Our sincere thanks to Dr Sachin Shetty MBBS, MD(PMR), FAFRM(RACP), FFPM(ANZCA), Director of the Spinal Injuries Unit at the Prince of Wales Hospital, for presenting a Facebook Live Chat discussing concerns regarding SCI and covid-19. Dr Shetty spoke for 40 mins and answered viewers questions on health maintenance, risk minimisation, and preventative measures relevant for people with SCI.
We realise the connection was less than perfect. Due to social distancing restrictions, Dr Shetty was presenting from his home with remote help from our team. We know the pauses and interruptions came during important talking points so we have published the questions raised and Dr Shetty’s responses below.
Questions and answers
What are the increased risks associated with covid-19 for those of us living with a spinal cord injury? And are they immunocompromised?
Answer: People with SCI are not necessarily at greater risk for infection, the impact on their bodies if infected might be greater depending on your level of injury. What makes it more difficult is following through with the preventative strategies. People who have an injury above mid-thoracic level will present differently. In patients with these types of injuries their autonomic nervous systems and respiratory muscles are affected. This affects how the system will recover from viral infections. It also compromises temperature and blood pressure regulation.
Are SCI patients more likely to get very sick (or die) than others with compromised immune systems?
Answer: Not necessarily. It depends of level of injury and other risk factors that can affect the mortality rate, but there is not enough data available to completely answer this question.
Are there guidelines for ventilated patients in the community?
Answer: Dr Shetty along with the ACI team are working to develop specific guidelines around ventilated patients. Once completed this will be circulated around the ACI and other medical teams. It will be available very soon. It is recommended to have viral filters in the outlets which need to be changed every day or immediately if wet. There should be a high level of vigilance of monitoring staff and if in doubt, have them use a mask and have the client use a mask. If symptoms develop contact a spinal or respiratory specialist immediately.
If I have a child who lives part-time elsewhere, do I need to stop seeing my child? And if I can still see my child, what precautions should I take?
Answer: If you have been seeing your child thus far, keep seeing your child. Keep precautions in place. Maintain distance and good hand hygiene. Try to avoid letting your child sleepover unless you can isolate your child.
If I get covid-19, will I need to be hospitalised?
Answer: Not necessarily. It depends on what else is happening. The majority of infections are slight. However, if you are symptomatic get in touch with your spinal and respiratory physicians so they can plan the next step.
If I go to the hospital, do I take my BiPAP?
Answer: No, do not take it. If you are symptomatic do not use it as it could cause the infection to spread throughout the air. There is no safe way to use it without the potential of aerosolising the virus to a very high degree. Covid-19 affects the lower airways so BiPap will not be very helpful. BiPAPs offer a long-term treatment to obstructive sleep apnoea. If you don’t use a BiPAP for a short period of time, there should be no issues. If you must have it, there are scenarios where it can be set up safely but you will need to discuss this in detail to ensure the health of your carer, i.e. being able to turn it on after they leave the room and turning it off at least thirty minutes before they return to the room.
What about our carers? What if they get compromised and backup teams cannot be found?
Answer: If you can work around the reduced care safely without any imminent risk to your health, stay home. If you feel as though your health will be compromised straightaway with the reduced care, consult your doctor with planning to present to hospital.
Please also read this document that outlines and gives specific advice for people with SCI <a href=”https://www.spinalcure.org.au/wp-content/uploads/covid-19-planning.pdf” target=”_blank” rel=”noopener noreferrer”>for the planning of disruption to supports and services, which can be found here</a>.
Medication planning – how do we organise prescriptions?
Answer: Plan ahead to make sure you always have enough medication. Call the pharmacy and organise medication to be mailed to you in advance of completing your current amount. Also call your GP and ask that prescriptions be sent directly to the pharmacy. Wherever possible, try to avoid visits.
Will people with SCI be able to access ventilators?
Answer: Yes. If patients require it, they will be offered ventilators. The only scenario where a patient would not be provided with a ventilator is if that patient has given an advance care directive expressing that they do not want escalation to ventilation.
From Samoa: How do we care for people in the community as we don’t have any spinal centres?
Answer: Please reference these documents regarding <a href=”https://www.spinalcure.org.au/wp-content/uploads/covid-19-planning.pdf” target=”_blank” rel=”noopener noreferrer”>planning</a> and <a href=”https://www.spinalcure.org.au/wp-content/uploads/Handwashing-Poster-for-Wheelchair-Users.pdf” target=”_blank” rel=”noopener noreferrer”>prevention</a>.
Should we allow cleaning services to come into the house?
Answer: If you think you can manage without then please do. If you do continue to use them, please put in place an extra layer of precaution, i.e. fresh masks and gloves and clean clothes when they enter the house.
Who is entitled to be working from home?
Answer: Certain groups who provide essential services need to work out of home. Some of those individuals are high risk and should have provisions to work from home. Unfortunately SCI patients do not feature in that group. Dr Shetty will raise it as an issue but recommends that people who wish to pursue working from home to get in touch with their physicians and ask for letters of support.
There is a lot of concern around hand sanitiser and PPE being available and accessible.
Answer: Dr Shetty with the ACI has raised these concerns with the Ministry of Health and has been assured that there are provisions in place to allow easy access to individuals who need these.
How does a bad flu in general affect people with SCI differently? Would there be an increased risk of pneumonia?
Answer: With regards to the increased risk of pneumonia, yes, that is possible if you have a higher level of injury and your cough response isn’t the best. Therefore the risk of respiratory illnesses is higher.
Additional Questions
What should be done regarding hospital visits for annual maintenance procedures such as bladder botox?
Answer: When the Botox is administered to maintain ISC routines else it has resulted in increased infection, we will continue supporting it.
Our organisation provides services across 4 states. They are all c1/2 and fully ventilated at home (40 people). There is no access to PPE for the workers, please respond
Answer: We are working to prioritise direct access of PPE to high risk patients and their carers with the Ministry. I have been told there are new logistics procurement chains put in place to make this available very soon (from early April). <a href=”https://www.spinalcure.org.au/wp-content/uploads/20-04-03-Hunt-Ruston-Robert-Joint-Media-Release-Immediate-respons….pdf” target=”_blank” rel=”noopener noreferrer”>Please also see this media release from the Federal Government</a>.
Is the Philips Cough Assist a worthwhile investment?
Answer: Not for the covid-19 scenario, long-term maybe depending on your resp health, discuss this specifically with your doctor.
With C6 incomplete quadriplegia I've yet to experience a bad flu/respiratory illness. How differently does it affect someone with SCI, given reduced coughing and shallow breathing?
That is very fortunate not having been affected badly with flu. Covid reports suggest shortness of breath, cough and fatigue with fevers can be prominent symptoms. There is no reason why a quad would not experience this, however it can be manifested in a variety of flavours — temperature dysregulation with even hypothermia, shallow coughs/poor cough means the secretion clearance from lungs is affected, this will reduce efficiency of gas exchange and increase risk of secondary bacterial infections occurring. All of these factors could quite rapidly worsen the shortness of breath which increases the need to move towards mechanical ventilation to support organ functioning.
Depending on the level of co-morbidities present the recovery rate post infection can be affected. e.g if there has been a tendency of frequent urinary infections with some compromised renal function the likelihood of renal compromise happening as infection progresses will be higher.