Founder Letter: It’s Time to Prepare for the Second Wave and Beyond

Time gets a little funny when you’re in lockdown—something that has become a nearly universal experience over the past eight months. When all of your days start looking the same, the human brain has a difficult time holding onto the memories that differentiate each one from the next. That tedium is one of the many reasons picking up a new hobby during the pandemic is a very wise idea (mountain biking and piano have been mine), and it’s also one of the reasons so many of us are eager to get back to our “normal” lives.

In many ways, our lives have regained some semblance of normalcy—especially compared to the situation back in March and April. Most businesses and schools have reopened in some capacity, and people are cautiously emerging from their homes and resuming some of their social activities—albeit with caution and some alterations.

The US is still very much in the woods.

However, I’m concerned that this race to return to our former lives is premature—and many health experts agree. When it comes to COVID-19, the United States is far from being out of the woods. In fact, at the time I am writing this article, according to Reuters, the US has exceeded the peak infection numbers we saw over the summer. If you’ve been paying attention—and as healthcare providers, parents, and/or community members, I’m sure you have—this shouldn’t come as a surprise: experts have been warning us for months of another COVID wave that will coincide with the holidays and the regular cold and flu seasons. Not only are the cooler, cloudier, and dryer conditions more conducive to the transmission of these types of viruses, but people also tend to remain in close quarters during the winter months, which makes social distancing exceedingly difficult. It would appear that the second wave is already upon us, but experts say it’s more like an extension of the first wave—an unfortunate consequence of failing to take proper steps earlier this year.

Now, here’s the good news: we’ve been through this once already, and we know what to expect. (The team here at WebPT actually put together this guide to rehab therapy in the age of COVID-19 to help practices prepare for the expected additional case spikes.) All of us—rehab therapy providers and patients included—were caught off guard the first time around, and it is critically important to our future viability that we prepare ourselves for the waves ahead.

The next several months will be key.

Now, I don’t want to be all doom and gloom—especially when there are reasons to be optimistic. As of today, there are five potential vaccines in the final stages of testing, and according to Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, a vaccine will likely become available to the public as early as January 2021. Others predict that it will be available to select groups in early 2021 and the general public by mid-to-late summer. (The dates are still iffy due to ongoing testing and the pending emergency use approval.)

Some are saying we could see a return to some form of normal life (i.e., one that includes large events, group gatherings, and travel) by summer 2021. However, that’s assuming we not only have a viable vaccine—or multiple vaccines—available for widespread public use, but also that:

1. as many people as possible actually receive vaccinations,
2. there aren’t any major complications, and
3. there is a public willingness to continue adhering to safety precautions (e.g., mask use and social distancing).

That’s a lot of ifs. And here’s one more: Even if all goes to plan and we see widespread vaccination early next year, we still won’t be 100% “back to the way things were before.” That’s because, as we’ve seen over the past eight months, social—and political—challenges are waiting at every turn, and we should not expect the next six to nine months to be any different. After all, even after we have a vaccine, it may only be 50% effective, meaning people will continue contracting the virus—and others will continue doubting the vaccine’s efficacy. So, that means mask-wearing is here to stay for the foreseeable future.

This is not the time to let our guard down.

Eventually, we’ll see another decline in case numbers—which means there’s a strong chance we’ll see more people downplay the seriousness of the pandemic. Up until a few weeks ago, the test positivity rates for the virus were down compared to where they were over the summer—likely the result of widespread safety measures like mask mandates, group size restrictions, and reduced caps on business capacity. But, there were many folks who took this development as a sign that we were nearing the finish line. 

And when you have a restless population of people who have been relatively isolated for months, many want to believe we’re almost done with this thing. Unfortunately, this false-hope mentality has given way to more spikes—and suddenly, it’s like we’re back at square one. With winter on the way and many heading indoors, the data is showing we are on our way back to mini-lockdowns and hospital capacity issues in some areas.

It’s go time for clinic leaders.

As physical therapists, your first concern should obviously be the health of your patients. But if you’re a practice owner or leader, the financial health of your business—as well as the health and safety of your team and their families—should also be at the top of your priority list. After all, patient safety starts with clinic and staff safety.

Tighten up your clinic’s revenue cycle management.

As I write this, Congress remains at an impasse regarding additional small business loans and PPP funding. However, an agreement may come shortly after the presidential election—regardless of the outcome. If that happens, you’ll want to apply for any necessary funding the moment it becomes available. In the meantime, though, turn your attention to the financial variables you can control. Take a look at your current revenue cycle, complete all outstanding documentation on completed visits, and push out any claims that have not yet gone to payers. You may also want to run through your A/R and push even harder to collect outstanding balances. (Just keep in mind that many patients may be in a tough financial situation themselves, so consider working out alternative arrangements with these individuals to avoid losing their future business.)

Review your staff and patient-facing policies.

When maneuvering through the intricacies of any disaster—especially a pandemic—it’s critical that you have a robust scheduling and sick leave policy in your organization. Clinic management can support social distancing via thoughtful scheduling. If clinics stagger the times that front- and back-office staff and therapists come into the office, it’s much easier to monitor and limit the number of people who are inside the clinic at any single point in time.

But, that’s not the only critical element to an effective pandemic staffing policy; establishing a rock-solid sick leave policy that maximizes employee and patient safety is of the utmost importance.

Additionally, be sure to adjust your intake, check-in/check-out, and treatment procedures with patient safety in mind:

• Masks should be worn—with both nose and mouth covered—by all staff and patients at all times within the clinic.
• Gloves may also be appropriate for clinicians providing manual therapy treatment.
• Patients should be spaced at least six feet apart on the treatment floor.
• Visitors and patient family members should wait outside of the clinic whenever possible.
• Hand sanitizer should always be available for staff and patient use.
• Team members should adhere to proper handwashing and surface sanitization protocols.
• Telehealth and virtual services should be available—and encouraged—for any patients who are good candidates for remote care.

Furthermore, all of these precautions should be shared in staff meetings and with patients prior to their visits—both during the office visit and on your website. Broadcasting your thought leadership as a medical provider in disease prevention and spread is important to our overall profession and industry.

Plan ahead for future layoffs, furloughs, or clinic closures.

Many practice owners faced a harsh reality earlier this year: lower patient volumes led to excruciatingly difficult staffing decisions—or total clinic closures. In fact, a few practices still have yet to reopen their doors since closing back in March—and in some instances, those closures sadly will be permanent. This is where developing a solid communication plan with key metrics and guidelines is essential. As infection rates continue to rise, transparency and frequent communication with your team and patients will be critical to maintaining trust amid anticipation of potential clinic closures or necessary staffing changes. 

We must rise above the fear rhetoric.

I don’t believe fear-mongering is an effective approach to anything. In this case, trying to make people afraid of a virus that the vast majority of people survive only emboldens some to not take it seriously. But mortality rates aside, there are still plenty of good reasons to take it seriously. For example, many people who contract and survive the virus experience a significantly diminished quality of life in the long term. Many have experienced symptoms like brain fog, fatigue, and joint pain months after infection—and some end up requiring hospitalization, which may lead to extensive rehabilitation to recover from weeks of lying in a hospital bed.

These are things we know. But beyond that, there is still so much about COVID-19 that we don’t know. Again, I’m not saying we should blow up this fear of the unknown in an effort to scare each other into taking precautions. It shouldn’t be about “being afraid” versus “not being afraid.” It’s about respecting the virus and recognizing that we still have a lot to learn. It’s about owning our lack of comprehensive knowledge. There is still so much research that must be done before we can fully understand the impact this virus will have—and has had. We still don’t know why some cases are so much more severe than others. We still don’t know what all of the long-term health effects will be after recovery. So, respect that lack of certainty, and don’t let your positions and actions be driven by fear or the need to “conquer” fear. Just put on a mask, stay six feet away from people, practice good hand hygiene, and use common sense as you go about your daily life.

It’s time to start thinking about the future.

All of this is to say, we’re going to be dealing with the fallout of COVID-19 for a long time—in our daily lives and in the clinic. As I mentioned before, careful adherence to safety precautions will be necessary for some time—even after we have a vaccine. But beyond our role in mitigating outbreaks, rehab therapists will play a major role in restoring health for patients who survive the disease.

As I explained in the previous section, one of the most perplexing aspects of the novel coronavirus is the lingering long-term effects of the illness. According to a recent UK study (referenced in this JAMA Network article), “approximately 10% of people who’ve had COVID-19 experience prolonged symptoms.” Furthermore, a recent JAMA research letter stated that “125 of 143 Italian patients ranging in age from 19 to 84 years still experienced physician-confirmed COVID-19–related symptoms an average of 2 months after their first symptom emerged.” And if we look back to our experience with severe acute respiratory syndrome (SARS)—a predecessor to COVID-19—we know that some patients continued experiencing diminished lung function for up to two years after their initial diagnosis (according to this survey). But COVID-19 symptoms aren’t just persistent; they’re also prolific. COVID-19 “long haulers” have reported a myriad of symptoms, from upper respiratory issues to chronic fatigue to heart inflammation. PTs have a significant role to play in getting these patients back to full function, and we must take the lead in driving these patients into our clinics now.

PTs are—and will remain—essential to combatting illnesses like COVID-19.  

Physical therapists have proven themselves invaluable when it comes to post-COVID rehabilitation, and the persistence of COVID symptoms will only reinforce the value of PT in a post-pandemic world. After all, this won’t be the last pandemic. In fact, we’ve had five near-misses in the United States over the past two decades: swine flu, avian flu, ebola, MERS, and SARS. COVID-19 just so happened to be the one that got us. In other words, this is not a one-and-done kind of thing. Pandemics will be a concern for the US health system indefinitely, which leaves a massive opportunity for PTs to assert their value—namely, by addressing comorbidities at the population level.

While COVID-19 has reached virtually every corner of the world, the United States remains the hardest hit—and our relatively high incidence of comorbidities is one of the biggest reasons why.

According to The Commonwealth Fund, the US “has the highest chronic disease burden” compared to 10 other high-income countries, as well as “an obesity rate that is two times higher than the OECD average.” Furthermore, Americans had the lowest life expectancy and experienced 50% more hospitalizations for both hypertension and diabetes. Here’s the kicker: according to the CDC, all of these conditions increase the risk (or potentially increase the risk) “of severe illness from the virus that causes COVID-19.”

Again, we still have a lot to learn about COVID-19, but one thing is clear: physical therapists are specially trained—and perfectly positioned—to address the comorbidities that complicate the disease. And by doing so, we can help Americans be better prepared for whatever new viruses lie ahead.  

The data is out there, but we must drive the research.

Unfortunately, PTs are still suffering from a major branding problem, and it’s not going to be fixed with a single call-to-action or social media post. But, we have an opportunity to more strongly assert our value as our nation recovers from the pandemic. Consider this recently published study, which found that cardiorespiratory fitness reduces the incidence of hospitalization (as well as lowers the risk of complications) following a COVID-19 infection.

To me, this is massive, and physical therapists should not only be blasting these findings on their websites and social media pages, but also calling for more research that directly implicates the critical need for their services and expertise in a post-COVID era. In the meantime, there is no reason to wait for research when it comes to population health issues—namely, reducing the high incidence of comorbidities that lead to a higher mortality rate from the disease. We’re talking about the future of our population here, and a focus on relevant problem-solving now will help carry our profession into the next era of health care.

Here’s the bottom line: prepare yourself for the next few months—but also think beyond that to the next few years or even the next few decades. I know we’re all ready to be done with COVID, but COVID isn’t ready to be done with us. PTs have a huge opportunity in front of us—but we must persevere and own our role as healthcare leaders. If we take it one step at a time and focus on facts over rhetoric, I know we can—and will.