Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and I'd like to welcome you to my podcast and videocast station. Today I'd like to talk about the coronavirus or COVID-19. Really the technical name for what we're currently calling severe acute respiratory syndrome, COVID-2, which is a group... of the corona viruses, which include the common cold actually. It turns out that COVID-19, which we're calling SARS-CoV-2, is in fact relatively closely related to SARS. pandemic or epidemic that we had in 2002, which was referred to as SARS-CoV-1. So similar sort of bugs, except it appears quite clearly at the moment that coronavirus or COVID-19 or SARS-CoV-2, so I'm going to call it COVID-19 or coronavirus for the rest of this, It seems that COVID-19 spreads somewhat more efficiently than SARS did in 2002, but doesn't seem to have as bad a prognosis. And you've probably been keeping up with the news about this, but just a reminder, COVID-19 turned up in December, Wuhan province with severe pneumonia testing for this virus that hadn't been seen before. And this is one of the critical components of why there's a lot of concern regarding this virus. It hasn't been around before. There is no immunity within the community. And that's a big difference to the influenza virus, which many people talk about and say, oh, this is just a bit like influenza. Well, it's not just like influenza. There's a lot of community-based immunity with influenza because we've had multiple strains which have some similarity over the years. When it comes to coronavirus or our current COVID-19, there isn't any community-based immunity. So it can spread through rapidly and people who are exposed have a high probability of potentially taking that virus on and not having anything to deal with it. It turns out that it is more virulent than the influenza virus, which we tend to see affecting millions of people each year, and it is a major cause of death, but the death rate from influenza is approximately one in a thousand. Currently, COVID-19 is running at a death rate of approximately 10 times that. So we're seeing almost 1% of people affected by this virus potentially. uh being being killed by it which is quite distressing the current state of play is that within the world and this is when i checked yesterday we were looking at somewhere around 160 odd thousand people affected in 90 odd countries somewhere around 6 000 plus deaths and in australia around about 300 cases confirmed. That's just creeping up at the moment and approximately five deaths again. These are numbers that are changing and we will see them increase with time. There's no doubt about that. The virus has been confirmed to transmit human to human. It also seems to be able to be picked up from surfaces. It's very important, therefore, that we're aware of these transmission opportunities. It turns out that some people can carry this virus and be completely asymptomatic. And I think that's really important to know. And it's also important to realise that children similarly can really be asymptomatic with this condition. And I think that's important if we're thinking about groups or collections of people, particularly children, particularly schools, there could be a huge amount of... COVID-19 within these institutions with very little sign that it's there until those children go home and mix with their parents and grandparents. Most often, COVID-19 presents as a common cold flu-like illness. Importantly, though, it can take up to 14 days after exposure for individuals to demonstrate the symptoms of COVID-19. The virus. This is very significant. It turns out that different people at different ages respond differently to this virus, and that's probably not surprising. As you might expect, people with suppressed immunity have the greatest chance of succumbing to the condition. It turns out, when I looked at this last, there were no fatalities in individuals under 10 years of age. None. It turns out that of the deaths, 22% of the deaths were in individuals over 80 years of age. And the death rate in people over 80 years of age was somewhere around 10 to 15% when the death rate in the remainder of the population was down around 1%. This is really important. And I think it's a flag for us to be aware that for individuals who could be at increased risk, that's the immunosuppressed and the elderly, to be particularly careful with exposure opportunities. The other important aspect is there is no available treatment at the moment. There's no antiviral treatment and there's no vaccine, although these things have been sped up, particularly vaccines. the best we can do is supportive measures if someone gets sick. And that's supportive measures, particularly since it affects the lungs of supporting lung ventilation. And that's ICU intubation with machines that help the individual breathe until the body recovers to take over that work itself. I think it's really important to recognise that if you've got something planned, for example, elective surgery, that you take into account if you've travelled to an area that may have been affected by COVID-19, obviously places like Wuhan if you've been there, but also places like Italy and South Korea where there are high numbers, even Iran. So you may have been exposed, not be aware of it. To be planning a surgical procedure during that time obviously doesn't make a lot of sense. Because if you were incubating the virus, had your surgery, and then subsequently developed the illness during recovery, then you're really putting yourself at detriment to recovery from the surgery and increasing the risk substantially of having complications. So some pretty common sense sort of thoughts in there. There is talk about... particulate masks i know that hong kong have used these and used them quite effectively well quite broadly in the sars outbreak i'm getting different reads when it comes to the role of particulate masks and these masks are referred to as p2 and n95 masks and they're often for very small particles used in the building industry so they need to be well sealed but they do offer as far as i can tell some protection although there's little advice that I can find that recommends using them on a regular basis. I guess if you were in a situation where you thought you might be at increased exposure for some reason, I know we now no longer have gatherings greater than 500 people in Australia, but if you had, for example, the weekend planned with a family get together and there were going to be a number of kids there and someone who'd recently been overseas and you really wanted to be there you may actually take the precaution of wearing a mask it needs to be well fitted it probably does have some role and it might be just as prudent to bring a few spare masks and if you thought someone was infected plonk them on their face as well common sense really important in this space there is a bit of question about the role of in particular ACE inhibitors because ACE inhibitors are a type of medication that we use for lowering blood pressure. ACE inhibitors have particular receptors within the lung and there is talk that the COVID-19 virus actually uses those receptors as part of its pathological role in infiltrating the lungs. And so there's been some theoretical and speculative comments about stopping ACE inhibitors to reduce severity of the condition. Of the reading I've done, I've found nothing that supports that. I don't know the answer there. There is no clear recommendation. I guess if your blood pressure is well controlled with ACE inhibitors, it's hard to make a case to stop them. But similarly, if the blood pressure is not so bad, with ACE inhibitors taken away, with a view to restart them down the line, then a few weeks of reduced blood pressure coverage may not be so bad, particularly if you go and see your doctor and chat with them about perhaps an alternate agent for the short period of time. But there is no clarity at this stage. I guess being overcautious is not unreasonable, but certainly no clear guideline. at this stage. Something you could talk to your doctor about. And if I had a patient who was asking about swapping from an ACE inhibitor to something else for the short term until this was clear, I'd be pretty comfortable with that and I'd help them do it. I would generally encourage them to get back on their ACE inhibitor at the end of all this or swap them over to an angiotensin 2 converting enzyme and to an angiotensin 2 receptor blocker, which I don't believe has the same question of problem or interaction with the virus in association. So that's COVID-19. It will continue to unfold. It is the most significant medical global threat that I can remember has gone beyond SARS, the impact on life. individuals on business is just astounding I know people in a wide range of different businesses are being impacted substantially and this is even without any health issues at all so there's a little bit of information about it I really hope it unfolds soon and we get some clarity as to a potential end to it. The Spanish flu at the turn of the century took nearly two years to work through the planet. I'm hoping we might see something faster with COVID-19 because there's been some very aggressive efforts by governments to try and limit. spread of this condition, particularly in places like India who shut their borders even before the United States of America. We've started obviously in Australia to start to be aware and starting to close down things like cruise ship arrivals and care through airports as well. I've given you a whole heap of stuff on COVID-19. If you think you have it, please isolate. Be sensible about it. Go and see your doctor ASAP. The testing kits will be everywhere. Be aware of children because, well, children can carry it without any symptoms at all. Be aware of where people have travelled. If you are in the high-risk group, that's people who are older, particularly 80 or above, and have comorbidities. These are things like diabetes, renal disease, lung disease, et cetera, particularly lung disease, and particularly smokers as well. Just lots of caution, please. There's no treatment at the moment. Look after yourselves. And please don't catch COVID-19. Of course, if you have any queries or questions, drop me a note at members at Dr Warrick Bishop online. Or if you have any suggestions for future podcasts, again. please let me know and I'd love to help out. Take care, all the very best, and please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
