The moment of maximum risk

Wednesday 13 May 2020

The virus may decide to affect the heart

The virus may decide to affect the heart


Officially, today was the day when the nation could return to work, or at least some of us. The reality is that plenty of folk have already gone back. The country is in a form of honeymoon period, when it is trying to pretend life is normal although in practice it is not.

The nation’s death toll is increasing, and we are way in excess of other countries in Europe. Most telling, perhaps, is the government’s evening briefing when the figures of the day are presented. The presentation is generally good but for the last two days the national comparisons have been lacking. They were once always a feature of the update but have now vanished. My guess is that this is to avoid awkward questions. The only excuse left for the government for such a disparity is that different countries collect their data in different ways. They may be right but when headline figures are inspected, the UK is not doing well.

Today the nation can return to work (ISABEL INFANTES)

Today the nation can return to work (ISABEL INFANTES)

It has been decreed that those who can work from home should continue doing so. Those who cannot work from home should return to their workplace, which should be suitably adjusted. People should use public transport as little as they can. That has not gone down well, as commuters squashed themselves into London’s buses and underground trains today. It was so bad that bus and rail operators have been advised to shut parts of the public transport system to prevent overcrowding. Grant Shapps, the Transport Secretary, has warned that carriages may only be able to carry 10% of their normal loads. The next few days should be interesting but to some extent the damage is already done. The many commuters, packed into tiny spaces, will already have infected each other. The UK right now, London in particular, is an epidemiologist’s nightmare, or dream, depending on how you see it.

Economically, it is evident that the bigwigs are worrying, which is why they want the country back to work. We are now not only saving lives, according to the government, but livelihoods as well. There is good sense in that. It is perhaps better to allow high risk patients, people like me, to take their chances. Personally, I would prefer that. We have been told that the economy is shrinking at its fastest pace since the 2008 financial crisis but, right now, not as fast as the boffins had predicted. In addition, the Bank of England has warned of the sharpest recession on record.

To help life along, the government is keen to get the housing market going once more, so has openly declared that estate agents should get back to business. I understand this statement was made without any consultation with professional estate agent bodies, although it is good news that the housing sector is being prodded. Builders have been told to get on with things and those who had suspended their buying and selling activities in mid-purchase have been told they can restart.

Exercise is being permitted, although now as much as we like. I can stagger-stumble around Hyde Park a million times if I choose, or am able, to do so. It is also possible to meet a friend in the park, an enemy if I wish, as long as it is a one-on-one meeting and in the open air. That is easy to say in the summer, but I am unsure what happens when it rains.

Dr Anthony Fauci, who has warned that premature reopening can have serious consequences (MANDEL NGAN:AFP)

Dr Anthony Fauci, who has warned that premature reopening can have serious consequences (MANDEL NGAN:AFP)

Relaxing lockdown is clearly a major gamble as no one truly knows what can happen. The USA is similarly troubled, with a strong warning from their Dr Anthony Fauci, the Director of the National Institute of Allergy and Infectious Disease. He has said that US states that open prematurely could have “really serious” consequences. He stated that before a phased comeback is initiated, there must be a 14-day downward trajectory of cases. Or, a downward trajectory of positive tests as a percentage of total tests within a 14-day period. There were other guidelines as well. Live Science reports Fauci’s views well, and continues with his words:

“Reopening is not only about doing it at the appropriate time, with the appropriate constraints, but having in place the capability of responding when the inevitable return of infection occurs.”

What I do not know is if our figures in UK would adhere to Fauci’s recommendations, let alone if they follow our own. What is without question is that when lockdown is removed, a nation is at a point of maximum risk and must be able to instantly respond should the situation change for the worse.

As the weeks go by and Covid-19 exerts its effects, I am noticing how the beastie is much more than about lungs. At the beginning, if a patient developed Covid-19, they ended up with pneumonia and either got better or they were admitted to Intensive Care, with a roughly 50% chance of not making it home. It is now clear that there is much more to this virus than everyone once thought.

The Covid-affected heart has recently become a focus of attention in the medical world. From New York, and published in a journal called Circulation, is a good paper but of only four cases. Two were women and two were men, with ages from 38 to 64 years. Each had an underlying illness, or illnesses, and one actually had a heart transplant. However, a dodgy heart can cause shortness of breath, as can lungs filled with virus, so it is sometimes difficult for a medic to tell between the two in a disease’s early stages. It is becoming evident that Covid-19 infection can involve the cardiovascular system in many different ways that were previously not understood. There is a long list of problems – high blood pressure (hypertension), abnormal heart rhythms (arrhythmias), blood clots (pulmonary embolism), inflammation of the heart muscle (myocarditis), heart failure, and abnormal blood clotting (disseminated intravascular coagulation), and more. I have put the full medical terms in brackets.

The situation this morning - 13 May 2020 (courtesy Center for Systems Science and Engineering at Johns Hopkins University)

The situation this morning – 13 May 2020 (courtesy Center for Systems Science and Engineering at Johns Hopkins University)

The Chinese in Wuhan have found the same, with four male patients who presented to their hospital with severe heart failure and who also had confirmed Covid-19 infection. Tellingly, the Chinese believe that three of the four patients became infected while in hospital, as they had all been in the same ward before their isolation. This was what is called a retrospective study, where a researcher looks back at what happened previously. The opposite is a prospective study, where you are unsure what will happen and are recording your findings as things go along. Retrospective studies can sometime be very inaccurate. Prospective studies are generally more precise but can be harder to perform. When these Wuhan patients were diagnosed, they had just a mild cough or fatigue and none developed a fever during their illness. Had they been in England, they did not have the classic features of Covid-19 and would not have been permitted testing. Their ages ranged, frighteningly, from 11 to 67 years. The two older patients died, and the two younger ones survived.

These four Chinese cases, few though they are, do say a number of things to me. There was the 11-year-old who developed Covid problems with his heart, so children are not exempt. Then there are the three patients who acquired the disease in hospital, rather than outside. One of them actually died. The hospital seems to have given him the disease, so hospital-acquired infection is also a problem in China. We know it is a problem elsewhere, including in UK. These are valuable lessons from a small handful of patients.

This pandemic is a major learning experience, that is certain, although many of its teachings never become headlines.