Decision to close practice until September

As an acupuncturist I am required by the British Acupuncture Council (BAcC) to conduct COVID risk assessments as part of running a COVID secure business. One of the key components of operating close contact service is the necessity to screen patients for active infection before attendance. The opinion of the BAcC is that is best done using symptom based questions, and these should be specified by following the governments guidelines for COVID -19, namely asking about new continuous cough, high fever and recent loss of taste or smell (1).

Of course someone with any of these symptoms is required to obtain PCR testing. If a patient has active infection, or if they have been contacted by test and trace and told to self isolate, they would be not permitted to attend the clinic. Clearly a lot depends upon the symptoms being an accurate measure of infection status.

The third wave in England has seen the Delta become the dominant COVID variant (2). We know from the Zoe COVID study that COVID-19 infection is now associated with a range of symptoms more in keeping with the common cold (3). If true it means the current screening measures are much less likely to capture active cases. In addition people are discouraged from getting a PCR test in the absence of the classic triad of symptoms meaning more reliance on less sensitive lateral flow tests or not getting tested at all.

It seems widespread vaccination has meant a reduction in severe infection, so the risk is lower for vaccinated patients. However there is still significant mild infection amongst vaccinated individuals and the likelihood of vaccination reducing transmission of the Delta variant is looking less optimistic (4).

The purpose of COVID secure practice is to reduce risk to patients and practitioners. If community surveillance and clinic based screening is compromised by poor guidance and also if vaccinated people are likely to transmit current strains of COVID-19, it presents a dual challenge to maintaining a safe clinic environment. This is especially so whilst infection rates are high. Vaccinated people seem well protected from severe disease, however guarantees are not possible and the probability of developing long COVID is unclear post vaccination. The simultaneous relaxation of rules means the challenge is particularly acute at this time. Withdrawing treatment to patients is always a difficult decision. In my opinion the lack of certainty and the current prevalence of COVID-19 make closing the clinic until September the best option at the moment.