Spinal cord injured (SCI) patients, whether complete or incomplete, pose a distinct physiological challenge for an acute healthcare team, especially during the pandemic. A spinal cord injured patient can normally suffer from respiratory issues, infections, wounds, swallowing issues, and blood clots. A patient with SCI with Covid-19 can present an array of different physiological symptoms that may require aggressive interventions. For example, generalized body aches or fever in a spinal cord injured person can produce a slow response from the Autonomic Nervous System (ANS) which helps produce natural antibodies to help us fight disease. Unfortunately, this slow response can cause the virus to quickly ravage the body, lower the immune system, and duplicate, causing havoc to the respiratory system and cause cytokine storm syndrome (CSS).
The impact of CSS on Covid-19 and SCI patients has not been thoroughly studied which can make it more difficult to treat. Interventions by the acute care team tend to be trial and error which needs to change. We know that normally Covid patients suffer from lack of taste and smell, delirium, blood clots, vascular changes in the body, and respiratory issues. A spinal cord patient can miss subtle signs from the body. For instance generalized aches and pains may be missed but present as Autonomic Dysreflexia (or AD, a syndrome in which blood pressure increases suddenly to dangerous levels and affects spinal cord patients who are T6 or above injury)and a lower immune response can increase infections.
Protecting SCI Patients from Covid
Individuals living with spinal cord injury need to be hyper vigilant of the symptoms and seek medical assistance immediately. Increasing vitamin intake—especially vitamin C, D, and zinc—can help. Getting enough rest helps boost the immune system and they should consider getting vaccinated for the flu and Covid-19. Staying healthy during the pandemic is key.
As a healthcare provider, know that a normal regimen may not apply to an SCI patient and aggressive treatments may need to be discussed. Consider that perhaps because of the patient’s level of physical function and respiratory function, he/she may not be able to wear a mask. Patients may need a combination of inhalers, steroids, or antibiotics. Encourage patients to seek early medical interventions – including telemed visits. The biggest advice from healthcare workers to SCI patients is, eliminate your exposure, wear a mask, get vaccinated, and keep an eye on any and all symptoms. If you think you have been exposed to Covid-19, call your doctor immediately, get tested, seek medical interventions early to avoid dangerous complications, and stay informed.
Lastly, we are all learning about this virus, and staying informed can make a huge difference. Nurses know how to advocate and educate which has been an essential tool during this pandemic. We must learn to share our resources and information in order to slow the spread of this virus and keep our patients safe and healthy.
As the numbers in Covid-19 rise and healthcare workers struggle to keep patients safe, indigenous communities still struggle to be recognized. The current pandemic, along with many other diseases, has disproportionately impacted tribal communities, who at times lack basic essential needs or access to adequate medical care. Covid-19 is just the tip of a very big iceburg that has systematically crushed indigenous people for generations which has woven itself into the fabric, or the very essence, of a nation, causing economic loss, environmental instability, religious and political oppression and more.
The current health crisis has had a ripple effect on indigenous people who already suffer from chronic illnesses like heart disease, diabetes, PTSD, depression, and suicide. Tribal Health Programs and Urban Indian Organizations provide limited resources, health options, and timely information. As we know, Covid-19 is a virus that has been difficult to contain and misinformation along with fear have devastated many communities. We, as healthcare workers must educate the public in order to contain it. If part of our community distrust the information given, it puts everyone at risk.
According to the Urban Indian Health Institute (a division of the Seattle Indian Health Board) 35% of Native People who get Covid-19 die compared to 6.3% of white people. Furthermore, the CDC is lacking the available data to quantify the disparity in covid-19 incidence among indigenous people. The lack of data, exclusion in research, and misrepresentation in medical and academic publications can continually harm native people by delaying assistance and affect evidence based practice models.
The lack of information can increase risk factors, prevent proper education regarding disease process, and continue to have an insurmountable effect on the social and economic growth of a tribe. Not having the adequate information to treat our patients affects how we do our job. Generalized equation models of data, does not adequately include covid-19 symptoms, current underline health issues, ICU admissions, indigenous survival rate and deaths.
So how do we as healthcare providers, help break this cycle? First, we must recognize tribal communities as sovereign entities. Our interventions must be tailored to a very unique group of people who need to be respected and who historically, distrust the medical community. We need to educate in a way that encompasses and includes the tribal traditions in order for the information to be received properly. Healthcare workers must ask questions that are unique to indigenous people. For instance, does the patient prefer the information in his/her language which is pivotal in curtailing this virus or would the patient prefer to have his/her family involved in medical decisions. Furthermore, health services for indigenous people need rich resources that extend throughout their community and include important elders and those that have a political, economic, and religious impact. We must learn to think outside the box and realize not every community sees health and disease process the same way.
Hospitals must also implement a better system of documentation that includes native people. Exclusion of data and research will not help any healthcare system who is servicing an indigenous community. Documentation should include not just basic statistics and medications, but availability of testing, results, side -effects, availability for research or vaccines, and understanding of current disease process.
Lastly, we must not only educate but advocate for the health of the community where elders are pivotal to the survival of a tribe. They are the guardians of tribal culture and language and the most at risk during this pandemic. As healthcare workers, we have a responsibility to all communities and seek preventative mechanisms that are appropriate for all.
