Management of Spinal Cord Injury During COVID-19 Era

Abstract

Coronavirus disease (COVID-19) was declared a pandemic in March 2020 and has the potential to overload health system, compromise hospital staffs and use up essential hospital supplies. Patients with Spinal Cord Injuries (SCI) are classified as patient with disability and has increased morbidity from COVID-19 due to physiological changes from the nature of pathology, subsequently their clinical and social characteristics puts them in high risk of contracting COVID-19. Patients with SCI might present different symptoms of COVID-19 than others. Weakness in thoraco-abdominal and diaphragm muscles might impair cough, reduce lung volumes, and reduce flow rates. Interrupted pathway between hypothalamus and efferent nerves (sympathetic and motoric) might results in temperature dysregulation (poikilothermia) and dysfunction of febrile response. Patients with injuries at higher levels would present with more severe symptoms. The pandemic of COVID-19 further complex the situation of delivering adequate and dignified treatment. Therefore, the main goal is for complete avoidance of infection in this specific population and should be considered with high index of suspicion when mild symptoms of COVID-19 are present. This vulnerable group of patients deserves more attention when presented with extraordinary situations such as pandemics or earthquakes. This overview summarizes the symptom and pathophysiology of SCI in COVID-19 pandemic.