March 20, 2020
To the physical therapy community,
This is far from the world's first pandemic, but it's the first of this scale of our lifetimes. It's not often that we are aware we're in a historical moment as it's happening, but this is one of those times — and the story is still being written.
None of us knows how this will end. It's hard to predict when it will even feel "over." At some point confirmed cases of COVID-19 will wane and go away, but left in the outbreak's wake will be collateral damage that, on a personal level, will affect many of us far more than the virus itself.
Earlier this week, APTA released a statement encouraging physical therapists to "use their professional judgment to determine when, where, and how to provide care, with the understanding this is not the optimal environment for care, for anyone involved."
I've heard from some members of our physical therapy community who feel that this statement didn't go far enough, that we should have called for all outpatient clinics to temporarily shut down. I understand those concerns.
This is a challenging time to be in health care. I commend all those who are putting their own health at risk to treat their patients and clients who have immediate health needs. I also applaud those who are selflessly closing the doors to their practices because they have determined the risk of spreading COVID-19 outweighs the benefits of providing care that is not urgent. Both actions are heroic.
Things are changing rapidly, but as of this moment federal government recommendations supported by the CDC include the following: "If you work in a critical infrastructure industry ... such as healthcare services and pharmaceutical and food supply, you have a special responsibility to maintain your normal work schedule. You and your employers should follow CDC guidance to protect your health at work."
Meanwhile, at the local level, communities with "shelter in place" rules include health care among the exceptions.
Of course, this does not mean that all physical therapist treatment must continue uninterrupted.
The CDC has not released guidance specific to physical therapy, but CMS released recommendations related to surgical procedures that should and shouldn't be postponed. Fundamental to those recommendations is the notion that some care needs are immediate, and some are not. That's true for surgery, and for physical therapy.
That's why the APTA Board of Directors felt that the best approach is to rely on the professional judgment of physical therapists — because care decisions should be based on a specific person's needs and a risk/benefit analysis for the individual, not simply by the setting in which the care is provided. The COVID-19 outbreak changes the factors we must consider in our professional evaluation, but it does not change our basic responsibility to do what is best for our patients. As licensees, physical therapists are empowered and obligated to make those decisions.
We are going through this together, day by day, doing our best to make a positive impact on society in a moment in time when there are no easy solutions.
Some people in our physical therapy community will have their lives affected by the coronavirus. Others will be harmed by our country's very necessary efforts to stop its spread. Jobs will be lost. Some clinics that close may struggle to reopen. And students will graduate into what could be an unstable economy.
My heart hurts when imagining what might be. But I also have hope.
I hope that this disruption to our health care system will prove once and for all the necessity of broad-based access to our services, including telehealth, and that the primitive barriers APTA has spent years advocating to remove will finally start to fall.
I hope that this uncertain time brings us together — as a nation, as a community, as an association — by showing us how connected we are, and how much we depend on each other.
And I hope that our profession will do what it does best: help our society move on from a period of suffering, by restoring function, independence, and dignity to survivors.
Just as we rose to the occasion during the polio epidemic, I believe we have another watershed moment at our doorstep to help rehabilitate a world challenged by COVID-19.
Based on some of the forecasts, our fellow health care providers could soon be inundated by an influx of patients with needs specific to COVID-19, which will lead to an increased demand for physical therapists in critical care units, emergency departments, and triage. We will need to pivot quickly in order to respond to our calling.
Take care of yourselves and your community. We need each other.
Sharon L. Dunn, PT, PhD
Board-Certified Orthopaedic Clinical Specialist