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Doing Good with Good intentions

In case you have been in the international space station doing a sleep study for the last few months, there is a world wide concern that is the COVID-19 virus. I was recently inspired by some colleagues off island to formulate some ideas…

We all know that the most severe cases of C19 require ICU care. But are we all aware that physiotherapists are integral to the ICU teams caring for such (and other) patients? These physios are usually called ‘respiratory’ physiotherapists.

What is respiratory physiotherapy?

Believe it or not, the role of the physio in ICU (and general inpatient hospital wards for that matter) is to work alongside the ICU doctors and nurses to ensure that the integrity of a patients’ airways remain optimised, as well as to maintain skin integrity, and some semblance of functional ability (yes ICU patients have to exercise!). These are professionals who are as proficient in suctioning lungs, setting up the various forms of ventilators, reading and understanding things like chest x-rays, blood gasses, blood counts, and medication lists. They are however not usually entitled to the power of prescription (bar special instances) and not usually involved with admisistering medications or drawing blood etc that is affiliated with doctor/nurse work.

There is one caveat to this great bit of news, there are more physios in the world of ‘muscle and bone’ injuries than inpatient and ICU care. You will faster find a physio who can give essential advice about whiplash injuries than inpatient therapy. Being an avid social media user, I have seen the physiotherapy world go crazy with advice about washing hands and how to manage risks for the virus…. WHY???

It seems to be a case of too many cooks can spoil the pot! The best advice is from published and reputable sources that we all rely on for news of the world. Without ranting on about what these very useful and integral professionals are doing wrong, I would like to highlight that they are trying, with the best intentions, to discern important information. My question is why don’t we leave the respiratory information to be discerned by ‘respiratory’ physiotherapists? Having trained in ICU physio as well as maintaining an active role in inpatient care, I thought I would take up the mantle!

What does COVID-19 do?

There have been several corona-viruses over the last few decades. Most recently we have had SARS, MERS, and H1N1 (swine flu). Without going into their ongoing contributions to human mortality, these corona-viruses are associated with the production of mucus within the actual airways of the lung. The treatment of such infections is to keep the airways clear so that air can get in and provide us with essential oxygen. Of-course it can be more complicated than that, but you get the picture.

COVID-19 (aka SARS 2) causes acute respiratory distress syndrome (ARDS). This simply means that as the virus progresses it causes widespread inflammation OF the actual airways, and not a build up of infected mucus IN the airways. This can lead to the development of secondary infections such as pneumonia, which can seriously contribute to the onset of respiratory failure.

What are the symptoms…

Symptoms of C19 also seem to vary. There is the dry cough (as there is nothing there to cough up), extreme fatigue, reduced sense of taste and smell, and fever to name a few. There seems to be a percentage of C19 positive cases who also suffer bowel disturbance. Anecdotally, it is said that the virus can live for up to 5 weeks in faeces in asymptomatic patients. This adds to the need for you to WASH YOUR HANDS!!!!!

…And what are the numbers?

More info on C19 according to the WHO; rough figures are that those who test positive,

- 80% have mild symptoms

- 14% have difficulty breathing

- 6% become critical

Therefore, lets assume 25% of the 20% (14% plus 6%) from above will go to ICU, and lets assume that 50% of the cases who go to ICU will survive. In other words, as of a few short weeks ago, ICU admission survival could have been as low as 50%!!!

The large numbers of the population who the big wigs keep telling us are more at risk, such as those with congested cardiac failure, cystic fibrosis, COPD, asthma etc all have the potential to build up fluid in their lungs as part of their diseases. So those who are already in fairly acute phases of management of the above, mainly the elderly, will certainly suffer most.

Making sense of it all…

Now let’s talk practically here. Let’s assume that you ignore shut down protocols and go visiting friends. Somehow, you contract the virus. Its likely that if you are a young healthy person, you will survive the virus, but let’s hope you don’t have to go to ICU, because you have a 50% chance of death. Now let’s assume you pass on the virus during the incubation phase. You could pass it on to your young, healthy peers, but you go to visit your old aunt. She has heart failure and is quite elderly. She has a 20% chance of contracting the virus worse than you. She has a 25% chance of going to ICU, and she dies as she only had a 50% chance to live. You have now actively contributed to your aunt death through your own selfishness and ignorance. Well done!

Would you cross the street knowing that you have 20% chance of being hit by a car? And if you were hit by a car, would you be ok with a 50% survival rate? I’m guessing level headed readers would unanimously say ‘NO WAY!’ At least you’ll have the ‘normal’ physio to help with your whiplash pain!

In summary…..

So, to surmise, stay the F@$% home, wash your F@$%ing hands, wear your F@$%ing masks, and isolate yourselves responsibly!

……………more of the physio’s role next time………….

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