Cheryl Dennison Himmelfarb|Diana Baptiste
Coronavirus Disease (COVID-19)
Johns Hopkins University
novel coronavirus disease covid19 emerged december 2019 less 3 months evolved worldwide pandemic13 virus spread rapidly leading unprecedented global crisis shows signs abating near future wednesday april 1 2020 911 308 cases 45 000 deaths reported globally4 confirmed cases united states 206 207 4542 deaths4 statistical models predict 260 000 hospital beds used united states end april 20205 impact covid19 daily lives work families overall operations unprecedented modern times situation continues change daytoday basis addition constantly evolving information misconceptions among public pathology etiology transmission treatment risks associated covid19 covid19 infectious respiratory disease caused newly discovered pathogen sarscov2 novel rnadependent rna polymerase betacoronavirus thought derive bats6 incubation period covid19 thought within 14 days exposure transmission occurs humantohuman contact6 covid19 virus spreads primarily droplets saliva discharge nose infected person coughs sneezes1 understanding pathobiology clinical presentation virus risk factors morbidity mortality seen covid19 although limited rapidly increasing see table 1 25 infected asymptomatic creates challenges prevention efforts asymptomatic carriers often unaware covid19 status people infected covid19 virus experience mild moderate respiratory illness recover without requiring special treatment older people underlying medical problems cardiovascular disease diabetes chronic respiratory disease cancer likely develop serious illness37 clinical presentation severe cases covid19 characterized hypoxia dyspnea greater 50 lung involvement imaging critical cases people infected covid19 experience acute respiratory distress syndrome multipleorgan failure shock death8 time specific vaccines treatments covid199 best way prevent slow transmission well informed covid19 virus disease causes spreads world health organization centers disease control prevention cdc reliable public information sources10table 1 potential cardiovascular complications covid19 infectionearly data suggest covid19 hypertension cardiovascular disease mortality rate 2 3 times higher general covid19 population suggesting highly susceptible severe effects disease11 40 patients hospitalized covid19 china underlying cardiovascular disease12 furthermore early reports profound myocarditis fatal dysrhythmias suggest deleterious impact covid19 cardiovascular systems1214 acute chronic cardiovascular complications pneumonia common covid19 result various mechanisms including ischemia systemic inflammation pathogenmediated damage715 chronic cardiovascular conditions may become exacerbated setting viral infection consequence imbalance infectioninduced increase metabolic demand reduced cardiac reserve15 patients coronary artery disease heart failure may particular risk result coronary plaque rupture secondary virally induced systemic inflammation rigorous use plaque stabilizing agents aspirin statins blockers angiotensinconverting enzyme ace inhibitors suggested possible therapeutic strategy15 procoagulant effects systemic inflammation may increase likelihood stent thrombosis assessment platelet function intensified antiplatelet therapy considered history previous coronary intervention15 clear yet whether heightened systemic inflammatory procoagulant activity persist resolution covid19 infection addition conjecture ace inhibitors angiotensin receptor blockers ubiquitously used cardiovascular patients may increase patients susceptibility virus16 however currently american college cardiology american heart association recommended preemptively stopping starting ace inhibitor angiotensin receptor blocker setting covid1931017 100 million americans form cardiovascular disease urgency increase awareness among healthcare providers potential impact covid19 highrisk population cdc released general preventive measures covid19 infection however socially atrisk persons underlying cardiovascular chronic conditions bear burden elevated risk developing severe complications death918 april 1 2020 general preventive measures including recommendations frequent handwashing social distancing curfews stayathome orders sanctioned hospitals healthcare systems across united states suspended elective surgeries procedures inpatient visits changing way people seek receive healthcare facilitated new legislation many healthcare providers offer telemedicine use mobile health technologies efforts limit exposure patients healthcare providers19 options provide protection ongoing care many highrisk individuals feasible american heart association advising intensified caution underlying heart conditions including persons diabetes cardiovascular chronic lung kidney conditions9 additional recommendations heart failure society america american college cardiology noted see table 291017 evidence guide clinical decision making generated extraordinary pace hypervigilance close attention guidelines needed critical timetable 2 considerations cardiovascular disease chronic conditionsthere substantial concern socially atrisk persons cardiovascular conditions could experience delays seeking healthcare result selfisolation low health digital literacy lack primary care medical home19 furthermore persons already limited access healthcare could compromised specifically ethnic minorities low income experience food insecurity housing instability lack social support transportation increase selfisolation due covid19 particularly among older persons may also accelerate risks cardiovascular neurocognitive mental health problems1820 addition concerns public health crisis may exacerbate discrimination racism stigma widespread disinformation across social media outlets7 assessment health disparities covid19 warranted fully understand burden pandemic atrisk populations including children removed school environment preventive measure aspects healthcare delivery affected pandemic18 sudden rapid advancement covid19 created unanticipated risk healthcare providers beyond transmission contraction disease frontline healthcare providers higher risk experiencing anxiety depression insomnia due burnout compassion fatigue8 accelerating demands hospital beds personal protective equipment lifesaving apparatus ventilators continuous renal replacement machines introduced new financial burdens otherwise highresource health systems united states although close daily monitoring ongoing global battle covid19 examination pandemics impact healthcare workers healthcare delivery systems warranted18 many states enforcing stayathome orders healthcare providers challenged changing modes practice uncertain lengths time healthcare settings across nation expeditiously transitioning inperson telehealth visits retain access healthcare chronic conditions moreover telehealth visits used reduce visits emergency departments nonurgent matters timely intervention preserve emergency services severe symptoms silver lining may acceleration adoption expanded reimbursement telehealth broadening reach increasing efficiency chronic disease care21 efforts sustain care improvements critical rapid spread phase pandemic covid19 pandemic expected persist months must become familiar reliable sources information world health organization cdc9 multitude ongoing studies clinical experience individuals covid19 provide us much needed data illuminate understanding virus impact potential effect individual risk factors medications unclear time covid19 impact physical mental health individuals recovery overall health disparities among socially atrisk populations information covid19 rapidly evolving imperative healthcare providers reinforce general prevention guidelines addition recommendations persons cardiovascular disease american heart association heart failure society america american college cardiology9