The COVID-19 associated challenges faced by citizens worldwide are experienced more
intensely by persons living with spinal cord injury (SCI). The unique medical and
mobility concerns of such individuals and their families can often be overlooked in
emergencies [1], as catastrophically apparent in disasters such as the earthquake
in Haiti 2010 and the hurricane flooding in New Orleans 2005. Global pandemic, while
not a sudden-onset disaster, is an emergency, and requires dedicated efforts to mitigate
such disproportional impact [2]. Advocacy groups for persons with disability, such
as the International Disability Alliance, stress that disability-based abandonment
or deprioritization for access to health, care and support services is unacceptable
and requires a disability-inclusive response to the COVID-19 crisis (http://www.internationaldisabilityalliance.org/covid-19).
In several countries, it is being reported that patients with SCI are experiencing
limited availability of protective material for health care providers, disruptions
in caregiver services and medical supplies [3]. In Washington State, several disability
groups have filed a federal complaint with the Department of Health and Human Services
against the state’s care rationing plans, being fearful about access to essential
treatment and equipment, such as ventilators, being denied to persons with disability.
The World Health Organization has warned that communities must act to avoid discrimination
of persons with disability in such emergency situations, with guidance published to
assist providers and governments in ensuring disability-related issues are incorporated
into all stages of pandemic response [1].
As such, the SCI community, including health professionals and advocacy groups, has
rapidly come together in a cohesive and responsive manner to proactively mitigate
the direct and indirect effects of COVID-19 on our SCI population. Regionally, nationally,
and internationally, leaders in SCI have been working collaboratively to address both
immediate concerns, such as basic guidance on hand washing, to longer term planning
for issues including access to consumable resources (gloves, catheters), caregiver
shortages, and implications for discharge planning for in-hospital patients with SCI.
A rapid pulse survey to generate a global scan of providers on SCI-related issues
and cases has been conducted, which will assist in providing information on the current
and projected needs. In Canada, a community of SCI stakeholders including clinicians,
researchers, and people with lived experience of SCI, rapidly crowdsourced an SCI-specific
hand hygiene guide, and through international networks, have moved towards global
access with multiple translations available. Globally, the move to incorporation of
telehealth/telemedicine for patient care and consultation is an increasingly relevant
and viable option, the positive effects of which we might realize long term post pandemic
in improving patient access to services.
The COVID-19 outbreak has and will have a direct impact on our rehabilitation services,
not only in the acute sector (especially intensive care units) but also as the pandemic
progresses, the effects of COVID-19 on both inpatient and community rehabilitation
will be faced, including pressure from acute care services to transfer patients to
rehabilitation units, and difficulty to provide rehabilitation services in outpatient
and home-based settings (due to national and local set restrictions to prevent spreading
of the virus). Italy has been one of the countries worldwide confronted with the COVID-19
outbreak. The Italian PMR Society (SIFMER) has published recommendations to ensure
appropriate interventions to persons in need of rehabilitation in acute care, inpatient
rehabilitation care and outpatient and home-based rehabilitation services [4]. Koh
and Hoenig recently published a paper on interventions to prevent spreading of the
virus in the rehabilitation community [5].
We have the opportunity and responsibility to learn from the experiences of our Italian
and other colleagues. How COVID-19 will directly affect persons with SCI is not known
yet. Where possible, data on COVID-19 in persons with SCI should be collected in order
to learn from the current situation; a detailed data collection initiative on SCI
patients with COVID-19 has begun in Italy.
ISCoS through its External Relations Committee has initiated a COVID-19 Task Force/Community
of Practice to bring together our Affiliated Societies and Networks, along with other
key partner organizations and representatives to facilitate networking and discussion,
learn from each other and work together, sharing resources, clinical experiences and
strategies, in an effort to improve our health systems preparedness and responses
to this evolving Pandemic and assist our patients, colleagues, and SCI community.
Thank you all for taking care of our vulnerable population of people with SCI and
please take care of yourselves in the process.