Managing Cardiovascular Disease in the Time of COVID-19

by Jason Deen, MD

Coronavirus disease 2019 (COVID-19) is a lung illness caused by a virus (a new-type of coronavirus) which has spread rapidly through most countries in the world. Currently, the United States has the most documented cases with much of those affected living in large cities. The virus itself is very easily passed between individuals and may cause severe illness or death in a significant portion of those with the infection.

While the viral infection mainly affects the lungs, it may affect the heart as well, particularly in people already diagnosed with heart disease. People with diabetes, high blood pressure, and those who have had a heart attack, heart failure or stroke are at risk of getting an infection which may require hospital admission and treatment in an intensive care unit. Further, reports from the American Medical Association state that COVID-19 infection directly weakens the heart muscle. Because of this stress on the heart, an active COVID-19 infection may lead to a heart attack or worsening of heart failure.

Unfortunately, the COVID-19 virus is beginning to spread into rural areas, and we should expect to see infections increase in Tribal nations across the country. American Indian and Alaska Native people are more likely to be severely affected by COVID-19, particularly elders, those with heart disease, and people living on reservations. As of April 8, 2020, there were 661 documented COVID-19 infections within the Indian Health Service (IHS) system with the Navajo Service Area being most affected with 322.

Indian Health Service (IHS) and Tribal health clinics are not equipped to care for patients with a severe COVID-19 infection. For instance, of the 24 IHS hospitals, there are only 33 intensive care beds. Tribal leaders and medical providers have noted in conversations with the National Indian Health Board, a severe shortage of personal protective equipment (PPE) for doctors, nurses and frontline workers in IHS and Tribal clinics. They anticipate challenges in keeping medical providers and their clinic staff protected.

The main symptoms of COVID-19 infection are fever, cough and shortness of breath. Less common symptoms are runny nose and nausea or diarrhea. Some patients report muscle aches, headache or loss of taste or smell. Many infected with the virus display mild symptoms or no symptoms at all. Patients with and without symptoms may pass the virus to others and most of those individuals will experience symptoms in about 14 days. COVID-19 may cause severe illness in elders over the age of 60 and those with underlying heart disease and diabetes.

Currently, there is no medication to treat those with COVID-19 and no vaccines to prevent the infection. Despite some news reports, it is not currently recommended to discontinue blood pressure medicines to avoid infection. These medications include angiotensin-converting enzyme inhibitor (ACEi) inhibitors or angiotensin II receptor blockers (ARB). Stopping these medications may worsen blood pressure or heart failure and conversely could worsen a potential COVID-19 infection.

The best strategy to avoid contracting the virus in the first place is to stay home. If a person is sick – stay home and separate from others in the home, if possible. Wash hands frequently with soap and water for 20 seconds or use hand sanitizer. Cover coughs with a tissue or cough into the elbow, not the hands. Clean commonly touched surfaces with soap and water or a household disinfectant (including tables, doorknobs, light switches, computers, tablets and phones).

The Centers for Disease Control and Prevention (CDC) recommends a period of staying home, avoiding groups of more than 10 people and staying six feet away from people when outside of the home. Granted, while this is the hardest recommendation for Native people to follow from a cultural standpoint, it would be worth remembering the collective goal of protecting elders from this disease. Areas of the United States that have followed social distancing and stay-at-home guidelines have seen decreased rates of COVID-19 infection.

We are all in this together. We are all related.

Jason Deen, MD

Dr. Jason Deen is a Blackfeet descendant and member of the Association of American Indian Physicians. He is an Assistant Professor of Pediatrics and Medicine in the Divisions of Cardiology at the University of Washington and serves as a co-principal investigator of the Strong Heart Study.