The Coronavirus and Spinal Cord Injury

Update:
The COVID-19 information is changing as more information is being gathered about this historic time. I would like to correct some information. The following symptoms of COVID-19 as listed by the CDC may appear 2-14 days after exposure:

• Fever
• Cough
• Shortness of breath

Please note the cough can be dry or wet. You can keep up with current information on the CDC website at https://www.cdc.gov/

Another point I would like to stress is that coughing will not remove the COVID-19 virus from your body. Coughing helps to clear the lungs of debris that collects but will not cure COVID-19. Keeping your respiratory system healthy is important to your general health and well-being. Currently, the treatment for COVID-19 is by symptoms.

Your compliance with the guidelines for keeping COVID-19 from spreading is important to your health, the health of your family and of the nation and the world. This is a difficult time. It is a situation that we have not faced before. But we will survive. Nurse Linda

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It seems all we hear about is the new coronavirus or as it is now named COVID-19. This virus is so new that it did not even have an official name until just recently. Some days, there is no other news reported except about COVID-19. Just a little over a month ago, the virus was in other countries but not in the United States. It traveled quickly. Now, this is all we are hearing about and for good reason.

Although we know little about this specific virus, we do know some things about viruses in general. A virus has one purpose in its life and that is to survive. It will multiply and mutate to keep living. Therefore, viruses can be hard to treat. They change forms to stay alive. Viruses are not killed by antibiotics, bacteria are. People who have a virus are contagious because that virus wants to spread to keep itself alive.

The COVID-19 virus spreads rapidly. It is transmitted from person to person by droplets from your respiratory system through coughing and saliva, through mucous membranes such as touching your eye, nostril, mouth, genitals or rectum and by touching contaminated objects. The virus can live for hours on things that someone has touched with COVID-19 contaminated fluids or hands. When you connect with the contaminated droplet and touch a mucous membrane entry into your body occurs.

Risk Factors
Individuals who have reached the age of 60 years and those who are immunosuppressed are at highest risk for the worse cases. As a normal part of aging, the development of T cells that fight infection become less effective. That does not mean younger people or children are not susceptible, they just seem to have less symptoms for now.

For individuals with spinal cord injury at any age, immunosuppression or the way your body responds to bacteria and viruses is not as strong. This is because after a spinal cord injury messages about viruses and bacteria may not be transmitted to the brain correctly for the body to initiate and early response.

Adding some of the complications of spinal cord injury further compounds the problem. Diabetes is one complication of SCI that further affects the body’s immune response. Adding a urinary tract infection is another. Individuals who catheterize are at higher risk of viruses and bacteria because of entry into the sterile urinary system. Open pressure injuries are another avenue for viruses and bacteria to enter the body. The spleen is the major infection fighting organ of the body. If you have disease that affects your spleen or trauma or removal of the spleen, you have an increased risk of infection. Heart disease is also a risk factor.

How COVID-19 affects your body
The lungs are elastic in that they inflate and deflate. COVID-19 affects the lungs by making them fibrous or less able to stretch.

The COVID-19 favors to live in your respiratory system particularly in your lungs. Individuals with spinal cord injury at any level of injury have immunosuppression due to affected breathing. It takes three sets of muscles to have great breathing ability. The diaphragm does most of the work of breathing, followed by the support team of the intercostal muscles (those in between the ribs) and the abdominal muscles. The three work together to create a deep, full and effective respiration and cough.

Helping your respiratory system
Coughing helps to keep your lungs clear of debris such as mucous and particles that enter the lungs as you breathe. Coughing also helps disrupt viruses and bacteria from making a home in your lungs. It won’t completely stop you from becoming ill, but it can help move debris around in the lungs. Perform three deep breaths followed by a cough at a minimum of four times a day.

If you have an incentive spirometer from your hospital or rehabiliation stay, now is the time to use it if you can. These devices are issued to everyone with a spinal cord injury but are soon forgotten about as life moves on. If you can locate yours, get it out and start using it. It is a plastic device with typically three balls each in a chamber. You draw air into your lungs while using the mouth piece to make the balls flow up in the chambers. Try to hold the balls up while breathing in. Start low and build up tolerance. This can help reduce flus and colds by keeping your lungs clear and healthy. Clean your incentive spirometer with soap and water daily.

Symptoms of COVID-19
Symptoms of COVID-19 are fever of 100.4 and above, wet cough and difficulty or painful breathing. Notice most of the symptoms are in the upper respiratory system as COVID-19 is currently mostly a respiratory virus. The virus can mutate and involve other systems at any time.

What to do if you suspect COVID-19
If you have symptoms, you should call your healthcare provider. They will instruct you where you can get tested. Plans are underway to keep infected people out of the offices and hospitals to avoid spreading the virus to others. If you are having difficulties breathing, you should always call 911. Tell them COVID-19 is suspected so the emergency personnel can come prepared to protect themselves and you.

Test kits and testing sites are available. The test kit, which consists of a deep nasal swab, will indicate if your have COVID-19 or not. It can take 24 to 72 hours for results depending on the supplier of the test kit and volume of tests.

COVID-19 Treatment
There currently is no treatment specific to COVID-19 as with many viruses. Treatment is based on symptoms. You will be treated by symptom if you have COVID-19 or not. The test kits are very important for assessing the rates and patterns of the virus. However, medical care is based on treatment of the symptoms of your condition. If you have COVID-19 or another virus, you should remove yourself from others. If you do not have COVID-19, you should still isolate yourself to avoid spreading whatever you do have.

If you are diagnosed with COVID-19, you will need to be isolated. If you have a mild case, you will be asked to remain in your home and away from others including family members. This will include separate sleeping arrangements. No one should come in to say hello, like visitors and children. If your case is severe, you will need to be hospitalized and will be in isolation there.

Prevention
The goal is to keep you from having the COVID-19 virus. Washing your hands is essential to avoid infection. With spinal cord injury, hand washing is essential when doing self-care. Washing your hands now should be in overdrive. This does not mean a little spritz. Effective hand washing is based on three principles, warm flowing water, soap and friction. Wash your hands for at least 20 seconds to the time it takes to sing Happy Birthday-twice. Gloria Gaynor has a wonderful play on her hit, I Will Survive, as she washes her hands. It makes hand washing a lot more fun.

You will need supplies. Delivery services are very helpful. Have the package left at the door and bring it in after the delivery. Drive throughs are helpful as well. If you do need to go to the store, start at the location where the cart cleaner wipes are. For some odd reason, most stores have you get your cart and then clean it. Once you have touched the cart, you have picked up the germs! Start with the cleaning wipes, wipe your hands with them, then get your cart and clean the pushing bar. If you have access to the hand wipes at the exit, re-wipe your hands on the way out.

Hand sanitizer works well when you are out. Hand sanitizer works if it contains 60% alcohol per CDC guidelines. 70% alcohol is better. It is difficult to buy right now. However, you can make your own wipes by putting wet, soapy paper towels in a tightly sealed bag or food saver box. You will also need a separate wet paper towel set for rinsing and some dry paper towels for drying. Yes, that is a lot to tote around but better than getting a virus.

Because of your location in a wheelchair, you are at a disadvantage because your head is lower than most standing people. This puts you in a vulnerable position. After being out or interacting with others, wash your face as well as your hands. Remember, your face has mucous membranes that allow viruses and bacteria to enter. Wash your hands first then wash your face starting with eye lids, then the rest of your face. Use a clean wash cloth each time you wash your face.

Maintain the three to six-foot distance when talking or interacting with others. Respiratory droplets cannot travel that far, so you are protecting yourself from breathing their germs. People might spread the COVID-19 virus but not know they have it. Avoid individuals who have been in large groups or who have recently traveled. Recent guidelines suggest groups of less than 50. Scientists suggest even smaller numbers. Some say gatherings should be no larger than ten.