COVID. A word that has become as taboo to utter in public as the name of He Who Shall Not Be Named is in the wizarding world. SARS-CoV-2 is a virus believed to be a mutation of SARS-CoV and MERS CoV1, two viruses that caused their own societal havoc when initially encountered. COVID-19 is the disease resulting from the body’s response to infection from SARS-CoV-2, and the rapidity and extent of its spread led the World Health Organization to declare the outbreak a pandemic on March 11, 20201. The ‘normal’ we once enjoyed has been obliterated, and the world has been reeling in shock since.
Sara Parsons
As chiropractors and chiropractic students, we know that health is dependent on the interaction of the human body with its environment and the innate ability of the body to protect and heal itself. Many in our profession (and a growing number of people outside of it) trust their bodies to defend against SARS-CoV-2 and have been able to maintain a level of relative calmness compared to those who have less understanding about the strength of their body. This is not highlighted to take away from the intensely serious nature of a virus that has taken far too many lives, but with the intention to urge the chiropractic profession and those who live the chiropractic lifestyle of the importance of educating our community about the importance of taking care of their body so that it retains the ability to protect against infection and repair itself when insulted. SARS-CoV-19 has proven to be much more deadly than SARS-CoV and MERS2 and verifies that serving our community by increasing their knowledge of how to properly care for their body is of the utmost importance. So many of those that have succumbed to COVID had underlying health problems due to lifestyle, and we have a duty to our communities to teach them that they have the power and responsibility of making healthy choices to strengthen their bodies.
Chiropractors are also in a unique, essential role as primary care providers to act as a screening system for early detection of SARS-CoV-2 in our patients. We have been told since the beginning of this pandemic that the main signs and symptoms one would expect to experience if they have COVID are a very high fever, dry cough, and myalgia. Yet before these symptoms appear, there are earlier neurologic conditions involved3 that Chiropractors have the unique opportunity to identify. With a central focus and in-depth education on the nervous system, Chiropractors are trained extensively in identifying any abnormalities in neural functioning within the body. Not only that, chiropractors tend to see their patients more often than other health care professionals, and are thus more familiar with each individual’s ‘normal’ function. Due to these two factors, Chiropractors have the ability to act as peripheral screeners and reduce the amount of people crowding hospitals for testing purposes.
The most common neurological symptom of early infection of SARS-CoV-2 is headaches3. People frequently seek out chiropractic offices for relief of headaches. Chiropractors, regardless of personal beliefs, have the responsibility to recognize headaches as a potential early sign of infection and dive deeper into the history of the headache to determine if the individual should seek further medical testing. Other common symptoms of infection that affect the Central Nervous System (CNS) are dizziness, confusion, mild cognitive impairments, seizures and strokes. There are also peripheral nervous system (PNS) symptoms that include loss of smell, loss of taste, blurred vision, muscle and nerve pain, and loss of speech4. We know that the elderly population is at a higher risk, and common symptoms amongst that population are impaired consciousness, delirium, and confusion3.
There are two distinct phases of SARS-CoV-2 infection; the incubation phase and the symptomatic phase. The incubation phase lasts 3-5 days, during which the virus enters and infects the lower respiratory tract and the periphery of the lungs. The afore mentioned neurologic signs and symptoms that affect the CNS, PNS, and skeletal muscle begin to appear during this phase. In the symptomatic, or severe, stage the infection has spread enough to cause lung damage, cough, fever, and shortness of breath4. The symptoms of the symptomatic stage are the symptoms the nation is being told to look out for, but by the time they are present the body has already started to respond with defense mechanisms that not only attack the virus, but harm the body as well.
Once the virus is inside of the cell, it leads to two mechanisms of damage; hypoxia and/or immune-mediated damage. Immune-mediated damage is brought on by a reaction of the body called cytokine storms. During a cytokine storm immune cells flood the body and if the response is prolonged it may lead to vascular leakage and activation of the coagulation cascade resulting in intravascular coagulation and end organ damage1. This provides an explanation of how neurologic and other symptoms appear. During the body’s response to the initial infection, opportunistic bacteria have an increased chance of gaining access to the body because of the stressed immune system. A secondary infection may lead to pneumonia and bacteremia. Excessive inflammation and infection can lead to peripheral vasodilation, the accumulation of toxins, neuronal swelling, and brain edema1.
There are several hypotheses circulating in the effort to explain the mechanism through which SARS-CoV-19 enters the body. It is known that the spike protein on SARS-CoV-2 docks to ACE2 receptors present on different cells. Glial cells of spinal neurons have ACE2 receptors that the virus is able to bind to and enter the cell. The virus may then travel to the cell’s nucleus via retrograde transport, where it could highjack the cell’s coding mechanism, enabling it to replicate its RNA and multiply. SARS-CoV-2 may also enter through olfactory neurons or the cribriform plate cells via the same mechanism, and can spread to the brain in 7 days. Another possible pathway the virus may take to the brain is by binding to the ACE2 receptors on endothelial cells that make up the blood-brain barrier. Inhabiting these cells would grant direct access to brain tissue. And lastly, the virus may be taken up by peripheral nerve terminals via random sampling of the environment inherent to presynaptic neurons. The neuron inadvertently consumes the circulating virus, giving it access to the cell via the synaptic cleft1.
Due to the immune-related nature of COVID-19, it is emphasized that treatment should include and target specifically anti-inflammatory pathways2 with the goal of keeping the immune response under control. Enter chiropractic care. While chiropractic care will not provide a cure, it has been shown to help modulate the immune response5,6. Two biomarkers used in the medical community to assess the activity of the immune system are IL-2 and CD4 counts. In studies conducted by Teodorczyk-Injeyan et. al. and Selano et. al., increased IL-2 and CD4 counts were seen to normalize after chiropractic adjustments, respectfully5,6.
The immune-related nature of the body’s response to the virus, the results of the studies conducted on the effects of chiropractic adjustments on the immune system, and the low-risk nature of chiropractic adjustments are justification for the use of chiropractic care as a wellness intervention, especially in a time where there is so little known about the virus and a lack of treatments shown to stop the spread of infection. The chiropractic profession should acknowledge its ability and responsibility to screen for the spread of the SARS-CoV-19, should be confident in the modulating effects of a chiropractic adjustment on the immune system, and be active in educating the public about the strength and defenses inherent to the human body. We have not been presented an opportunity, but have revealed a duty inherent within our philosophy, to serve and educate our community members of the innate strength of their bodies. This is how we have an impact on humanity.
Resources
- Ahmad I, Rathore FA. Neurological manifestations and complications of COVID-19: A literature review. Journal of Clinical Neuroscience [Internet]. 2020 May 4 [cited 2020 July 27]; 77 (8-12). Available from: https://www.jocn-journal.com/article/S0967-5868(20)31078-X/pdf
- Kwong KC, et. al. COVID-19, SARS and MERS: A neurological perspective. Journal of Clinical Neuroscience [Internet]. 2020 Apr 30 [cited 2020 Jul 27]; 77(13-16). Available from: https://www.jocn-journal.com/article/S0967-5868(20)31185-1/pdf
- Niazkar HR, Zibaee B, Nasimi A, et al. The neurological manifestations of COVID-19: a review article. Neurological Sciences [Internet]. 2020 Jul [cited 2020 Jul 27];41(7):1667-1671. Available from https://www-ncbi-nlm-nih-gov.lifewest.idm.oclc.org/pmc/articles/PMC7262683/
- Zhou Y, Li W, Wang D, et al. Clinical time course of COVID-19, its neurological manifestation and some thoughts on its management. Stroke and Vascular Neurology [Internet]. 2020 Jun [cited 2020 Jul 27]; 5(2):177-179. Available from: https://www-ncbi-nlm-nih-gov.lifewest.idm.oclc.org/pmc/articles/PMC7211099/
- Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, et al. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropractic & Osteopathy [Internet]. 2008 May 28 [cited 2020 Jul 27]; 16:5(9 pages). Available from: https://chiromt.biomedcentral.com/articles/10.1186/1746-1340-16-5
- Selano JL, Hightower BC, Pfleger B, et al. The Effects of Specific Upper Cervical Adjustments on the CD4 Counts of HIV Positive Patients. Chiropractic Research Journal [Internet]. 1994 [cited 2020 Jul 27]; 3(1):32-39. Available from: https://www.upcspine.com/dloads/rs80.pdf