Coronavirus (Covid-19) Restart:

Information last updated : Weds 11th Nov 2020 //
Note that guideline details can change - if on any doubt, please contact me directly.

morning sunlight

I am pleased to announce that my professional body, the CSTA has take legal advice on the new CV19 regulations and has confirmed I am able to provide hands-on treatments. I intend to do my best to continue to provide help and support throughout this period of transition and beyond to whoever needs it; and to apply appropriate measures to ensure your safety (i.e. the safety of everyone visiting the clinic) so far as possible.

Norwich bookings are still through the reception desk. I am managing Hethersett bookings myself. See contact page for phone numbers and working days. Bookings are now for 75 minutes : that's just under an hours treatment time for you, plus 15 or 20 minutes for me to clear the room and prepare for the next person.

The medical evidence from several countries is that in the vast majority of cases, Covid-19 does not transfer if there are no symptoms, many infections appear to be asymptomatic, and we appear to retain T-cell immunity for at least 6 months. So provided you are not in one of the vulnerable groups and provided we take a few small precautions, the treatments don't involve a high degree of risk, so long as the total infection rate in Norfolk is low. You should therefore continue come for treatment if you are in need of assistance - but also respect the general rules designed to reduce transmission. If you are concerned about risk and want to receive treatment for trauma or chronic pain, I can provide online sessions which work very well, and we can do face-to-face treatments later when some of the initial ground as been covered. For more information including online treatments please see here, or contact me.

The simple version : what you really need to know

  1. BASIC PRECAUTIONS
    In order to be able to provide a treatment service during the second CV19 lockdown (starting 4th Nov 2020) I am legally required to "triage" - i.e. do my best to make sure that nobody comes into my practice who should be self-isolating. In particular, if you
    • have had any potential CV19 symptoms (or been in close contact with someone who has for more than 10 minutes) in the past 14 days – particularly a fever or
    • have tested positive in the past 10 days, or live with someone who has tested positive in the past 2 weeks,
    ... See HERE> for more details or call me if you are uncertain about self-isolation periods - this is important.
  2. LEGAL STUFF
    It is impossible to guarantee that Covid-19 will not transfer during a hands-on ("Close Contact") treatment. You will therefore need to have signed a consent-to-treatment form before I can treat you. I also require a GDPR declaration so I know your wishes on data handling. If you can't print these forms to bring with you on first treatment, I can always supply a form when you arrive. If the forms below do not appear immediately on a new browser window/tab, they have probably been sent to your Downloads folder. These only need to be signed once.
    1. The Consent-to-treatment form can be downloaded from HERE - please read it and bring page 5 (signed and dated) in to your first appointment
    2. The GDPR/data processing form can be downloaded from HERE.
  3. MOVING THROUGH THE CLINIC
    The requirements for you when you pass through the public spaces of the clinic are the same as for every other public building – see here for details.
  4. WHAT TO BRING TO EACH TREATMENT
    I have to open the window regularly to air the room, and cannot supply blankets. So as we are going into winter I advise you to BRING A BLANKET to make sure that you stay warm during treatments.
  5. NUMBER OF PEOPLE
    In most circumstances only ONE adult (other than myself) may be in the room at any one time. Babies and children under 11 do not count in the most recent government advice on distancing and groups. If 2 adults are coming with a baby, the adult not involved directly in treatment has to sit 2 metres away from the treatment area, which might require a little juggling of chairs.
  6. PPE IN THE TREATMENT ROOM
    Provided we sit more than 2 metres apart and the room is regularly ventilated, there is no need to wear masks. Once I approach you I will wear a face mask. This will be supplemented by a visor and gloves if I am carrying our intraoral work (e.g. for treating TMJ/TMD) or by a visor when working near the face for extended periods. Due to the fact that masks leak round the edges, they usually direct moist exhaled air up through the top of the mask. Therefore I prefer that you NOT wear a mask when lying on the treatment table.
  7. OTHER CONSIDERATIONS
    • Rowan House Hethersett : Please wait in your car or outside in the car park and I will come to get you.
    • Exchange Street Clinic, Norwich : We have limited space in the waiting room. Please come as near as possible to the appointment time so that the waiting room space is kept clear.
    • If you are in the Vulnerable person (Moderate or High) risk group, or live with anyone who is, please talk to me before any appointments are made.
    • Longer term chronic CV19 symptoms (“Long Covid”) can persist after you cease to be infectious – see below, andcall me for information on how I might be able to help.
    • That's it! Simple :-)

More detailed information

Basic PPE guidelines in clinic public spaces
  • Each clinic is essentially a public space that has to be kept as free from cross-contamination as possible to ensure safety of yourself, myself, clinic employees and all other visitors.
  • Face masks are recommended in indoors public spaces – specifically where there is no free circulation of air or extraction ventilation. However, if you are claustrophobic or have other reasons that face masks cannot be worn, you can go without. If you are not wearing a mask, please advise us in advance.
  • Similarly hand washing is recommended, but not mandatory (e.g. where there are skin sensitivities or allergies).
  • please observe the usual physical distancing rules (2m if possible, 1m minimum)
How Viruses move

Viruses are so small that breathable filters (i.e. passive masks) are something like using chicken wire to stop a fly. Viruses do cling to water droplets, so a mask stops these droplets being projected so far from the body. BUT after a while standing still or sitting or lying down in stationary air, the whole body will have a fug of water droplets around it regardless of whether a mask is being worn. So passive PPE (e.g. a filter mask) provides only marginal protection for typical prolonged close contact work such as coming for a clinic treatment. In this light, if you are in one of the risk groups (or live with someone who is), you have to give a little more thought as to your degree of concern. Unfortunately at this moment in time nothing is completely risk-free. The risk of contracting and experiencing serious symptoms is still quite low in Norfolk – see notes on risk below.

What masks do

Masks do NOT protect the wearer against viruses, nor do they stop all virus transmission. They do reduce the quantity of virus that can be passed to other people provided that (1) contact is brief (up to a few minutes), and (2) you are not both in an enclosed space with no moving air. Masks also reduce the wearers’s ability to clear bacteria, moisture and fungus from the lungs. So they should really only be worn when it is clear that they might protect someone else – i.e. someone you come into contact with for a brief period (less than about 10 minutes) who you are not in regular contact with. Wearing them outside this optimum timeframe places you at greater risk of general respiratory infection, and therefore also places other people at greater risk. Unfortunately the Government guidelines only focus on protection from cross-contamination, and do not make consideration of immunological aspects to the wearer. Getting an optimum balance is not simple, and the Government is attempting to make its message as simple as possible for ease of communication. Please do NOT use essential oils or wood-based alcohols or formaldehyde or other antibacterials directly on the mask as disinfectants when you wear it, because these can cause inflammation of the mucosa and make you more susceptible to infection.

Safety from CV19 (or any other airborne virus)

We have typically dealt with many kinds of virus all the time, including coronaviruses, for thousands of years. So provided our immune system is functioning well, the risk is pretty low. Some viruses are more able to bypass the immune system, and CV19 is one of those. However, in most people, and particularly young children, we still have adequate immunological response so that we might get a few mild symptoms (or none at all) and then they go again. So the best measure we can take to be safe against CV19 is to have a healthy immune system. I talk about this a little more below.

The next best protection is to reduce viral load – the number of viruses that we take in. This is what the physical distancing measures and masks and hand washing attempt to do. In the case of the prolonged contact you get during a hands-on treatment, a circulation of fresh air in the room is probably far more effective than PPE in reducing viral load.

Research – what works to prevent symptomatic Covid infection?

Of all the various things that have been tested, Vitamin D has been shown to be very protective against CV19. If you buy Vitamin D (e.g. as a spray), it is important to stick to the recommended dose.

Your immune system

One upshot of all the above is that viruses are here to stay, and are a normal part of the environment we have evolved in. So being frightened of them is not helpful. In fact, fear (of illness or anything else) is one factor that weakens the immune system. And our skin is also an important immune barrier because of the “friendly” bacteria on its surface. I have decided to use either common bar soap or a standard Ammonium laureth sulfate soap gel at work - rather than alcohol-based or volatile hand sanitisers. It is ironic that fear of illness plus excessive use of antibacterial hand sanitisers plus excessive mask wearing – in combination – is a recipe for increasing risk of contracting a respiratory infection. Simple actions that will strengthen the immune response of your body include :

  • Being happy and in the company of people you love
  • Being in fresh air and sunshine. Exercise.
  • Having a healthy ecology of digestive bacteria (the “microbiome”). This is helped by eating Organic food, raw foods (washed if not organic), moderate to no refined sugars, moderate to no alcohol, moderate volumes of food, fermented foods (such as sauerkraut), dark skinned fruits and other natural antioxidants such as turmeric or cumin, bitter skins (such as the brown skin on almonds – which contain a high level of anthocyanins) and Vitamin C.
  • Omega-3 oils and >Vitamin D
Also helpful is :
  • Adequate hydration (your urine should be clear), but fluid should not generally be taken within one hour either side of a main meal.
  • Keeping your sugar balance stable – some people need meat to achieve this, and protein is best taken in as breakfast
  • And if you are wearing re-usable face masks, wash them daily using hot soapy water and dry them thoroughly before re-use
Risk

Risk is not a straightforward thing to assess. There is no doubt that a substantial % of the population have already been infected and were asymptomatic, some possibly as far back as October 2019. And although there is ongoing scientific debate, T-cell immunity appears to be preserved for at least 6 months after active infection. Norfolk is something of a backwater, so we had less of the kind of international movement of people that has caused extensive outbreaks in large cities, Northern Italy, Belgium, etc. And the testing has a high false positive rate in that people who have had asymptomatic infections can potentially test positive up to 2 months after they are no longer infectious. So given the low prevalance of CV19 in Norfolk, the risk of cross-infection is very low – provided that we are all sensible and self-isolate if we have a symptomatic CV19 infection

CV19 Symptoms

CV19 has a sequence of common onset symptoms as follows :

  1. fever, followed by
  2. dry or hacking cough and/or muscle aches, followed by
  3. nausea or vomiting, followed by
  4. diarrhea, followed by
  5. other miscellaneous symptoms sometimes leading to "long covid" - loss of smell, tiredness/fatigue, difficulty concentrating etc.

This typical progression is not necessarily going to occur exactly in this way for every individual. The further the progression 1..5, the less active your immune system has been in containing the virus. If you experience the first two symptoms (fever, dry cough/muscle pain), it is important to act to improve your immune response. You can help to protect your digestive tract and reduce risk of further progression by simple measures such as :

  1. removing flour-based foods, milk and refined sugar from your diet, and
  2. eating small simple meals (i.e. reducing your food intake for a few days), and
  3. drinking plenty of water (i.e. not sweetened drinks) with fresh lemon juice
  4. separating fluid from food by at least 1 hour : i.e. fluids not taken in during the hour before eating, or during the meal, or during the hour after eating.
  5. Also see the notes on Vitamin D and "Your immune system" above.
REFERENCES
  1. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/910885/COVID-19_Infection_prevention_and_control_guidance_FINAL_PDF_20082020.pdf
  2. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/910594/Final_appendix_2_IPC_19082020.pdf
  3. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/standard-infection-prevention-control-precautions-sicpsall-pathways
  4. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-infection-prevention-and-control-guidance-low-risk-pathway
  5. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/886217/Best_practice_hand_wash.
  6. pdf

PDF guidelines, forms and information sheets for patients

If you click these links and nothing seems to have happened, the file has probably gone direct to your Download folder instead of displaying in your browser. If you cannot view or print PDF files, please call me and I can send you paper copies.

Further information

SARS-COVID

The Coronavirus pandemic has brought about many changes to people's lives, some of which will have long term consequences to how we all live. Some individuals and families have been hit very hard and others not at all, some people have been working and some not, leading us to live in a set of parallel worlds with very different realities. This altered reality is also likely to be with us in one form or another for at least until well into 2021. So it is very likely that the eventual "normal" will not be the normal we currently know. We all have to adapt to circumstances, and cannot really wait until everything is known and familiar again.

It is encouraging that tests reported in Germany (31/July/2020) have shown ... "It is now quite certain that a large proportion of the population has T cell immunity to the SARS-CoV-2 virus. The German researchers found T-cell reactivity against the virus in 83 percent of those who had been confirmed covid-19, but also in 35 percent who had not had coronavirus disease caused by SARS-CoV-2.". The situation in Sweden is also showing that once the virus spreads widely into the general population there IS a large degree of herd immunity and a substantial reduction in cases and in mortality.

Social Distancing (physical distancing) and Safety

The term "social distancing" has been quite destructive, because it has led to widespread isolation and mental health problems. A better way to think of it is "physical distancing". Fortunately we are now being allowed to come together in small social "bubbles" so that close contact with a small number of people is possible again. Of course, if you come for treatment, I am not in your close social bubble. However, it would appear that most people have been infected with no symptoms. Therefore, so long as you do not fall into a specific risk group, the virus is for the vast majority of people not dangerous, and does not cause illness, and your best personal defence is maintaining a healthy immune system.

The available data also suggests that any close proximity in a vehicle or (non-sterile) room for more than 10 minutes results in a very high (>80%) likelihood of transmission of any virus, regardless of whether you might be wearing a paper filtering mask or protective gear, or not. Simply, viruses are so small that they go everywhere. However, it is also clear that much of the viral load transmits in small water droplets from the mouth, so a mask does reduce the total viral load transmitted to other people, even if it does not completely stop the spread of virus. Studies of infection transmission in China put mask wearing at the bottom of the list of effective measures, and non-contact/physical distancing at the top of the list. A good overall summary of transmission research is to be found here (Docjon.org).

Compromises and the Immune system

The advice that has been given by the government and in newspapers on preventing spread of Coronavirus has tended to focus ONLY on the Coronavirus and not on other health aspects. This narrow focus could be one reason why over the months March to June 2020 there were twice as many (about 33,000) "excess deaths" from non-Coronavirus causes as from Coronavirus (about 17,000). This trend has continued, and the whole CV19 issue is turning out to be more of an ethical issue than a scientific one - how do we balance different needs in a society, when every choce that can be made will cause harm to some sector of our society?

We have an active colony of bacteria on our skin that prevents us being infected by many other dangerous bacteria such as e-coli. Therefore, over-aggressive use of antibiotic/alcohol skin washes and over-frequent hand washing compromise the skin's immunity and therefore the whole immune system of the body. We did not evolve to wash our hands, and the hand washing used in hospitals is principally required to clear bacteria that propagate on dead flesh - such as streptococcus. This might all sound very contradictory, but nevertheless some measures are clearly of some (though limited) use.

The general fear that has been whipped up about cross-contamination is also almost more of a problem than the virus itself. Fear also inhibits the part of the immune system that deals with infections, making viruses and bacteria more dangerous. We naturally have an ecosystem of bacteria, viruses and other micro-organisms that live on and inside the body, which we have evolved to live with for a few hundred million years. These are usually not only stable (i.e we don't get ill), but also actively contribute to our health, and form a vital part of the immune system and digestive system. Viruses also transfer DNA and assist evolution - and without this viral transfer we would not (for instance) have developed a human brain. About 1/3 of our DNA originates from viruses. So really, a lot more attention should be placed on how to improve immune systems and less emphasis should be given to a fear of things that we can't see and that are essentially so small they are unstoppable.

Having said all that, there is clear evidence from trials that hand washing and masks used in combination substantially reduce the transmission rate of infections in general - not because they stop transfer altogether, but because they reduce the total load of transferred organisms of all kinds. Which again logically suggests that your immune system is an important factor, masks or no masks, washing or no washing. A stronger but generally less loaded immune system is naturally capable of dealing with a higher (coronavirus) viral load.

If you receive bodywork of any kind (i.e. close prolonged contact - usually table time is between 20 and 50 minutes) means that normal physical distancing principles do not apply. If the Coronavirus is in/on my body, you are fairly likely to have it passed onto (at least) your clothes, and if the Coronavirus is in/on your body then the same applies to me. If you are comfortable with that fact - i.e. the need for physical help is greater than your feeling of being at risk from Coronavirus infection - then you should probably come and have some treatment. In addition, the clinics I work from are not hospitals, and have not been designed to minimise infection transmission. They have carpets, wood and plastic surfaces, and although some cleansing of touched surfaces will help, anyone entering who is infected will still have a viral load on their clothes, their hair, their sweat - that will transfer to other surfaces that cannot be cleaned. In fact the most useful measure than can be taken in a non-sterile building is to keep the windows open. Similarly, being outdoors is far safer than staying indoors.

The standard precautions I will be adopting in the clinic will therefore (subject to mandatory guidelines from my professional body, and any current Government rulings) acknowledge these compromises, but also attempt to steer some path through them that maximises safety for us both, including helping to maintain the health of both our immune systems, and allows for effective use of treatment time.

Designated vulnerable people

I am required to take extra precautions with people who fall into designated vulnerable groups or their carers, who are supposed to be "shielded" until at least 1st August 2020. If you are in this category you will probably have already received an official letter. A simple summary of this is over 70 years old and/or serious underlying health issues affecting the lungs or immune system, and pregnant women. A full list is on the government website. Nevertheless, if you are desperately in need of treatment, the government guidelines allow for you to follow the normal social/physical distancing rules as current at any particular time. Also see the official distancing guidelines.

The mental-emotional effects of Social Distancing and a pandemic

The lockdown itself (along with other current issues in the world) is causing many people to have mental-emotional difficulties, which may be anything from outbursts of temper and frustration (that affect their companions), anxiety, depression, feelings of hopelessness and lethargy, confusion, and particularly feelings of overwhelm and grief. I can also provide some support for these issues, and train you how to reduce overwhelm/anxiety and how to process many of the other difficult emotions more easily.

I will also be running online workshops in the near future. I am also offering some free resources for the duration of the Coronavirus situation.

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