COVID-19 Resource Page

CHIROPRACTIC IS ESSENTIAL

As the State of MN and individuals move towards integration and “business as usual”, the MCA urges you to follow safe guidelines (including social distancing, cleaning/disinfecting and hygiene) as recommended by the CDC, MN Dept of Health as well as any county or local health departments. Additionally, use your clinical skills as you begin to see more patients, including wellness and maintenance care patients. Always continue to educate yourself and stay up to date on the latest federal, state and your local health department recommendations. Expanded resources, including verbiage to use in patient communication and charting, is available on the COVID-19 Resource Page on our new & improved website. mnchiro.com.

With the Governor’s “stay-at-home” order Doctors of Chiropractic can continue to provide care to their patients. Governor Walz issued Executive Order 20-20 that requires, beginning on Friday, March 27, 2020 at 11:59 pm through the extension of Monday, May 18, 2020, all persons currently living within the State of Minnesota to stay at their place of residence except to engage in the Activities and Critical Sector work. The executive order excepts healthcare and public health workers listed in the CISA Guidance. It is the interpretation of the MCA that chiropractors and chiropractic clinics are included as healthcare providers under the CISA Guidance which lists health care “Caregivers” and “Workers in other medical facilities” that include “Clinics”.

The following articles are great resources as chiropractors move back into full patient care.

The MCA also recommends that you have COVID-19 pre-screening practices and documentation in place.

Examples of website and/or online booking wording:

Example #1

At our office, your health and safety are our top priorities. Chiropractic care is available in-office for patients meeting the COVID-19 safety guidelines. DO NOT COME INTO THE OFFICE IF YOU, A FAMILY MEMBER OR OTHER PERSON YOU ARE IN CLOSE CONTACT WITH HAS BEEN DIAGNOSISED OR IS WAITING ON A TEST RESULT. Telehealth sessions are also available and can be easily booked online.

Example #2

The health and safety of our patients, staff and visitors at our office are very important.

We review changes daily, and incorporate information from the CDC, Minnesota Department of Health, Minnesota Chiropractic Association (MCA) and updates through local media.

We are committed to remaining open with modified hours and available to all the patients who might need us. Some of the key operational changes we have made so far to limit the likelihood of COVID transmission:

Change the structure of how and when we see patients according to their symptoms, we are seeing acute neuromusculoskeletal conditions and conditions which need immediate care.
Allowing additional time to see patients so we have time to properly disinfect.
Discontinued walk-in visits to ensure that we are able to triage all patient symptoms before patients arrive at our facilities.
Enacted visitor restrictions to one parent/guardian per patient.
Implemented telemedicine visits that will allow patients to discuss symptoms, progress, recommendations, plan and determine immediate need for care
Tables and components are disinfected between EVERY patient.
Any additional therapy equipment and supplies are either disinfected or disposed of properly between every patient.
The clinics will be cleaned and sanitized before and at the end of day in preparation for visitors.

If you have an upcoming visit or are wanting to schedule and are experiencing any of the following symptoms, please call the office and reschedule for a later date. It is also our recommendation that you enter a 2-week self-quarantine.

Fever (+100.4)
Cough (Productive or Non-Productive)
Bronchitis or Respiratory Infection
Sore Throat
Shortness of Breath
Digestive Complaints, including Vomiting or Diarrhea
Severe fatigue not associated with travel, myalgia and/or arthralgia.

Examples of chart documentation:

Example #1

Patient denies...

Having personally or being in contact with any family, friend or co-worker with a fever, cold or flu symptoms (including fatigue, cough, aches/pains non-musculoskeletal in nature, vomiting and/or diarrhea) within the last two weeks.
Having traveled or been non-compliant with the Social Distancing and Stay-At Home orders in place.
Having or been near any family member, friend or co-worker who has or had been suspected of having COVID19.

Example #2

Today before his office visit, John Doe denies to office staff the following in regard to COVID-19:

Having or being in contact with any family, friend or co-worker with a fever or anyone who has had one within the last two weeks.
Themselves or any family member, friend or co-worker who currently has or had any cold or flu symptoms ( ie. fever, tiredness and a cough that isn't necessarily productive, aches, pains, runny nose or nasal congestion, and vomiting or diarrhea).
They have not traveled abroad in the last two weeks or been in contact with any family member, friend or co-worker who has.
They have not been near any family member, friend or co-worker who has or had been suspected of having COVID19.

COMMON QUESTIONS:

The following information addresses the most common inquiries received by the MCA office at this time. We are continually monitoring the situation and will provide updates as we receive more information.

Closing of offices: At this time, the MCA recommends that doctors use their best professional judgment, applying relevant guidelines, such as those of the CDC and the White House Coronavirus Task Force, to determine whether to close offices.
Offices remaining open:

The following recommendations are based on current CDC and MN Department of Health guidelines, closures and executive orders. All chiropractors are subject to and must follow all federal and state laws, rules and regulations regarding public health
both at the state and federal level.

It is our recommendation that you, any patient or staff member not come into the office and enter a 2-week self-quarantine if anyone they have been in contact with exhibits any of the following symptoms:

Fever (+100.4)
Cough (Productive or Non-Productive)
Bronchitis or Respiratory Infection
Sore Throat
Shortness of Breath
Digestive Complaints, including Vomiting or Diarrhea
Severe fatigue not associated with travel, myalgia and/or arthralgia

It is our recommendation that you enter a 2-week self-quarantine if you or anyone you know:

Have any symptoms of COVID-19
Are waiting to be tested for COVID-19
Are waiting for test results for COVID-19
Have tested positive for COVID-19
Have traveled on an airplane in the past 2 weeks

Your employees, staff and patients/practice members are an extension of you. Whatever you do, say, email or post on social media is ultimately your responsibility and leaves you & your practice liable. While MCA values patient and community education, including the important role of chiropractic in health and wellbeing, please pause and think before speaking and/or responding in person/on email/via social media as your words and actions may not be perceived by everyone the way you intended. And unfortunately, when the general public is in fear, innocent misperceptions can result in a malpractice accusation or complaint to the MN Board of Chiropractic Examiners. If you would not say something publicly, on National TV, do not say it at all. Remember that you are bound to HIPAA. Reporting to the media or discussing that a patient could be positive, or a carrier of COVID-19 is a HIPAA violation.

It is our recommendation that you and your practice/office:

Alert your patients/practice members of the above guidelines
Designate different days and/or times of day for pediatric patients that is not when any elderly patients would be seen in your office
Remove the toys from treatment rooms/office play areas. Disinfect any toys before and after patient contact
Remove all magazine from reception area

It is our recommendation that you do the following regarding Record-Keeping & Documentation

Chart that you are being proactive in protecting and identifying individuals who may present to your practice with possible exposure, refusal of entry into your office and recommending a 2-week quarantine for the individual
Report suspected individuals as necessary to the MN Department of Health
Chart that patients/practice members were questioned with regard to recent travel and exposure to illness including COVID-19 and that the patient denies recent travel to any current region or country of outbreak nor having been exposed to anyone at risk to their knowledge
Chart that the patient denies any of the following symptoms listed above

Advertising and marketing caveat:

Due to the lack of research and the severity of COVID-19, it is negligent to make any claims for treatment or cure. There are currently no therapies, medications or over the-counter products proven to treat or cure COVID-19. This includes promoting chiropractic care or other healing modalities that are not substantiated by peer-reviewed journal articles (such as PubMed or JMPT), the WHO and the WFC.

MCA strongly recommends that our members exercise extreme care when writing blogs, newsletter, patient emails and anything sent out on social media. Regulators are on high alert for the exploitation of the pandemic and may view as grounds for license suspension any claim that certain treatments can prevent or cure COVID-19 until more is known about the virus. For example, it would be misleading and prohibited to advertise that adjustments or natural remedies can cure or lessen this illness.

Please refer to the Advertising Rules by the Minnesota Board of Chiropractic Examiners (MBCE) for further information and specific details.

The MCA is making available to our members a template letter for our doctors to provide to their patients regarding the COVID-19 virus (coronavirus). The letter explains the steps you are taking in your offices to protect your patients.

Example Communication to Patients

RESOURCES:

Minnesota Specific

CDC/WHO/US Chamber

American Chiropractic Association

Coronavirus (COVID-19)

MASSAGE, ACUPUNCTURE, PHYSIOTHERAPY/REHAB RECOMMENDATIONS:

Based on the current MN Department of Health Guidelines and the Executive Orders 20-04 and 20-08 by Governor Walz (regarding closure of specific facilities), it is the recommendation of MCA that offices consider the safety of staff, patients & their community.

The MCA would like to clarify that if you provide massage therapy, physiotherapy/rehab, or other therapeutic services for acute, musculoskeletal injuries/symptoms, the services must be performed within a practice where the primary focus is the provision of chiropractic services, to prepare the patient for chiropractic services, or to complement the provision of chiropractic services.

CLARIFICATION OF MASSAGE IN CHIROPRACTIC CLINICS:

In response to inquiries the MCA has received about providing massage, the MCA requested clarification from the Minnesota Board of Chiropractic Examiners. It is the Board’s position that massage therapy performed as a complement to chiropractic care would be considered essential.

Accordingly, based on this clarification from the board, providing massage is allowed in a chiropractic clinic if the doctor of chiropractic determines it is a necessary part of the treatment plan. This is a clarification of an earlier MCA recommendation that doctors of chiropractic only see acute, neuromusculoskeletal patients. All care should be provided in a manner that adheres to Minnesota Occupational Safety and Health Standards and the Minnesota Department of Health and CDC Guidelines related to COVID-19, including social distancing and hygiene. In addition, the MCA recommends that chiropractors DO NOT see wellness/maintenance patients in your clinic at this time. This is to support executive orders issued by Governor Walz while keeping those who can benefit greatly from chiropractic care out of Urgent Care and/or the Emergency Room.

CDC WEBINAR FOR CLINICIANS

The CDC presented a one-hour live webinar for clinicians on March 5th. It is now available at no cost on-demand here. The presenters reported on important updates, including recommendations for office protocols for control of the spread of the virus. The experts recommend similar protocols for other infectious diseases, such as influenza. Aside from the obvious standards for the physical facility and staff (sanitizing surfaces, handwashing, etc.), if a patient presents to the office with symptoms, the patient should be separated from others in the waiting area and masked to prevent the spread of droplets. The CDC also discussed how to determine which patients to refer for testing. CDC recommends using professional judgment to assess the presence of the following factors in presenting patients:

Epidemiological factors such as being in close contact with a diagnosed patient or having been in an area of known community transmission
Symptoms including:
- Fever
- Acute respiratory illness – cough, shortness of breath, difficulty breathing
- Myalgia
- Fatigue
Persons over 65 years of age
Persons with underlying conditions and comorbidities

Physicians are to use their best judgment in assessing patients and refer those for testing as appropriate. Due to the general scarcity of testing kits, the CDC currently recommends that physicians should refer “persons under investigation” (PUI) to state and local public health laboratories in their areas. Additionally, the CDC states that “Healthcare providers should immediately notify their local or state health department in the event of a PUI for COVID-19.”