Covid19 is continuing to steadily rise in the Indian Subcontinent coincident with the relaxation of lockdown restrictions and easing of travel, work and business related movement of people and goods.
The novel corona virus, Covid19, damages the lungs predominantly and causes breathing difficulty and lowering of oxygen levels in the blood. This is one of the major mode of damage caused by the novel corona virus and responsible for the increased death rates in a large proportion of patients.
However, in the most severe form of the disease which occurs in about 5 – 10% of those infected with Covid19, the heart and other organs like kidney,liver etc can get involved leading to multiorgan failure. The reason for the Covid19 being able to cause cardiac damage involves multiple mechanisms.
The virus can directly infect and damage the heart muscle and cause inflammation. This may result in “Myocarditis” and can cause dangerous rhythm problems in the heart which can result in death. Secondly, the heart can get inflamed and damaged indirectly from the immune response of the body to the novel corona virus. The body in its fight against the virus mounts an immune response and releases multiple chemicals in the blood stream that are called “cytokines” and a condition called “Cytokine storm” happens late in the course of the disease (after 10 – 14 days of onset of symptoms) . Due to the immune response, a person’s own body tissues like kidney, heart etc can get damaged. The damage to multiple organs like lungs,heart, kidney, liver etc that occur late in the disease course is a collateral damage caused by cytokines released into the blood stream as a response to the infection. Third mechanism of damage to heart involves damage to the right side of heart called “Right Ventricular dysfunction” as a result of elevated lung pressures from involvement of the lungs with Covid virus.
Enforcement of prolonged lockdown to contain the spread of the disease and diversion and preferential allocation of hospital resources like ICU beds, ventilators, physicians,nursing and allied health staff to tackle the growing number of Covid19 patients has led to a chronic neglect of other non communicable diseases like diabetes,hypertension, coronary artery disease and even cancer.
It is imperative that people with preexisting cardiac disease and other chronic illness continue their timely follow up and medications and seek medical help in case of worsening of symptoms or onset of new symptoms. Especially in people who have coronary artery disease and valvular heart diseases, any new change in their symptoms needs to be investigated thoroughly and further course of action needs to be pursued.
All necessary precautions like social distancing, wearing of masks, hand hygiene should be followed while visiting hospitals for follow up and treatment. Hospitals are typically hotspots for Covid19 as there are many patients who are suspects and also proven positive patients who are being treated. There is a slight but definitive risk of acquiring the Covid19 virus if proper safety measures are not followed. It is important to keep in mind the basic principles of hand hygiene,wearing of masks at all times and using hand sanitizers and social distancing.
Just visiting a hospital will not make a person infected with Covid19 virus if all safety and sanitary precautions are strictly adhered to all times during their presence in the hospital. Many major hospitals, like our own at Continental, have implemented all safety measures to reduce the risk of transmission of corona virus and ensure that the proper flow of patients and social distancing is adhered to at all times and follow hand hygiene and wearing of masks.