COVID‐19 and spinal cord injuries: The viewpoint from an emergency department resident with quadriplegia

Abstract

Spinal cord injuries (SCIs) present distinct physiological and social considerations for the emergency physician. During the COVID-19 pandemic, these considerations may generate unique challenges for emergency physicians managing patients with SCIs. Physiological disruptions may alter the way SCI patients present with COVID-19. The same disruptions can affect management of this vulnerable patient group, perhaps warranting early aggressive treatment. The medical picture will often be complicated by unique social characteristics. The reliance on caregivers for activities of daily living can, as an example, increase the human resource requirement of an ED. Considering the vulnerabilities and complexities of patients with SCI, the community should prioritise prevention of COVID-19 infections in this group. In the event that they do present to an ED, planning for and understanding their complexities will facilitate optimal management.

Spinal cord dysfunction after COVID-19 infection

“…The impact of COVID-19 on individuals with SCD has been reported. However, to the best of our knowledge, SCD after COVID-19 has not been described [ 17 – 22 ].…”

Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID‐19 era

“…Those who are already ventilatordependent may require an increase in oxygen percentage compared to the usual. Details of when to choose which ventilation modality is outside the scope of this article; however, frailty scores based on physical function measures should not be used in persons with SCI/D or other neurological deficits to judge who qualifies for advanced care 32 …”

Letter to the Editor Regarding “Opinion Piece: Microsurgery in COVID-19–Positive Patients”

“…Although a recent report described a 56-year-old patient with COVID-19, the infection was mild, perhaps owing to the patient's relatively young age and the absence of comorbidities. [3][4][5][6] Brachial plexus procedures or nerve transfer surgery in quadriplegic patients 7 , although based on the presence of "chronic" lesions in stable patients, have resulted in concrete benefits from surgery only if performed within a certain period after the trauma has occurred. In addition, it is well known that nerves and muscles that have not been working for >1 year will be less likely to benefit from new innervation because of the progressive onset of atrophy.…”