RED ALERT CARDIAC PATIENTS WITH COVID19

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NIHAR RANJAN PARIDA Intervention Cardiologist speaks on Pandemic COVID19 virus infection and cardiac illness and red alert cardiac patients with COVID19.

How did a new virus strain emerge suddenly out of nowhere?

Influenza viruses are known for genetic resortments: Mutation of a surface protein on the new CORONA VIRUS lead to infection of humans, with the new spillover events, from animal reservoir to humans, required the modification of the S protein to acquire the ability to infect human cells, a key step to overcome the specie barrier. As expected, in addition to S, other viral genes (such as orf8) can mutate during the viral adaptation to the new host, as reported for the SARS-CoV. Data indicates that several recombination events have taken place between the genome of different CoVids. Therefore, the ability to originate new viral variants can promote jumps from bats to other sylvatic animals, the adaptation to the new host and then the transmission to domestic animals or humans. Overall, data collected so far strongly suggest that the CoVid-2019 is a new human-infecting beta CORONA VIRUS likely originated from bats jumped to humans probably after the passage in one or more intermediate hosts like bats or rodents. Current research focuses on effective prophylactic and/or therapeutic interventions. 

Why CORONA VIRUS is not responding so easily to treatment?

One way influenza virus change is called “antigenic drift.” These are small changes (or mutations) in the genes of influenza viruses that can lead to changes in the surface proteins of the virus: HA (hem agglutinin) and NA (neuraminidase). The HA and NA surface proteins of influenza viruses are “antigens,” which means they are recognized by the immune system and are capable of triggering an immune response, including production of antibodies that can block infection. However, the small changes associated with antigenic drift can accumulate over time and result in viruses that are antigenically different (further away on the phylogenetic tree).When antigenic drift occurs; the body’s immune system may not recognize and prevent sickness caused by the newer influenza viruses. As a result, a person becomes susceptible to flu infection again; as antigenic drift has changed the virus enough that a person’s existent antibodies won’t recognize and neutralize the newer influenza virus.

Antigenic shift is an abrupt, major change in influenza. A virus, resulting in new HA and/or new HA and NA proteins in influenza viruses that infect humans. Shift can result in a new influenza A subtype in humans. One way this shift can happen is when an influenza virus from an animal population gains the ability to infect humans. Such animal-origin viruses can contain an HA or HA/NA combination that is so different from the same subtype in humans that most people do not have immunity to the new (e.g., novel) virus. Such a “shift” occurred in the spring of 2009, when an H1N1 virus with genes from North American Swine, Eurasian Swine, humans and birds emerged to infect people and quickly spread, causing a pandemic. But it’s only seen between two strains of Influenza viruses.

What are the cardiac complications of Covid-19?

Itself Covid-19 can cause rhythm a disturbance of heart, being acute cardiac injury, myocarditis but incidence is below 10 percent. In two to three Wuhan based studies it’s the rhythm disturbances which was around 17 percent otherwise all other cardiac complications were below 10 per cent, ‘according to the current American and European cardiac statements’. A Covid-19 patient presenting with cardiac complication is very rare. It’s the pulmonary complications in the form of viral pneumonia and reduced pulmonary compliance that cardiac decompensation sets in. Over and above the viral proteins itself in high doses can cause cardiac injury.

What is the risk for diagnosed heart patients for Covid-19? 

It’s definitely a red alert for those who are elderly with diabetic, hypertensive, brain stroke or have heart diseases, like stroke, heart failure or any form of heart disease. The risk is ten times greater than non heart disease people of same age group. They may have worsening of the current cardiac illness or can have acute cardiac injury.

Are we doing enough to prevent the community spread?

It’s a collective approach which can prevent the spread of the disease. Because at Government level they are doing their best, it’s up to the people to help implementing the rules. If people won’t be aware of the hazards then nothing is going to change. There are news stories regarding the hiding of travel and contact history. Those people should realise that it’s not only their family members who would be at risk but the whole community. We should start contact tracing from  community. Strict legislation should be followed for benefit of everyone. If we fail at this level then in a country of 138 crores it would be havoc.

What would be your advice for heart patients?

My first advice is don’t panic over the situation , follow strict lockdown, stay at home, do your daily household work as usual, wash your hands as many times for twenty seconds each time, stay away from Covid patients. Don’t run to hospital for minor ailments. Take your usual dose of medicines as advised. Don’t get exposed to outside unless some serious problem is there. Lastly stay inside and stay safe.

Is India in control of the Covid-19 pandemic?

Yes, it is because of continued efforts of Government machinery, all the healthcare personal, police, and most importantly media, NGOs and all those people who are involved in containing the pandemic. Having said this I would like to highlight the rising trends of new cases for last four days is definitely creating hiccups. However, if we can tighten the knot for another two weeks as issued by Government then we can get in the safe zone.

Are the Indians to some extent immune to the current virus?

It’s not true, currently there’s no randomised study of the novel Corona virus so that we can draw any conclusions over our immunity. Maybe we are immune but time would answer this query. For now postulating this hypothesis and roaming outside against the Government guidelines would create the a worse situation than Italy and USA.

Does temperature play a role in containing the spread?

Most viruses are destroyed in high temperatures but the behaviour of the Covid-19 is not yet studied in detail. Few small studies postulate in favour of temperature and some studies show temperature has no role. So more studies by microbiologists will required to establish the truth.

Can Corona Virus in a dead body infect anyone?   

Regarding the burial or cremation of dead bodies of Covid19 patients it’s nowhere studied and proved that dead body parts infect others. Corona virus spread via droplets, as a dead body can’t cough, sneeze or talk so chances of infection is almost negligible. Burial or cremation if done in proper method is almost safe.

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