Under the COVID Cloud: World perspectives

COVID has affected us all in short and long term ways. Some still playing out. With presenters from around the world, I thought it would be a great opportunity to find out in more detail how physiotherapists in different countries and regions have been affected.

Europe - Italy - Julie Day

Let's start with Italy, where an early explosion of COVID showed us how fast it could spread. Julie presents the Level 1 and Level 2 Fascial Manipulation courses for AAP Education. Julie was literally on the tarmac in March, heading to Australia when the Italian government closed all airports. Bam. Here is Julie's account of current life as a physio in Italy.

Well here in Italy life is very gradually returning to a somewhat more normal rhythm as we have now entered the Phase 2 stage. Fortunately the curve continues to flatten but it's still a long way from being anywhere near comfortable.

We are obliged to wear face-masks and gloves for any activity outside of the house, including shopping, individual sport and meeting up with family members or 'significant others' and we are still maintaining a physical distance of at least one metre at all times. We still can't gather in groups of friends, so no picnics or dinner parties, which meant that the Easter holidays were very quiet and almost eery.

I have now started to see some outpatient patients after a solid 2 month break, but I have had to reduce my case load by a third. The rest of my time seems to be spent on gowning up (we use light weight plasticised gowns, which are cumbersome - see photo), adding a face mask and a visor as well as 2 pairs of latex gloves. We are also sanitising all surfaces and any equipment we use before and after each patient, so extra time is needed for all that.

We do a mandatory triage at the first session, asking questions about potential symptoms and or any contact that patients may have had with Covid-positive cases etc. This triage is repeated at each new session and patients have to counter sign a declaration saying that they have answered all questions truthfully.

Despite the tragic loss of life here, which was particularly stressful in March, we have seen some interesting emerging phenomena: pollution reduced dramatically due to an almost total lack of traffic; there has been a surge in online activities with schools and universities having been closed since mid-February (they are not opening until September!); many offices have discovered that smart-working (i. e. from home) often gets the job done quite nicely and I am particularly thrilled to discover that Italians can actually stand in a line without even attempting to jump the queue!

Seriously though, we are all quite shell-shocked here in Italy and it will have ongoing repercussions on the economy for a long time to come.

As an update, the Stecco Institute has created the theory component of Level 1 to online so that participants can complete this before attending the 3 days of practical.

Australia - East Coast - Ebonie Rio

Ebonie Rio is presenting our Lower Limb Tendon Rehabilitation Course later in the year. Here Ebonie explains what changes have occurred in her home and research situations.

Nothing normal here! All La Trobe research is on hold. COVID-19 has forced me to learn how to schedule a Zoom meeting, Skype while trying to home-school, Facetime a group, tele-health with Microsoft teams because it is secure and of course WEBEX (yep its a thing) because there aren't enough platforms to be across! It has certainly been a steep learning curve 😊

I think as physios sometimes we devalue our brains and don't prioritise education – these platforms encourage us to listen but also provide strategies that empower our patients – and that's a good thing. It has also helped us develop a plan for how we may support some of our athletes when they travel and don't have physical contact with us. 

Australia - Rural Practice

My experience echos bits of both Julie's and Ebonie's. We closed the practice for several days to train staff on new protocols and install an external wash station (not just hand sanitising). We removed chairs in the waiting room, scrambled to secure PPE and put around distance barriers. Our little figurine has helped out with the education process STOP - 1.5m. Being in Esperance, in WA, in Australia, means we are exceptionally fortunate, but people still were very concerned. I had recently changed from 20 minute appointments to 30 minutes and everything now takes so much longer, so I was glad of the extra time. We started to see a lot more lower limb injuries - everyone seemed to have taken up running, and neck pain - tele-meetings, maxing out free trial periods of Netflix/Stan/Foxtel plus doses of COVID stress/anxiety.

In regards to my sleep research, I was fortunate to be on the writing end, not data collection end of the process. I have submitted my thesis, received my marks and responded to examiner questions. All done and dusted, which closes a 9 year chapter. I a few papers still to write from our results chapters and was heading off to IFOMPT 2020 in Melbourne, but that will have to be another day.

In the past 2 weeks, with declining active cases in Australis, no new cases in WA and no cases at all in Esperance, regional life is warming up slowly. Being a 'after hours' farmer, this part of my life hasn't changed. Cows still need feeding, calves to calve, pastures to tend and avocados need smashing. Autumn is a lovely and busy time in both garden and on the farm, so it has all been normal busy in this regard. I have still have been able to scuba dive/underwater photography and while cold, open water swimming has also been possible. Looking around and seeing other's experiences, I consider myself very fortunate.

UK - England - Jeremy Lewis

Jeremy presents his The Shoulder: Theory & Practice course and is due in Australia in August. Fingers crossed that travel bans are lifted by this stage. Here are Jeremy's experiences and insights so far.

I love medical history and there appears to be a few similarities about the political and healthcare responses between the current virus as there was for the polio pandemic last century. Being in London I admit some jealousy about how the pandemic was handled in the country of my birth, NZ and the country of my younger life, Australia. I have had the virus twice , once after a teaching trip to the Gulf region and then again when back in the UK. It was a bit of a battle but nothing like the people needing hospitalisation and ventilation. I have three children working in the UK NHS, 2 doctors and 1 midwife, they are my heroes and my youngest daughter, a first year doctor and I shared time at home when we both had the virus.

I haven't minded the physical distancing and am grateful for Skype, What's App, Zoom etc to stay in contact with family and friends and am so grateful we have a small garden and live close to beautiful woodlands. I miss the gym now that I feel I can exercise again but am enjoying the home circuit we have set up and take turns to lead on. I do admit to having trouble with people who clearly missed that day at junior school when they were taught what two metres actually is!

I have enjoyed become more comfortable with telehealth and although I am not always great at it, in many ways for people seeking care not needing to travel to our NHS clinic and wait in waiting rooms has been easier more convenient and a time saver for them. If there are 500,000 physiotherapists in the world treating 30,000,000 plus patients / month I wonder how our profession might contribute to a cleaner planet by reducing patient travel and greenhouse gases, especially for the first appointment? Telehealth is hard when it's not the right medium for the person on the other side of the screen, which I am sure everyone has experienced.

I think this could be a fantastic time for our profession to decide what the new normal should be to ensure sustainable and high quality care. Advances in technology will really make this interaction much better. I am supervising 2 PhD students and 1 Masters student who are researching Virtual Reality and shoulder assessment and management and I can really see how this will make a huge impact in the future of telehealth. It has become easier to deliver exercises via Zoom etc, and send people links to quality exercise and educational videos and publications. The one intervention that frustrates me is not being able to offer ultrasound guided injections for those in the pain stage of frozen shoulders. This has become a constant part of my NHS practice and as it is supported by the research and it frustrates me I can't discuss the harms and benefits with people for them to decide if it's the right intervention for them to consider, especially when pain is 'consuming' the individual.

I hope everyone reading this and your loved ones stay safe and well.

I echo Jeremy's sentiments and well wishes to you all. COVID has been and continues to be a force of consideration and change. As we all ride this wave, let us continue to support our family, friends, neighbours and colleagues.

I would love to hear how you have been challenged or have been able to assist others.