HEART HEALTH

What we have learned about the coronavirus

“We are learning about
this virus every day and
working together to
benefit all of us.”

It has been a month since the coronavirus spread throughout New York, closing schools, sending non-essential workers home, canceling public events, clearing our social calendars, and stalling the economy. When the first reports of patients infected with coronavirus disease 2019, COVID-19, in China surfaced in early January of 2020, most Americans were focused on the beginning of the new year. In only a few months, we have transformed into a society on PAUSE as medical officials and elected leaders responded to a virus that can only be viewed under an electron microscope, virtually unknown to science until its effect was reported on the nightly news.

Scott Purga, MD, FACC

What has the Capital Region medical community learned about the coronavirus and how might that knowledge help end this pandemic? That is the question we posed to Dr. Scott Purga, a board-certified cardiologist at Capital Cardiology Associates, who is part of the area’s COVID-task force. “What’s new for all of us is that we are learning about this virus every day. Our team is quite thorough and working together to provide the best care. You may see things on the news about how hospitals were overwhelmed, that is not the case in Albany. We had extra time to get our systems in place.” Dr. Purga joined me on a recent episode of HeartTalk, presented by Capital Cardiology Associates to discuss the treatment, recovery, and possible cure options during this pandemic.

What we have learned

It has been established that COVID-19 is highly contagious and quickly spread across the globe after first being reported in Wuhan, China, on December 31, 2019. The World Health Organization began publishing risk assessments and advice to the public health crisis that was developing in Wuhan medical institutions. On January 13, the first confirmed case of COVID-19 in Thailand was reported, signaling that the virus had traveled outside of China. Fast forward to February 29 when the first death from the virus was reported in America. Dr. Purga explained the challenge with COVID-19 is in identifying those who have the virus. “We have seen COVID-19 in patients with the main presenting symptom of fever, chills, the usual flu-like symptoms, but then a substantial portion also have lung involvement.” The virus had reached America during the peak of the seasonal flu. Common respiratory viruses (like the common cold and influenza) affect young children, those with health conditions, and adults 65+ at greater rates, causing a spike in hospitalization. Unlike the cold and flu, coronavirus “can progress to pneumonia, which can become severe, requiring intensive care unit (ICU)admission. A large subset also have cardiac complications, either from the virus itself or from breathing issues associated with the virus. Anywhere from 10-20% are going to have a heart issue coming from the coronavirus infection, particularly those that are more severe cases,” noted Dr. Purga.

Another unique twist to coronavirus is that an infection can be generally mild. “A substantial portion, manly younger and healthier people with fewer comorbidities, they have a relatively mild illness with flu-like symptoms with shortness of breath for a few days but can recover quickly,” commented Dr. Purga. Mild symptoms create an opportunity for the virus to spread to others through a cough, sneeze, or any close contact. This is why there is a concern about hand washing, wearing masks, and adhering to social distancing. And like the cold and flu, coronavirus is transmitted from germs that can live for hours on unsanitized surfaces.

Dr. Lance Sullenberger, COVID-19 task force

“Once inside, the virus attacks the body’s immune cells and is able to ‘get inside’ to replicate using our own cells to make more copies of the virus. The concern here is that this virus spreads to affect the lungs, which is the major reason that this virus is deadly. This virus is able to get through certain receptors on the cell surfaces. You may have heard about the ACE receptor. (Cell receptors play a key role in passing chemicals into cells and in triggering signals between cells.) There are some theories that COVID is using these receptors to gain entry into cells. A lot of that is being studied every day by researchers,” said Dr. Purga. Even worse, coronavirus may trigger the body’s immune system into overdrive, causing inflammation in the lungs, causing Acute Respiratory Distress Syndrome (ARDS), which requires the use of a ventilator to assist with breathing. “The downside is two-fold, we are learning about residual damage to the heart and lungs from the virus as well as the fact that these people can spread the virus to others without realizing it. We think a good percentage of people are asymptomatic, meaning that they have the virus infection but have no symptoms of it. They can be walking around with friends, spreading the virus without realizing it. That is the double-edged sword when you have milder cases.”

COVID-19 Task Force members at Albany Med

Working together

There is no specific antiviral treatment recommended for COVID-19, and no vaccine is currently available. While we have been separated during this pandemic with social distancing and the New York State on PAUSE guidelines, a group of Albany-area medical professionals has formed to combat this virus, together. Special COVID-19 task forces have been assembled at area hospitals, comprised of emergency room nurses and physicians, nursing care, respiratory therapists, ICU physicians, and cardiologists. “We do this in a controlled fashion, keeping everyone safe, isolating COVID patients for treatment,” detailed Dr. Purga. “The cardiologists consult the attending internal physicians on the care and treatment progress. Our diverse backgrounds are the strength of the team; we can bring new ideas to each other and share what we know from our unique specialties and training. Our team at Albany Med can collaborate with the team at St. Peter’s to benefit all of us. It is a good atmosphere and quite unique!”

There are two main goals in ending the COVID pandemic: treating symptoms and finding a cure. Currently, there is considerable discussion on the effectiveness of drugs used to treat other illnesses on COVID patients. Dr. Purga addressed the two most popular drugs being used to treat symptoms. “Under controlled circumstances, it is useful to give these drugs under physician supervision. Zithromax, or as it is called ‘Z-pack,’ is typically used for community pneumonia, pneumonia caught outside of the hospital, and some other bacterial infections. It also can reduce inflammation in the lungs. That is why we think it may be helpful in combatting the lung problems associated with coronavirus. Hydroxychloroquine is traditionally an anti-malarial drug that is used to fight that parasitic infection. It also has some anti-inflammatory properties and has been used in autoimmune conditions like lupus. The thought here is that by reducing the body’s response, this may reduce the frequency of severe complications, needing a ventilator and other respiratory problems. They are being used together with the hope that they are helping. It’s premature to say that they are making a definitive impact yet.” It has also been reported that remdesivir, a drug developed to treat disease caused by the Ebola virus, could possibly stop the virus from being able to copy and spread to other parts of the body. The drug was successful in animals and laboratory dishes, but scientists insist on more studies to confirm its effectiveness in people. “There is a lot to come, with the use of other off label anti-inflammatory medication options that are being used in the hospital, on the treatment of COVID symptoms,” added Dr. Purga.

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The race for a cure

As of April 8th, there were 115 COVID-19 vaccines under development around the world. The most advanced candidates have recently moved into clinical development, some looking to being human testing this year. Time is the one commodity scientists will need to develop a cure. Even Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases (NIAID), has questioned a drug being developed within a year. While scientists have cracked COVID-19’s code in record time (determining the genetic sequence of the virus), there are still critical steps in developing a vaccine. Researchers will use clinical trials to test for dangers, and adverse side effects in small to large populations before a cure can be released. “Typically, randomized trials, say for a new heart drug that comes to the market, that usually takes several phases of trials over years to develop approval from the FDA. In the case of the COVID virus, the CDC and FDA have are expediting approval of trials and allowing us to enroll patients quickly due to the rapid need for this data,” said Dr. Purga.

Healthcare during the new normal

One concern that has developed while we wait for things to return to normal is that doctors throughout the United States have reported treating fewer patients than normal for heart attack and stroke symptoms since the start of the COVID-19 pandemic. This week, the Journal of American Medical Association reported results from a large study involving patients hospitalized with COVID-19 in the New York City area, that people with obesity, diabetes, and high blood pressure are at greater risk for complications from the coronavirus. I asked Dr. Purga about the issue of patients not reporting their conditions out of fear of the virus. “My message is if you have a true concern, a new symptom: chest pain, shortness of breath, dizziness — any of our red flag cardiac symptoms — do not stay home. Heart disease isn’t on hold just because there is a viral outbreak. People have heart attacks, stroke, arrhythmia even while staying at home during this pandemic. The hospitals have isolated patients being treated for COVID conditions. Setting foot in the hospital does not mean you are going to catch coronavirus. I would encourage people who are presenting heart or cardiac symptoms to call their primary doctor, call our office, or if it is an emergency, go to the hospital.”

(l to r): Karen Canniff, NP with Dr. Scott Purga – holding a portable ultrasound unit

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates