Coronavirus Update

Answering questions about coronavirus (COVID-19), cardiac disease and the latest research

6 April 2020

Watch our video interview with Executive Director Professor Jason Kovacic, who has recently returned from Mount Sinai Hospital in New York. He shares his first hand experience dealing with #coronavirus (COVID-19) and its impact on his patients who have cardiovascular disease.

Update 25 Nov 2021: Information from this article was accurate at the time of publishing and reflected the rules/advice announced by governing bodies at that time.

Video transcript

Hi, I'm Professor Jason Kovacic, the new Executive Director of the Victor Chang Cardiac Research Institute. It's my honour to be taking over this role from Professor Robert Graham who just completed an amazing 26 years in this position. My background is that I come from a cardiology field and I actually did my training here at St Vincent's Hospital in Sydney, and then a PhD at the Victor Chang Cardiac Research Institute. I've spent the last 13 years in United States, including the last 11 years at Mount Sinai Hospital in New York. As you're aware, Mount Sinai is currently at the very epicentre of the Coronavirus (COVID-19) epidemic. And my thoughts for today in this first video was to bring you up-to-date on what I understand is happening with COVID-19, and also the perspective from Mount Sinai in New York.

How does coronavirus (COVID-19) affect your heart?

I can say I'm speaking from personal direct experience here because two of my current cardiac patients are actually currently infected with COVID-19, one of them is actually in intensive care at Mount Sinai in New York at the present time.

So it appears that COVID-19 primarily affects the heart in two ways. The first is that the virus can apparently directly infect the heart. This is a condition called myocarditis, and "myo-" being the heart and "carditis" meaning inflammation of the heart.

So this condition, myocarditis, is actually more common than we think. As you know, viruses can affect our bodies in very different ways. Some viruses just cause a common head cold, some cause are more chesty infection. Some cause sinusitis, some cause gastroenteritis and cause you to have vomiting or diarrhoea. Viruses can also affect the heart. Unlike the great majority of viruses, viruses that do affect the heart mostly tend to just affect the heart. We may feel tired or fatigued or short of breath for a short period of time and then they go away.

Sometimes the viral infections of the heart can be more substantial. And like other viral infections, they can lead people to be hospitalised for primarily reduced pumping function of the heart. And it seems that this is one of the ways that coronavirus (COVID-19) can actually cause cardiac problems- is by directly infecting the heart and causing myocarditis. Thankfully, the proportion of patients that actually get these symptoms is relatively low, and only a small proportion of patients are actually ending up in the intensive care unit with this problem. We do have a lot of experience in dealing with myocarditis in viral infections of the heart. And thankfully, many of the standard treatments we're using do seem to be effective.

The second way that coronavirus (COVID-19) appears to be able to affect the heart is indirectly through very substantial stimulation of the immune system. So this is a secondary effect, but what the virus appears to be doing is causing such dramatic stimulation of our immune systems that the stimulation of the immune system is causing secondary effects on the heart and cardiac. The pump of the heart isn't working as effectively as it should. So this is called a cytokine storm - the medical term - that can conspire with the direct infection of the heart to cause reduced pumping capacity of the heart.

How are people with heart problems and coronavirus (COVID-19) being treated at the moment?

People are being hospitalised. People are ending up in intensive care units and being incubated, that's a breathing tube is needed to help support their breathing. But a small, small minority of patients are actually needing to go onto cardiac support systems to help support their heart through the time when the pump isn't pumping normally.

So this is a very similar heart-lung machine to what we'd use when people are having bypass surgery, not exactly the same but similar, but thankfully, it's only a very, very small minority of patients that are infected with COVID-19 that are actually needing to go on to these lengths to support them. It is really important to note as we face this COVID-19 situation that the vast majority of people have fairly mild infections. It appears that actually a lot of people might get COVID-19 and have no symptoms at all, or very minimal symptoms, just like a regular head cold or a passing viral infection that we all get several times a year.

It really is important to stress that it's only a small minority go on to get these more severe presentations. In the case of my own patients, one of them actually presented initially with cardiac problems though and she subsequently fully recovered. I spoke to her only just a few minutes ago and she's doing very well back at home in New York City. My other patient in the intensive care unit is improving thankfully, so I hope he'll pull through over the next few days. But these are certainly challenging times for us all, and it's important that we really keep our attention on this situation as it evolves and changes.

How is the Victor Chang Cardiac Research Institute involved in the coronavirus (COVID-19) research space?

So we are directly involved at the Victor Chang Cardiac Research Institute in a number of initiatives to try and get a better understanding on how COVID-19 can affect the heart. This involves us looking at how different medications affect the heart, and these are medications that are currently being used to treat COVID-19. And we're also involved in some other early stages looking at how different genetics of people of different genetic backgrounds may actually influence the likelihood you are to develop a severe infection from COVID-19.

What has been the latest developments in terms of medical research surrounding the COVID-19 coronavirus?

I can also say my colleagues at Mount Sinai at New York are really at the cutting age of medical research and pushing the boundaries with therapies and tests for COVID-19. There is a current push led initially in China but now at Mount Sinai to use what's called Convalesce Serum, and we're very fortunate in Australia that we obviously lag behind the development of the coronavirus (COVID-19) epidemic here in Australia so that we can learn a lot from what's happening in the New York experience. Convalesce Serum is something that, some of you might remember, many, many years ago that used to be a vaccine we used to use for hepatitis, and you'd have a large injection in your backside. This is the same thing they are using for COVID-19 to collect plasma from people that have recovered and have a significant antibody level in their blood. That is then being concentrated and those antibodies are being given back to patients that are suffering a severe infection to help directly fight the virus for them.

So it really has been an unprecedented mobilization of doctors, physicians, and scientists around the globe, and a really inspiring thing for me as a medical practitioner to be involved in this effort to fight the situation we find ourselves in front of. I can say one of the most warming things that I learned today is that in New York City, every day at 7:00 PM, everybody, all the residents are coming to their windows and banging and clanging and shouting and making as much noise as they possibly can to spur on the medical profession and the medical doctors and nurses and healthcare providers at the front line to really inspire them to keep going. It's a really, really heartwarming warming thing that's going on around the globe, the effort from the medical profession and also the support they're getting from the community and from people like you.

What types of cardiac disease patients may be at specific risk of getting coronavirus (COVID-19)?

So cardiac disease in most forms doesn't actually put you at more risk for getting the infection; our concern with cardiac disease and indeed any significant medical conditions, is it puts you perhaps more likely risk to suffer a more severe infection. So it's really important that people with any form of significant medical disease, be it cardiac or otherwise are extra cautious in making sure they don't get infected with COVID-19. There is a small proportion of cardiac patients and particularly those that have had transplants or that are on immune suppressing drugs such as prednisone or other immune drugs that they may be at more likely risk to have an infection from coronavirus (COVID-19).

These particular patients should be in very close contact with their cardiologist, and they're exerting very, very stringent measures to avoid contracting the infection. Indeed, I have several of these patients myself, I've locked them all away in their homes and they're all doing fine at the present time. That's a particular population that we are worried about at the present time.

Can lifestyle factors put you at increased risk of contracting coronavirus?

The main factor I would say that would put you at increased risk of contracting the virus is not adhering to the social distancing measures that are currently in place.

So it's really critical to emphasise that you should all be listening very carefully to the advisories that are currently being issued, practicing safe social distancing is not getting within two meters of other people. At the present time, we're not supposed to be gathering more than two people at a time, and all the other measures that have been put in place by the government, both state and federal governments, to ensure our protection and also to minimise the spread of coronavirus here in the community.

Other lifestyle factors such as smoking? It's unclear if smoking would put you at greater risk for an infection from coronavirus. We don't directly believe so, but certainly if that's leading to significant lung disease that maybe be a concern. So anytime is a good time to quit smoking, and I would urge you that if the COVID situation has all got you worried, take the opportunity and try to quit smoking. There's never been a better time than right now to try and do that.

What does "flattening the curve" mean"?

What "flattening the curve" really means is avoiding a huge surge in the number of patients that are infected with COVID-19 at any one time. If we have a huge surge in patients, that would likely overwhelm the hospital system and make it impossible for us to treat all the people that needed to be treated at that given moment. So what "flattening the curve" means is really avoiding a huge peak or a huge surge in the number of infected people, and spreading it out over a period of time such that we never overwhelm the hospital system or our ability to help and treat these patients that are sick.

And certainly, there are some early positive signs that the measures that we put in place are working very effectively and we are optimistic that our situation in Australia will never get anything like its currently become in New York or other parts of America.

How long do we think these social distancing measures will be in place?

The current statement from the government as of 4th of April today is that we can expect this to be in place for another three months, and I do believe that's a fairly reasonable outlook at the present time.

At the Victor Chang Cardiac Research Institute, we're constantly reassessing and reevaluating our position in what we're doing within our facility to minimise the exposure and the risk to our employees, and we have certainly geared ourselves up for that three month period of significant social isolation. It may be that that period is extended or it may be cut back depending on how things go. But I think planning for three months of this current situation is appropriate at the present time, and is in line with what the government is recommending for us.

Summary

So that's a very brief summary of our outlook on the COVID-19 situation. I would encourage any of you if you have questions or concerns, you can please reach out to me or our team directly. We'd be only too happy to field your questions and to respond to you. We fully appreciate this is a very difficult and trying time for all of us, and I think it's important to stay well connected to family and friends. It's a great opportunity to catch up with those friends that you haven't spoken to for five or ten years. Look after each other, but do importantly practice those social distancing measures that have been put forward by the government for us to adhere to.

So I thank you for listening to this video. I'm again once delighted to be in the position of the new Executive Director of the Victor Chang Cardiac Research Institute, and I look forward to conveying with you more and talking with you more about this situation and the Victor Chang Cardiac Research Institute and the amazing work we're doing here in the future. Thank you very much.

** Professor Jason Kovavic is the new Executive Director of the Victor Chang Cardiac Research Institute.

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