Physical Therapy and the Coronavirus: Interview with Dr. Veronica Velasquez
In this interview, we discussed a topic that has been on everyone’s mind: the coronavirus. I wanted to interview the amazing Dr. Veronica Velasquez (Instagram: @thisPTlife) about the physical therapist’s role in this pandemic and how it is working on the frontlines. I wanted to help the public, or even those in the physical therapy profession currently, learn more about the influence of physical therapy on the coronavirus. Hope you learn lots from this interview! I know I did 😊
Because this was a pretty long interview, here are some links for you that will jump to that particular section of questions and answers:
✨ New Grad Physical Therapist
✨ Acute Care Physical Therapy
New Grad Physical Therapist
Val: Hey Dr. V! Can you introduce yourself for everyone?
Dr. V: My name is Dr. Veronica Velasquez, and I am a new grad physical therapist. I just graduated last year, and my first job is in acute care. I work in a small community hospital in the South LA/Compton area, and we serve a lot of the underserved community who have no insurance and have a lower socioeconomic status. Many of the people I see are African American and Spanish-speaking patients, so we’ve seen a big hit in the community in terms of the aftereffects of COVID-19.
Val: Wow, you covered a lot in that intro! How has your experience been as a new grad therapist?
Dr. V: Yeah, it has been really interesting working as a new grad therapist while all of these things are going on. While using everything I learned from school, I’ve been learning a lot of things that school can’t possibly teach you. Dealing with insurance is a one of those things; it was a big eye opener to me that certain patients can’t get all of the DME* that they need, simply because of what insurance they have. That’s so wild to me. It’s also crazy thinking of PT in the whole healthcare field and seeing that our healthcare system is kind of broken. We can use all of the awesome things that we can in PT school, but we still live in a broken world and a broken system. We can just try the best that we can with everything that we learned from school in order to provide for patients that deserve a lot more. And this was all before COVID-19!
*DME: durable medical equipment – any equipment used to aid in improving a person’s quality of life
Val: On top of the transition from school to actually working in the field, you have to deal with all this extra stress and change because of the pandemic. How is being a new grad in these times?
Dr. V: It’s been a hard transition. The first few months have been hard because I was going through the typical growing pains of being a new grad. I was still making mistakes, whether it was billing or not communicating things through documentation. I was having a hard time with the little things that will come to you with experience. Mistakes are bound to happen, but I also said in an Instagram post that you should be gracious to yourself in a time of transition. So now, I feel like I’m going through a second wave of transition. Right when I felt like I was getting the hang of it and was starting to feel more confident, the virus hit. I thought, “Oh my goodness, I have to be on top of my game because I don’t want to get the coronavirus but I do want to treat these patients.” But like I said, I’ll figure it out, and hopefully I’ll get back to the level of confidence that I was at before.
Acute Care Physical Therapy
Val: In school, we learned that patients are usually in acute care for 3-5 days, so you guys are basically the first PT’s that patients would see if they are medically unstable. An acute care PT’s general goal is to get the patient discharged home or transferred to another facility/setting. What is the most important thing that PT’s have to worry about or monitor in the acute care setting?
Dr. V: Overall, every acute care physical therapist – I would even say all therapists – would think the biggest thing is “safety first.” Yes, we want to progress the patient, but, especially in such a medically unstable state where the patients are not cleared to go home, safety is of the utmost importance. This is especially true because you’re seeing patients that are fall risks. You have really got to be on top of guarding patients and making sure that they’re safe. On the other hand, we also have to make sure that their vitals are in a safe range as well. So the BIG general rule is always putting patient safety first. If I was planning to ambulate* a patient but I feel like the patient is not safe to walk, I will not walk them. Sure, they would benefit from walking, but if their blood pressure is too low or if they’re dizzy, I will not take therapy further. It is well within our rights to stop because our number 1 rule is patient safety.
*ambulate: to walk
“Safety is of the utmost importance”
Coronavirus Patients
Val: How would that situation relate to a COVID-19 patient?
Dr. V: COVID-19 patients’ oxygen levels are so varied. For the more severe cases, the patient’s oxygen saturation* can be at 100% while lying in bed. And then for some reason, just as I sit them up, the patient can desaturate down to the 80’s, like that *snaps*. And they’re on oxygen already, so their lungs are so weak at this point. There’s only so much that physical therapy can do. I can’t magically make their lungs strong enough to be saturating at 100%, so safety is always very important. We’re working within a very small window that the patient can progress in. Anytime they go outside that window, your instincts better kick in and stop what the patient is doing.
*oxygen saturation: the amount of oxygen in a person’s blood, with normal being 95-100% saturated
Val: Because these patients are so medically involved, especially with fluctuating oxygen saturation, what can PT’s do to help the patients with coronavirus in the small window that you have?
Dr. V: Even though we can’t push them further to walking, there are a lot of things that we learned in PT school to help the patients in the small time frame that we have. It is always about downgrading. So let’s talk about working with a patient at the bed mobility* level. If they can’t even sit up, then I’m going to work on rolling left and right. That will help them work on their core and respiration. Once they’re able to do that, we can work on trunk stability* by working on going from supine* to sitting. We can teach them diaphragmatic breathing, pursed lip breathing, inspiratory holds* – there are so many things that we can do as PT’s. That’s why I really want to push education on acute care. It looks like we’re not doing much from an outsider’s point of view. “Oh that PT is just sitting at the edge of the patient’s bed with the patient and that’s it?” There’s SO much more to it because they’re medically unstable. These patients have to be good in sitting before I’m ever going to stand them up. They have to be good with standing before I ever decide to walk the patient. It is an entire process, and every little thing that we do functionally will help them get back home.
*bed mobility: essential activities that people need to be able to do in bed (rolling, scooting, sitting up, etc.)
*trunk stability: the muscular control around the torso to prevent unwanted movement
*supine: lying down, facing up
*diaphragmatic breathing, pursed lip breathing, and inspiratory holds: all techniques to train the patient’s respiratory system
Val: Besides the desaturation, what is the typical patient presentation for someone with COVID-19?
Dr. V: It ranges. Let me just talk to you about the worst that I’ve seen. There is usually shortness of breath – I’ve even heard wheezing sounds. It sounds really distressing. For one patient I had this last week, he was fine until he started walking, which is when he started coughing a lot and desaturating. So it is a lot of respiratory symptoms: shortness of breath, coughing, wheezing, and desaturation. Overall, the patients are very deconditioned and have poor tolerance with out-of-bed activities.
Val: Have you noticed factors that can influence how severe the symptoms can be or is it pretty random?
Dr. V: Definitely comorbidities*, especially cardiovascular comorbidities. If someone’s lungs are affected, their heart will be affected too. And vice versa. Diabetes is also a big one. I don’t know if they’re seeing this in the evidence, but at least in our hospital, patients who are obese to morbidly obese tend to be on the mechanical ventilator* longer, and their mortality rate seems to be higher. So we see a lot more deaths in obese patients. And age is, of course, another factor. In the really good cases that I see, the patients are young, have fewer comorbidities, and are rather healthy before this disease. The most severe symptom that I see for these patients are that they desaturate, but, for some reason, they don’t even know it. They get a little lightheaded, but that’s it.
*comorbidities: other chronic diseases or conditions that the patient has
*mechanical ventilator: a machine that helps the patient breathe when they can’t breathe on their own
Val: It seems like a lot of people recognize physicians and nurses as the healthcare frontline workers, but there are so many other hospital workers that are fighting this too. In regards to PT, I feel like physical therapists are very instrumental in fighting this pandemic, and they have a lot of the tools and skills that would benefit these kinds of patients. What is the role of physical therapists in this pandemic compared to the roles of other health care professions in the hospital?
Dr. V: Doctors and nurses are amazing, but their expertise focuses on the medical sphere. Their main and very important goal is to get patients medically stable. Our main goal is to make sure that the patient is safe and strong enough to go home. We also need to make sure that they don’t come back to the hospital. So in order for that to happen, we have to ensure that they are moving in the hospital. Understandably, doctors and nurses have other jobs to do. You will never see a doctor or nurse sit a patient up in order to ambulate and mobilize* them. That is all on us. It is our job to ensure that the patient can walk more than 100 feet so that they can go home. We’re constantly thinking “how does this patient go home and how do they get there safely?” So it is just a different thought process. The medical staff’s goal is to make sure that the body is staying alive. The physical therapists need to make sure that the body that’s staying alive is safe and can go home. The medical and rehab teams work hand in hand to help the patient.
*mobilize: to move
“Our goal is to make sure that the patient is safe and strong enough to go home.”
Val: This pandemic has been going on for a couple months now. How would you describe the progression from when it first started? Like for how it is in the hospital, how many patients you see, etc.?
Dr. V: In the beginning, it was definitely chaotic in the hospital. The hospital was figuring out how to treat COVID-19 patients and how they would have enough beds for these patients because they were expecting a big surge in the number of cases. They were also trying to make sure there was enough PPE*. Fast forward to now – it has been about two months, I think. Now, it is the new norm. We have good policies in place, and we have enough PPE at our hospital to make sure that the patients are safe and that we’re protecting ourselves. On the PT side, things have really changed. Our manager tries to limit it to only one therapist that would be on the COVID-19 floors. She doesn’t want us to go from those floors down to the regular floors. We need to make sure that we’re not spreading it.
*PPE: personal protective equipment – worn to minimize exposure to hazards (masks, gloves, gowns, etc.)
Val: How important is PPE in preventing this spread?
Dr. V: PPE donning and doffing* is very important, which was what my last Instagram post was about. Everyone is trained on it, and we take our time with it because that’s how we protect ourselves. So those are the main changes, but other than that, I’ve been very lucky to have a full schedule. I still see around 7-9 patients a day depending on if they’re evaluations or treatments. So far, the number of patients I see is not different. It is just different in that sometimes they’re all COVID-19 patients.
*donning and doffing: putting on and taking off protective gear or clothing
Flattening the Curve
Val: I’ve heard that the curve is flattening now. Do you see that representation in the hospital or do you think the number of patients is still increasing?
Dr. V: That’s great that you asked that! I actually just got an email this week from our founders saying that the numbers have shown that we are plateauing. It’s not like we’re rising, but it’s also not like we’re falling. It’s basically showing that we’re admitting as many COVID-19 patients as we’re discharging, which is good. We’re not getting an overflow. Of course, we want to see a decline, but at least for now, in my hospital and LA county, it looks like it’s flattening out. Unfortunately though, that’s not the case everywhere. My friend messaged me, and she works in the San Diego area and told me that she has actually seen an increase in patients. It’s interesting because she works at a hospital right at the border. Certain hospitals in Mexico don’t have enough PPE, so patients can’t be seen there. Because of that, people are coming to some of the hospitals at the border to get treatment there. So that’s why in her area, we’re seeing a rise in the numbers. It’s weird; it really depends on the geography and demographics. It’s also affected by how much people are following social distancing because I don’t know if we’re about to get a second wave due to some recent protests.
Val: Yeah, I was going to ask you about that! What do you think about these protests happening because of the stay-at-home order, and how important do you think it is for people to stay home and follow social distancing?
Dr. V: Man, I’m going to be kind and say it’s really silly and irresponsible to be participating in large gatherings. That’s exactly what medical professionals are saying NOT to do! I totally understand free speech and speaking your mind, but you can do that virtually too. It doesn’t make me feel good, and people at the hospital have talked about it. We believe that there’s going to be a second wave because of people wanting to gather in large crowds like that against medical advice. There are ways to exercise your freedom of speech without endangering the public. Also, it’s a little, if I can say it, a little ungrateful. It’s ungrateful for the great work being done by hospitals, scientists, and essential workers. I’m sorry that being at home is tough but, you know what’s also tough? Being mechanically ventilated and not being able to see your family. I think that’s tough. It’s just a matter of perspective, and people just need to see that this virus is real and affecting people. If you can do your part by staying at home, why not? It’s working! We see it working!
Val: Have you heard of any misinformation that has been floating around? I know there are so many different sources where people are getting their information from, and, because of that, they feel like it’s not real or as bad as you’ve seen it to be.
Dr. V: I’ve heard those. I’ve heard people believe that they don’t think it’s a real thing. Somehow, we have to show proof of our sick patients? It’s really odd. I’ve heard that it’s a government conspiracy in order to make people stay home. I think the government just wants to contain the virus! Those are the things I’ve mostly been hearing.
Val: So what do you want the general public to know about this disease, and what do you suggest people, who are not essential workers, do in order to get through this time?
Dr. V: I really want them to know that this coronavirus is serious. I’ve seen it really affect patients, and not just medically either. Depression is a real thing in the hospital, especially when the hospital is on lockdown. Patients can’t see their families. I’ve had patients just break down and cry. I just feel so helpless; I don’t know what to do. For one, you’re sick because of a virus that you’re hearing on the media is killing people. And two, you can’t see your social support because we want to prevent the spread of the disease. These patients are locked in rooms where the doors are closed, where a very limited amount of people are allowed to go in. It’s very isolating for them. I really want people to empathize with them and understand that we need to play our part because of those patients. They’re going through probably some of the hardest moments of their lives, and I feel like it’s our responsibility to uplift them and respect their struggles. My call to action for people is to stay at home, limit going out as much as possible, wash your hands, make sure to wear a mask, and also, take care of your own mental health. Call a friend, go on Zoom, use other virtual ways to talk to people. There are ways to feel connected and not be so isolated, while also protecting the public and respecting the struggle of our patients. That’s what I want.
“My call to action for people is to stay at home, limit going out as much as possible, wash your hands, make sure to wear a mask, and also, take care of your own mental health.”
Val: Do you expect this to go on for a longer period of time? What do you think is going to happen when everything goes back to “normal”?
Dr. V: Unfortunately, the talk in the hospital is that this is kind of the new normal. I think we’re going to have a COVID-19 floor for a while, especially because of how widespread this virus really is. I think we’re always going to have people patients trickling in that are COVID-19 patients. I don’t know when it will end, but it might end is when we get a vaccine. The earliest I heard that we can get it is maybe September? That’s exciting, but that’s still a little while away, and it’s also a maybe. This might be our new “normal.”
Val: Is there anything else you want people to understand about the coronavirus and physical therapy in general?
Dr. V: I want people to know that we are heavily involved. Physical therapists are essential. I’ve heard talks that certain hospitals aren’t giving therapy and rehab to their patients. However, thankfully, our department really advocated for these patients. We got some pushback because of the fear. But I feel like this is a shining moment for physical therapists to show how important we are, not just for sick patients, but also in a pandemic crisis. We play a vital role so that patients can get up and moving out of the hospital and back home. We ensure the safety of the public in a way, and I think that’s super important. This is a great opportunity for our field; we’re so important in the hospital and in the lives of our patients.
“Physical therapists are essential.”
Hope you guys enjoyed reading the interview on physical therapy and the coronavirus! I’m so thankful that essential workers, like Dr. V, are fighting this pandemic head on and risking their lives to help others. If you found this helpful, make sure to share it with your friends! Head over to Dr. V’s instagram for more helpful information on this virus and physical therapy! See you guys on the next blog post!
