Expert alert: When you can't cough—extra COVID-19 precautions for people with physical disabilities

ROCHESTER, Minn. - People with conditions such as spinal cord injury, Lou Gehrig's disease and multiple sclerosis are at risk of developing severe respiratory problems related to COVID-19 because the muscles that help them breathe already may not function normally.

"When you have a condition that causes paralysis, or weakens muscles in the chest, abdomen or diaphragm, you may not be able to remove lung secretions by coughing," says Kristin Garlanger, D.O., a Mayo Clinic physiatrist. "You may have difficulty inhaling and filling the lungs with oxygen that is carried to the rest of the body.

"If you have a physical disability, now is the time to take extra precautions to protect yourself from this dangerous virus."

Be proactive to prevent illness, Dr. Garlanger says:

• Stay hydrated to keep lung secretions thin.
• Eat a healthy, well-balanced diet to boost the immune system.
• Perform deep breathing and "coughing exercises," which are controlled coughing maneuvers that help clear lungs.
• Change position frequently, using gravity to help clear lungs.

• Wash your hands.
• Practice social distancing.
• Avoid touching your face.
• Stay home when sick.

"When CDC guidelines talk about keeping at least 6 feet from another person, that's especially important if you use a wheelchair," Beck says. "Your head is lower than people who are standing, so you may be more vulnerable to respiratory droplets produced when an infected person coughs, sneezes or talks. Droplets drop."

Dr. Garlanger and Beck offer tips regarding wheelchair use, caregiver plans and respiratory devices:

Wheelchair users

Wheelchair users should consider these tips:

• Keep at least 6 feet from others, when possible.
• Wash your face, in addition to your hands, after being in public and after having in-person conversations.
• Use an antibacterial solution to clean high-touch surfaces, such as wheels, brakes and push rims of a manual wheelchair chair, throughout the day. For a power

"If you use other assistive devices, like walkers or canes, be sure to regularly wipe those with antibacterial products too," Beck says.

People with caregivers

People with caregivers should consider these tips:

• Ask caregivers to wear a mask when they enter and work with you in your home.
• Have caregivers wash their hands when they arrive and each time before touching you.
• Ask caregivers to be vigilant about not touching their face or yours.
• Have caregivers check their temperature before arrival.
• Ask caregivers not to come to your house if they are not well, including symptoms such as a cough or temperature of 100.4 degrees Fahrenheit or higher, or if they have a known exposure to someone who is sick.

"Finding appropriate caregivers for your personal or your pet's needs can be difficult to coordinate, but it is so crucial to plan ahead to find someone who can help if your caregiver gets sick or isn't able to assist you," Beck says.

If your usual caregiver is unavailable:

• Plan on backup caregivers and prepare anyone you may need to rely on in an emergency.
• Ensure you can get assistance if a caregiver does not show up.
• Identify people to assist with groceries or have meals delivered to your home.
• Identify a way to get medications and other supplies in a timely manner.
• Remember pet needs, too. Ensure plenty of food and arrange a backup caregiver for your service animal or pet.

"Some people with disabilities rely on ventilators every day," Beck says. "Making sure caregivers follow strict guidelines to clean and use these machines will help protect those who are vulnerable to respiratory illnesses."

Users of ventilators or other respiratory assistive devices

Users of ventilators or other respiratory assistive devices should consider these tips:

• Clean and disinfect medical equipment according to the manufacturer's instruction.
• Change filters, as suggested by the manufacturer's instructions.
• Wash hands before and after working with the ventilator or the person.
• Make sure caregivers wear a mask or eye shield if they are suctioning secretions.

Self-assessment tool and resources

Mayo Clinic offers a COVID-19 self-assessment tool to help people assess symptoms. The tool also offers guidance on when to seek medical care and what to do in the meantime.

"If you do become sick and need medical attention, make sure you or your caregivers mention your disability and how it affects your respiratory system when you reach out to medical providers or emergency responders," Dr. Garlanger says. "They will be better prepared to help you."