During the COVID-19 Pandemic
By Mark Studin
In a conversation with Jonathan Epstein, an epidemiologist at the EcoHealth Alliance in New York who has traveled the globe in studying zoonotic viruses—those that can jump from animals to people, and was part of the research team in China’s Guandong Province that discovered bats were the natural reservoir for SARS, I now understand that the current COVID-19 strain is related to SARS and MERS, two other recently emergent zoonotic coronaviruses. These viruses live in certain bat species and have co-evolved with bats for the entire span of human civilization. Dr. Epstein explained, “These viruses are made up of RNA and can mutate quickly, making them promiscuous. Often, when a virus jumps from its natural host (e.g. bats) to a new host (e.g. people) it can cause disease. A virus that transmits easily and doesn’t readily kill its host has the best chance to survive in nature.”
A German study published just as a few weeks ago revealed that the coronavirus is an outstanding “shedder” and seeks to leave its host once it replicates. It searches mucosal exists, even our breath well before the host is experiencing symptoms. The New Yorker Magazine reported, “Outside a host, in parasitical purgatory, a virus is inert, not quite alive, but not dead, either. It was found that the virus can linger on copper for four hours, on a piece of cardboard for twenty-four hours, and on plastic or stainless steel for as long as three days. They also found that the virus can survive, for three hours, floating through the air, transmitted by the tiny respiratory droplets as an infected person exhales, sneezes, or coughs out.”
Living in New York, at the epicenter of this crisis and now self-isolated for 17 days, this is eerily reminiscent of 9-11 to many New Yorkers where we know someone infected, and someone knows someone who has lost their life. We live in fear for friends and families who are “hospital-based first responders,” and most everyone wants to be part of the solution. The Long Island Expressway dubbed the “longest parking lot in the world” is perpetually empty, and the largest railway commuter system on the planet hardly has a passenger. We are also fearful of others in our nation due to political “misinformation” because we are in the epicenter living and witnessing the truth through ourselves, family, and friends with confirmation through local media.
Where does that leave our profession?
I have spent the last two weeks becoming an expert on infectious disease prevention in chiropractic offices, telemedicine, home-based treatments, acquiring feedback from patients, risk management, coding, preserving referral sources, managing finances, and labor/employment laws. I have been teaching doctors how to prepare for “opening day” that will come sooner than you think and a host of other things chiropractic would have never considered.
For those who have chosen to stay open, the patient’s car in the parking lot has become the new waiting room, where one person at a time is allowed in the office for treatment. Most staff has been furloughed, leaving only the doctor and essential treating staff with hand and treatment table sanitizing between every patient. A mask for the doctor is strongly advised due to the “breath” transmission of this virus. If you treat a patient that has been diagnosed with Covid-19, you and your staff are then mandated by your state’s department of health to self-isolate for 15 days.
For those who have closed, telemedicine has become a necessity, and the Federal Government has relaxed its HIPAA rules, practicing over state line rule and others. Carriers have added chiropractic telemedicine services, and many have waived co-pays and deductibles because these are billable events. There have been recent E-Codes added by the AMA to create clarity in billing telemedicine codes. You should consider using modifier “95” [telemedicine services], and place of service “02” [telemedicine]. These are predominantly timed services involving patient management and have specific documentation requirements to consider.
If you would like to learn more about coding and other COVID-19 issues, I am providing a link for a 40-minute Webinar I created for the profession to help clarify these issues [there is no cost]:
There is lots of money in the system right now with the Federal Bail-Out, but be careful not to borrow what you don’t need and start with your local bank. They have the Federally backed money that includes some type of forgiveness in the Payroll Protection Program (PPP). I have also been told by many on Wall Street that inflation is not far away. Should you have a variable rate, or high-interest loan on any property, now is the time to refinance with interest rates low. Be financially smart.
Patient communication is paramount now. You do not want to see yourself re-starting your practice from “ground-zero” because you neglected to engage them during this mandatory isolation time. If you regularly have telemedicine visits, that is great; if not, ensure you touch base with them periodically via telephone to “check on them.” The same goes for lawyers and MD’s that you have referral relationships with, communicate with them. We have instituted regular academic programs for lawyers and MD‘s to keep them engaged with our doctors at a very high level. Opening day is coming sooner than you think, and the referral sources will remember you, if you made that extra effort.
What you do with your time is critical. I urge every chiropractor in the nation to get better academically. Take as many online post-doctoral courses as you can. I don’t care if your state allows online courses or not. Market research has proven over the last decade; the more credentials a doctor of chiropractic has, the more they can help their patients, the more referral they get, and the financial bottom line goes up. Cleaning your garage with your extra free time is admirable, but elevating your knowledge will help the multitudes in your community, yourself included.
Should you open if you have the opportunity or not? That is a personal question for you to answer. For me, I want to be part of the solution, and today is day 17 of being self-isolated, where I work long days and sleepless nights in being creative to ensure that I am prepared for opening day.
 Woelfel, R., Corman, V. M., Guggemos, W., Seilmaier, M., Zange, S., Mueller, M. A., ... & Bleicker, T. (2020). Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster. medRxiv.