What is known…
The novel COVID-19 virus or SARS-CoV2, is the 7th known virus within the coronavirus family. Severe Acute Respiratory Syndromes (SARS) have occurred in the past as a result of other coronarviruses, however the unique characteristics of COVID-19 have made it particularly notorious. One feature of COVID-19 that has gained controversy is where it originated from. Coronaviruses have been found in animal species including the pangolin and the bat. COVID-19 is 96.2% identical to bat coronarviruses supporting the theory that the initial infection was contracted from these animal species however this continues to be debated. The virus uses a protein found abundantly within the lungs entering the cells in a similar fashion to HIV. A single patient infected with COVID-19 is estimated to spread on average to 2-3 individuals. Compare this with the infectivity of Influenza which falls between 1.4-1.6. The rate of death after a patient contracts COVID-19 is significantly higher than Influenza however less than other viral syndromes. Unfortunately, a virus which does not kill its host immediately is in fact a greater threat to the public as this enables the virus to spread more efficiently. In the case of COVID-19, patients may not immediately have symptoms which enhances the viruses ability to spread undetected. In fact, the symptoms of COVID-19 infection are common to many respiratory infections and include fever, shortness of breath, fatigue, and diarrhea.
What was once thought to be a health issue endemic to Wuhan, Hubei, China, is now a pandemic; or a disease process affecting the entire world. Originally identified in December of 2019 as an isolated case is now at the time of this writing at 381,598 confirmed cases in 168 countries/regions and 16,559 deaths worldwide. For current numbers, please visit our COVID-19 resource page to find informative resources here (https://www.tampacardiac.com/covid19).
The issue at heart…
Of the original cases identified, patients at greatest risk for serious complications even death included age, and coexisting disease such as cancer, hypertension, lung disease, diabetes, and of greatest risk, cardiovascular disease. In fact, patients with cardiovascular disease in the original case studies had a risk of dying as high as 10.5%. The risk of death and complications of the disease rose from 8% for patients aged 70-79 to 14.8% in patients over the age of 80. While many theories abound, the high risk of complications and death in elderly patients and patients with cardiovascular disease remain unknown. Although the risk in the elderly is attributed to weakened immune systems, the cause of injury in heart disease patients appear to be related to an increased inflammatory state caused by the infection leading to arrhythmias or electrical heart disturbances, coronary syndromes such as heart attacks, and myocardial depression leading to heart failure. Observations made while investigating other similar viral illnesses such as the Middle East Respiratory Syndrome and Influenza, help us understand why patients with cardiovascular disease might experience more complications with COVID-19 than other infected patients. Myocarditis, or infection of the heart, can occur with many viral illnesses. The presence of infection involving the heart has been documented on MRI studies and this has been thought of as a principal cause of cardiac arrest, heart failure and electrical disturbances or arrhythmia. Electrical disturbances in particular have been noted in as many as 16.7% of patients hospitalized in China.
Treatment for COVID19…
At the current time, there are several strategies being investigated: either antiretroviral therapies used to treat other viral infections such as Ebola or HIV, an antimalarial drug called Hydrochlorquine, steroids, a drug used for rheumatoid arthritis, antibodies extracted from a previously infected patient, or a vaccination; a gold standard treatment is not known as of yet. Until such a day, the advice by officials is to observe isolation or social distancing, appropriate hygiene to avoid contracting the virus, use of telehealth where possible to avoid the waiting room, and finally, vaccination against other common infectious diseases such as bacterial pneumonia and Influenza.
Other controversies…
There have been many controversial statements made about anti inflammatory agents and classes of blood pressure pills such as ACE inhibitors (lisinopril for example) and ARBs (losartan for example). The ACC does not advise discontinuing blood pressure pills to avoid increasing the damage caused by COVID19 and in fact cautions patients that discontinuation of these drugs may in itself cause complications. With regards to anti inflammatory agents or NSAIDS, authorities do not feel these agents are of significant harm in patients who are infected with the virus. Guidelines change daily.
A disease in evolution…
It is important to note that much of the recommendations for how to manage COVID19 are being borrowed by the behavior and response of other viral infections such as Influenza and/or observations made in China. The recommendations change weekly if not daily. For that reason, authorities such as the CDC should be the first source of information as their sites are updated frequently. The CDC website can be found here: (https://www.cdc.gov/coronavirus/2019-ncov/index.html).