‘Not Just Dots On a Map’: SLPs Speak Their Truth From the COVID-19 Battlefront

COVID-19 people map

Tuesday, March 10. Speech-language pathologist Fatima Warren was grocery purchasing along with her grandmother when she first seen the painful physique aches. Chalking it as much as the wet day and an earlier exercise, she ran a scorching tub.

Wednesday, March 11. Warren wakened with chills, fever, and worsening aches. She drove straight to the closest ER in her hometown of Lexington, Kentucky. There, employees ran quite a few checks, however not for COVID-19. The 45-year-old didn’t qualify as a result of she hadn’t traveled outdoors the nation and couldn’t identify a contact with the virus.

Thursday, March 12. Worried about infecting her 13-year-old son and 87-year-old grandmother—who lives with them—Warren shuttled between the ER, pressing care, and the native well being division in pursuit of COVID-19 testing. Meanwhile, she fought shortness of breath. “I stored taking these huge deep breaths out of nowhere,” she says.

Fatima Warren

SLP Fatima Warren battled to get examined for COVID-19. She obtained a constructive end result.

Fast-forward every week: Warren self-quarantined to guard her son and grandmother and at last obtained a COVID-19 check after badgering the well being division nonstop. It got here again constructive. The operator of a cellular fiberoptic endoscopic analysis of swallowing (FEES) clinic, Warren final ran FEES on a affected person Feb. 19 and doesn’t understand how she contracted the virus.

She can also’t fathom why it was so onerous for her, a well being care employee, to get examined. Unfortunately, different SLPs on the well being care entrance traces are encountering comparable obstacles as they rush in to assist contaminated sufferers in hospitals and expert nursing services (SNFs). Even as they threat publicity to the virus whereas treating the sufferers they look after deeply, many have restricted or no entry to testing and private protecting gear (PPE—robes, facemasks, N95 respirators, and/or powered air purifying respirators [PAPRs]) as a consequence of a nationwide scarcity.

While some employers have pulled SLPs out of direct therapy—transferring them to digital providers or to supporting different overburdened employees—it seems that many, if not most, have designated SLPs as “important personnel.” This means SLPs are required to proceed treating sufferers instantly. For these SLPs, performing endoscopic procedures might pose specific dangers due to potential contact with excessive viral concentrations within the nostril and nasopharynx.

According to ASHA’s steering on SLP well being care providers throughout COVID-19 (see extra associated sources on the finish of this put up), “procedures reminiscent of FEES might contain the usage of sprays, which might aerosolize the pathogens on the mucosa.” Given the danger, ASHA recommends that endoscopic procedures be delayed each time potential, and that full PPE be supplied to clinicians when performing these procedures. This advice derives from a risk-assessment framework issued by the Centers for Medicare and Medicaid Services (CMS).

Leader Live spoke with SLPs throughout the gamut of well being care settings about COVID-19’s results on them and their services. Many requested to not be recognized to guard their privateness and/or as a result of their employers have forbidden employees from talking with the media. Others, like Warren, are wanting to share their names.

“It’s so vital to symbolize untold truths—placing a face with a narrative—so that folks don’t really feel threatened or shamed by COVID-19,” Warren says. “All we hear and see are the numbers and dots on a map. When, in truth, the dots on the maps ought to actually be my face, your face, the faces of our co-workers, members of the family, church members, and buddies inside our group.”

Here are your colleagues’ tales.
Biji Thomas, Milwaukee, Wisconsin

Today marks the tip of two weeks of self-quarantine for Biji Thomas, an SLP—and model new dad—working in acute care at Aurora Medical Center within the Milwaukee suburbs. On March 19, he and his spouse rushed to the hospital for supply of their first little one.

The subsequent day he acquired the decision: A affected person he had handled for dysphagia for 30 minutes on the 18th had simply examined constructive for COVID-19. The hospital suggested him to self-quarantine instantly, so he fled the maternity ward—and his spouse and new child—for his brother’s condominium. (His brother moved out briefly.)

“It’s been very onerous,” says Thomas of the separation. “But I’m doing what I’ve to do.”

During his two weeks of isolation, Thomas was grateful for the video chats that helped him really feel related to his additionally self-quarantined spouse and new child son. Fortunately, none the members of the family developed signs, and immediately they’re lastly collectively once more.

Linda (identify modified), Midwestern metropolis

At the Midwestern hospital the place Linda works, management have instructed SLPs to not present direct providers to sufferers beneath investigation for COVID-19, or to sufferers who’ve examined constructive.

However, employees are nonetheless not shielded from sufferers who might have the virus however are asymptomatic or not but exhibiting signs. For instance, a affected person Linda lately noticed for a swallowing analysis started exhibiting signs proper after the process. Per the hospital’s course, Linda continued seeing sufferers. But she frightened that she may infect them as—for 4 days—she awaited the affected person’s COVID-19 check end result. Fortunately, it got here again damaging.

“It’s a scenario that raises moral questions on either side,” says Linda. “Continuing to deal with sufferers means presumably being uncovered. But not doing so means we depart individuals with authentic wants for care with out care.”

And, as a result of PPE scarcity, most SLPs at her hospital aren’t sporting masks. This makes virus publicity inevitable. Another affected person Linda evaluated additionally simply underwent COVID-19 testing, once more triggering worries about viral transmission. Per hospital protocol, Linda is self-monitoring for temperatures above 100 and different signs for 14 days. She continues working however is required to masks. If the affected person’s check comes again constructive, she’s going to await directions.

“When we do swallowing evaluations, individuals cough and sneeze, vastly elevating our publicity threat,” Linda says. “We can considerably scale back that threat once we are in a position to make use of PPE.” As a workaround, many employees save their highest-risk sufferers for day’s finish: “So we will instantly bathe off and scrub down with high-level disinfectant.”

Given the dangers, Miller would like to see SLPs just about guiding different medical personnel—who’re prioritized to put on PPE (that’s occurring in some locations). Nevertheless, she’s impressed with how onerous her rehab workforce is working to maintain each other and their sufferers protected. She urges fellow SLPs to self-advocate for PPE. “I’ve requested that each one SLPs the place I work be allowed entry to masks throughout medical swallowing evaluations,” she says. “So far this has not been accredited.”

Gia (identify modified), San Francisco Bay Area

As COVID-19 began hitting the Bay Area three weeks in the past, Gia wore a masks to her job at an acute-care hospital. Many of her SLP colleagues did the identical, till their rehab supervisor pulled them apart.

“She flagged us for sporting masks, asking why we have been sporting them,” Gia says. “She mentioned, ‘If you’re feeling sick go house. If not, don’t put on masks across the sufferers. We don’t wish to create a tradition of worry.’”

A number of days later, extra employees started masking. Again, their supervisor suggested towards it as a result of N95 masks provides have been working low, and employees at increased threat needed to reuse them. That similar day, Gia performed a modified barium research on a febrile aged affected person (in her 70s) with a cough. The subsequent day the affected person was on COVID rule-out—exhibiting signs and present process testing.

“Right away, I informed everybody on the fluoroscopy suite to masks up,” says Gia. The worker well being line suggested her to maintain working however put on a masks—and examine her temperatures twice a day. That weekend, on Saturday night time, Gia felt the primary signs approaching: a fever and sore throat. The signs escalated, and Gia known as in sick on Monday. That prompted a flurry of texts from her supervisor, who pressed her for particulars on her signs and urged nervousness was possible the offender.

“She informed me to meditate,” Gia says. “I couldn’t imagine it. She actually simply needed me to come back again to work.” After a lot forwards and backwards, the hospital suggested Gia to hunt COVID-19 testing at an pressing care. She ultimately dragged herself to do it, and shortly after discovered that her COVID rule-out affected person had simply died of lung most cancers (the affected person’s COVID-19 swab had been misplaced).

Gia’s personal check got here again damaging, however she isn’t certain meaning she’s virus-free. She’s been watching co-workers’ group texts about utilizing bathe curtains as shields—and he or she simply can’t convey herself to return to work. “I do know I’ve to resign,” says Gia. “You need your employer to take a disaster like this severely, to really feel like they may defend you from the dangers. It’s about belief. And that’s all gone.”

As Gia negotiates the phrases of her employment termination, she’s considering shifting to telepractice or different specialization areas. “I don’t know,” she says. “Maybe there may be some divine side to this. You begin asking, ‘What are the true priorities in my life?’”

Ashley Lopez, Houston, Texas

Staff are bracing for a barrage of COVID-19 sufferers at Houston Methodist Continuing Care Hospital. As the virus tore via the Seattle, San Francisco, and New York City areas, the hospital—which homes the Texas Medical Center system’s extremely infectious illness unit—had a slight reprieve. Just a little additional time to arrange.

“We’re prepared,” says SLP Ashley Lopez, who’s stationed within the hospital’s long-term acute care unit. The hospital has expanded its beds by 50% and designated two contained items for COVID-19 sufferers. Lopez and the workforce of SLPs she leads have been equipping iPads for communication between sufferers and suppliers—including automated communication boards and downloading trach instruments apps.

Using ASHA steering, Lopez has additionally advocated for her SLPs to carry off performing FEES till sufferers are stabilized—and to obtain N95 masks and face shields when performing swallowing evaluations. Her unit’s infection-control practitioner helps this course as a part of hospital protocols put in throughout the 2004 Ebola outbreak. “If we have now to threat our well being, it’s the most effective safety we may hope for in a really tough scenario,” Lopez says.

And so, they wait. “It’s the calm earlier than the storm,” Lopez says. “But we acquired via Hurricane Harvey collectively. And we’ll get via this.”

The following are verbatim tales informed within the phrases of SLPs themselves (extra are being added as we obtain them; per request, names have been modified the place indicated).

Linda Stuart, Kaiser Permanente (acute care), San Diego

As you already know, the COVID-19 pandemic has resulted in ever-changing protocols in order to finest defend our sufferers and ourselves.

On Tuesday, March 24, I accomplished a bedside swallow analysis on a affected person who had no precautions within the chart nor room. At that point, we have been instructed to avoid wasting PPE for sufferers in isolation solely. I confirmed with the affected person’s RN that the affected person was protected to guage earlier than getting into the room. After finishing oral care, oral mech examination, and starting oral trials, the RN got here in and knowledgeable me that the affected person had been uncovered to somebody who was constructive for COVID-19. She had simply acquired phrase.

I left the room, washed up totally, placed on PPE, after which returned to finish my swallow eval. The affected person was then examined for COVID-19. My supervisor despatched me house as a precaution till the affected person’s check got here again the following day. It was constructive, and I used to be positioned on 14-day quarantine at house. I haven’t been examined.

Due to this incident, my coworkers are actually allowed to put on masks when doing oral care or bedside swallow evals with all sufferers, not simply these on droplet precautions. Today my supervisor despatched a message for us all to put on a masks with each affected person. So far I’m asymptomatic. Hopefully it’ll keep that manner.

 JY (identify modified), rural Alabama, outpatient assisted residing

As a FEES supplier, a lot of my services see me one to 3 instances every week to make sure we offer well timed instrumental assessments. At this time, in response to the Stanford University article and ASHA’s response, my firm pulled us from touring and stopped us from doing FEES for a short while.

I’m at present doing therapies in an assisted residing facility via outpatient. The constructing is on lockdown with no guests apart from important workers (no caregivers are allowed both). Every day, earlier than getting into the power, we’re mandated to put on a masks. Our temperature is taken and recorded on the entrance desk sign-in and within the remedy workplace. The receptionist asks us the vital questions concerning our potential publicity to COVID-19, and we’re instructed to instantly wash our palms previous to starting our work day.

The masks is worn by all professionals and workers within the constructing always. Masks are supplied to us as wanted. After we see a affected person, we should sanitize all gear (iPads, supplies, train gear). Once we’re completed for the day, we should signal out and depart the constructing. The sufferers are consuming all meals in rooms, and they aren’t allowed out of their flats.

My issues: I’ve seen some sufferers with cognitive decline having a fast change in psychological standing. Many imagine they’re being held on this place, and their households aren’t conscious of the place they’re. These cases are onerous, actually because, as an expert, I’m conscious of all of the analysis associated to socialization, routine, and cognition. Some know concerning the virus and perceive the rationale for the modifications. Others are unaware and don’t require a lot consideration. It has been onerous discovering the center floor of a affected person who requires extra nursing/doctor consideration for potential causes of modifications in cognition, or an individual who misses the interplay between buddies.

Ronda Polansky, DiagnosTEX, Hurst, Texas

We are nonetheless working our cellular MBSS [modified barium swallow study] clinic. We do have entry to PPE and are taking each additional precaution, utilizing disinfectants and sanitizing measures diligently. The sufferers come aboard, we display screen for regular temp and/or different signs. No different customer, employees, or household is allowed on the cellular clinic right now.

We are chatting with employees or households outdoors the cellular clinic after the research or chatting with them on the cellphone. The services are assembly us on the door with the affected person. Some of them display screen us as properly for temp, and so forth. Our concern is that if the services are doing their half adequately. One location in our space has had 9 instances. We are not servicing that facility.

The different concern is overreaction and making poor choices for the sufferers. One administrator informed us that he wouldn’t approve any instrumental evaluations, and that anybody coughing and suspected to have dysphagia will likely be tubed. I’m involved that there are numerous sufferers not getting the dysphagia analysis and therapy they want. If there may be any time {that a} affected person’s respiratory system must be as robust and uncompromised as potential, it’s now.

It is tough. Each new day brings one thing new from our authorities and native cities. The media stories a lot damaging data, by no means a constructive spin on something. Staff is frightened about their jobs and payments. As house owners, we’re frightened about our employees, payments, and total funds, and all choices to be made to verify we keep in existence. We are encouraging hope, constructive attitudes, workforce help, which will be contagious.

But it’s onerous to look previous the elephant within the room. Our referral supply has dropped not less than 50% as a result of so many services are not totally staffed with SLPs treating dysphagia. The stress stage may be very onerous to handle recently. As an proprietor, it consumes my whole psychological capability from AM to PM. My employees is prolonged household, and so they depend on me, and there’s a big sense of dedication to that.

The uncertainty of “how lengthy” it will final is so unsettling for each considered one of us! I imagine as soon as the nation will get again to working, we’ll work fuller schedules once more, however it is going to be a course of that may happen over months, not days, as a result of geriatric inhabitants affected by this virus. Long time period, this occasion will have an effect on us ultimately or one other for the remainder of the 12 months.

Rinki Varindani Desai, affiliate coordinator, ASHA SIG 13 (Swallowing Disorders), Jackson, Mississippi, Outpatient Academic Medical Center

We have been grappling with a number of points. Are we thought-about important personnel? What providers ought to we be rendering? Should helpful PPE be utilized by us or saved for different suppliers?

With the suggestions concerning avoiding aerosol-generating procedures—something which produces a cough—ought to we be doing FEES and MBS research, and on whom? How ought to service/supply change with COVID-19-suspected or constructive sufferers? Every facility appears to be making these choices in another way, and generally even on a case-by-case foundation.

From an outpatient perspective, most clinics have positioned sufferers on maintain for remedy providers. The largest problem right here appears to be associated to telehealth. At this time, Medicare has not prolonged telepractice to audiologists and SLPs, regardless of latest publicity concerning alleviation of penalties concerning noncompliance with telepractice necessities. This is irritating to say the least. It is important, significantly at a time like this, for us to have the ability to attain our sufferers and supply ongoing care, in order to attenuate the danger of re-hospitalizations, to maintain them protected, and to assist enhance their communication and swallow operate.

This world pandemic has impacted so many people on a human stage, too. It is disturbing to see the an infection and demise toll rising each day. We aren’t solely scared of being contaminated, however extra so of turning into carriers and passing it on to another person who is likely to be extra susceptible than us and should have critical penalties. At the tip of the day, all our fates are interconnected, and the mitigation of COVID-19 would require a number of extra weeks of world solidarity.

Rather than dwell on the problems at hand, I’ve tried to focus my power on creating options. I’ve been utilizing the Medical SLP Forum on Facebook to advertise information, provide help, and share sources with SLPs world wide. At my day job, I’ve been helping with the transition to telehealth outpatient providers and supporting the acute workforce as wanted. As affiliate coordinator of ASHA’s SIG 13, I’m fortunate to work with some wonderful colleagues. Together we created this record of sources to information SLP service supply throughout COVID-19. Using ASHA COVID-19 sources, we’re doing all we will to teach the general public, help clinicians, and advocate for affected person wants.

At my day job, I’ve been helping with the transition to telehealth outpatient providers and supporting the acute workforce as wanted. It has been heartwarming to see so many individuals step as much as help the group, regardless of social distancing. We all have a job to play. As we’re making ready for the worst, I hope for the most effective and urge my fellow SLPs to remain robust and be protected!

Nicole Troncale, Encore Rehabilitation, Clinton, Connecticut

I work in two totally different SNF areas for Encore, which staffs the rehab departments in numerous nursing properties. I’m a former classroom instructor turned college SLP, and solely began working in a SNF lower than a 12 months in the past. I’m seeing sufferers instantly; nonetheless, past swallowing evaluations, I don’t see myself as an important worker. During this pandemic, it appears pointless to be doing remedy for one thing like dysarthria and threat spreading the virus.

I didn’t have entry to masks at both SNF location up till final week. In truth, employees was informed by administration not to put on masks as a result of it could frighten the sufferers. Several sufferers at one location began exhibiting signs of the virus final week, and some sufferers have been despatched to the hospital. At that time, employees complained, and masks have been supplied (N95 and surgical masks). At the opposite location, we proceed to be informed to not put on masks, and none are supplied. I’ve been defying the rule for the previous two weeks, and have been sporting a surgical masks. However, I solely have one masks and I’m sporting it time and again, making it not very efficient.

My largest worry is that I’ll have been uncovered to the virus at one location, am not exhibiting signs, and should infect sufferers on the different location. My different moral concern is that, since guests haven’t been allowed within the constructing for a number of weeks, members of the family of sufferers aren’t conscious that employees members haven’t been utilizing protecting gear. I believe they might be surprised and dismayed to know the reality: that their liked one’s well being and survival will not be the primary curiosity of the individuals who run the nursing properties.

It appears that the scenario is being dealt with higher in some SNFs than in others. [To cope], I’m additionally doing yoga on YouTube and meditation with an teacher through Zoom. And I stroll my canine.

Short time period, I’m working out of contemporary fruit and greens and dairy merchandise. Long time period, I imagine that a few of my sufferers might die from the virus. Also, I understand, as a former instructor and college SLP, the significance of getting a union to guard its members and people their members serve. I’ll depart the SNF setting and alter again to working within the college setting as quickly as potential, in all probability within the fall.

Update: Today I came upon that some sufferers at one facility the place I work have examined constructive for COVID-19. They at present have 40 different sufferers with fever and are assuming these sufferers even have it, though they haven’t been examined. They are not sending me to the opposite facility, as I’ve been uncovered. But I used to be going to each services via the tip of final week, so I’ll have already unfold it to that that facility.

The rehab supervisor requested if rehab employees may go into quarantine and was informed that we should go in to work. I’m planning to contact my physician to ask if I will be examined for COVID-19. I’m unsure if this will likely be potential since I do not need any signs. Other than work and residential (and strolling my canine), I’m not going wherever else.

COVID-19 Resources for SLPs Working in Health Care

Bridget Murray Law is editor-in-chief of The ASHA Leader. [email protected]

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