We have a large population of high-risk individuals in the valley with diabetes, high blood pressure, Previous heart attacks, patients with low left ventricular function (ejection fraction lower than 45%). Besides this a large population has chronic lung disease like chronic bronchitis, healed tuberculosis etc. These are the individuals who if they get COVID19 due to contact with a positive patient or his contacts have an outcome which is poor with high mortality.
Besides this there are reports showing that Corona virus infection itself can produce heart problems. This is because lungs are primarily affected through the virus entering from droplet mode and producing pneumonias. Lungs and heart have an intimate relation ship both because of contiguity and may be extension of inflammation. This can produce ECG picture mimicking a heart attack, inflammation producing swelling of heart (myocarditis), disorders of heart rhythm leading to chaotic and bizarre arrhythmias (Ventricular tachycardia, ventricular fibrillation) leading to sudden death. Many of these individuals are on treatment for high blood pressure, heart failure drugs, anti-diabetic drugs, anti-platelets like (aspirin, clopidogrel etc), anti-coagulants (Warfarin or agents like dabigatran, apixaban, rivaroxaban).
The general hygienic measures which are being propagated extensively like Social distancing, repeated washing of hands with soap and water, using handkerchief to cover mouth and nose while coughing and sneezing need to be observed very rigorously by all these patients.
Besides these it is very important that all patients with high blood pressure must continue their BP lowering medicines. It had come in as a news in some media reports that patients on Ace inhibitors (Ramipril, lisinopril, enalapril etc) or Angiotensin receptor blockers (Losartan, Telmisartan, Olmesartan etc) should not be taken because the Corona virus also acts through the ACE receptor. These reports were however refuted and guidelines were released by American and European Societies that these drugs are absolutely safe and in fact should be the preferred agents. BP should be measured often at home only to ensure that it is less than 140/90 mms Hg. If it is not or is causing concern to the individual, then an opinion should be sought. They should contact the treating physician on telephone, watts up or social media and take action accordingly. Self-medication or altering medicines without consulting should be strongly discouraged.
Like wise patients on other medicines for the cardiac problems must continue as such. In response to some media reports there has been an upsurge in some people to take hydroxychloroquine and azathioprine etc. These are not recommended except in some special situations like for asymptomatic healthcare workers involved in the care of suspected or confirmed cases of Covid-19 and asymptomatic household contacts of laboratory confirmed cases.
As per the advisory from Indian Council of Medical Research (ICMR). Hydroxy-chloroquine is found to be effective against coronavirus in laboratory studies and in-vivo studies. Its use in prophylaxis is derived from the available evidence of benefit as treatment and supported by preclinical data,” the advisory said. The drug is not recommended for prophylaxis in children under 15 years of age. According to the advisory, the drug has to be given only on the prescription of a registered medical practitioner.
Chloroquine and Hydroxy Chloroquine are drugs traditionally used for treatment of malaria, rheumatoid and some auto immune diseases. One has to be very careful regarding administration of Hydroxy chloroquine in elderly people and also in patients with a background of heart disease. It can produce ECG changes leading to serious arrhythmias and death. This drug has also interaction with anticoagulants making them more prone to serious bleeding and needs frequent checks of INR if on warfarin.
Any body with a contact with a positive case of COVID-19 or his close family members or contacts should be very careful. He or she should contact the designated Govt centre to get a test for COVID done which at present is a nasal and naso-pharyngeal swab taken by professionals trained to take it. They wear a special attire called Personal protection instrument (PPI) to protect themselves and the community from infection . The sample is highly contagious and is to be transported in a sealed tube un exposed to the atmosphere.
Lastly it is extremely important to keep these high-risk individuals isolated. It is the duty of the family to ensure this in the larger interests of the society at large.
Author is a Cardiologist. Recipient of Padmshiri and Dr B C Roy Award