Coronaviruses are defined as a large family of viruses that cause illness ranging from the common cold to more severe diseases. Common signs of coronavirus infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. WHO named “COVID-19” as a novel coronavirus which is new strain that has not been previously identified in humans. The current outbreak of COVID-19 that was first reported from Wuhan, China has becoming the most worrisome issues in global healthcare since numbers of infected patients and death rates have been increasingly reported in several countries across the world. Indications so far are that elderly people aged over 60 who have chronic medical conditions, such as diabetes, hypertension, cardiovascular disease (CVD) and neurovascular disease as well as cancer patients who have been receiving chemotherapy, potentially have a worse prognosis if they become infected with COVID-19. If COVID-19 is left untreated, systemic complications leading to death include pneumonia, heart failure and eventually multiorgan failure.

COVID-19 and heart disease 

Current estimated incubation period of COVID-19 ranges from 2 to 14 days. The spread of COVID-19 only happens after symptoms of infected patients manifest. Each infected patient could averagely transmit disease to 2-4 people, depending on seasons and population density in particular areas.   The signs and symptoms of COVID-19 disease vary ranging from mild to severe conditions. Presenting signs and symptoms include fever, cough, sore throat, runny nose, nasal congestion, shortness of breath, chest pain or discomfort, fatigue or malaise, muscle ache, headache, diarrhea, nausea and vomiting. Life-threatening manifestations are pneumonitis, pneumonia, heart failure and eventually death.

Medical researche published on The Lancet strongly indicates that patients with chronic medical conditions, particularly heart diseases have greater risks of death if they become infected with COVID-19. Current statistical data points out that up to 40% of patients who died from COVID-19 have cardiovascular diseases and neurovascular diseases e.g. brain aneurysms and stroke. When these particular patients are infected with COVID-19, the infection leads to cardiac arrhythmia or abnormal heartbeat (17%), myocardial infarction defined as irreversible death of heart muscle (7%), circulatory failure (9%) and acute kidney failure (4%).  In addition, researches reveal that risks of death from COVID-19 disease significantly increase in patients who have underlying diseases. Medical information derived from 138 infected cases in Wuhan, China indicates that infected patients who required intensive care have underlying diseases: hypertension (58%), diabetes (22%), cardiovascular diseases (25%) and neurovascular diseases (17%). In terms of provided treatments, 76% of patients infected with COVID-19 needed oxygen therapy, 13% of patients needed non-invasive ventilation (e.g. face mask) while 4% of infected patients required mechanical ventilators. In severe cases, 3% of patients required  ECMO machine (extracorporeal membrane oxygenation) that supports for both the lungs and the heart.

Since chronic medical conditions significantly increase the risks of death from COVID-19 disease particularly in the elderly aged over 60 with cardiovascular and neurovascular problems, annual health checkups and lifestyle modifications that enhance immune function are highly recommended. Blood lipid and blood sugar levels must be strictly controlled in order to reduce risks of developing coronary artery disease. Unhealthy habits e.g. physical inactivity and smoking must be also avoided.   

Prevention of COVID-19 

To control endemic spread of COVID-19, public awareness in reducing disease transmission must be raised. Recommendations made by WHO and health authorities include: 

• Frequent washing of hands with soap and water which takes at least 20 seconds per time.  Alcohol-based hand rub  can be also used. Alcohol-based hand rub or hand sanitizer with at least 60% – 70% alcohol is considerably equal to soap and water. Washing hands with soap and water or using alcohol-based hand rub kills viruses that may be on the hands.
• Wearing medical/surgical masks properly by placing mask carefully to entirely cover mouth and nose. Masks  must be tied securely to minimize any gaps between the nose and the mask. While in use, avoid touching the mask. To remove the mask, the lace should be removed from behind. After removal or whenever inadvertently touching a used mask, hands must be cleaned by using an alcohol-based hand rub or soap and water if visibly soiled. Do not re-use single-use masks. Discard single-use masks after each use and dispose of them immediately upon removal. The inner side of used masks must be folded and thrown away into infectious waste.  By limiting the volume and travel distance of expiratory droplets dispersed when sneezing, coughing or talking, masks can serve a public health benefit in reducing transmission by those unknowingly infected.
• Healthy people are accepted to wear medical-grade masks while suspected or infected patients need to wear surgical face masks and N95 respirators in order to limit disease transmission.
• Touching face, eyes, nose, mouth must be avoided. Hands touch many surfaces and can accidentally pick up viruses. Once contaminated, hands can transfer the virus to the eyes, nose or mouth. From there, the virus can enter the body and cause disease.
• Good respiratory hygiene is essentially vital. During sneezing or coughing, instead of using hands, it is highly recommended to cover the mouth and nose with bent elbow or tissue, then used tissue must be disposed immediately in the contaminated garbage. If hands are used to cover the mouth and nose, hand wash is always needed.
• Since coronavirus droplets stay suspended in the air for a short time and it can also stay viable and contagious on a metal, glass or plastic surface for up to several days, touching surfaces e.g. a doorknob, tabletop, staircase railing, lift buttons and IT equipment must be frequently cleaned with alcohol or soap and water, depending on material types.
• Visiting congested places such as cinemas, shopping malls, food courts, bus stations, train stations, airports should be avoided. If necessary, exposure time must be as short as possible. Wearing masks and frequent hand wash are crucial.
• Viruses can be excreted via stool, covering the toilet lid while flushing is definitely essential in order to reduce the transmission of viruses in the air. Toilet disinfectants might be helpful and can be also used.
• Even though science is racing to develop vaccines to blunt the outbreak’s impact. Currently, there is no specific vaccine to prevent infections against COVID-19 disease. Although symptoms caused by COVID-19 are fairly similar to those induced by influenza viruses, influenza vaccines or flu shots are vaccines that only protect against infection caused by influenza viruses, NOT coronaviruses. Therefore being vaccinated with influenza vaccines does not help minimizing the risks of novel coronavirus infections.

Dr. Anusith Tunhasiriwet, Cardiologist, Bangkok Heart Hospital suggests that due to coronavirus droplets can stay suspended in the air and it can also stay contagious on several types of surface for up to several days, COVID-19 might attack anyone at any time. Personal hygiene must be strictly applied in order to reduce chances of disease transmission. The risks of death significantly increase in elderly people, aged over 60 who have chronic medical conditions such as diabetes, hypertension, cardiovascular and neurovascular diseases.  If patients develop signs and symptoms e.g. common cold symptoms, runny nose, coughing, sneezing, muscle pain, fatigue, breathing difficulties with or without fever after traveling to Wuhan or other specified endemic areas within the last 14 days or previous exposure to suspected or infected patients with COVID-19, immediate medical assistance must be urgently provided. Early detection greatly helps reducing disease severity and serious complications involving multiple organs e.g. the lungs, heart and kidneys. More importantly, patients who have underlying diseases e.g. diabetes, hypertension, chronic kidney diseases and cardiovascular diseases should strictly follow doctor’s instructions. Prescribed medications must be regularly taken. Blood pressure, blood sugar level and serum markers of vascular inflammation must be controlled. In addition, pneumococcal vaccines can protect against pneumococcal disease, which is any type of infection caused by bacteria –Streptococcus pneumoniae. These vaccines are essentially recommended in elderly patients and patients with impaired immune functions. Pneumococcal vaccines, however, do not have any roles to act against a novel coronavirus disease. Vaccination must be advised by expert specialists.