In December of 2019, doctors in China started to notice the emergence of a new disease. The patients had flu-like symptoms and severe lung infection. Over the past few months, this disease which is now known as COVID-19 has spread all over the world and in Jamaica we have seen our first case in March of this year.

It is estimated that nearly 300,000 patients worldwide have contracted this disease and more than 10,000 deaths have been reported. These numbers continue to rise daily. In Jamaica, as at Friday, March 20, 2020, we have confirmed 19 cases with several more patients undergoing evaluation. We expect the number of cases to increase. So far it appears that the disease spreads very easily and as a result, large parts of our population are at risk. Clinical experience so far has suggested that patients with cardiac disease appear to be at high risk of catching the disease and at high risk of dying or having severe complications when infected.

Given the importance of this disease to our cardiac patients in Jamaica, we have attempted to summarise what we know so far about this emerging illness and how it impacts on our heart patients in Jamaica.

Why should we be concerned about COVID-19?

The germ that causes COVID-19 is a virus and is very easily spread from infected patients to people in close contact with them. People who are infected have a spectrum of symptoms that can range from no symptoms at all to being very sick and needing care in the intensive care unit on a breathing machine. So far, it does appear that most infected people (more than 80 per cent) will have relatively mild symptoms and can be treated at home. These patients can take over-the-counter medications and may not need to go to hospital or see a physician. It is very important, however, that these patients isolate themselves at home to protect others. Ideally, they should be in a room by themselves, should use their own bathroom and should not eat or share eating utensils with other members of their family. This is particularly important if family members are elderly or have chronic illnesses as these people have a high risk of infection and do not do well with this disease if infected.

In China, which has the most experience with this disease so far, the chance of dying appears to be about 1 in 100. This chance, however, does vary. The chance of dying increases with age, with patients above the age of 80 dying about 15 per cent of the time. Patients who have chronic illnesses such as hypertension, diabetes, or heart disease are also at increased risk of dying if they are infected with this virus. We therefore recommend that people with chronic diseases, especially heart and other cardiovascular diseases like hypertension and diabetes, be very careful to avoid getting infected.

Heart complications of COVID-19

Clinical experience has demonstrated that patients with heart disease are at a higher risk of becoming infected with the COVID-19 virus if exposed to an infected person. We also know that heart complications pose an important problem in the care of patients infected with the COVID-19 virus. These heart complications are more likely to be seen in patients who are above the age of 65, who have heart disease, hypertension, or diabetes. The complications that can be seen are quite varied but include heart attacks, heart inflammation, abnormal heart rhythms, congestive heart failure, and cardiac arrest.

What should patients with heart disease do?

As noted above, patients with heart disease have a higher risk of getting this infection and when infected they tend to do worse than other patients. Patients with diabetes and hypertension are also at increased risk. We therefore recommend that the elderly and those with chronic illnesses should take special precautions;

(1) It is important that they avoid situations in which patients who already have infections are present or likely to be present, particularly if they are present in large numbers.

(2) Patients with heart disease should avoid crowded emergency rooms (A&Es) or crowded medical offices. Ideally these patients should be taken care of, in places where low numbers of people are present and where they can be seen quickly and then either admitted or be discharged home.

(3) On social media there have been some concerns about blood pressure medications in patients with COVID-19 infections. The current experience suggests that for the great majority of patients with COVID-19 infections, continuation of their regular blood pressure medications is safe and will help prevent problems with poorly controlled hypertension and poorly controlled heart disease. There may be a small proportion of patients who will need to stop their blood pressure medications, but this should be done only on the advice of their doctors.

(4) There is, however, concern about the use of nonsteroidal medications for pain and fever. These include medications like ibuprofen (Motrin), Aleve, Cataflam, etc. These may interfere with the body’s response to the infection and should be avoided. Paracetamol “acetaminophen” is recommended for pain and fever.

Recognising the heightened risk to heart patients, we encourage all heart patients to practise the following measures in their day-to-day lives:

• Avoid crowded locations, especially crowded A&Es with long waits.

• Practise keeping about six feet away from people around you.

• Wash your hands with soap and water for at least 20 seconds making sure that the fingertips are thoroughly washed or where washing your hands is not possible, use an alcohol-based sanitiser, with at least 60 per cent alcohol to cleanse hands and fingertips frequently.

• Avoid or limit contact with people who are sick and if you feel sick, stay away from your family members at home and call your general practitioner (GP) for guidance.

• When coughing or sneezing do so on your elbow or into a tissue paper which should be immediately disposed of in a bin.

• Avoid touching your face, particularly your eyes, nose, and mouth.

• Clean frequently, the common surfaces you touch including phones, keyboards, remote controls, tablets, and laptops.

The Heart Institute of the Caribbean (HIC) and HIC Heart Hospital remain committed to the cardiovascular care of Jamaicans and at this time have made preparations to treat cardiac patients in a low-risk environment designed to reduce exposure to the COVID-19 virus. Our staff has been trained in the latest prevention guidelines from the Centers for Disease Control and Prevention in the United States and the World Health Organization on hygiene and cleaning. Our health and safety measures are designed to reduce the risk from all germs including COVID-19. These measures include hand-washing hygiene and special cleaning procedures of all areas including examination rooms, hospital rooms, diagnostic testing areas, and waiting areas.

We have also taken additional steps to safeguard our patients with heart diseases. Some of the things we have done include the following:

• To accommodate all heart patients across the island (including non HIC Cares Members), we have reinforced our staffing and resource allocation for our 24/7 Cardiac Emergency Room to ensure that patients with heart disease get speedy attention in a concierge setting without the risk attendant in crowded A&Es. If you experience chest pain or other cardiac-related complaints, please call our Heart Hotline at 876-906-2107 or visit our Heart Emergency Room at 23 Balmoral Avenue, Kingston 10.

• We also encourage heart patients when possible to demand virtual cardiology consultations with their cardiologists to avoid unnecessary exposure. HIC Cares Members are encouraged to take advantage of the HIC Virtual Cardiology Consultation Service by calling our office to schedule an appointment with our virtual care coordinators.

• We have made available automatic, touch-less hand sanitiser dispensers in multiple locations in our facilities to ensure that staff are able to frequently clean their hands which has been shown to reduce the risk of catching the infection.

• We have also increased the frequency of our deep hospital grade cleaning and sanitisation of all surfaces including all service and procedure areas, all entryways, door handles, and elevator panels on all floors.

• To further limit the risk of transmission, our hospital cooling system has been evaluated to ensure that the air in our facility is changed multiple times an hour in the emergency room and hospital to kill germs and reduce the risk of infection.

• We have increased clinical staffing levels in our Emergency Room (A&E) to ensure that patient wait times are short (less than 15 minutes) and that waiting patients are not crowded together.

• We are also restricting the number of visitors and duration of visits for hospitalised patients until the crisis is over.

• Furthermore, all visitors will be required to clean their hands on entry and exit from our facilities.

We recognise that these are unsettling times and whether you are currently an HIC patient or not, we want you to know that your safety and well-being are our first priority and assure you that we are here for your heart health 24/7. Together, we shall overcome this challenge.

Stay well and be safe.

Dr Ernest Madu, MD, FACC; and Dr Paul Edwards, MD, FACC, are consultant cardiologists at the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital

Correspondence to emadu@caribbeanheart.com or call 876-906-2107