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COVID-19 and Cardiology Read more

Giving teamwork a new meaning – Madrid, Spain

 

Two things are striking about COVID-19. First is how quickly the infection spreads. Every two days or so we double the number of patients. Now we are not really concerned about who is positive because we assume all patients are positive. Today two patients with infarction were admitted. Both of them were COVID positive.

The second striking thing is the solidarity of staff in the cardiology department. We have 120 hospital staff, including cardiologists, in quarantine, some with infections. In fact, some cardiologists have already been admitted with pneumonia and respiratory impairment. But still, you see the solidarity and how the doctors want to help others. Even with insufficient resources they continue to work.

Our hospital emergency room normally receives about 800 patients per day. Now it deals with COVID patients, so you need to readapt the emergency department and try not to receive extra ones. On Sunday, 100 new COVIDs suspicions came to the emergency room. On Monday it is 150 COVID patients and on Tuesday 200. Most ICU patients currently have COVID-19.

This infection can appear so suddenly that you may find yourself without adequate protective measures for all the people working at the hospital. This not only includes masks but also gloves, coats and glasses. The infection spreads not by inhalation, but via droplets, so the way you protect your eyes and face is very important. But it may happen that some hospitals don’t have a large enough stockpile. At these moments in your life you need people with imagination. A nurse invented a way to make a protective face covering using a plastic folder, and hospital staff were wearing her invention until supplies arrived. 

We do our best to segregate COVID patients the moment they arrive at the hospital so that they don’t mix with uninfected patients. That means a dedicated COVID emergency area within the emergency department, a COVID cardiology area inside the cardiology department, and so on. Normally, cardiology patients stay in the emergency department for two to three hours for an ECG, clinical exam, triage…troponins, etc. But now we want to take them directly to the cardiology department straightaway because we don’t want them to be infected with the coronavirus. We treat them, discharge them if feasible, and follow them at home using teleconferencing.

Our cardiology department has been doing 51,000 outpatient visits per year. For the last two weeks, every single outpatient visit is done by teleconference with a cardiologist. Patients only come into the hospital after their teleconference in extreme situations – around two patients per day. We keep this to a minimum because we need to cut the spread of infection. But it’s also worth noting, most patients don’t want to come to the hospital these days.

The non-COVID area in the cardiology department gets smaller and smaller every day. Everyone in the department has volunteered to do shifts in the COVID area. We have 32 senior staff and every week I will alternate who is assigned to the COVID area or to the teleconferencing work because it’s much more stressful now. You cannot see more than six COVID patients on the ward per day, whereas we are used to seeing 12 cardiac patients in a day. To see COVID patients you need to dress yourself in a different way, with a coat, special mask, glasses, gloves.

At the intensive care unit, our anaesthesiologist puts COVID patients in a prone position because they cannot breathe. And we have patients that require ventilatory assistance.  I told my department that I am afraid I will infect my wife, my kids... But you should never take decisions based on fear. Instead, fear is something that makes you better – to respect the disease, the infection, and the virus. We are all together fighting this disease

Our cardiology trials have also changed as a result of COVID-19. All of the research fellows and the research nurses work from home instead of at the hospital. We have not enrolled any new patients in any single trial because we don’t know if they will become infected and need to be in intensive care. I cannot recommend our approach to others, but this is what we did. For face-to-face visits by research nurses, we have asked the companies for permission to change these to telemonitoring visits.

I think that the world is going to be different post-COVID – hospitals, companies, ESC meetings – because we have all moved so quickly to digital. It was what everybody was planning to do, but we have been forced to implement it immediately. There is no other way. In companies, the remote work that was mainly for millennials is now there for older people. In our hospital, we did a pilot cardiac rehabilitation programme called HAZLO and now all patients do it at home. If you think about that, why should low risk patients come to the hospital for rehabilitation? I think that post-COVID, only high-risk patients will come to the hospital for rehabilitation. We were thinking pre- COVID of doing this. But now it is simply implemented

I’m so proud of being a cardiologist and a doctor. ESC cardiology colleagues around the world are in contact: they send you an email, how are you doing, this is my experience. The ESC has helped us to establish this network to share problems and learn from each other. I have learned a lot from Italian colleagues, and colleagues in Belgium, Portugal, France, and China. It seems like a minor thing, but Luigi Badano from Italy told me that when he gets home from the hospital, he leaves his shoes and clothes outside and goes straight to the shower. I do that now and have told my department to do it. Others told me their relatives are infected, wife or parents. We share our concerns and ideas.

Another helpful thing was to exchange protocols and treatments with Australia. We don’t know a lot about this virus. But it seems that the treatment we are giving patients is pretty much the same worldwide. Around 10 drugs including interleukin-6 antibodies, chloroquine, and antivirals. This is a respiratory disease, mainly pneumonia. And they may have the usual cardiac manifestations of an infection, meaning tachycardia, blood pressure problems or even heart failure.

In Spain, we have been involved treating Avian flu and Ebola, but the infection rate with COVID-19 is like nothing I’ve seen before related to how easy it is to be infected.  When I drive home from the hospital, Madrid is a ghost city.  It’s a strange situation. We are all in this together, no frontiers. The solidarity I am seeing is really outstanding. My best wishes to all of you, aware that some of you are already suffering in their close families. If I can be of help, just give me a call or email.

 

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