Renee Kinder

Let’s face it: COVID-19 is here to stay for a while and as our summer season ends another season is on the way.

Flu season.

Rehab professionals, in their effort to stay steadfast in caring for and promoting recovery of individuals recovering from COVID-19 must be prepared for both.

And not just both individually, but both in conjunction with one another. 

In a recently published article in Journal of the American Medical Association (JAMA), titled “What happens when COVID-19 Collides with Flu Season?” the following were noted:

  • “Coinfection was a significant risk factor for prolonged hospital stay,” … In addition, studies found that COVID-19 patients who were coinfected with influenza shed SARS-CoV-2 longer than other COVID-19 patients (17 days vs. 12 days on average).
  • Northern California, laboratories that simultaneously tested for SARS-CoV-2 and other respiratory pathogens found a tenfold higher coinfection rate (20.7%)

What does this mean for the rehab team?

To begin, we must remain dedicated to effective infection control procedures. Communities should already be familiar with CMS’s infection control survey tool and refer back to the guide often for reference and updates. 

Keen observation should be given to areas in red, as these are a cue that the updates are new. 

Take, for example, recent additions to the Covid-19 Focused Survey for Nursing Homes per the August 26 Interim Final Rule

Surveyor(s) are now conducting reviews for:

  • Standard and Transmission-Based Precautions (review care of a resident under observation, suspected of, or confirmed to have COVID-19 infection); 
  • Quality of resident care practices, including those under observation, suspected of, and confirmed to have COVID-19 infection, if applicable; 
  • The surveillance and testing process; 
  •  Actions taken to prevent transmission, such as cohorting and managing care for residents suspected of having or confirmed to have COVID19;
  • The infection preventionist role.

Hand hygiene updates now include:

  • How are residents reminded to perform hand hygiene?

And Personal Protective Equipment (PPE) was updated to include the following:

  • Are all staff wearing a facemask (e.g., a cloth face covering can be used by staff where PPE is not indicated, such as administrative staff who are not at risk of coming in contact with infectious materials)?
  •  When COVID-19 is present in the facility, are staff wearing an N95 or equivalent or higher-level respirator, instead of a facemask, for aerosol generating procedures?

Consider based on above:

Are your rehab teams appropriately integrated and engaged in cohorts along with adhering to facility policies?

Are there effective cleaning methods in place for therapy materials and tools?

Is adherence to PPE being considered?

And what are the outlined methods for patient hand washing during, and after rehab services?

Next, we go back to our therapy roots and remember what we know about the risk factors for respiratory based illnesses and the impact of respiratory impairment on the road to recovery.

Considerations should include:

Effective discharge planning that begins day one.

Ensuring our patients and their loved ones understand effective techniques to be used for activities of daily living and the residual impacts we may see after recovery from flu, COVID-19, or a combination of the two. 

So, what will a combined COVID-19 and flu season look like?

Right now, it’s too early to tell.

I will close with scenarios from experts outlined in the above mentioned JAMA article. 

The best-case explanation for the Southern Hemisphere’s mild flu season is that COVID-19 mitigation strategies are tamping down the spread of other respiratory viruses, said Brendan Flannery, Ph.D., coauthor of the letter calling for systematic testing for both influenza and COVID-19. 

But the worst-case scenario is that COVID-19 has overwhelmed healthcare systems, so people with the flu are staying home and not being counted or seeking care but getting lost in the crowd of COVID-19 patients, said Flannery, lead investigator from the U.S. Centers for Disease Control and for the US Flu Vaccine Effectiveness Network.

“We’re all going to learn a lot,” Osterholm said of the upcoming flu season.

“We can speculate until we’re blue in the face, and I don’t think we know yet what’s going to happen.”

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).