COVID-19: Advice for individuals living with heart disease or stroke

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.

Updated November 17th

A message from Prof. Bill McEvoy, Consultant Cardiologist, Medical and Research Director National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre.    

COVID-19 has had a major impact on all our lives. While we still have much to learn about this disease and the virus that causes it, we do know that adults with underlying medical conditions – inclusive of hypertension, diabetes, obesity, and cardiovascular disease – tend to have worse outcomes and become sicker when stricken by COVID-19. This is particularly true for adults over 70 years. While the death rate from this infection is less than 1% for most people, it can rise to 5-10% among the very old and those with many underlying medical conditions. Therefore, this is a serious disease that deserves ongoing our attention and vigilance.

One of the less known issues with COVID-19 is that it can result in complications among infected adults who were previously healthy. While these adults have a very high chance of surviving the infection (over 99%), they are consequently vulnerable to any long-term side effects and complications from the virus. Without doubt, these long-term complications appear to be UNCOMMON; however, they do exist. For example, we know that, in rare cases, COVID-19 can injure the heart (leading to damage from a condition called myocarditis or ‘type 2 myocardial infarction’). The frequency with which these cardiac complications happen, the exact reasons why they happen (hypothesized to be related to inflammation or an increased propensity for blood clotting among those infected), and the reversibility or responsiveness to treatment of these complications remains an open question. Long-term complications in other body organs have been reported also, so this concern is not just unique to the heart.

Therefore, until these questions are answered, I encourage you all, even if young and healthy, to take this disease seriously. If you do get infected, your chances of a complete recovery are very high. We should not live in fear. However, why take any chances, everyone has a role to play in reducing the spread of this virus and if we all take collective responsibility we will minimise the risk for everyone.

What do the latest Level 5 restrictions mean?

  • People should stay at home as much as possible – you may leave you home to exercise within a 5km radius.
  • The new changes allow for support “bubbles”- this is a small group of people that a person can have close contact with. For example, single parents with children under 18 or the elderly may have close contact with one other set of people.
  • You should only go into work if you absolutely cannot work from home.
  • Schools and childcare facilities will remain open.
  • Pubs and restaurants will close and revert to take-away only.

Key Messages

The key messages remain the same. We need to Stay Safe.

  • Physical distancing should continue to be maintained at all times.
  • Continue to follow good hand washing, respiratory hygiene and physical distancing because we know these work and are now more important than ever.
  • Face coverings are now required on public transport and should be worn in shops and shopping centres and in situations where physical distancing is not possible. For further guidelines and information about how to correctly fit/ remove face mask visit the HSE website.
  • If you have cold or flu like symptoms, even mild ones, it is important to isolate at home and call your GP
  • People over 70 years and the extremely medically vulnerable, remain at the highest risk of severe illness from COVID-19, and are advised to take extra caution. This includes people living with cardiovascular disease.  It is important that you continue to attend essential medical services such as GPs and receive medical care at home (if appropriate) to protect your health and wellbeing.

Further information on latest updates can be found on the Government’s website.

The Croí Health team are determined to stay connected with all our groups and supporters and aim to keep you informed and up to date on a regular basis. We will continuously explore the latest evidence on COVID-19 and cardiovascular disease and will share this important information with you.

Everyone has a role to play in reducing the spread of this virus and if we all take collective responsibility we will minimise the risk for everyone.

Is there any specific advice for individuals living with heart disease or stroke?

For heart and stroke patients, prevention is key. While it is normal to feel anxious about how this condition might affect you, you are at no greater risk of developing COVID-19 than anyone else. However if you do contract the virus you have a higher chance of developing complications.

As you are at higher risk of a more serious illness if you contract Coronavirus, you are being advised to stay at home as much as possible and to limit your social contact. We strongly urge you to take extra care in ensuring you follow all of the recommended precautions. Please see advice below regarding cocooning.

While all individuals with underlying cardiovascular disease are at increased risk of complications if affected by COVID-19, those at greatest risk include individuals who have:

  • Had a heart transplant
    • At any time in the past or more recently.
  • Are pregnant with a heart condition
    • Lung viruses can cause severe illness in pregnant women, particularly those with an underlying heart condition.
      • Heart conditions include: symptomatic coronary disease, hypertrophic cardiomyopathy (if it affects your heart function), thickening of the heart muscle (left ventricular hypertrophy, pulmonary hypertension, a moderate / severely narrowed or leaking heart valve, heart failure that affects your left ventricular function, or significant congenital heart disease.
  • Had recent open heart surgery
    • Including coronary artery bypass grafts (CABG) and valve repair or replacement.
  • Heart failure
    • Especially if you have been recently diagnosed, it affects your activities of daily living or you have been recently hospitalised for treatment.
  • Heart valve disease
    • Where this is severe disease or you have ongoing symptoms or are awaiting valve surgery.
    • A heart murmur in itself where you do not have symptoms or not diagnosed with valve disease does not increase your risk.
  • Congenital heart disease
    • There are many types, but in particular if you have complex disease or have other underlying conditions increasing your vulnerability.
  • Cardiomyopathy
    • Any type if you have ongoing symptoms or your daily activities are limited.
  • Angina
    • That limits your daily activities or means you have to use your GTN spray frequently.
  • Heart disease with other health conditions such as chronic kidney disease and lung disease.

With the emphasis being on minimising contact outside the home, it is still important to maintain your healthy lifestyle habits and not to disregard your usual exercise routine. As it may not be possible to continue outdoors, please visit the Croí website for lots of helpful health tips and advice to keep you on track.

Refill your medication prescription as normal and have over the counter medications such as paracetamol and a thermometer in your home. There is no disruption to the supply of medicines and therefore there is no need to order more medicines than you need.  Ask a family member to collect any medicines you need. If you do feel unwell, it’s still really important to carry on taking any medication you’ve been prescribed and speak to your doctor if you have any concerns.

Look after your emotional health and well-being. Any unexpected changes to our daily lives can be a source of stress and COVID -19 is no different. It is important to obtain information from reputable sources and focus on the facts rather than opinions on social media.

Cocooning

What is cocooning?

Cocooning is a recommendation from the HSE and the Irish government to protect those who are most at risk of developing serious complications if they contract the COVID-19 virus. Cocooning aims to minimize interaction between those most at risk and others.

What should I do?

  • Try to stay at home as much as possible.
  • Avoid physical contact with other people.
  • Limit your social interactions to a small social group for short periods of time – this is sometimes called a “social bubble”.
  • People who visit to help care for you should still attend as long as they have no symptom’s of COVID-19. Ask them to wash their hands on arrival and when possible keep 2 meters apart.
  • Avoid anyone who is sick. If you usually have carers, have a backup plan in case one of them becomes unwell.
  • You can ask your family to keep in touch with you via WhatsApp, video or social media so you don’t miss out.
  • If you need to contact your GP, use the telephone.
  • You may leave the house to get fresh air or exercise within 5km of your home, if social distancing is observed.

 Do I need to Cocoon?

The HSE have advised the following people to cocoon:

  • people aged 70 years or over
  • solid organ transplant recipients (including heart transplant)
  • people with specific cancers, rare diseases, respiratory conditions
  • women who are pregnant with significant heart disease, congenital or acquired

In addition to HSE recommendations, international cardiac societies advise people living with the following conditions to cocoon:

  • Heart conditions include symptomatic coronary disease, hypertrophic cardiomyopathy (if it affects your heart function)
  • Had recent open heart surgery
  • Heart failure
  • Heart valve disease– that is moderate or severe
  • Significant congenital heart disease
  • Cardiomyopathy-any type if you have ongoing symptoms or your daily activities are limited
  • Those with Angina that limits your daily activities or means you have to use your GTN spray frequently

What are the symptoms of COVID-19?

The main symptoms to watch out for are:

  • A cough
  • A high temperature
  • Shortness of breath
  • Breathing difficulties
  • Loss of taste or sense of smell

Other symptoms are fatigue, headaches, sore throat, aches and pains. But these symptoms do not necessarily mean you have the illness. The symptoms are similar to other illnesses that are much more common, such as cold and flu.

If you are experiencing any of these symptoms and are concerned you should contact your GP for further advice.

How to avoid catching or spreading COVID-19

Coronavirus is spread by droplet infection – coughing and sneezing or by close contact with someone who has the virus. As it’s a new illness, we do not know how easily the virus spreads from person to person. Spread is most likely from those who have symptoms.

In accordance with recent guidelines, people should stay at home as much as possible to limit close contacts. You should only leave home to:

  • Go to work
  • Take children to school or childcare
  • Go to shops for essential supplies
  • Care for others
  • Attend hospital and medical appointments
  • Avoid hand shaking and close contact with people- keep a distance of 2 meters (6.5 feet) between you and others
  • Work from home if, and where possible
  • Make a joint plan with family friends and neighbours on what to do if you become ill

Travel

Self-quarantine and self-isolation

  • To help stop the spread of Coronavirus, you may need to either self-quarantine or self-isolate:
    • Self-quarantine means avoiding contact with other people and social situations as much as possible. You will need to do this if you are a close contact of a confirmed case of coronavirus and you are still well.
    • Self-isolation means staying indoors and completely avoiding contact with other people. You will need to do this if you have symptoms of coronavirus.

Other Do's and Don't's

Do:

  • Wash your hands with soap and water often – do this for at least 20 seconds
  • Always wash your hands when you get home or arrive at work
  • Use hand sanitiser gel if soap and water are not available
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
  • Put used tissues in the bin straight away and wash your hands afterwards
  • Try to avoid close contact with people who are unwell

Don’t:

  • Do not touch your eyes, nose or mouth if your hands are not clean
  • Do not share objects that touch your mouth. For example, bottles and cups
  • Do not shake hands
  • Don’t have visitors to your home, unless they are helping with your care needs

Treatment for COVID-19

There is currently no specific treatment or vaccine for COVID 19. The treatment approach involves alleviating symptoms and reducing the risk of others becoming infected. This includes:

  • Getting plenty of rest
  • Staying hydrated by drinking plenty of water
  • Taking paracetamol to help with symptoms such as a high temperature
  • Staying in isolation away from other people until you have recovered

Further information

For further information you can visit the following websites: