muscular dysfunction and pain related complaints. Patients with varied neuromuscular complaints post-infection have reported short-term subjective improvements in their pain experience and quality of life with conservative chiropractic care. (16)

So, can Integrity chiropractors cure the Coronavirus, of course not, but there is published evidence to support that chiropractic care can positively influence immune modulators. (17) More evidence is need to state that chiropractic can specifically boost the entire immune system. (17) It is the duty of chiropractic physicians to educate and apply proper sanitary precautions to reduce COVID-19 transmission, and give great musculoskeletal spinal care so that we can free up the hospitals and acute care centers for addressing specific cases of respiratory infection and distress that require medical triage and support. Additionally, post-care of those who have been confirmed and recovered is absolutely appropriate. 

REFERENCES:

1.    https://globalhandwashing.org/resources/handwashing-and-coronavirus-fact-sheet/ 

2.    Harry Stephens. Why Outbreaks like the Coronavirus spread exponentially, and how to flatten the curve. March 14, 2020. https://www.washingtonpost.com/graphics/2020/world/corona-simulator/?fbclid=IwAR0esC0GRJdV6JN5beO_eu3DNzFbOOF17B0HuCPuPU6G9RHVGkGUW6raFr8

3.    WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009. 4, Historical perspective on hand hygiene in health care. https://www.ncbi.nlm.nih.gov/books/NBK144018/

4.    https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html 

5.    https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

6.    https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

7.    https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

8.    Teodorczyk-Injeyan JA1, Injeyan HS, Ruegg R. Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther. 2006 Jan;29(1):14-21. https://www.ncbi.nlm.nih.gov/pubmed/16396725 

9.    Teodorczyk-Injeyan JA1, Injeyan HS, McGregor M, Harris GM, Ruegg R. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat. 2008 May 28;16:5. doi: 10.1186/1746-1340-16-5. https://www.ncbi.nlm.nih.gov/pubmed/18507834/

10.  Teodorczyk-Injeyan JA, McGregor M, Ruegg R, Injeyan HS. Interleukin 2-regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat. 2010;18:26. Published 2010 Sep 8. doi:10.1186/1746-1340-18-26 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945351/

11.  Emma Di Carlo , Guido Forni , PierLuigi Lollini , Mario P. Colombo , Andrea Modesti , Piero Musiani. The intriguing role of polymorphonuclear neutrophils in antitumor reactions. Blood. Volume 97, Issue 2 January 15 2001. https://ashpublications.org/blood/article/97/2/339/52823/

12.  Brennan PC1, Triano JJ, McGregor M, Kokjohn K, Hondras MA, Brennan DC. Enhanced neutrophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. J Manipulative Physiol Ther. 1992 Feb;15(2):83-9. https://www.ncbi.nlm.nih.gov/pubmed/1373431

13.  Selano JL, Hightower BC, Pfleger B, Feeley-Collins K, Grostic JD. "The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients." The Chiro Research Journal; 3(1); 1994.

14.  Pero R. "Medical Researcher Excited By CBSRF Project Results." The Chiropractic Journal, August 1989; 32.

15.  Leung TW, Wong KS, Hui AC, et al. Myopathic changes associated with severe acute respiratory syndrome. Arch Neurol. 2005;62:1113–1117. https://www.ncbi.nlm.nih.gov/pubmed/16009768 

16.  Stainsby B, Howitt S, Porr J. Neuromusculoskeletal disorders following SARS: a case series. J Can Chiropr Assoc. 2011;55(1):32–39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044805/

17. Immune Function and Chiropractic. What Does the Evidence Provide? The International Chiropractors Association, March 2020 http://www.chiropractic.org/wp-content/uploads/2020/03/ICA-Report-on-Immune-Function-and-Chiropractic-3-20-20.pdf