Domestic violence during the covid-19 pandemic ey 2020 Ata time when many people are more vulnerable to domestic abuse, healincare professionals, J 7 J should be extra vigiantof the signs, say Mands Dave and Neil Pate! ‘The World Health Orgarization WHO) estimates that one in thvee women experience physicalor vexual violence in thelr lfetine, with the majority of sbusers being partners or former partners The UK mediahasreparted an _nreaoe in eat02 of domestic vislonoe sines the e=vic-19 lockdown begen, with siilerpatterne Being 22en bereze he were In China. a crarty estimates that 905 of al causes of violence during the lockdown were related tothe pandemic. Increases have been reported in several other countries too, with dstacollatedtrom scurces such as ‘the number of calls to helplinesan¢ the queries entered into search engines frompecple looking for help from ‘domestic violence. thas amounted to what the UN chief Antonio Guterres called a “horrifying global surge in domeste violence” ‘The covid-19 pandemichacresulted ina globalrestructuring of public services, whichwillhave éicrupted sources of support for people experiencing domestic violence. Quarantines and lockdowns have meant that people trick of abuse are let alone with abusive partners for prolenged and continucus periods. With fewer Damers, abuse maybe more frequent and of s higher savarity The stress generated fram hasth concerns sudden inancia challenges: and the quarantine itsef, which has been shown to increase psychological distress. ‘can all negativey affect mental heath. wellbeing. and intensify the risk of éomestic violence taking place Other ‘isk factors for comestic abuse include butare not limited to pregnancy, ending of relationship end someone hols dependent on a eare® or disabled People experiencing domestic violence may seek medical tention for thei injuries 216 clinicians shoule be alert to non accidental injuries as a potential c2use an¢ initiate further enquiry, asper local protocols, if they “deem itappropsate. A complication of the covie-19 pandemicis that many people are avcicing healthcare ‘aciites or naving meatal appointments deterreato alater cate. Consurtations are also being undertaken “ighally.This can stop people trom aisclosing meir situation tohealtncare professionals ther abuse’s are in ‘lose vicinity in she nomes It iso means that visible signs of physical abuse will be missed with telephone ‘consultations. ifhealtheare professionals have concems about a patient, guidance from domestic buse charities emphasises the importance of crecking that a patient s alone befere making any enquiries Italsorecommends that patients cannotspeak English, an oficial interpreter sevice should be used and nota friend or family member, {as this can form bariers to the disclosure of abuse and. healthcare professional'suncerstancing ofthe situation. Fer patients who are known to have expevienced domestic abuse, code words can be devised, which patients can use to inform healthcare staff that their abuser is istening orf they do not feel sefe and need hep. Pubic healt authorities need to ensure that ell vuherable eduts are protected by incuding cesignated refuges ‘or"safe accommodation” stesin their covid-19 contingency plans, and ensuring theyremain staffedand open during ths lockdown,Limited awareness of resources nd knowledge abcut domestic violence have b sified ae barriers fer health professionals enquiring about abuse wity patients Furtherinformaton is avalable from the WHO Global lan of Action, United Nations Warnes, and specific advice inthe context of covd-19 is accessible from chasties| bach a2 Women’s A {Ata time when many peopleare more vulnerable to Comestic abuse and fee| trapped by thei circumstances, eaitncare professionals should be hypervgilant of signs of ebuse that canaffect any adult or child. Ts can safeguard some of the most vulnerable peoplein society ané, potentially, help save theirlives ‘Mans Dave is 2n NIHR academic clinical fellow in otal and maxillofacial pathology at the Unhersity of -Mancnester, US Competingiinterests: None declared [Nell Patel’: = senior lecturerin oral sugely atthe Univesity of Manchester UK ‘Competing interests: None decarec