Stories from the coronavirus frontline – A Consultant Cardiologist on changes brought about by the pandemic

In a series of posts giving a frank account of experiences on the NHS frontline, Sally Williams hears from a Cardiology Consultant who works in a tertiary cardiac centre. Here’s what he said on 22 April 2020.

I believe COVID-19 will change medicine forever.

Rapid dissemination of learning

One big change has been the pace at which information is shared. It has been astonishing. There are papers coming out of China that, following rapid review, land in my inbox the next week. It’s enabling us to learn from other countries about the pattern of disease and the impact of drugs far faster than ever before.

Normally there is a lag as papers go through a rigorous peer review process. Due to the urgency of the situation, editors have allowed knowledge to be shared either unreviewed or following rapid peer review. It also means doing your own appraisal of the evidence, but this is something clinicians should be doing anyway.

I’ve just listened to a webinar from a cardiologist and intensivist working in Wuhan, on his experience of looking after patients with COVID-19. It has been hugely informative, and the knowledge is transferable to the UK context. There are also webinars from intensivists in Italy, which share what they have learnt and the serious problems that can occur if the right action isn’t taken.

For instance, the main lesson from places with a much flatter curve has been to test, test, test, isolate and trace. Presently, the strategy in the UK is based on isolating because of a fever and/or a cough. At any one time, there are 600 plus members of staff in the hospital off work, reflecting government guidelines that all members of a household where someone has symptoms should self-isolate for 14 days. We have lost a lot of staff for what may or may not be COVID-19.

Virtual clinics

Another change has been the move to virtual clinics. Due to COVID-19, all our clinics are being conducted virtually. We have talked about telemedicine for years, but the workforce has been concerned about patient confidentiality and usability for patients. The COVID pandemic has forced us into it. Currently, I am triaging 40 patients per clinic, sifting between those who need to be seen. For most patients, this means conducting an initial assessment and triage over the telephone.

There are hot hub clinics for those patients who really need to be seen in person. Most of our patients are very anxious and the prospect of coming to hospital for anything is worrying. Keeping in touch with them by telephone is important. I know many of the patients well. It can be harder conducting a virtual consultation with a new patient. Assessment of a medical problem often requires you to physically examine the patient.

Drop in patients seeking medical help

The incidence of strokes and hearts attacks has diminished significantly. A lack of attendance at hospital is a real phenomenon, particularly for cardiac conditions. The British Heart Foundation has warned that people suffering heart attacks may be putting their lives at risk by delaying seeking help. The number of people attending A&E with symptoms of a possible heart attack has dropped by 50% over March (https://www.britishcardiovascularsociety.org/news/drop-in-heart-attack-a-and-e-attendances).

Patients with cardiovascular disease are vulnerable to the complications of COVID-19 increasing the risk of death. They are already anxious about their ongoing condition. To receive a letter advising they shield themselves by isolating for 12 weeks only compounds that anxiety. These messages have left people reluctant to seek care from hospital, which is understandable, as that’s where all patients who are seriously unwell with COVID-19 are being cared for.

One patient with a major heart attack, only attended hospital because his wife insisted. He thought that having a heart attack at home posed less of a risk than coming into hospital to get COVID. That simply isn’t the case and we are continuing to treat heart attacks and perform a range of interventions.

The wards have been allocated as green for non-COVID or red for COVID. Patient suspected as having, or proven to have, COVID go to the red wards; patients with no suspicion of COVID go to a green ward. Most patients with acute heart problems are kept on the green wards and are usually discharged home in a day or two.

We have tended to divide up the cardiac workforce, assigning them to either ward or non-ward work. The aim is to limit the number of staff who interact with COVID patients – reflecting the SPACES approach [see blog on 1st April 2020]. I hope this will reassure patients with cardiovascular disease that we are doing all we can to keep both them and staff safe.

The main challenge for us all is not now, but when the whole world is struggling to get up and running, and COVID returns. Until a vaccine is developed it is going to take some pretty skilful political manipulation to get life fully functioning once again.

As told to Sally Williams

Image by gfk DSGN from Pixabay

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