Patients with heart failure, diabetes more vulnerable to Covid infection: Cardiologist Dr. Bikash Majumder

Are you testing all heart patients coming to your hospital for Covid before starting treatment?

Before hospital admission all of our patients are getting screened and tested for COVID 19 infection. If patients are getting admitted through the Emergency then everyone is getting screened by a designated COVID consultant in the Emergency, patients are getting a CT scan of chest and then any suspected patient is getting swab test for COVID 19 in a designated ward. Once the COVID 19 test is negative then the patients are getting transferred to the Cardiology ward.

Do you feel the heart patients are more vulnerable to Covid? Kindly explain a little for our readers.

Vulnerability of the heart patients are dependent on the heart conditions they are suffering from. Patients with heart failure, diabetes and Cardiac transplant patients are more vulnerable to COVID infection as they are immunocompromised to some extent. It has been seen if COVID infected patients suffer from pre-existing cardiac disease their clinical outcome is somewhat worse compared to patients who do not have any pre-existing cardiac conditions.

It has also been observed that though majority of the COVID infected patients get better within few days, a minority of COVID-19 patients develop severe symptoms. In some percentage of COVID infected patients, heart also gets involved. There are possibilities of development of heart attacks, myocarditis (inflammation of heart muscle), heart rhythm problem etc. Those patients who develop heart involvement have poorer outcome.

Do younger people with heart ailments have equal risk as elders?

It depends on the type of heart disease. As already mentioned, heart patients with poor heart pumping ability (heart failure), cardiac transplant will have higher risk of development of COVID related complications.

As a doctor, what is your assessment of Covid-19? Is it a new normal to live with the virus?

COVID-19 is going to stay with us in the coming future. We have to adapt to the ‘new normal’ and we need to learn to live with it. It is important we learn how to deliver best care to our heart patients without increasing the risk of getting infected or spreading infections. I am confident with the help of our patients, relatives, hospital management, government we will quickly adapt to the ‘new normal’ and continue to serve our patients in the best possible way so that our patients do not suffer from cardiac diseases.

What are your advices for heart patients in these days?

Heart patients with stable conditions should stay at home and continue their regular medicines during this lockdown period. They should maintain heart healthy food habit and continue aerobic exercise at home. If they want to contact their cardiologists to clarify certain problems or medicine related issues, online consultations with their Cardiologists are getting momentum when the possibilities of attending the OPD in person are not there. Some patients are fitted with pacemakers or ICDs (implantable cardioverter defibrillator). These devices need periodic check-ups. These check-ups can be performed with the remote monitoring system. With the remote monitoring device, the pacemaker and ICD devices data can be transmitted to the Cardiologists from a remote location without being present in person at the consultant’s office. Adapting to new technologies like this may be the new normal in the coming future as well.

These technologies like online consultation platform and remote monitoring of pacemakers will help to prevent crowding in the outpatient departments and consultant’s office and will be able to deliver adequate care to our cardiology patients. Of course, in case of emergency I suggest patients must present themselves in the hospital emergencies and consult the cardiologist in person. Heart attacks cannot be treated at home and cannot be treated by online consultation. There are standard operating procedures in place in hospitals to treat cardiac emergencies in the COVID-19 situation.

What is your advice in general for everyone in these times?

Please follow government instructions, maintain social distancing and use masks. As coronavirus is going to stay with us for coming months and probably years so it is necessary to adapt to the ‘new normal’ and learn to live with it. We all need to continue our activities and remain productive economically and socially once the lockdown is lifted but we should not forget the safety norms and will abide by the norms to protect ourselves and to protect the society from spreading the virus.

Are all heart departments open in your hospital?

We are open and providing services to our patients maintaining proper precautions to minimise the risk of infection.

There is an increasing risk of getting infected with Covid in any hospital at the present time. How are you taking precautions for patients?

Precautions are must in order to protect our patients and healthcare professionals. Before entering the hospital building everyone is getting temperature check and going through a health questionnaire. In the OPD area we are maintaining social distancing by clearly marking the seats not to be used. We are making sure everyone is using a mask. Only one relative is allowed with a patient.

We are providing hand sanitizer to the patients and relatives. In order to prevent overcrowding in the out patients’ department we are giving out patient appointments in a staggered fashion. Those patients who require admission from the OPD for any cardiological procedure are undergoing mandatory COVID swab testing before admission to the Cardiology ward in order to protect our patients from COVID-19 infection. We have designated separate area for COVID testing.

If patient comes to the emergency department and requires emergency heart procedure, we are using PPE (personal protective equipment) and doing the procedure in a designated catheter laboratory and keeping the patient in a separate ward till the COVID test result is available. Once the test result is negative then only, we are transferring the patients in the Cardiology area.

In this way we are efficiently separating COVID positive patients from the COVID negative cardiology patients without hampering the much-needed Cardiology care of our patients. In the semi urgent admission through the emergency room all our patients are getting screened by a specialist COVID consultant and initially the patients are getting CT scan of the chest and then swab test before getting admitted to the Cardiology ward.

How are doctors taking precautions?

Before seeing the patients in the 'outpatient department’ we are changing in to ‘hospital blues’ after taking off our clothes. We doctor and health care workers are taking precautions by wearing N 95 masks, face shields, hand gloves and gowns while seeing patients in the outpatient department. We are maintaining social distancing norms and using hand sanitizers routinely.

After finishing the clinic, we are again changing to our regular dresses in a designated place. During the emergency procedures in the catheter laboratory the doctors and nurses are using PPE and we have designated catheter laboratory for the suspected COVID 19 patients. We have designated PPE donning and doffing area in our catheter laboratory.