Coronavirus: Physiotherapists Call for Level 3 Guideline Change So More Patients Needing Ongoing Care Can Access It

Published on 6th October 2021.

An Auckland-based physiotherapist is urging the Ministry of Health to reconsider alert level 3 guidelines for opening some health services because there has been an “inequitable reopening” of businesses. Yousif Mansour works at a private physiotherapy clinic in Auckland and hasn’t been able to work throughout levels 3 and 4. He says because clinics can’t reopen, the profession is facing mental and financial hardship and clients are facing worsened and delayed outcomes. As physiotherapists, they can provide healthcare through Telehealth to current or prospective patients.

During level 3, appointments for allied health services such as physiotherapy, podiatry, optometry and Well Child Tamariki Ora services are mainly online or over the phone. Some face-to-face appointments can be arranged on a case-by-case basis as long as health professionals take appropriate measures to manage public health. But Mansour says the eligibility criteria to treat patients in-person is too strict. “In essence, when taking clinical reasoning into consideration, the client has to be in a life or death situation or facing long-term disability from an injury or condition if left untreated,” he tells Newshub. While Telehealth allows physios to diagnose and begin or continue the rehabilitation process, it’s no substitute for face-to-face consultations, Mansour says. Additionally, not everyone has access to Telehealth so uptake isn’t equal across regions.

Mansour says physiotherapists are well-trained in health and safety, including infection prevention controls, and many clinic owners are audited against such standards. Physios can also screen patients in detail, to the point where medical, social, and family history can be taken into consideration to see whether or not a client can be safely seen and treated. Clinics can also be set up in a way where alternate rooms can be used, staff can work alternate shifts, and they can disinfect clinics accordingly between patients, he says. They also have access to full personal protective equipment and know-how to apply it appropriately and accordingly.

Mansour says these health protocols can’t be as effectively done in supermarkets or other businesses that can open during level 3. “It is hard to believe that this can be done while being in supermarket brushing through multiple people, lining up for coffee, or when your food is being prepared or delivered. Not being able to operate properly will soon take its toll on clinics, as the outgoings simply don’t match whatever subsidy is being provided.”

The health and physical condition of some patients who have acute injuries or long-standing conditions is at risk of being compromised because they can’t receive ongoing treatment, he says.”Clients who aren’t able to be seen over level 3 and 4 go on to have pain or injuries that take a lot longer to settle down than they would if they were seen acutely, and that while they don’t meet the criteria of long-term impairment to be seen currently, it does cause significant distress and an inability to carry on with activities of daily living,” Mansour says. “The impact of not being able to deal with pain and other worsening symptoms can only have negative impacts on a person, which importantly can extend to mental health and social wellbeing.”

Even after the Government announced Auckland’s three-stage roadmap out of COVID-19 restrictions – which includes a phased reopening of people’s bubbles, retail, hospitality, and schools – Mansour says it is “ridiculous” physiotherapists aren’t included in this. He adds that physiotherapist clinics are being challenged financially too since no specific financial help has been offered to the industry. He believes many are worrying about how much longer their businesses can survive and whether they’ll have money to survive.  Sandra Kirby, CEO of Physiotherapy New Zealand, agrees with this, saying allied health services are “suffering” because of the lockdown.

“Physios have been very supportive [of the level 3 guidelines], but level 3 was always intended to be short and sharp, and seven weeks is neither short nor sharp,” she tells Newshub. “The concerns we’ve got are that it’s not sustainable for the long term – so that’s a very definite concern – and that while generally physios have been very supportive of public health measures, there’s concern they’re not being implemented fairly across the health sector.” During level 3, hospitals must operate in line with the National Hospital Response Framework and primary and community health providers can open following the Community Response Framework. Infection prevention and control regulations must be followed. Other health services such as community midwives and dentists are allowed to open, but only in-person for certain types of care.

“We would say people are really focused on hospitality, but actually, there are other businesses much more associated with health outcomes that are not able to work,” Kirby says. She adds that a range of businesses in Auckland, including allied health physiotherapy and other allied health providers, are “definitely suffering” because of the extended lockdown. “While the Government released packages and provided a wage subsidy, that doesn’t cover all of the outgoings,” Kirby says. “This does impact patient health outcomes. We know that, we know that from last year, so we can’t just say everything can wait.”

Dr Martin Chadwick, chief allied health professions officer at the Ministry of Health, tells Newshub maintaining a balance between protecting patients during the pandemic and maintaining people’s wellness has always been a priority.  At level 3, he says face-to-face appointments may be provided for urgent care only, so long as clinicians take appropriate public health measures.

Urgent care for community allied health is defined as:

  • a condition which is life or limb-threatening; or
  • treatment required to maintain the basic necessities of life; or
  • treatment that cannot be delayed or carried out remotely without the risk of significant harm or permanent and/or significant disability; or
  • where failure to access services will lead to acute deterioration of a known condition, or
  • where delay in access to services will impact the consumer’s ability to maintain functional independence and significantly negatively impact the quality of life
  • and it cannot be delivered by a service that is currently operating or by clinicians that are already in contact with the patient for ongoing care.

“For physiotherapists, the threshold for treatment to be carried out has recently been reviewed and the threshold has been modified to include the extra flexibility to support treatment provision if the treatment cannot be delayed or carried out remotely without risk of significant harm or permanent and/or significant disability,” Dr Chadwick says. “While this is a high threshold, it is necessary to reduce the spread of COVID-19.”

He recommends the infection prevention and control measures that could be taken into consideration by health practitioners to safely operate under level 3 include:

  • staff being fully vaccinated
  • understanding the ventilation capabilities of the environment they would be operating in
  • health practitioners have undertaken pre-requisite fit testing and know how to fit check a P2/N95 particulate respirator as part of donning and doffing of personal protective equipment
  • utilisation of the alert level 3 and 4 risk assessment tool has been applied
  • screening patients for COVID-19 symptoms.

In an email from the Physiotherapy Board sent to non-district health board physiotherapists earlier on Tuesday that has been seen by Newshub, Dr Chadwick told them that “initially there is no plan to change advice to physiotherapists at this time and the current level 3 advice provided at the last change still stands”.

“We know this has been an extremely hard time (to say the least) for those of you in Auckland,” the email from the board concludes. “You are definitely doing the hard lifting in fighting COVID – you are at the front line professionally and personally.” In his statement to Newshub, Dr Chadwick says he will continue to work with the sector in operating under alert level 3.