The 2019–20 coronavirus pandemic is an ongoing pandemic caused by novel coronavirus, COVID-19 and first was identified in Wuhan, China, in December 2019 and then rapidly spread around the world.
As of 15 April 2020, more than 1.98 million cases COVID-19 have been reported resulting in more than 126,000 deaths.
The pandemic has led to severe global socioeconomic disruption with many populations across the world are locked down.
It has changed the way as we doctor will operate in this world with physical distancing, wearing personal protection and use of effective, efficient telemedicine care becoming more of a norm.
The virus is primarily spread between people during close contact, via small droplets produced by coughing, sneezing, or talking. People may also become infected by touching a contaminated surface and then their face. Common symptoms include fever, cough and shortness of breath. Complications may include pneumonia and acute respiratory distress syndrome.
Most people with COVID-19 recover and for those who do not, the time from development of symptoms to death has been between 6 and 41 days, with the most common being 14 days. This quick turn to the worse are mostly due to “overly exuberant” reaction by the immune system as it fights the virus, called a cytokine storm.
Though lungs bear the brunt of the disease, heart is involved in many cases and can be the cause of death.
COVID-19 uses the ACE2 protein to enter cells, however general consensus is that RAS inhibitors, which are one of the most commonly prescribed antihypertensive medicines are to be continued.
In patients presenting with what appears to be a typical cardiac syndrome, COVID-19 infection should be in the differential during the current pandemic, even in the absence of fever or cough.
Some may proceed to cardiogenic shock needed circulatory support in form of IABP or ECMO. Primary treatment is symptomatic and supportive therapy, though trial are ongoing with Hydroxychloroquine, Azithromycin, convalescent plasma therapy and retroviral drugs, though as of on 14 April ISDA said that there insufficient evidence to recommend any particular medication.
Cardiac injury as seen by elevated troponin were seen in 1 in 5 patients and was an independent predictor of dying (up to 10 times) in the hospital.