What every Health care

provider should know about

Novel Corona virus(COVID-19)

Ahmed Mohsen
Department of Cardiovascular Medicine
Cairo University
 Agenda
• 1-What is Corona virus?
• 2-What is COVID-19?
• 3-What are the symptoms of COVID-19?
• 4-How does COVID-19 spread?
• 5-Can COVID-19 be caught from a person who
has no symptoms?
• 6-How can I protect myself and prevent the
spread of the disease?
• 7-Should I wear mask to protect myself?
• 8-Is there a vaccine, drug, or treatment for
COVID-19?
• 9-Should I worry about COVID-19?
• 10-Who is at the risk of developing severe
illness?
• 11-Cardiac Implications of Novel Coronavirus
 1-What is Corona virus?
• Coronaviruses are a large family of viruses which
may cause illness in animals or humans.
• In humans, several coronaviruses are known to
cause respiratory infections ranging from the
common cold to more severe diseases such as
Middle East Respiratory Syndrome (MERS) and
Severe Acute Respiratory Syndrome (SARS).
• The most recently discovered corona virus
causes corona virus disease COVID-19
 2-What is COVID-19?
• COVID-19 is the infectious disease caused by the most
recently discovered coronavirus.
• This new virus and disease were unknown before the
outbreak began in Wuhan, China, in December 2019
• 3% of cases occur in patients below 20 year
• 81% of patients have no or mild symptoms and can
recover spontaneously
• 14% of patients have severe pneumonia
• COVID-19 can cause critical illness in only 5% of
patients
 Mortality from COVID-19 in patients
in general population
• The overall mortality is about 3.4%
• Mortality is only 0.2% below the age of 40
years
• However, morbidity and mortality increase
significantly with age
• Mortality is about 8.0% among patients 70-79
years and about 14.8% in patients over 80
year
 Mortality from COVID-19 in patients with
different comorbidities
• Cancer: 5.6%
• Hypertension: 6.0%
• Chronic respiratory disease: 6.3%
• Diabetes: 7.3%
• Cardiovascular disease: 10.5%
CVOID-19 vs. Seasonal flu, MERS and
SARS
 3-What are the symptoms of COVID-19?

• The most common symptoms of COVID-19 are

fever, tiredness, and dry cough
• Some patients may have aches and pains,
nasal congestion, runny nose, sore throat or
diarrhea
• These symptoms are usually mild and begin
gradually
• Some people become infected but don’t
develop any symptoms and don't feel unwell
 3-What are the symptoms of COVID-19?

• Most people (about 80%) recover from the

disease without needing special treatment.
• Around 1 out of every 6 people who gets COVID-
19 becomes seriously ill and develops difficulty
breathing.
• Older people, and those with underlying medical
problems like hypertension, heart problems or
diabetes, are more likely to develop serious
illness.
• People with fever, cough and difficulty breathing
should seek medical attention
 4-How does COVID-19 spread?
• The disease can spread from person to person
through small droplets from the nose or
mouth (Cough or sneezing)
• These droplets land on objects and surfaces
around the person.
• Other people then catch COVID-19 by
touching these objects or surfaces, then
touching their eyes, nose or mouth.
 5-Can COVID-19 be caught from a
person who has no symptoms?
• The risk of catching COVID-19 from someone
with no symptoms at all is very low.
• However, many people with COVID-19
experience only mild symptoms.
• This is particularly true at the early stages of
the disease.
• It is therefore possible to catch COVID-19 from
someone who has, for example, just a mild
cough and does not feel ill.
 6-How can I protect myself and
prevent the spread of the disease
• Regularly and thoroughly clean your hands
with an alcohol-based hand rub or wash them
with soap and water.
• Maintain at least 1 metre (3 feet) distance
between yourself and anyone who is coughing
or sneezing.
 6-How can I protect myself and
prevent the spread of the disease
• Avoid touching eyes, nose and mouth.
• Make sure you, and the people around you,
follow good respiratory hygiene.
• This means covering your mouth and nose
with your bent elbow or tissue when you
cough or sneeze, then dispose of the used
tissue immediately.
 6-How can I protect myself and
prevent the spread of the disease
• Stay home if you feel unwell
• If you have a fever, cough and difficulty
breathing, seek medical attention
• If possible, avoid traveling especially if you are
an older person or have diabetes, heart or
lung disease
 7-Should I wear mask to protect
myself?
• Only wear a mask if you are ill with COVID-19
symptoms (especially coughing) or looking
after someone who may have COVID-19.
• Disposable face mask can only be used once.
• If you are not ill or looking after someone
who is ill then you are wasting a mask.
• There is a world-wide shortage of masks, so
WHO urges people to use masks wisely.
 8-Is there a vaccine, drug, or
treatment for COVID-19?
• Not yet. To date, there is no vaccine and no
specific antiviral medicine to prevent or treat
COVID-2019.
• However, those affected should receive care to
relieve symptoms.
• People with serious illness should be hospitalized.
• Most patients recover thanks to supportive care.
• Possible vaccines and some specific drug
treatments are under investigation
9-Should I worry about COVID-19?
• Illness due to COVID-19 infection is generally
mild, especially for children and young adults
• However, it can cause serious illness: about 1
in every 5 people who catch it need hospital
care
 10-Who is at the risk of developing
severe illness?
• Older persons
• Persons with pre-existing medical conditions
(such as hypertension, heart disease, lung
disease, cancer or diabetes) appear to
develop serious illness more often than others
Cardiac Implications of Novel Corona virus
 The ACC lists the following points regarding early
cardiac implications from case reports on Coronavirus

• Up to 50% of hospitalized patients have a chronic

medical illness
• 40% of hospitalized patients with confirmed
COVID-19 patients have cardiovascular or
cerebrovascular disease.

• Patients with underlying cardiovascular disease

are at higher risk of contracting COVID-19 and
have a worse prognosis
 Cardiac implications of Corona virus
• 16.7% of patients developed arrhythmia
• 7.2 % developed acute cardiac injury.
• 8.7 % of patients developed shock
• Reported cases of acute onset heart failure,
Myocarditis, cardiac arrest, myocardial
infarction(especially type2 MI), as with any
acute illness, higher cardiometabolic demand
can precipitate cardiac complications
• 3.6% developed acute kidney injury.
• The first reported death was a 61-year-old
male, with a long history of smoking, who
Suffered from ARDS(acute respiratory distress
syndrome), heart failure and cardiac arrest.
 Drug interaction between antiviral drugs and
the commonly used cardiovascular medications
• Ribavirin and oseltamivir do not have significant
interaction with the cardiovascular medications
• Lopinavir and Ritonavir have a significant
interaction with the cardiovascular medications
• (including statins, NOACs, warfarin, clopidogrel,
antiarrhythmic drugs, betablockers, digoxin,
ivabradine and calcium channel blocker, PDEI-5
inhibitors)
• Interaction between hydroxychloroquine and
antiarrhythmic drugs, beta blockers and digitalis
 Additional precautions for Patients With
Underlying Cardiovascular Conditions

• Make plans for quickly identifying and isolating

cardiovascular patients with COVID19 symptoms from
other patients, including in the ambulatory setting

• It is important for patients with CVD to remain current

with vaccinations, including the pneumococcal vaccine
given the increased risk of secondary bacterial
infection with COVID-19; CVD patients should be
vaccinated against influenza in accordance with current
ACC/AHA guidelines
• In geographies with active COVID-19 outbreaks, it
may be reasonable to substitute telephonic or
telehealth visits for in-person routine visits for
stable CVD patients to avoid possible nosocomial
COVID-19 infection; planning for emergency
telehealth protocols should begin now

• It is reasonable to triage COVID-19 patients

according to underlying cardiovascular, diabetic,
respiratory, renal, oncological, or other comorbid
conditions for prioritized treatment
• For patients with heart failure or volume
overload conditions, copious fluid administration
for viral infection should be used cautiously and
carefully monitored

• General immunological health remains

important for both providers and patients,
including eating well, sleeping and managing
stress
 MI in patients with Corona
• Providers are cautioned that classic symptoms
and presentation of AMI may be masked in the
context of COVID-19, resulting in underdiagnosis

• Particular emphasis should be placed on acute

PCI and CABG, including protocols to limit
catheterization lab and OR personnel to a
required minimum, pre-determining
requirements for enhanced personal protection,
and assessing post-procedural sterilization
• It is crucial to assess the risk-benefit ratio of
acute MI intervention (given limited data on
primary PCI benefit for type-2-MI from acute
viral illness) against nosocomial infection risk
 Take home message
• Novel corona virus is an emerging new universal health problem that
necessitates careful medical attention

• More than 80% of infected patients experience mild symptoms and

recover without intensive medical intervention

• Elderly populations and patients with comorbidities especially cardiac

patients are at the highest risk for morbidity and mortality and require
special care

• The most effective ways for protection are frequent hand washing,
cover your mouth and nose during cough or sneezing and to maintain a
distance of at least 1 meter from people who are coughing or sneezing
Thank You