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APTA Releases Update to Report on the Impact of COVID-19 on the Profession
A follow-up to the association’s May report shows signs of improvement but continued challenges to PTs, PTAs, and students.

School-Based Physical Therapy in the Age of COVID-19
From APTA Magazine: "We're already seeing some improved connections, relationships, and exchanges between PTs, their colleagues on IEP teams, and parents and families due to increased contact by phone and electronically. This can be a lasting benefit of using remote models." PTs explain in this feature article how they have learned from their experiences with remote service provision and are prepared for a variety of scenarios in the new school year.

From CDC

U.S. COVID-19 Cases Reach Nearly 6 Million
Total coronavirus cases have reached 5.9 million as of August 31, with nearly 300,000 new cases in the previous week, according the CDC COVID-19 Data Tracker. Over 180,000 people have died from the virus so far. The average case rate appears to be on a downward trend.

CDC No Longer Recommends Testing for Asymptomatic People Exposed to COVID-19; Drops Mandatory Travel Quarantine
On August 24, CDC revised its guidelines to say that individuals who have been exposed to someone with the virus but who do not have symptoms "do not necessarily need a test unless you are a vulnerable individual or your health care provider or state or local public health officials recommend you take one." Many health experts, including Anthony Fauci, worry that the revision could decrease rates of testing. Several states have announced they will not follow the guidelines.

CDC also rescinded its mandatory 14-day quarantine for people who traveled to a country or area with a high number of COVID-19 cases.

From CMS

CMS To Require Nursing Homes To Test Staff, Offer COVID-19 Tests to Residents
The Centers for Medicare & Medicaid Services will now require nursing homes to test staff and offer testing to residents for the novel coronavirus. Laboratories and nursing homes using point-of-care testing devices will be required to report diagnostic test results as required by the Coronavirus Aid, Relief, and Economic Security Act.

CMS Will Resume Routine Inspections
CMS says it will resume routine inspections for all Medicare- and Medicaid-certified providers and suppliers. The inspections temporarily were suspended when the COVID-19 pandemic began in March.

From EPA

EPA Approves First-Ever Long-Lasting Antiviral Product for Use Against COVID-19
U.S. Environmental Protection Agency Administrator Andrew Wheeler issued an emergency exemption to the state of Texas permitting it to allow American Airlines and Total Orthopedics Sports & Spine to use a new product that kills coronaviruses such as SARS-CoV-2 on surfaces for up to seven days. Allied BioScience, maker of the product, still will need to apply for nonemergency approval and submit efficacy data to EPA.

From HHS

HHS Extends Provider Relief Fund Application Deadline to Sept. 13
The deadline to apply for COVID-19 pandemic-related relief funds has been extended to Sunday, Sept. 13. APTA urges all qualified providers to apply. Applications are now being accepted through a single portal, and providers may qualify for funds under several different circumstances, including those who have never received relief funds and those who've received funds but have yet to receive more than 2% of patient revenues. The "phase 2" relief money is open to Medicare, Medicaid, Medicaid managed care, and CHIP providers. Visit the HHS FAQ page for more information. 

In the Media

First COVID-19 Reinfection Case Confirmed in Hong KongFrom MedPage Today: "The man was diagnosed with COVID-19 on March 26, hospitalized, then recovered. He tested positive for SARS-CoV-2 again on August 15, and whole genome sequencing of viral isolates from the two episodes indicated they were from different clades, reported Kwok-Yung Yuen, MD, of the University of Hong Kong, and colleagues in a manuscript they said had been accepted for publication in Clinical Infectious Diseases, but not yet published."

Nevada Reports First U.S. Case of COVID-19 Reinfection
From The Hill: "The patient in Nevada initially tested positive for coronavirus in April, after exhibiting symptoms including a sore throat, cough, headache, nausea and diarrhea. The patient eventually reported having no more symptoms, and subsequently tested negative twice. But 48 days later, he started exhibiting symptoms again, with a much more severe case. He was hospitalized and required oxygen. The researchers sequenced the RNA from both virus samples, and found they were two different strains, making it a true reinfection."

COVID-19 Hospital Data Reporting System Not Going Back to CDC After All
From NewsWest9: "HHS made repeated attempts to explain to the Wall Street Journal that the process for COVID-19 data reporting has not and is not changing," said Michael Caputo, HHS assistant secretary for public affairs in a statement to TEGNA. "This false reporting will sow more confusion and only undermines the public health response." The report cited Deborah Birx, a top White House coronavirus official, who reportedly told hospital executives and government officials this week that reporting to HHS was "solely an interim system."

Type of Ventilation System Has No Effect on Nursing Home Outbreaks
From AP: "The state hired outside investigators to review ventilation at 28 long-term care facilities, including the hourly air exchange rate and how often filters were replaced. The systems varied widely in age and design, but the results showed no patterns in terms of the virus, said Department of Health and Human Services Commissioner Lori Shibinette."

Symptoms of COVID-19 and ME/CFS May Overlap
From Medscape: "Clinically, [Lily Chu, MD] said, one way to assess whether a patient with persistent COVID-19 symptoms might be progressing to myalgic encephalomyelitis/chronic fatigue syndrome is to ask him or her specifically about the level of fatigue following physical exertion and the timing of any fatigue. With ME/CFS, post-exertional malaise often involves a dramatic exacerbation of symptoms such as fatigue, pain, and cognitive impairment a day or two after exertion rather than immediately following it. In contrast, shortness of breath during exertion isn't typical of ME/CFS."

More Evidence for Airborne Transmission
An analysis by the Center for Infectious Disease Research and Policy provides greater support for aerosol particles as the primary mode of coronavirus transmission. According to the article, "One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak ... at a Dutch nursing home to inadequate ventilation." 

APTA has published a resource on precautions for PTs and PTAs when performing aerosol-generating procedures, such as for patient mobility and exercise.

New in Research

A "Learning Health Care System Approach" Can Optimize Telerehab Care Delivery
In a PTJ Perspective published ahead of print, authors call for telerehabilitation researchers and health care institution partnerships to learn how to best apply telerehabilitation. A learning health care system approach includes "rapid-cycle research that supports learning within health systems, uses rigorous methods, and is responsive to and driven by the questions of health system leaders and key stakeholders."

Impact of Social Isolation in Children
In a PTJ Point of View article published ahead of print, physical therapists in Brazil describe the potential impact of social isolation on pediatric patients with serious underlying conditions. They urge support for policies to support families of children with disabilities, more telerehabilitation research, and enhanced psychological and social support for families.

Repeat COVID-19 Testing May Be of Limited Value in Health Systems, Say Researchers
In the International Journal of Infectious Diseases, authors report on results of repeat testing within a large Los Angeles health system. "We found a low diagnostic yield of repeat testing for SARS-CoV-2 in our health system. Repeat testing might prove useful in certain clinical scenarios, such as in healthcare workers, when symptoms develop after a negative test, and in hospitalized patients with a high clinical suspicion for COVID-19."

Metabolic Syndrome, Obesity May Be Linked to COVID-19 Risk
In a summary of recently published research from patients around the world, the Center for Infectious Disease Research and Policy reports that individuals with obesity or metabolic syndrome — diabetes, obesity, high blood pressure, and high cholesterol — may be at higher risk for contracting the virus as well as for hospitalization, acute respiratory distress, and even death from COVID-19.

Physical Distancing Rule "Oversimplified," Should Be Part of Broader Strategy   
Authors of an article in BMJ write that guidance for risk of transmitting the novel coronavirus should be more nuanced and consider mask wearing, ventilation level, length of time, type of activity, and location when evaluating level of risk. "Physical distancing … needs to be implemented alongside combined strategies of people-air-surface-space management, including hand hygiene, cleaning, occupancy and indoor space and air managements, and appropriate protective equipment, such as masks, for the setting."

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