COVID-19 has many people, clinicians and patients alike concerned about their health and safety. Developments of the last few days highlight the fact that this is a fluid situation with new information and recommendations emerging daily. Like all health professionals and health organizations, Physiotherapy Alberta is working to remain abreast of and consider the implications of new developments. We strongly encourage all clinicians, managers, business owners and organizations to do the same.
We also recognize that there is an abundance of information (and misinformation) available through mainstream media, social media, and other sources and that it can be difficult to know what information to trust. Physiotherapy Alberta is not the expert when it comes to COVID-19, or pandemics in general. For these topics we defer to the expertise of Alberta’s Chief Medical Officer of Health, Alberta Health, the Public Health Agency of Canada, and the World Health Organization. When there is disagreement between recommendations of different organizations, we defer to our local experts at Alberta Health and Alberta’s Chief Medical Officer of Health, recognizing that recommendations and actions should reflect local context and circumstances.
The Evidence-Informed Practice Standard of Practice was not written with pandemics in mind. However, the expectations that “the physiotherapist incorporates evidence-informed practice in all aspects of physiotherapy service delivery” and “integrates critical thinking and professional judgment into client-centered care” still apply to this situation. As health professionals, physiotherapists have a duty to be informed and to share credible information with their patients, peers and broader community. You can find information about COVID-19 through the following sources:
Alberta specific information (including travel restrictions, local actions, etc.)
Health Canada
WHO
Physiotherapy Alberta has received many calls from registrants regarding pandemic considerations specific to physiotherapy practice, to that end, the remainder of this article will focus on frequently asked questions and our current recommendations for clinicians.
The Infection Control Standard of Practice includes the expectation that the physiotherapist:
“Adheres to best practices of infection prevention and control in physiotherapy practice according to applicable legislation, regulatory requirements, standards, and guidelines.”
To be clear, the standards and guidelines referred to include those developed by Physiotherapy Alberta and those of other agencies including Alberta Health, the Public Health Agency of Canada, and the World Health Organization.
Some key points regarding environmental cleaning include:
The Safety and Risk Management Standards of Practice require that physiotherapists maintain “a safe environment for clients, health-care providers, her/himself, and others” and participate “in risk management activities to promote quality physiotherapy services.” Physiotherapists need to create a safe practice environment and implement measures to address specific risks relevant to their practice environment and population served.
In the case of COVID-19 the key public health focus is on limiting the spread of the disease both among patients and from patients to staff. Measures to consider may include:
Business owners are subject to Occupational Health and Safety legislation which requires that they create a safe work environment and provide appropriate controls to address identified risks in the workplace. Meeting these requirements includes educating employees about risks, providing supplies necessary to mitigate risks, and encouraging appropriate use of supplies and behaviours to mitigate the risk of spread of COVID-19. Examples may include:
Employers need to consider implementing the measures suggested by Health Canada to mitigate the spread of COVID-19 as appropriate for their work environment. These measures include enabling remote working where possible, staggering start and end times to reduce the need to travel at peak times, increasing space between workstations and treatment beds.
The Government of Canada recently announced that the waiting period for access to Employment Insurance would be waived for individuals required to stay home under quarantine from COVID-19. The Government of Alberta recently announced that workers would be entitled to 14 days of paid job-protected leave if they are required to self-isolate, are ill or are caring for a loved one with COVID-19, however, details about how this will work were not available at the time of writing.
Employers need to be aware of this information and updates as they become available.
We strongly recommend that members and their employers abide by the direction provided by Alberta Health and Alberta’s Chief Medical Officer of Health. Direction on self-isolation protocols can be found on Alberta Health’s website. Recognizing that staff who have been out of the country may not have been paying attention to local news, employers are encouraged to be proactive in communicating this information to staff before the staff member arrives for their first day back to work.
It depends.
If you are working with patients with presumptive or confirmed COVID-19 you need to follow IPC recommendations consistent with the directions of Alberta Health and your point of care risk assessment. Alberta Health recommends that people who are sick should wear surgical masks to help reduce the spread of infection. Alberta Health Services has a number of resources available on a range of topics
However, PPE supplies are not infinite and therefore it is important that they be used appropriately. At this time, Alberta Health does not recommend use of surgical masks by healthy people as they “can create a false sense of security” and can serve as a vector of infection as people touch their faces in order to remove the mask. Similarly, use of non-sterile gloves when using high contact surfaces can create a false sense of security and discarded gloves can serve as a reservoir for infectious agents if not discarded properly.
You can find a robust collection Alberta Health Services resources related to COVID-19 on their website.
Telerehabilitation is an option for the delivery of physiotherapy services. Physiotherapy Alberta has a Telerehabilitation Resource Guide available for reference if you are considering delivering services in this manner.
However, it is essential that members do their due diligence when setting up these services. It is critical that members consider:
The Code of Ethical Conduct states that physiotherapists do not “refuse care or treatment to any client on the prohibited grounds of discrimination as specified in the Canadian Human Rights Act** as well as on the grounds of social or health status.”
When it comes to patients seeking care due to a diagnosis of COVID-19, the physiotherapist cannot decline to provide care on the basis of their diagnosis. Some patients with COVID-19 develop pneumonia and may benefit from physiotherapy intervention. For other patients, COVID-19 may exacerbate pre-existing conditions resulting in hospitalization and the need for physiotherapy intervention.
However, the physiotherapist must use measures to prevent the spread of infection, including appropriate use of PPE and point of care risk assessment when delivering care. Under Occupational Health and Safety legislation, workers have the right to decline unsafe work, and this includes declining to treat patients if PPE is not available.
In the case of a patient who is seeking care for an unrelated condition and who is exhibiting symptoms of a respiratory illness, has been directed to self-isolate, or who has a concurrent diagnosis of COVID-19, it is recommended that the physiotherapist reinforce the directions of Alberta’s Chief Medical Officer of Health and Alberta Health regarding self-isolation and reschedule the patient’s appointment for a future date.
Alberta Health Services has developed an online screening tool to help to identify people who do not required a COVID-19 test. Testing is a topic of much discussion and debate, however, in the words of the Chief Medical Officer of Health, Dr. Deena Hinshaw: “You don’t need a lab test to do the right thing. If you are sick you need to stay home... People should not rely on a test result to take the appropriate actions of limiting spread to others.”
There has been much discussion about “flattening the curve” in recent days. Physiotherapists have a role to play in helping to prevent the spread of COVID-19, educating the public and providing services to patients with a diagnosis of COVID-19. We strongly encourage all clinicians, managers, business owners and organizations to stay abreast of new developments as they arise and to critically evaluate how they deliver services and actions they can take to help mitigate the spread and manage the care of patients who develop COVID-19.