01-32 Backspace Oct20-FINAL-WEB

Newsletter of the European Chiropractors’ Union
Covid-19
The associations during the
first wave of Covid-19
In April the ECU waived the Spring dues for all member associations to help them weather
the Covid storm. In September ECU members showed solidarity with the British Chiropractic
Association agreeing to its request for the BCA’s ECU Autumn dues to also be waived.
Ian Beesley, Secretary General, explores here how associations fared between March and
August, and is grateful for information provided by the presidents of ECU member associations in
Belgium, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain and Switzerland.
DURING MARCH, most
ECU member associations
advised their members to close
clinics, shortly after the World
Health Organisation (WHO)
had declared a global pandemic.
Thereafter, clinics responded to
health authority guidance that
acute patients could be treated,
provided that treatment was
essential and social distancing and
hygiene guidelines were strictly
observed. The green light to open
for non-urgent care came after
varying periods over the months
of May and June. Typically, clinics
remained substantially closed for
two months with chiropractors
eligible in some countries, but by
no means all, for government aid.
Uncertain of the likely duration
of hardship, the ECU Executive
Council first decided to defer the
Spring dues to the Autumn but
subsequently proposed to the
General Council that the Spring
dues should be waived altogether.
This proposition was accepted by
vote and announced on 20 April.
Confusion and
ambiguity
The challenge facing associations
was (and to some extent remains)
complex – even in countries
that had previously identified
a global pandemic as a major
threat to their populations, and
in some cases had conducted
contingency planning exercises
to test emergency procedures,
events moved fast. Inter-country
competition for medical supplies
intensified as it became clear that
the understanding of the disease
was poor, and responsibilities were
divided. ChiroSuisse had to deal at
first with 26 Cantons; in Germany
the initial responsibility lay with
the 16 Länder before being taken
over by the federal authorities. In
Spain the chiropractic association
(AEQ) had to deal with 17
regions. Scotland, Wales and
Northern Ireland asserted their
independence from the United
Kingdom; they could not (and still
cannot) agree on common policies
or on co-ordinated phasing of
measures to combat the pandemic.
In some cases risk aversion became
the unwritten association rule.
The health authorities in every
country were faced with a rapidly
moving situation affecting every
aspect of economic and social life.
A key question for governments
was what could sensibly be
designated essential and at what
cost in risk to the population?
Several rulings seem strange in
hindsight: Italians could not
move more than 80 metres from
their homes, Spaniards could
not exercise outside the house.
Italy suspended autopsies. As
a small health care profession,
chiropractic could not expect to be
covered explicitly in government
pronouncements, even where
it is regulated. Yet individual
chiropractors understandably were
looking to their associations to be
told what they should do and what
would constitute a valid assessment
of acute need. Existing contacts
between associations and public
health authorities demonstrated
their worth. The federal authorities
in Switzerland helped ChiroSuisse
source face masks at the time of
greatest shortage. In Denmark,
after a couple of weeks, the
“The more that the authorities
know about us... the less likely
they are to close us down...”
National Health Care Authority
(Sundhedsstyrelsen) took the
view that it was important for
the health care system to remain
open and all critical functions
maintained. These included
treating conditions such as acute
pain and ongoing programmes
where postponement would lead
to a worsening outcome with
an enhanced risk of disability.
Some clinics never closed. By
14 April Sundhedsstyrelsen had
published a plan for returning
to normal practice, allowing
most treatments whether acute
or for maintenance. Currently,
chiropractors In Denmark need
not wear facemasks, gloves or other
protective equipment, though they
must observe guidelines regarding
social distancing in waiting rooms
and hygiene measures before and
after seeing patients.
In Belgium, as there were no
specific guidelines for chiropractic,
a long-standing contact in the
cabinet of Minister De Block
validated association guidance
to postpone maintenance and
non-urgent care until early
April. The Belgian association
(BCU) emphasised that whilst
each clinician had to decide for
themselves what constituted
need for care, they should not
feel obliged to provide it if their
personal circumstances would be
greatly compromised. As from
4 May, government advice on
an exit strategy from lockdown
pointed to a gradual enlargement
of access to health care consistent
with avoiding saturating the
medical services dealing with
the virus. “This does not mean
business as usual,” stressed the
association, “as clinicians will still
have to continue with the safety
and hygiene measures put in place
in the earlier part of the year.”
In Norway the association
(NKF) persistently posed questions
to the ministries and health
authorities, on a daily basis, until it
was given identified ‘point-persons’
to handle queries. An appearance
of the NKF president on national
television helped stimulate an
official response that, as responsible
health care professionals, clinicians
could determine which patients
were in acute need of care. In
Ireland, a radio interview with
a lady who had been severely
injured when a driver committed
suicide by driving into her head-
BACKspace www.chiropractic-ecu.org October 2020 21
01-32 Backspace Oct20.indd 21 08/10/2020 19:11