COVID-19 infection – Learning’s from Italy

While many of us are still standing on the shore (hopefully in a save haven) waiting for the tsunami to arrive, others are already in the midst of the “warzone”.

With all the speculations about the spread of the virus one thing is clear: We will see many more severe and fatal cases.

In the current situation it is vital that we listen to those doctors who are already treating patients.

I recently had the opportunity talk to some Italian colleagues from our community and hear their reports. What are some of the key findings?

When the doctor becomes the patient
We need to keep health care professionals free of infection. The true number of medical professionals in Italy, which are infected has not been released but colleagues in Italy tell me there are many:

“It is increasingly more difficult to staff the hospitals. We are starting to recruit doctors which have never dealt with such patients”

They emphasize that: testing, self-protection and a high level of awareness for the COVID-19 are of great importance.

Especially patients with heart failure presenting with dyspnea could in reality have COVID-19 infection.

COVID-19 and the heart
While the SARS-CoV-2 virus primarily affects the lungs there are a significant number of patients where the heart is strongly involved. Colleagues report cases of acute left and right heart failure.

Looking at data from China myocardial damage and heart failure is quite frequently a cause of death (alone or in combination with respiratory failure).
02_Graph Cardiac death
The heart is involved in 40% of patients dying from COVID-19 infection. Source: Guan et al NEJM 2020 and Yang et al Lancet Resp. 2020

Many patients show an elevation of troponin levels, which indicates myocardial damage.

Viral myocarditis
We do not yet know if deterioration of heart failure is the result of viral myocarditis, a cytokine storm or simply a result of exacerbation of heart failure in patients with a pre-existing heart condition.

Viral myocarditis is a concern. Especially fulminate viral myocardits. The following case of a patient with cytomegalovirus infection and biventricular heart failure demonstrates how severe viral myocarditis can appear.
Fulminate viral myocarditis with severe left- and right heart failure

A final thought:
Many countries are still a few weeks behind Italy, South Korea and China and this gives them the chance to learn from their experience. Those countries can still set actions to slow the rate of infection and to prepare for what might come.

It is incredible to see how quickly, the SARS-CoV-2 virus is spreading. But let us combat the virus by spreading our knowledge. I am convinced that our knowledge will eventually defeat COVID-19.

If you want to hear more about the “Italian Experience” and learn about the presentation and imaging of COVID-19 patients join us in our free webinar: GO TO WEBINAR PAGE

... and stay tuned for tons of more information on this topic soon

Thomas Binder and the 123sonography team