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Oak Ridges Heart Clinic

Dear patients & referring physicians,
We have closed our clinic for in person consultations and visits in light of COVID-19 for now until March 30th.  A full week prior to that, we hope to make a decision on the following weeks depending on the threat still faced.  We will however continue to provide care in a number of ways.  We are now fully equiped to do consultations through the OTN.  This is secure.  We will therefore triage the consults received in this time period for this purpose.  We will also return all phone calls and fax correspondence.  Our reception staff have been set up to work from home.

I also want to highlight that heart patients (previous heart attacks, stenting, strokes, arrhythmia, cardiomyopathies) are at the highest risk with a 10% mortality rate should they be affected by COVID 19.  That is in addition to the 14.8% mortality for those above age 80.

The presentation has been varied with the virus causing more heart attacks, heart arrhythmia, heart failure,  as well as myocarditis (inflammation of the heart muscle). 

Most will survive but depends on resource allocation and utilization.  So, for example if there are few cases in a community then the elderly person who contracts the virus and presents to the ER will get the appropriate supportive treatment which may include ventilation in an ICU and angioplasty (if deemed necessary) as well as the appropriate medications until the bodies own immune system gradually - maybe weeks- fought off the bug itself.

However, the current situation in Italy and what happened in Hubei is that many presented at once resulting in delays in getting the appropriate such treatment for the cardiorespiratory complications so that some died waiting for these treatments.

The bottom line for us at present is to do all we can to NOT get infected especially if we have close and regular contacts with those who are elderly or have heart disease (as well as lung disease). 

I suggest we do the following to keep our patients, parents and loved vulnerable ones safe for the next 2 weeks while we get more information, and a semblance of control (resource wise).  The idea is to delay as much as possible getting sick so that resources are not overwhelmed in the short term.

1)Stay home especially if you are elderly and/or have been diagnosed with heart disease.
2)Have non-essential visitors stay away.
3)Assign someone to keep supplies up to speed - groceries, medications.
a)This person & all should use all published precautions in public places such as the grocery store or bank. I.e. keep at least a meter from others and wash or sanitize the hands after touching objects especially but not limited to door handles,  knobs, elevator buttons, money, cell phones, shopping carts (if washing with soap and water, do so for 20 seconds and make sure you get the spaces in between your fingers and under the nail bed.  Short nails a very good idea in these times). 
b)If you hear a sneeze or a cough where you are, turn around and go elsewhere. 
c)Don't bother with masks.  Unless you are a healthcare professional who is fit tested, the mask is only going to give you a false sense of security.  You will not have the training to use the mask appropriately as well.   Masks are more appropriate for the person who is sick to prevent spread.  Such infected person in any case should also self isolate for 2 weeks.
4) when in doubt, just wash your hands before you have to touch food or your face.  Best is soap and water but if not available, then use hand sanitizer.
5)Do not consume outside meals.  Ensure you can assure that the food is not contaminated.  So, avoid fast food, avoid restaurants.  Essentially, cook your own food. 

Hopefully we only need do this for the next 2 weeks until system wise, we get things under control.  Most of us suspect this is the calm before the storm.  We may go the South Korean way or the Italian way.  It all depends on everyone participating in social distancing.

We hope to ensure all are protected so that we pull through this situation in good health and with life. and return to a semblance of enjoyable life after a period of sacrifice. 

-Drs. Ramya Raghavan and Mahesan Srivamadevan