Covid-19 pandemic

What BradCliff professionals should know.

Unfortunately, we are in the midst of an unprecedented COVID-19 pandemic and it's at the top of everyone's mind at present.

We know this virus affects the respiratory system, and the work Respiratory Physiotherapists and BradCliff Practitioners are involved in day to day. Some of our practitioners are based in hospitals on the front lines while some are in private practice. More than ever we will need skilled practitioners in the field of breathing, as it appears the role of the physiotherapist will be in post viral respiratory rehabilitation and post viral fatigue; rehabilitation for the frail; and those left with lung disorders. There will also be a huge need for therapy for anxiety, post trauma, and stress on many many levels.

Currently we believe it is important to have a logical, evidence-based approach to managing and informing our clients. Each country will have a different local response, but broad guidelines exist at present.

In New Zealand, we are still in containment mode (as of 19.3.2020 we have 28 cases) but overseas the virus has become community transmitted and has forced some countries to go into a lockdown. Computer based models provide some information over what the next few months could look like, but some basic advice is needed at present to educate our patients and the public and to get a "flattening of the curve".

At present, our focus should be at 3 levels:

  1. Clinic health & safety / personal hygiene

  2. High risk groups – education

  3. Manage anxiety and the stress of self-isolation and Covid-19 fears

1. Clinic health & safety / personal hygiene / increase self-isolation

Covid-19 is droplet-borne so hand washing is key!
 
Droplet versus aerosol based.
The weight of the evidence currently suggests that the coronavirus is droplet borne but may exist as an aerosol transmitted virus only under very limited conditions (mostly in health care settings). It is likely the droplet borne route that is driving the pandemic.
 
But "limited" conditions does not mean “no” conditions. Frontline treatments such as intubation have the greatest chance of creating coronavirus aerosols but there is also a need for awareness if you are in private practice.

Performing procedures such as PEFR, or any of our assessment procedures requiring forced exhalatory techniques are a risk for transmission. We have stopped these tests in our Clinic for the foreseeable future.
 
See the Heath & Safety Handout we have implemented in our private practice.
 
For the front line respiratory therapist, here is a great link to a pod cast from Consultant Respiratory Physiotherapist Rachel Moses UK.
  
Advice for everyone

  • Wash your hands (gloves don’t work well for the general public), especially before eating or any task that means your fingers touch your face.
  • Say hello – do not shake hands.
  • Avoid hand contact with your face.
  • Breathe through your nose whenever practical, it may help protect against the virus.
  • Try to keep a 1-metre distance in public.
  • Cough into tissues or your elbow – dispose of tissues immediately. Wash hands.
  • Follow local advice for self-isolation measures – we would add that an extra layer is care is needed for at risk individuals (see points).
  • There is a possibility of fecal-oral transmission, so hand washing and care is required in some situations (for example take extra care when changing nappies, etc). See link here.

The world health organization has some excellent links and facts. View here.

2.  High risk groups – education  

There are some groups that are at greater risk who you might be working with, and we are in an excellent position to provide health education. If you are at risk then staying aware and educated can be helpful!
 
At risk groups include diabetics, immuno-compromised patients, cardiovascular disease patients (hypertension), respiratory patients and older age patients (>65 years old).
(Wu, Chen, Cai et al; 2020, Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease in 2019 Pneumonia Wuhan, China)
 
Our advice is extra precautions are needed in these groups if they are available (for example, if the country advice is to avoid gatherings greater than 500 people – this group should be avoiding 50 person gatherings or avoiding gatherings completely). Avoiding areas of more interaction should also be a goal in this group if possible. In countries that have gone into lock-down then moving these patients to online based follow-ups via skype or zoom might be a better plan. Having a stationary bike in the home, or IMT for respiratory strengthening is a good option currently so that home exercise is a possibility.
 
An excellent breakdown of advice for those with specific respiratory conditions can be found here.

3.  Manage anxiety and the stress of self-isolation and Covid-19 fears

Advice for everyone:
Concerns are emerging that incorrect media reports, information overload and social media is increasing fear and anxiety in many people. The WHO has acknowledged that this is a major concern and has suggested several steps:

  • Talking to friends and family.
  • Eating healthy and exercising as able.
  • Don’t use alcohol or drugs to deal with your emotions. Instead have a plan and talk to a health worker / counsellor.
  • Reduce the time watching negative news items and upsetting media.
  • Sleep is important for optimising our immunity - don’t read news updates just before you want to nod off.
  • Use a credible source to inform your plans and decision making such as the WHO or your government.

We would of course add that working with breathing to relax your nervous system, reduce muscular tension and calm down your brain is a great idea. Using your nose is the first step – then connecting this to gentle nose diaphragm breathing at rest to make a huge difference to stress levels.

Download Patient Handout

General health guidelines:

  • Exercise – at home, or by yourself. For example you can walk, paddleboard, run, (avoid gyms), do burpees, star-jumps, stairs, push-ups, sit to stand, stationary bike, treadmill etc. Maybe you could set up an online challenge with some friends.
  • Practice relaxation and mindfulness.
  • Nutrition – eat a healthy diet as best as you can.
  • Supplementation of Vitamin D, C and Zinc are all helpful for upper respiratory tract health and reducing infections. It is unknown whether it helps combat Covid -19, but might be worth trying.

Notice re the up coming BradCliff courses

Thank-you to those who have subscribed to our courses this year.

At this stage, we are working fast to put the course content online so that the courses can still go ahead.

We will be aiming to run Level 1 this year as an online course, and details will be sent out once we have them sorted. We are currently reviewing Level 2, and will update everyone as we make decisions.

We will keep everyone in the loop regularly! Bradcliff Practioners, use your handouts i.e. Nasal Hygiene, Dry Cough, Calm Down Bliss Out.