The novel corona virus came into existence in Dec 2019 reported for the first time from the Chinese district of Wuhan. On 30th January 2020, the World Health Organization (WHO) declared an epidemic and on 11th March 2020 COVID-19 was defined as a pandemic. The first case of COVID 19 was reported on 30 th January 2020 in India while Maharashtra saw its first case on 9 March 2020. MGM Hospital was declared a COVID hospital in March 2020. Being strategically located on the outskirts of rural areas of Raigad district and urban part of Navi Mumbai, the hospital received an inflow of patients from both areas.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a highly contagious Coronavirus Disease 2019 (COVID-19) which is transmitted from human-to-human transmission via droplet infection from coughing, sneezing, or a runny nose within two meters of the infected person. A large majority of our cases were people with mild to moderate respiratory affection while 3-5% of patients presented with acute respiratory distress, with lung CT scan demonstrating multiple mottling and ground-glass opacity and diffuse lung consolidation. These patients required admission to the intensive care unit (ICU) and oxygen therapy.
The Physiotherapy team is trained to use all infection control guidelines throughout therapy. Physiotherapists were trained in correct donning and doffing of PPE, wore surgical mask, fluid resistant long-sleeved gown, Goggles/face shield, Gloves, N95/P2 mask, hair cover and shoe cover.
Goals of Physiotherapy intervention and management strategies:
Goal of physiotherapy in acutely ill patients in the ICU were to minimize the complications of the prolonged recumbent position and to facilitate oxygenation.
Physiotherapy management includes active therapeutic positioning and breathing exercises to reduce the work of breathing, improve lung capacity, facilitate oxygenation, improve functional capacity and to prevent ICU acquired muscle weakness by using active range of motion (ROM) exercises. Physiotherapy treatment plan is individualized based on the patient’s clinical condition and comorbid factors. Physiotherapy interventions in the wards included range of motion exercises, progressive strengthening exercises, progressive mobilization, exercises to improve balance and to induce relaxation. Patients are monitored continuously throughout the entire physiotherapy process. The treatment plan is individualized as feasible in the acute and in-ward patients to improve the patient's condition and prevent immobilization-related complications. During exercise, oxygen saturation, heart rate, blood pressure and respiratory rate are monitored continuously. The level of exertion is maintained at 3-4 points on the Borg scale which is indicative of moderate exertion.