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Editorial
As our country struggles to manage the reality of COVID-19, governmental and organizational leaders find themselves in positions that they likely never anticipated when they initially sought their posts. Their decisions in this environment reach far beyond the typical boundaries of their constituencies, members, and direct stakeholders. They now find themselves making decisions about a global pandemic, which poses a material threat to the public at large. With that in mind, it is easy to be sympathetic to the plight of chiropractic professional boards and organizations as they juggle the diverse and passionate views of the chiropractors they oversee. Here in North Carolina, the Chiropractic Board released a position statement requiring Doctors of Chiropractic to follow CDC guidance as well as all applicable state and local requirements. Their position statement is both prudent and reasonable. It officially aligns chiropractic in the state with the same guidance and regulations imposed upon other businesses. To put it simply, it directs chiropractors to wear masks in their offices and to follow recommended best practices to prevent widespread transmission of SARS-CoV-2. On June 23, 2020, the Board sent the position statement along with a brief message from the president of the Board, which included the following quote: “Remember that the Board consists of 8 members, 6 of which are practicing doctors of chiropractic. At a meeting on June 19th, the Board considered input from multiple sources on the issue of masks in the chiropractic office. The Board considered the obvious challenges such as discomfort and image issues related to doctors and staff wearing masks in the chiropractic office.” It is comforting that our State Board landed on the side of science and public health. While a robust discussion of fact and opinion is appropriate before any action taken by the Board, it is, however, disconcerting that they felt compelled to highlight their debate over “discomfort and image” in their message to their licentiates. As a follow-up to the Board’s email, North Carolina’s newest chiropractic professional association sent out an open poll to its email marketing list. The survey contained several questions regarding opinions about the Board’s position, including nonsensical questions about mask-related CO2 toxicity and pleurisy, as well as other philosophy-driven questions that lacked any apparent awareness of the rapidly rising infection counts and death rates in our state and across the county. The debate over masks in chiropractic offices is not isolated at the state level. On July 13, 2020, the International Chiropractic Association (ICA) released a YouTube video, promoting the opinions of Kelly Victory, MD and describing her words as “the truth about COVID-19.” Victory’s video presents her claims as facts. She perpetuates a host of extreme statements about SARS-CoV-2 and COVID-19, including an unsubstantiated assertion that social distancing and masks are not scientifically justified. Since scientific understanding of this virus remains incomplete at this time, statements made with absolute certainty that minimize SARS-CoV-2’s potential for widespread harm are dangerous until we know more. (Victory’s original video has been removed from YouTube as of July 16, 2020, but it is archived here.) COVID-19 has become an extreme public health event largely because of political and philosophical hubris. It is undeniable that SARS-CoV-2 is highly communicable, it disperses through aerosolized droplets, and it can be emitted by symptomatic, pre-symptomatic, and asymptomatic people. In a perfect world, this new virus would behave like a common cold virus. It would proliferate, our immune systems would respond, some of us would become visibly ill, some of us would not, and the world would move on with limited disability and loss of life. That is not what is happening in this case. SARS-CoV-2 is not following the path of a common cold virus, nor is our world a utopia of perfect immune systems. Our world and this virus are complicated, and this global crisis requires an extreme and unified response from us all—healthcare workers and non-healthcare workers alike. In chiropractic, many doctors lean heavily on philosophy for marketing and patient education. While Chiropractic Philosophy is not necessarily incorrect, we must have the humility to admit that there is not a plethora of reproducible, peer-reviewed evidence to support those claims. Many of us have witnessed dramatic changes in the general health of our patients after commencing chiropractic care, but without adequate research, much of this information remains anecdotal. When viewed through the lens of general public health during this pandemic, it is clear that a philosophy-only approach is inadequate to save the most lives. We cannot know which of our patients will achieve a sufficient degree of innate immunity to weather COVID-19 successfully. We cannot know if their families, friends, and coworkers will be suitably equipped if our patients pass the virus along to them. Furthermore, we do not yet know with certainty that SARS-CoV-2 infections will clear without sequelae or long-term disability. Conversely, there is adequate evidence to support the use of masks to mitigate the spread of viral particles between humans. Face masks are easily manageable tools that can help change the course of this epic national event for everyone. (A list of informational resources for patients is available at the bottom of this article.) “Optimal health” is a moving target for many chiropractic professionals and their patients. Often, it is a goal rather than a reliable reality. It is unconscionable to promote a philosophy that suggests a life lost to COVID-19 is merely collateral damage on the path toward “herd immunity,” which is frequently misunderstood and is unlikely to be achieved in the immediate future. We must never lose sight of the lives that have been lost, just as we must never wantonly risk the lives of those that remain. It is a chiropractor’s duty to help and protect all people—whether they utilize chiropractic care or not. In the context of COVID-19, donning a mask is neither an act of capitulation nor an excessive burden. It is imperative that chiropractors continue to provide treatment during this crisis, but we must do so in a manner that integrates unfolding scientific evidence and public health policies. As chiropractors, we should be leading the charge for widespread use of facemasks, distancing, and handwashing in addition to the promotion of healthy diets and lifestyles. At a minimum, we must put the safety and wellbeing of our patients and our communities first, which requires us to put aside our internal polarizations and dogmatic mudslinging until this crisis has passed. Author: Kirstin A. Counts, DC July 20, 2020 For resources concerning cloth masks for the general public, please visit the following links: How to Properly Wear a Face Mask: Infographic How to Wear Cloth Face Coverings COVID-19 advice for the public: When and how to use masks References Links
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