Coronavirus

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Tele-medicine and COVID-19

William Aitken, MD

The coronavirus pandemic has changed the world profoundly over the past few months. Globally, millions of people have contracted COVID-19 and hundreds of thousands have died [1]. Millions more have had their lives up-ended with jobs ending, schools closing, family separations, and varying degrees of quarantine. We face uncertainty daily: Did someone I pass at the grocery store have COVID? How much longer should I stay home? Fortunately, people have been taking precautions to keep themselves and others healthy: washing their hands, covering their mouths, and avoiding unnecessary exposures.

One exposure that I didn’t expect we would be able to avoid here in the US has been visits to the doctor’s office. However, given recent Centers for Medicare & Medicaid Services (CMS) temporary expansions, more people than ever are using tele-health. In March, there was a 50% increase in tele-health visits across the country [2]. This expansion into tele-health has been aided specifically by the recent CMS 1135 waiver that has increased access to and reimbursements for tele-health [3].

That said, I’m left wondering how tele-medicine will affect caring for patients with heart disease and other high-risk groups in the future. Will adherence improve without the hassles of having to drive to the office? Will tele-physical exams be accurate enough to confidently make medication changes? Only time will tell. Certainly something I’ll be looking out for.

[4]

 

References:

  1. https://coronavirus.jhu.edu/
  2. https://www.cnbc.com/2020/04/03/telehealth-visits-could-top-1-billion-in-2020-amid-the-coronavirus-crisis.html
  3. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
  4. Author: Intel Free Press

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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How Researchers Can Support Our MD Colleagues During the COVID-19 Pandemic

Christa Trexler, PhD

I’ve thought a lot about what to write this month. There’s no way to sugar coat that things are intense right now. Most basic research labs are shut down right — and they should be. As a basic researcher whose work can’t be relegated to the COIVD-19 battle, I’m finding myself in a weird limbo. Also, as a new mom, I don’t have childcare, so I am all of a sudden — like many people — trying to figure out a way to work from home and take care of my baby. We are trying to do it all while maneuvering through a pandemic.

But guess what? I’m home safe. So many of our community members don’t have this luxury because they are busy making sure the world keeps spinning.

So, I wanted to take this space to write about what basic researchers, who all of sudden find themselves without bench work, can do to support our physician colleagues.

  1. Stop Doing Non-Essential Research: Look, I understand you think your research is important — we all love our science. Can your research be helpful in understanding more about the SAR-CoV-2 virus/COVID-19 disease? If so, awesome — switch gears and contribute to the effort. If not, please stop. I know that many universities have effectively shut down, but many have only stated that “non-essential” research should stop without really defining what “essential” actually means. So, I know of some labs are that kind of skirting around this issue and having people work on projects that could otherwise be left for later. I get it. We will all need grant money. But right now, those pipette tips, gloves and other reagents you are using on your “non-essential” work could be better used elsewhere — especially since ordering and delivering goods is so tough right now. If you are in a situation where someone is making you work when you feel like you shouldn’t, speak up.
  2. Work to Flatten the Curve: This goes with #1 above, please stay home. More importantly, talk with your friends and family about what flattening the curve I don’t know about you, but I have several family members who aren’t taking this seriously. I think a lot of people still feel like they’re watching a movie on the news — like what’s happening in New York or Seattle isn’t real. But it is.
  3. Donate Your Lab’s Personal Protective Equipment (PPE): Many health care workers don’t have the PPE they need to treat their patients, so a lot of universities are stepping up to donate their supplies. Contact your department to see if your university has something like this in place and if not, considering organizing a donation drive.
  4. Hone Your Science Communication Skills: As scientists, this is the most important thing we can all do right now. I asked fellow Early Career Blogger, Jeff Hsu, MD, what he as a physician would like help with from his research colleagues and he said: “I think having basic scientists explain these things — all the COVID-19 diagnostic tests, treatment options & technology — in digestible formats is really helpful to clinicians.” We need to help the community, our family and friends, understand what is going on right now because things are changing drastically every day — it’s hard for even us to keep up with what’s new. If you are new to science communication, Liz Neely’s recent piece about how we are all science communicators now, is a really great primer. Also, like many news outlets, the Atlantic is making their COVID-19 collection publicly accessible for free, so that is a great source of reliable, well-written information to share. A great way to get involved is to see if your university’s communications department, who is undoubtedly overwhelmed right now, has a blog that they want pieces for. This is a great way also to channel all of that anxiety news reading you’ve been doing.

 Obviously, I’m sure there are a million different things we all could be doing, but these options are a great start. Also, be kind to yourself — this is an unprecedented time and there’s no right way to navigate through this experience.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”
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How Coronavirus (COVID-19) can affect your heart health?

Noora Alhajri, MD, MPH

The rapid spread of the coronavirus (now known as COVID-19) has sparked a global alarm. The World Health Organization (WHO) has declared a state of public health emergency of international concern (PHEIC), as many countries are grappling with a rise in the number of confirmed cases. As of March 5th 2020, data from WHO have shown that more than 95,499 confirmed cases have been identified in 84 countries/territories with more than > 99% of the cases emerging from China1. In the United States, the Centers for Disease Control and Prevention (CDC) have increased the risk from Coronavirus spread to level 3 and advised against non-essential travels to China, Iran, Italy, and South Korea. “It is not so much a questions of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness” said Dr. Nancy Messonier, director of the National Center for Immunization and Respiratory Disease at the Center for Disease Control and Prevention in the United States.

What is coronavirus?

Coronavirus (CoV) are a large family of viruses that causes illness ranging from the common cold to more severe diseases such as the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-Cov). A novel coronavirus (nCov) is a new strain that has not been previously identified in humans. Coronavirus are zoonotic, meaning they can transmit between animals (such as bats, cats, camel, and cattle) and human.

What is the clinical profile of COVID-19 infection?

 Coronavirus infection is spread from human-to-human via droplets or direct contact. The infection is estimated to have a mean incubation period of 6.4 days (0-27 days), and a basic reproduction number of 2.24-3.58. Fever was the most common clinical feature followed by cough, shortness of breath, body ache, headache, and sore throat. There have been reports of gastrointestinal symptoms (nausea, vomiting, or diarrhea) before respiratory symptoms occur, but this is largely a respiratory virus. Those who have the virus may not have obvious symptoms (asymptomatic), or may have symptoms ranging from mild to severe. In some cases, the virus could be life-threatening. Older adults are less likely to present with fever, thus close assessment of these group of patients with other symptoms such as cough and shortness of breath is critical.

What are the cardiac Implications of COVID-19?

Early reports show that 50% of hospitalized COVID-19 patients had an underlying chronic medical illness, 80% of which are cardiovascular and cerebrovascular disease. The American College of Cardiology (ACC) issued a bulletin recently to warn patients with heart disease about their potential risk for complications if they contracted the disease. This does not mean that patients with cardiovascular disease or with cerebrovascular disease are at increased risk of getting coronavirus. However, they should practice additional precautions, since they are at great risk for complications. Nearly 20% of people developed Acute Respiratory Distress Syndrome (ARDS) according to a case report of Wuhan hospitalized patients. In addition, 7.2% of patients developed acute cardiac injury, 8.7% shock, 3.6% developed acute kidney injury, and 16.7% developed arrhythmia. Several unpublished first-hand reports suggest at least some patients develop myocarditis. Therefore, it would be reasonable to triage patients with COVID-19 infection according to the presence of underlying cardiovascular disease, renal disease, respiratory and other chronic diseases for prioritized treatment.

Several experts suggested rigorous use of guideline-directed plaque stabilizers (such as ACE-inhibitors, Statin, Beta-blockers, Aspirin) as it could protect cardiovascular patients during wide-spread outbreak of the virus. Furthermore, it is important for patients with cardiovascular disease to remain up to date with vaccination, including pneumococcal vaccine given the risk of secondary bacterial infection. It would be also crucial to receive the influenza vaccine to prevent any other sources of fever which could be initially confused with coronavirus infection.

The outbreak of COVID-19 has become a global clinical and public health threat. Knowledge about this novel virus remains limited. What we can do now is aggressively implement infection control measures to prevent the spread of COVID-19 via human- to- human transmission.

References:

  1. World Health Organization declares Global Emergency: A review of the 2019 Novel Coronavirus (COVID-19), International Journal of Surgery, (March 2020)
  2. Travel Health Notices: https://wwwnc.cdc.gov/travel/notices#travel-notice-definitions
  3. Chen H, Zhou M, Dong X, et al. Epidemiological and Clinical Characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; published online January 29. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930211-7
  4. Wang D, Hu B, Hu C, et al.Clinical Characteristics of 138 Hospitalized Patients with2019 Novel Coronavirus- Infected Pneumonia in Wuhan, China. JAMA. Published online February 07, 2020. doi:10.1001/jama.2020.1585
  5. Cardiac Implications of Novel Coronavirus (COVID-19): https://www.acc.org/~/media/665AFA1E710B4B3293138D14BE8D1213.pdf

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”