Ever since 1951, the 8th of September has been World Physical Therapy Physiotherapy Day, a day which signifies a time for unity and solidarity with for the global physiotherapy community. Each year there is a new theme to focus the professions attention and this year the theme is Rehabilitation and Long COVID.
The Impact of COVID-19 on Fragile Health Systems and Vulnerable Communities
The pandemic has exposed fragilities in health systems in all settings. While it’s true that many vulnerable communities and fragile health systems are located in low and middle income countries, the pandemic has exposed the fragility in many higher income countries’ health systems too.
COVID-19 has highlighted the insidious growth in the socioeconomic divide in health outcomes between the rich and the poor. It’s a matter of fact that COVID-19 disproportionately affects the poor and the economic fall out of the pandemic will be felt for years to come.
We know that COVID-19 exposure was greatest in people in precarious low paid manual jobs which could not be completed at home. Often these people live in dense overcrowded urban areas without access to outside spaces, which is also associated with poor health outcomes. Poorer communities are also more vulnerable to severe COVID-19 infection because of higher levels of pre-existing illness. Therefore they are also more likely to develop long COVID symptoms.
These increased infection rates lead to loss of income putting immediate financial pressure on the most financially vulnerable, perpetuating a downward cycle in health outcomes. This is a demonstration of the importance of the interplay between health, wealth, community and environment.
The Fragile Nature of Rehabilitation Services Exposed
In fragile health systems, rehabilitation services are not viewed in the same light as other medical or curative services. This results in underfunding which creates a mismatch between supply and with real-world demand.
During the pandemic many rehabilitation services were suspended to allow staff to be redeployed to services focussed on managing the acute phase of the pandemic. This has caused a significant backlog in service provision which is a serious challenge. As rehabilitation plays a vital role in enabling people to return to work and contribute to their communities the economic knock on effect of being unable to access rehabilitation is not yet fully known. With the current backlog to rehabilitation services and clinical-fatigue among healthcare providers, there will be a real impact on people needing rehabilitative care.
Add long-COVID into the mix and we have a serious problem with not only those with existing rehabilitation needs being unable to access crucial services but potentially a surge of thousands who need post-COVID rehabilitation. Furthermore the type of rehabilitation that people require post-covid extends beyond physical rehabilitation into psycho-social support. This is a challenge for many services which do not provide these now essential services.
As World Physiotherapy rightly states in their briefing paper, “Now more than ever, physiotherapists have to emphasise their value by highlighting the role rehabilitation plays in reducing overall disability and burdens on the economy of a country”. Physiotherapists have played an important role both in the management of the COVID-19 crisis, and will continue to be vital to help people return to a functional state of health.
So for this World Physiotherapy Day, consider what you can do to promote the role of rehabilitation in your community and raise awareness of the importance of access to rehabilitation for all particularly those living with long COVID.
What is Long COVID
Around one in ten people who contract COVID-19 will experience a wide variety of long-term consequences both mentally and physically, the umbrella term for this is long COVID.
One of the more common and most misunderstood symptoms people living with Long COVID struggle with is post-exertional symptom exacerbation (PESE). This is a complicated condition which is poorly understood and is often associated with a damaging stigma despite being an internationally recognised cardinal sign of conditions such as ME/CFS.
In essence, a person struggling with PESE struggles to produce energy on demand which causes symptoms such as fatigue, exhaustion, difficulty thinking and pain; all of which are made worse by exertion. It is a vicious cycle and can have a real impact on a person’s quality of life.
This exertion isn’t limited to physical exertion but includes cognitive and emotional exertion too highlighting the need for more than just physical rehabilitation. PESE symptoms are variable in severity, intensity and consistency which means the condition is challenging to manage in a single session further impacting service provision. There are some great resources on the ME/CFS South Australia INC Website for more on PESE. Also check out the DePaul Post-Exertional Malaise Questionnaire, a reliable and validated tool, to assess the severity of the PESE symptoms.
What You Can Do Now
- Read the World Physiotherapy Briefing Paper (available in 9 languages with and 5 more soon)
- Keep your eye out for research such as the REGAIN Trial. This is a multicentre RCT comparing different forms of online, 1:1 and group rehabilitation and supervised home based rehabilitation for those living with long COVID.
- Learn More About Long-COVID with an online course
- Vitis the long-covid.physio website
- Take part in our MOOC to develop your understanding of health systems
- Be thankful towards the healthcare providers who are doing everything they can to improve a person’s quality of life.
- If you have ever been treated, are being treated, or know a physiotherapist, recognize their efforts and be a champion of their profession. Thank a physiotherapist today!
This work is supported by the USAID funded Learning Acting Building for Rehabilitation in Health Systems (ReLAB-HS) project and is not possible without the generous and committed contribution of the Leahy War Victims fund.
ReLAB-HS is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and is implemented under cooperative agreement number 7200AA20CA00033. The consortium is managed by prime recipient, Johns Hopkins Bloomberg School of Public Health.