Tracy Smith has been leading a team of more than 67 physical therapists, occupational therapists and athletic trainers through an unprecedented effort to rehabilitate COVID-19 patients — many of whom have endured stays of weeks in the intensive care unit, incapacitated and hooked up to numerous life-sustaining machines.
“When it all began, we were in unknown territory,” says the 45-year-old director of inpatient and outpatient physical and occupational therapy at the Cleveland Clinic Weston in Florida. “Everything was new, there was no normal, everyone was stressed out, we all had to adapt to new protocols and we were working in the hospital with sicker patients than we’d ever before seen.”
At the beginning of August, Florida surpassed New York in the number of people testing positive for COVID-19. After California, it was the state with the highest number of cases. The Centers for Disease Control and Prevention says that while Southern Florida, where Smith is based, makes up 29% of the population of the state, it comprises almost half of the state’s daily COVID-19 cases. In March, the median age of Floridians testing positive for COVID-19 was 65. Now it’s 40, with a rise in people in their 20s, 30s and 40s testing positive. Many attribute this to the state’s premature opening.
During lengthy hospital stays, like those being seen in the pandemic, the risk of physical decline is high. When a patient with COVID-19 is medically stable, Smith and her colleagues gauge the need for physical and/or occupational therapy. Smith says therapists begin by assessing physical response to movement and strength to determine what a patient can tolerate. Then patients are evaluated for their ability to carry out activities of daily living like the ability to wash oneself, brush one’s teeth and use the toilet. “Once capabilities have been determined, we design a unique physical and occupational therapy program for each patient, all while monitoring vital signs,” Smith says.
Not every patient needs physical therapy, but for those who’ve been on ventilators for weeks and sometimes months, the ability to simply swallow, hold up their heads or sit up is a big task, Smith says. When such patients are able to breathe on their own, therapy may begin with small movements like rolling over and working to sit at the end of the bed, say. Then, patients may work on moving from the bed to a chair and eventually walking.
Sherwin Chang, a lead physical therapist on Smith’s team, says that when patients start walking again — some using walkers trailed by staff with wheel chairs should they become unable to continue — a fine line between pushing them forward and not exhausting them has to be maintained to prevent physical relapses. “We try to get our patients as strong as possible before they leave the hospital to avoid sending them to rehab,” Chang says. “They have to be able to walk at least 100 feet with minimum assistance and be able to breathe before we send them home — and some are sent home with oxygen.”
Chang says he worked for 30 days with a COVID-19 patient who’d been in critical condition in the hospital for three months. It’s scary, he adds, because we don’t know who will make it and who won’t. “I had a 101-year-old COVID-19 patient who recovered well and went home and a 44-year-old patient who didn’t make it and died, and none of us knows why.”
To ensure that the strictest safety measures are in force, Smith’s team has implemented a two-person buddy system program for staff to follow when evaluating and rehabilitating patients recovering from COVID-19. Before entering their rooms, one therapist suits up with personal protective equipment while the other checks the process to reduce the chance for mistakes. The same routine is followed when removing PPE.
Smith says that in preparation for the battle against the pandemic, her team huddled to strategize and support each other. As more was learned about the virus, those huddles became socially distanced. “When things got rough at home, our ‘huddles’ became increasingly supportive and therapeutic.”
As levels of stress and exhaustion for the hospital staff intensified in March and April, Smith and her team created a “Relaxation Station” for colleagues inside the hospital. With the help of donors, they secured supplies to make the area comfortable. Smith was able to get a company to donate 30 massage guns. Brandon Marshall, the former football wide receiver who played for 13 seasons with the NFL, lent Weston several of his pneumatic pump systems that are said to reduce muscle soreness and fatigue and relieve swelling. A local store also donated foot massagers and other self-care items.
With the help of the community, Smith says she and her team were able to create a space for caregivers to take breaks and de-stress. That space has been used throughout the pandemic to help overwhelmed staff members relax. A rehab team from outside the hospital, trained in muscle and tissue manipulation, relaxation and postural recovery worked in the Relaxation Area for the first few harrowing months. “An onsite physical recovery site for staff was born, manned by physical therapists, physical therapy assistants, exercise psychologists and athletic trainers,” Smith says. Now it’s available to any hospital staff member who needs it.
Smith is also a wife and mother to two teenage children who are at home alone in the town of Davie, five miles from the hospital, attending classes virtually, as the school district gears up for continued, virtual learning. While she is supervising their home learning, she knows assignments have gone undone and is only able to monitor attendance from a distance. When she comes home, she’s not sure how close to get to her kids. Her husband is also concerned about the virus.
The number of COVID-19 patients at Weston appears to be lowering. Last week, Chang says there were 18 patients. Two weeks ago there were 60.
“In my 20-year career, I have never seen an illness impact the lives of nearly everyone,” Smith says. Like for so many others, she adds: “This is a challenging time for me at work, at home and in the community.”
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Physical Therapist: COVID-19 Patients ‘Sicker Than We’d Ever Before Seen’ originally appeared on usnews.com