The Delaware Chiropractic Society recommends that masks be utilized by all practices continuing to see patients during the COVID 19 emergency order shutdown of non-essential businesses. This is in accordance with the recommendations set forth by the State of Delaware, CDC, and White House. Furthermore, the Delaware Department of Health and Social Services has issued guidance that anyone who has been within 6 feet of a person known to have COVID 19 for more than a few minutes without appropriate Personal Protective Equipment should be quarantined for 14 days. DCS encourages all chiropractors to adhere to these recommendations. We will work to keep you abreast as the situation changes.

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WHO: When to wear a mask – Video

COVID 19 Position Statement

March 20, 2020

Doctors,

We are writing to give guidance on navigating through this difficult time. We are aware that many chiropractic physicians operate as solo practitioners or small businesses who may feel more isolated than large group practitioners. The Delaware Chiropractic Society continues to serve our chiropractic community and will assist in any way we can. We are working diligently to provide the most current guidance to our community.

The following information addresses the most common inquiries received by the DCS at this time. We are constantly monitoring and updating this information as it becomes available. Of course, given the fluidity of this situation, these recommendations are for the current time and are subject to change; please review CDC recommendations and your emails as this information could change at any time. As of this writing, the CDC guideline for group gatherings is 50 people or fewer; the White House Coronavirus Task Force guideline is 10 persons or fewer. The DCS is using the 10-person benchmark because we believe it is more prudent for health care offices.

Offices remaining open

For offices that remain open, the DCS recommends:

Apply all CDC guidelines regarding the screening of patients who call with concerns that they may be infected with Coronavirus and refer the patient to their county health department;
Reschedule staff and patients to adhere to social distancing recommendation between staff and patients
Conduct pre-screening of staff prior to any patient contact using CDC guidelines for signs and symptoms of COVID 19
Suspend restrictions on cancellations and do not apply penalties for cancellations and no-shows;
Begin to plan for the possibility of remote employment; i.e., consider whether some of your staff, such as billers, could work from home and other activities that could be continued via telehealth.

Advertising and marketing

The DCS strongly recommends that our members exercise extreme care in advertising at this time and refrain from making claims that are not substantiated by peer-reviewed, empirical evidence about COVID-19. Due to a lack of research at this time, it is almost impossible to make any claims for treatment or cure. For example, it would be misleading to advertise that adjustments or homeopathic remedies can cure or lessen the illness. The same would apply to the sharing or promotion of some of the home remedies currently circulating, such as gargling with bleach or saltwater.

Weighing the Risks

The question all healthcare professionals have to ask themselves during this time is if the service being provided outweighs the risk of infection, and have we taken proper precautions to mitigate risk to our patients, our staff, and ourselves. The coming weeks and possibly months are not business-as-usual. The welfare of our patients and our community must be on the forefront of our minds in all decisions. DCS suggests all providers consider the relative risk of exposure vs the benefit of care.

Signs and symptoms of COVID 19

Fever
Cough
Shortness of Breath
Highly suspicious if the person has previously had the Flu

High Risk Patients according to the CDC

All persons over the age of 65
Diabetes
Heart Disease
Lung Disease
Immune compromised Individuals

*** Pregnancy and infants: little is known about this population. Please consult the CDC’s website to learn more if this affects your practice.

Essential Services

We feel that chiropractic care is extremely important to the health care of patients. In the current COVID-19 environment, chiropractic care is essential for acute and chronic care of neuromuscular conditions. The influx of these patients in the absence of chiropractic care would stress an already-overly burdened system. We encourage you to reach out to your local medical providers to see if you can aid with their patient load during this time.

Closing of Offices

The state of Delaware has not made any statements implying that chiropractic offices should close. DCS recommends that doctors use their best professional judgment, applying relevant guidelines, such as those of the CDC, DHSS, WHO and the White House Coronavirus Task Force, to determine best practices for their office.

Physician License Expiration and Renewal Deadline Changes

DPR released a letter to all boards in the state granting a 60-day extension for the completion of CE hours. Licensees are still required to renew their licenses by the license renewal deadline but, if needed, they will have 60 additional days after lifting the state of emergency to complete their hours. Section 2.3 of the Rules and Regulations allows licensees to apply for hardship extensions or waivers as well. A key point in the hardship provision is that the licensee must apply for hardship before the renewal date.

2.3 Hardship. For good cause, the Board may grant extensions of the CE deadline or may grant waivers of the CE requirements. Good cause includes, but is not limited to disability, serious illness, extended absence from the country, exceptional family responsibilities, or unique personal hardship that is not the result of professional negligence or inadvertence. Requests for hardship extensions or waivers must be submitted to the Board in writing before the end of the licensing period for which the request is sought.

CDC Information for Employers

The CDC recommends the following strategies for employers to use now. The DCS has summarized the strategies here but strongly urges clinic owners to click on the link at the end of this article to review the details provided for businesses by the CDC:

Actively encourage sick employees to stay home;
Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees;
Perform routine environmental cleaning:
Advise employees before traveling to take certain steps as outlined in the employer link below
Additional Measures in Response to Currently Occurring Sporadic Importations of the COVID-19:
Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

As the DCS will continue to monitor CDC and other resources, we again encourage members to regularly check CDC in the links below, as they are revised to update the public, healthcare providers, and employers on this rapidly developing issue.

Respectfully,

Jesse Riggin, DC, CCSP®

President

Delaware Chiropractic Society

DCS Guidance For Practice During Emergency Shutdown

March 22, 2020

Current situation in DE: Effective 8am Tuesday March 24, 2020, all non-essential businesses are being closed by order of the Governor’s Office. It is our understanding that Chiropractic offices will be permitted to provide services in a limited capacity based on this ruling.

The chiropractic profession has the ability to help ease the burden of our medical system during this critical time. Our profession is able to lessen the burden on Urgent Care Centers, Primary Care Offices, and Emergency Rooms so they are best able to best focus on treating Covid-19 patients during this crisis. As our medical professionals prepare to serve and care for infectious cases, Chiropractors are here to treat acute neuro-musculoskeletal issues that otherwise would put more pressure on our medical system.

It is the opinion of the DCS that the primary role of chiropractors during this order is to provide emergent or acute neuro-musculoskeltal care which if left untreated would likely lead to significant disability. The Centers for Disease Control (CDC) has recommended that all non-urgent care in outpatient facilities be rescheduled. Based on these guidelines, DCS recommends that chiropractic facilities limit their care to acute or emergent cases only. DCS strongly recommends that our doctors postpone or cancel any appointments for in-office maintenance care or care for patients who are close to or have reached maximum medical improvement (MMI). DCS also urges doctors to postpone or cancel non-medically necessary or ancillary in-office services (such as massage and other services). All reasonable precautions should be taken to mitigate the risk of exposure to the patient, doctor and staff during chiropractic procedures.

The relative risk of exposure must be taken into consideration in triaging patients to be seen in chiropractic facilities. All patients and staff should be pre-screened for signs and symptoms of COVID-19 listed according to the US Center for Disease Control. At no time should a patient or staff member be permitted to knowingly enter a chiropractic facility with these signs and symptoms during this emergency order. All such persons should be instructed to consult with a medical provider for further direction. Individuals should be screened for preexisting comorbidities and the relative risk of exposure should be considered higher for these individuals. Signs of COVID-19 and comorbidities associated with higher morbidity and mortality rates according to the CDC are listed below.

Signs and symptoms of COVID 19

Fever
Cough
Shortness of Breath

High Risk Patients according to the CDC

All persons over the age of 65
Diabetes
Heart Disease
Lung Disease
Immune Compromised

*** S/S Highly suspicious if the person has previously had the Flu.

*** Pregnancy and infants: Little is known about this population. Please consult the CDC’s website to learn more.

Screening and Documentation

DCS recommends screening for the signs and symptoms listed above be performed for all staff present during patient care prior to all shifts. Patients should be screened prior to presenting to the office and confirmed by the doctor prior to rendering care.

SBA Programs You should know about

March 31, 2020

Economic Injury Disaster Loan (EIDL) 3.0: Funded

Directly from SBA
Apply at https://covid19relief.sba.gov/#/
Application takes about 20 min
Need basic financials and bank information
Very easy!
there are daily SBA zoom calls to help walk people through the EIDL loan application at 10:30am and 8pm via Zoom with code: 6794772946.
Up to 2 Mil
75 APR
30 year Pay Back
No Fees
10,000 Forgiveness but must be under current program
- If you have applied in earlier version you should re-apply
Min Credit Score of 560
1 year deferral
Everyone should apply
Scams are out there!
- SBA Will never call you
- You will get an application number so anyone you talk to should know it

Express Bridge Loan

Apply through your bank
Should be available early April
$25,000
APR 6% or 7%
May be Faster than EIDL

Cares Act (Includes Payroll Protection Plan)

Apply through your bank
Should be available early April
2.5 Months of pay
Is intended to help you retain or rehire employees
Will cover Payroll, Rent/Mortgage, and Utilities
Will be asked in June to Show Documentation for forgiveness
Through the Banks who will be ready later this week

Bottom Line: Most businesses will qualify for the $10,000 grant awarded by properly applying to the EIDL 3.0. You will be able to apply for the Payroll Protection Plan in early April which well help pay for overhead expenses for 2.5 months.

For information on all programs pertaining to COVID 19 go to:

https://www.sba.gov/page/coronavirus-covid-19-small-business-guidance-loan-resources#section-header-2

DCS Position on the Use of Masks

April 8, 2020

COVID-19

Information Regarding the COVID-19 Pandemic

DCS Guidance For Practice During Emergency Shutdown

DCS of Delaware

DCS Chiropractors