Dear Mayo Clinic: My father, who suffers from Lou Gehrig's disease, lives with me and my family, including three children. While my husband can work at home, I am still required to go on-site for my job. Although I practice social distancing, I am wondering if I need to do anything differently in caring for my father so that I do not put him at higher risk for COVID-19 and more severe problems. He already has trouble catching his breath and coughing at times. Do I need to isolate myself to lower his risk, or do I need to do anything special to help keep him safe?

Answer: It is always challenging being a caregiver, especially for one with physical and neurologic issues. During the COVID-19 pandemic, it can be even more trying to take care of yourself and your loved ones. I applaud you for being mindful of what your father may need to ensure he ― and you ― stay healthy.

You are correct in recognizing that people with certain neurologic conditions and associated physical disabilities, such as Lou Gehrig's disease, spinal cord injury and multiple sclerosis, are not only at a higher risk for contracting COVID-19 but also developing severe respiratory problems related to COVID-19. This is because the muscles that help them breathe already may not be functioning normally.

For people like your father, who have a condition that causes paralysis, or weakens muscles in the chest, abdomen or diaphragm, it becomes difficult for them to remove lung secretions by coughing. As you stated, your father already has difficulty inhaling and filling his lungs with oxygen that is carried to the rest of his body. It also may be difficult to recognize whether he is having typical symptoms related to COVID-19 due to his difficulty generating a cough. For instance, a fever may be the only abnormal symptom that one with baseline respiratory muscle weakness presents with.

Consider these tips that will offer extra protection for your father ― or anyone with a physical disability:

• Stay hydrated. It is important for patients with physical disabilities to stay hydrated to keep lung secretions thin. Drinking a bit more than normal also may help in warmer weather.
• Maintain good nutrition. 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. For people like your dad, changing position is beneficial since gravity is being used to help clear lungs.

Also, people with physical disabilities are encouraged to take extra safety measures regarding social distancing, especially if they use a wheelchair. When sitting in a wheelchair, their head is lower than people who are standing, so these people may be more vulnerable to respiratory droplets when an infected person coughs, sneezes or talks.

Even if you are being diligent with social distancing and hand-washing, if your father is in a wheelchair, he and you, as his caregiver, should consider these additional precautions:

• Maintain a distance of at least 6 feet from others, when possible.
• Wash the face and 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 wheelchair, use an antibacterial solution to clean the joystick, and any other controls, armrests, tray or any parts your hands touch.

If your father uses other assistive devices, like walkers or canes, be sure to regularly wipe those with antibacterial products, too. If your father relies on a ventilator, you will want to be diligent about cleaning and disinfecting the medical equipment, and changing the filters as directed by the manufacturer, too. As a caregiver, you will want to wear a mask when caring for your father. You also will want to wear an eye shield if you are suctioning his oral and respiratory secretions. Lastly, I also would recommend that you develop a backup plan, including identifying an alternative caregiver, in the event that you or your husband become ill and cannot care for your father.

You also may want to have a conversation with your father's health care provider to confirm what symptoms or issues you want to be mindful of that could warrant a call to 911.

In the meantime, continue to practice social distancing and good hand hygiene to protect yourself and your loved ones from COVID-19. ― Dr. Kristin Garlanger, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota

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For the latest updates on the COVID-19 pandemic, check the Centers for Disease Control and Prevention website. For more information and COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

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