Coronavirus (COVID-19) advice from OneWelbeck Heart Health

The infection is a virus, similar to the flu virus. From the Chinese epidemic that in the vast majority (more than 80%) of cases however, the infection will be just like flu with a complete recovery. However it is more contagious and the risk of dying from infection is about 10 times greater than that associated with seasonal flu.

The most common symptoms of COVID-19 are:

• A persistent new cough, which is most often dry and does not produce sputum
• Fever of  37.8o C or more
• Breathlessness – usually develops at a later stage

Non-specific symptoms include:

• Fatigue
• Aching muscles and bones/joints

Less common symptoms include:

• Sore Throat
• Headaches
• Chills

A runny or congested nose, sneezing, diarrhoea are much less common and would point towards a common cold or gastroenteritis.

We have learned that the risk of a serious illness is increased with any of the following risk factors, and more if you have more than one factor:

1. Increasing age, especially over 70 yrs
2. Cardiovascular conditions
3. Hypertension
4. Diabetes
5. Respiratory disease

The published reports so far show that the main damage is to the lungs causing a type of viral pneumonia and inflammation. This is caused by a direct effect of the virus to the lungs and as well as acute inflammation stress which is also seen in other overwhelming infections. The impact on the heart is also to cause inflammation resulting in heart muscle weakness as well as serious rhythm disturbances. In addition, with the body under greater stress, the heart is in turn under greater stress causing further problems with acute cardiac failure, rhythm disturbances and also in some cases heart attacks.

This is obviously frightening to hear – So what should I do?

The advice, and there is plenty in the public domain, is to try and avoid infection at all costs.

The principles are logical and can be applied by all of us.

Clearly if you are in a high-risk group such as those over 70yrs or older, then it is even more important and the current thinking is to consider the isolation measures for up to 12 weeks.

1. Avoid contact with anyone with suspected infection.
2. Avoid all unnecessary travel.
3. Exercise for up to one-hour, once a day – and only on your own or with those in your household.
4. Regularly wash your hands thoroughly for at least 20 seconds or with hand-sanitiser if soup and water is not available.
5. Avoid touching your face without hand-washing first as you may bring the virus nearer to your mouth and nose.
6. Mask usage is of limited value – it will protect others if you have symptoms but less likely to protect the mask wearer. Wearing a mask is uncomfortable and you will be more likely to touch your face to adjust it, paradoxically increasing risk. The medically approved FFP3 mask is for medical worker usage only and is in very short supply. You should NOT buy or hoard these masks.

If you develop symptoms do not go to your GP or hospital, but follow latest government advice to self-isolate for 14 days in your home and to only contact 111 if you become more seriously unwell.

Self-isolation applies for 7 days and also applies to all those who live in your household for 14 days.

If you are asked to self-isolate, then sleep in a separate room from the rest of the family members and confine yourself as much as possible to your room. Clean surfaces in toilets etc vigorously to avoid cross-contamination.

Answers to some specific questions raised by patients so far

Should I travel on holiday?

• All non-essential travel should be avoided.
• Though the air in-flight is safe, you will be in closer proximity to others and surface contact could cross-contaminate.
• Travel insurance may not cover cancellations and you may also face difficulty in returning home

I have had tests undertaken or need to be seen for follow up.

• In the NHS and privately tele-medicine protocols are being set up to reduce direct contact and unnecessary travel.
• Please contact the OneWelbeck Heart Health team (0203 652 2005) or your doctor’s medical secretary to enable this. The private insurers have agreed to reimburse for such consultations.
• Patients with worsening heart failure or serious valvular heart disease may need to be examined in person, but the team will be able to advise.

I am unwell with my heart condition – What should I do?

• Please contact the OneWelbeck Heart Health team (0203 652 2005) or your doctor’s medical secretary to arrange an initial telephone consultation and then we can decide on further tests and review.
• We will organise tests before reviewing, on the same day where possible, to minimise repeated journeys and in some instances can follow up with a tele-video consult afterwards. Please clear this with your insurers first.

Should I stop or replace Ramipril (ACEi, ending in -pril), or Losartan (the sartans) like drugs?

• Whilst there is a recent article in the Lancet stating theoretical reasons for a potential link between these drugs and greater harm from COVID-19, there are also potential benefits in protecting the lungs with these drugs.
• The cardiology community, in the absence of any clear evidence, has advised that you should not change your medication at the present moment.

The situation is likely to change rapidly and we will update this advice as required.

In the mean-time please follow gov.uk or other reputable websites for any changing advice.