May 31, 2020

Physiotherapists, the other brake on the coronavirus



Coronavirus patients with more severe cases should be admitted to the intensive care unit for respiratory problems. In countries like Argentina, the last stop to the disease of these patients is the physical therapists.

“The first thing that (thinks) with kinesiology – equivalent to physiotherapy in Europe – is orthopedic or neurological rehabilitation, it is rare that people in general can associate a kinesiologist with critical care”, acknowledges in an interview with Efe the Intensive care physiotherapist Nicolás G. Roux.

Roux, who is the head of the Rehabilitation and Respiratory Care Section at the Italian Hospital in Buenos Aires, explains that physiotherapists specialized in critical care in Argentina have the responsibility of deciding what therapy the patient should follow, whether or not it will be necessary to put a device of artificial respiration, and if it is put on, when and how to remove it.

THE IMPORTANCE OF NOT REPEATING MISTAKES

The coronavirus arrived in Argentina later than elsewhere, giving the country a valuable resource: time to prepare.

“We are permanently in contact with infectious diseases and kinesiologists from Spain, Italy and the United States (…) you have to have your antennas to the maximum seeing what is happening in the Northern Hemisphere,” stresses the president of the Argentine Society of Cardio Respiratory Kinesiologists ( SAKICARE), Magdalena Veronesi.

Not repeating “mistakes” and the safety of her colleagues are the main concerns of the leader of the association, who mentions the high rate of contagion that has occurred in health personnel in some countries in Europe.

“Here think of you first and then attend,” they tell him from the Old Continent.

EVERY CAUTION IS LITTLE

Despite the fact that, as Veronesi says, health personnel are not wasting time, the number of possible inconveniences they face does not stop increasing.

Under normal circumstances, each of these critical care physiotherapists would take care of seven beds; In the case of COVID-19 patients, they will only take care of one patient to reduce the risk of the staff becoming infected.

However, this measure is only sustainable if the number of admitted patients does not skyrocket.

Another key point is the use of protective equipment and masks. Associations have contacted medical supply companies to find ways to sterilize the masks once used so that they do not have to be discarded as a measure to avoid supply problems.

THE CHALLENGE OF THE PEAK

“We have not yet had that peak,” says Veronesi in reference to Europe, but acknowledges that sometimes, “unfortunately”, it is impossible to comply with the protocol and the same physical therapist must attend to several patients who have COVID-19.

The critical care specialist is concerned that in the event of a spike like that of some European countries, Argentina will have to deal with new problems stemming from the country’s poverty situation.

“We have an emerging population that does not even have running water and, if that peak reaches, here, how are we going to do with those people (…) who do not have the necessary means to be able to reach assistance,” he regrets.

In Argentina, more than one in three people was below the poverty rate at the end of the year, according to the latest official data, and this group is especially vulnerable to the pandemic.

Veronesi says they are already preparing to reach out to those people too in case the number of infected skyrockets.

ACCELERATED TRAINING

Roux estimates that there are some 1,000 critical care specialists in Argentina, a degree that requires about nine years of study.

For this reason, other non-respiratory kinesiologists are being trained at his hospital to increase the hospital’s capacity to welcome coronavirus patients.

At the moment, these actions increased the number of patients that can be accommodated by 40%, since less specialized physiotherapists will take care of the milder cases, so that specialists only have to focus on the seriously ill.

Veronesi explains that there are virtual and “in situ” trainings underway throughout the country to train as many kinesiologists as possible.

THE DAY AFTER

The battle against the coronavirus for the recovered physiotherapists and patients will take long to finish much later than for the rest of the population, maybe even years later: “The therapy comes out alive, but then the sequelae appear and it can last a long time,” says Roux. .

The physical deterioration of the patient while he is in intensive care is an inevitable thing that must be treated afterwards for months and even years, according to the person, to which are added challenges, such as what type of sequelae the coronavirus leaves behind is not well understood. .

In addition, the respiratory physiotherapist emphasizes that, while the pandemic lasts, specialists must remain in hospitals to attend to active cases, so the only way to monitor how the patients discharged are evolving will be through video calls.

They will have to be produced in the moments of respite that these professionals have, once they can remove their gloves, masks and chinstraps, amid the constant trickle of cases and concerns for their own safety until the virus gives up.

José Manuel Rodríguez

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