Information about Covid-19

Covid-19 – what are the symptoms?

Some individuals with Covid-19 can have no symptoms at all.

The main symptoms of Coronavirus are:

– High temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature);

– New, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual);

– Loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal;

– Most people with Coronavirus have at least one of these symptoms.

Urgent advice:

Use the 111 online or phone-call Coronavirus service if you have any of:

– High temperature;

– New, continuous cough; or

– Loss or change to your sense of smell or taste

– 111 will tell you what to do and help you get a test if you need one.

Incubation, infection and recovery period – how long does it usually last?

– The incubation period is from 1 to 14 days (with an average of 5 days). It is suggested that similar to SARS, most patients will not be infectious until they experience symptoms.

– Just how infectious individuals are depends on the severity of their symptoms and stage of their illness.

– The average time from symptom onset to recovery for mild cases is approximately 2 weeks and is 3 to 6 weeks for severe or critical cases.

Survival of Covid-19 – how long can it survive on surfaces and in the environment?

– There is little data on Covid-19, so most suggestions come from studies of similar viruses humans have had in the past.

– Human coronaviruses can survive on inanimate objects and can remain viable for up to 5 days at temperatures of 22 to 25°C and relative humidity of 40 to 50% (which is typical of airconditioned indoor environments)

Survival on environmental surfaces is also dependent on the surface type. An experimental study using a SARS-CoV-2 strain reported viability on:

– 72 hours on plastic;

– 48 hours on stainless steel; and

– up to 8 hours on copper.

– A minimum of 20 minutes, which is 2 air changes, in a contained room is deemed suitable to allow for adequate clearance of Covid-19 from the air. This will be put in practice between appointment times.

Transmission and exposure – how is Covid-19 transmitted and what are the risks of attending a face-to-face physiotherapy session?

Covid-19 can be transmitted via:

– Touching an object or surface that is contaminated with infected organisms that has been previously touched by someone who has Covid-19. Examples include: surfaces, toys, mobile telephones or any inanimate objects.

– Breathing in infectious air droplets – Respiratory droplets carrying infectious pathogens can transmit infection when they travel directly from the respiratory tract of an infectious individual to susceptible mucosal surfaces of a recipient, generally over short distances. This can be in the form of sneezing, coughing or speaking.

Risks of attending a face-to-face physiotherapy session:

– At First Physio, we will do everything in our power to limit the risks of transmitting or contracting Covid-19 in line legislation and guidance published by the government and our professional bodies (see below for further information). However, we cannot guarantee that you will not contract or transmit Covid-19 by attending a face-to-face physiotherapy session;

– The nature of a face-to-face physiotherapy session includes coming into close contact with our practitioners, putting you within transmission distance of our practitioners;

– We cannot guarantee that if our practitioners do not have Covid-19 symptoms that they do not have Covid-19;

– The clinical treatment environment will include a variety of members of the public passing through and we cannot guarantee that their lack of Covid-19 symptoms during our screening process means that they do not have the virus;

– Sharing an air-space with individuals who may have Covid-19 increases your risk of contraction via infected respiratory droplets;

– Although we will strive to remove all unnecessary contact surfaces and thoroughly clean all remaining contact surfaces in line with legislation and guidance, we cannot guarantee that all contact surfaces will be 100% free of Covid-19, thereby putting you at risk of contraction.

How we plan to prevent and control the risks of Covid-19 transmission

1. A virtual first approach

– All physiotherapy sessions will be held remotely via video call or otherwise, unless deemed necessary for a face to face appointment.

2. Non-admission of individuals at high risk who are considered ‘extremely clinically-vulnerable’ for face-to-face appointments (until indicated as safe to do so by government legislation or guidance), including the following people who:

• have had an organ transplant;
• are having chemotherapy or antibody treatment for cancer, including immunotherapy;
• are having an intense course of radiotherapy (radical radiotherapy) for lung cancer;
• are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors);
• have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma);
• have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine;
• have been told by a doctor they have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD);
• have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell);
• are taking medicine that makes them much more likely to get infections (such as high doses of steroids or immunosuppressant medicine); and/or
• have a serious heart condition and are pregnant.

3. Establish well-grounded clinical reasoning for face-to-face sessions with individuals who are at moderate risk, in which the benefits outweigh the risks and the patient would still prefer a face-to-face session in spite of full knowledge the risks involved and the steps taken by the clinic to prevent risk of transmission, including the following people who:

• are 70 or older;
• have a lung condition that’s not severe (such as asthma, COPD, emphysema or bronchitis);
• have heart disease (such as heart failure);
• have diabetes;
• have chronic kidney disease;
• have liver disease (such as hepatitis);
• have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy);
• have a condition that means they have a high risk of getting infections;
• are taking medicine that can affect the immune system (such as low doses of steroids); and/or
• are very obese (a BMI of 40 or above);
• are pregnant.

Vulnerable People (non-clinical) may be considered for face-to-face appointments; however, as such people are likely to require a chaperone which is not likely to be safely practiced until government legislation or guidance suggests otherwise. Such individuals may include (but not limited to):

– Children at risk;

– People with special educational needs or mental disabilities;

– Rough sleepers; and

– Others.

In the interim, non-clinical vulnerable people should be referred to support from public services where applicable.

3. Screening of patients for Covid-19 symptoms

All patients seeking physiotherapy must fill out our digital screening from for Covid-19. This will allow us to:

– Refer you to appropriate support services if you present with Covid-19 symptoms;

– Prevent the risk of transmitting Covid-19; and

– Determine if you are suitable for a face-to-face appointment, should you meet the necessary criteria.

4. Social distancing measures

Strict social distancing measures are to be enforced in our clinics, including:- A minimum 20-minute gap, between appointment times for a practitioner’s patient schedule, staggered to avoid multiple patients arriving at the same or similar times;

– Waiting rooms are cleared of seating to avoid overlap of patients;

– Patients should be asked to arrive at their appointment time and not early (including waiting in their cars if possible), and only enter the premises once invited in by the therapist;

– A one-way system in clinic to reduce risk of patient cross-over; and

Staff should always remain at least 2m apart;

5. Use of Personal Protective Equipment (PPE)

All staff operating either clinically or in the community must:

wear the following on face-to-face contact with patients either in clinic or in the community:
– disposable Gloves (single use);
– disposable plastic aprons (single use) or re-usable overalls;
– eye protection in the form of: a surgical mask with integrated visor, a full face shield or visor, or a polycarbonate safety spectacles or equivalent; and
– an appropriate face mask for level of interaction.

Patients should:

– Wear face masks where able;

– Not wear gloves;

– Be aware that wearing PPE may limit the ability to communicate, via body language or otherwise.

6. Regular cleaning and sanitisation practices

First Physio will ensure to enforce a strict cleaning and sanitisation protocol in line with current legislation and guidance. For further details, see our Covid-19 Policy.

– Shared spaces will enforce:

– No drinking, eating or shared reading materials

– Signage and instructions to avoid touching surfaces and to engage in social distancing

– No access to toilet facilities

All attending patients should:

– Not touch the door, walls, switches etc on entry or exit;

– Only touch the chair and treatment couch;

– Not bring any belongings into the room;

– Not wear gloves prior to or during the treatment session and be directed by staff dispose of them immediately in the bin if they attend clinic wearing gloves;

– Wear face masks in clinical settings if they have access to them; and

– Clean their hands on entrance and exit to the clinic with antibacterial gel, or wash their hands with soap and water if practical (such as in-treatment room sinks)

All staff, patients and visitors must:

– practice respiratory and cough hygiene standard – ‘Catch it, bin it, kill it’:

– Disposable, single-use tissues should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose ;

– Used tissues should be disposed of promptly in the nearest waste bin;

– Keep hands away from the eyes, mouth and nose; and

– Hands should be cleaned (using soap and water if possible, otherwise using alcohol-gel) after coughing, sneezing, using tissues or after any contact with respiratory secretions and contaminated objects.

– Some patients (such as the elderly and children) may need assistance with containment of respiratory secretions; those who are immobile will need a container (for example a plastic bag) readily at hand for immediate disposal of tissues.

Face-to-face appointments

All patients seeking physiotherapy must undertake a remote triage conversation with our therapists to determine if they are suitable for a face-to-face appointment. The purpose of this is to understand if you have any serious biomechanical symptoms which may require referral to emergency services – this could potentially save your life.

Who is suitable for a face-to-face appointment?

In line with legislation and guidance from the Government and our Professional bodies, patients are only deemed suitable for a face-to-face appointment if they have:

– Potentially serious symptoms that require onward referral; or

– If their symptoms are so severe that they limit the patient’s ability to function normally in daily activities (e.g. the ability to ascend and descend stairs).

What is involved in a face-to-face appointment?

A face-to-face appointment will normally include the following during the Covid-19 Pandemic:

– A subjective assessment of up to 20 minutes – this will involve a chat from a safe distance in which therapists can ask important questions and you can update us on your symptoms, activities and progress to date;

– An objective assessment and treatment for a maximum of 15 minutes – this will involve:

– close-contact assessment of your physical movements and functional ability; and

– potential of hands-on physiotherapy treatment if deemed necessary.

– an exercise guided rehabilitation session from a distance in a well-ventilated area where deemed the most suitable intervention and pre-agreed with patients prior to the beginning of the treatment session (in place of hands-on physiotherapy and/or objective / subjective assessment if this has already been completed over the phone);

– Exercise guidance with formation of a bespoke home exercise programme; and

– A prompt finishing time to allow for adequate cleaning between patients.

Who should attend face-to-face appointments?

– Only the patients who have passed the Covid-19 screening and Triage process should attend face-to-face appointments

– Patients must attend on their own, except where there is the requirement for a carer or legal guardian. In this case, the carer/guardian should be present for the minimal amount of time during the appointment and follow social distancing best practice. Where possible, the carer/guardian attending should live in the same household as the patient.