PMC:7156806 / 10213-15132 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7156806","sourcedb":"PMC","sourceid":"7156806","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7156806","text":"Discussion\nTo our knowledge, this is the first survey to have assessed COVID-19-related practices and adaptations among health care professionals working with individuals with SCI/D. While we did not specifically recruit people living with SCI/D, we were able to capture those concerns they have expressed to their care teams.\nFew respondents had tested their patients for COVID-19 or reported that they had a patient with the virus, indicating that rehabilitation medicine professionals may not yet have been able to fully engage with the pandemic. This may also relate to a lack of availability of testing, guidelines limiting testing, and an under-appreciation of the benefits of routine testing around the world. However, the large number of respondents who had already modified their outpatient practices to reduce their patients’ exposure shows that important actions have already been undertaken, and that there is an awareness of the need to help protect individuals who may be vulnerable to infection. This is an important issue to consider, as the hallmark of inpatient rehabilitation facilities has been rehabilitation participants coming together in gyms and dining areas to join in community. Individuals with COVID-19 can spread the disease before symptoms occur, therefore we advocate for the routine testing of individuals that are newly admitted to or currently in rehabilitation facilities and for use of personal protective equipment (PPE) on all individuals with SCI until test results are available. Visitors to rehabilitation facilities also ought to routinely use PPE.\nThis survey underscores substantial unmet educational needs, both for rehabilitation medicine professionals and for people living with SCI/D. It additionally reveals the specific and legitimate fears experienced by individuals with SCI/D during this pandemic and during disasters. The vulnerabilities of people with disabilities to a lack of care has recently been highlighted [6], and there is a distinct possibility that people with SCI/D and other disabilities may be denied care in times of crises when lawmakers and health care systems determine who will receive limited services [7]. This pandemic highlights the need to advocate for people with SCI/D and other disabilities as we adapt to an increasing worldwide population, climate change, and more frequent zoonoses and disasters. In addition, it emphasizes the need for educational tools for patients and professionals such as those recently created by John Shepherd at University of Toronto and available in multiple languages which discuss issues such as maintaining personal equipment and wheelchair hygiene [8].\nThese results also demonstrate the widespread and rapid implementation of telemedicine around the world, and a relaxation of privacy rules, at least in the United States, to accomplish this. Telemedicine for people with SCI/D has previously been reviewed [9] and has many advantages including saving travel time, limiting the costs of medical transportation, serving as an environmentally sound form of health care, and limiting the spread of infection to a potentially vulnerable population. Case reports have also demonstrated the utility of telemedicine to monitor and adjust home therapy regimens to maintain and improve functional potential [10]. We anticipate that the use of telerehabilitation and telemedicine for people with SCI/D will persist after this pandemic.\nFinally, in a small but meaningful way, these results demonstrate the importance of at least basic universal health care. In the United States, which does not offer its citizens guaranteed coverage, testing was not widely available as infection rates soared. At the time of this survey, the United States leads the world with over 100,000 confirmed COVID-19 cases. Respondents from countries with guaranteed care, however, were more likely to have reported that testing supplies had been adequate. Our hope is that this pandemic will expose the need for universal health care and will mobilize public support for its implementation.\nOur survey has a number of limitations. Due to its rapid deployment, we omitted questions that would have been meaningful to address such as the availability and routine use of PPE and ventilators. This has increasingly become a concern around the world and will undoubtedly continue to be a concern. Moreover, we did not address the issues of addressing adequacy of staffing at health care facilities and for individuals with SCI/D. The COVID-19 pandemic has and will contribute to professional and caregiver stress, and this ought to be addressed in future surveys. Finally, since the drafting of this manuscript, we have become aware of the repurposement of SCI/D beds as acute care beds. All of these issues will undoubtedly evolve over the next weeks and months and we are, therefore, planning to construct a follow-up survey in 4–8 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