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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.

Jeanette Centeno, RN, BSN, CM
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