Physiotherapy management of Covid-19 is undervalued in Bhutan

With the recent transition into Living with the virus and preparation of Covid dedicated hospitals, it is clear that our country has decided to survive along with the disease. Bhutan has not yet faced a worse-case scenario situation because of the divine leadership and intervention by His Majesty and the hard work and dedication of all the front liners.

Taking into account the recent move by the government it is expected that we will be having increased hospitalization cases and deaths.

Bhutan currently has 39 ventilators for a vulnerable population of 90,000 individuals and a population of 700,000 approximately. In case of a worst-case scenario, if 100 patients required ventilators and we are only left with 39 ventilators in numbers, are we going to let the rest of the 61 patients succumb to the virus? It is a question we must ask ourselves as healthcare professionals.

And this is where Physiotherapy and respiratory care treatment comes into the picture. Early mobilization and Respiratory Physiotherapy are strongly backed objectively by evidence and globally by recognized clinicians and institutions. Below are the significant benefits of early mobilization and Respiratory care.

Liberation and decreased days on mechanical ventilation.

Decreased length of stay (LOS) in the ICU.

Reduced complications of ICU like ICU- acquired weakness (ICU-AW), VAP (ventilator-associated Pneumonia), delirium, Deep Venous Thrombosis, and Post-intensive care syndromes (PICS).

Improved Health-related quality of life (HR-QOL).

Abate the effects of Long Covid syndrome.

Generally, Physiotherapy interventions are considered Aerosol generating procedures (AGPs), but there are advancements in the field of Respiratory Physiotherapy, where interventions can be delivered without generating aerosols through the ventilator and without exposing everyone involved.

Physiotherapy along with exercise medicine is often overlooked and misunderstood in Bhutan. We are often scoped to just providing Chest Physiotherapy in the forms of Percussion and breathing exercises and passive range of motions in case of musculoskeletal domains. It is erroneous considering us futile and not important, after all, exercise is Physiology and an important component of medicine.

Global bodies like WHO and Society of critical care medicine- PADIS guidelines, all objectively recommend the significance of Early mobilization and Physiotherapy in the intensive care settings.

To date, the clinical management team for Covid-19 is primarily composed of GDMOs, Physician –specialists, and nurses. It is appreciable our Ministry of Health (MoH) is minimizing the unnecessary exposure of health staff to the virus, but there will be incidences like a “worse-case scenario” where the health system will be overwhelmed especially in the intensive care settings.

I recommend the MoH consider involving Physiotherapists in the Clinical management team and develop SOPs (standard operating procedures) for the Physiotherapy management of COVID-19 patients.

It is His Majesty’s primary concern regarding the survival of Bhutanese citizens. As a health care professional, I find it unethical when interventions are backed by science and not implemented due to various factors. I have tried contacting senior TAG members and various heads of related agencies with qualitative objective data and science but came up to no fruition. I’m still waiting for a green signal from the MoH to put us on board.

By Namgay Wangchuk

The writer is the Intensive care Physiotherapist at MRRH  and the opinion piece reflects his views.