Coronavirusin WA

Western Australia’s “secondary pandemic” – a cardiovascular crisis

15 September 2020

An Opinion Piece from Professor Livia Hool from the Victor Chang Cardiac Institute, Western Australia

The nation has looked on Victoria’s second wave of COVID-19 infections with a mixture of concern and alarm. Here in Western Australia, we are very fortunate to have hitherto avoided a second wave, due to a combination of our hard border and swift responses from our state’s public health authorities. To avoid a widespread outbreak here, the general consensus is that we will need to remain vigilant until we are vaccinated or the virus is eradicated. This will be critical for saving lives.

But there is a more insidious enemy evolving that will have a greater impact: COVID-19’s ‘long tail’. The long-term consequences of the virus for those who survive are very significant and are creating a new cohort who will continue to suffer years after they have been declared non-infectious.

Age is by far the strongest predictor of an infected person’s risk of dying, but COVID-19 is also hazardous for those who become infected in their younger years. Australian Government data indicate that those in their twenties continue to report the highest number of infected cases. While the mortality rate is low in this age group, the ongoing effects of the infection, and its impact on our health budget, will be long lasting.

Surviving patients experience sustained significant damage to their bodies that includes persistent physical, cognitive and psychological impairments. During the acute phase of the infection patients suffer a “cytokine storm”, an inflammatory response that attacks organs in the body. We already know that the long-term effects include ongoing neurological symptoms, damage to the liver, pancreas and blood vessels. The average time a COVID-19 patient is breathing via a tube in intensive care is three weeks; experience shows this leads to long term scarring of the lungs and chronic respiratory problems, including shortness of breath.

Significantly, tests performed months after recovery (even in those with mild symptoms) have shown long lasting damage to heart muscle. COVID-19 patients have evidence of increased troponin levels in blood, that typically occurs following a heart attack. 20 per cent of hospitalised patients with COVID-19 in China had heart damage and 16 per cent experienced cardiac arrhythmias. Patients experience inflammation of the heart muscle (or myocarditis) and studies have demonstrated that the virus can linger in the heart for months after the initial infection. Patients who have cardiac muscle damage have the highest fatality rate, at 10.5 per cent.

The effects of COVID-19 infection present researchers and WA’s healthcare sector with a new cohort of unknown biology. Although we are yet to understand the implications fully, we know myocardial damage leads to heart failure, representing a significant healthcare and economic cost. Targeted cardiovascular research into the long-term experience of COVID-19 patients is required to provide many of the answers we desperately need and help us to quantify the impact of this burden.

Funding WA cardiovascular research will set the foundations for the development and translation of improved treatment therapies. However, there is a critical shortage of cardiovascular researchers in WA.

Cardiovascular disease is already the leading cause of death in Australia and around the world. The significant rise in obesity and diabetes in recent decades is contributing to an increase in mortality – and the long lasting effects of COVID-19 is adding to this burden. Cardiovascular disease is a broad term that includes a range of heart and vascular system disorders, kidney disease and stroke. It can impact people at all stages of life. WA needs a visionary, multi-disciplinary solution involving researchers, clinicians, public health advocates and government to tackle this “secondary pandemic” effectively.

Last year the local cardiovascular research community joined forces to create the Western Australian Cardiovascular Research Alliance (WACRA), with the aim of working closely with the WA Government to find solutions to our unique challenges when it comes to delivering cardiovascular healthcare across such a vast, isolated territory.

WACRA members are at the frontline of this problem. WA has done so well to keep COVID-19 cases low, but we all need to understand that the pandemic will not simply end when a vaccine is found. The virus has a long tail that will impact the health of Western Australians – and the health budget – for years to come. We need our best cardiovascular researchers on the case.

*This Opinion Piece was published in The West Australian on 14 September 2020.

Professor Livia Hool is Chair and Founding Director of Western Australian Cardiovascular Research Alliance and an academic at the University of Western Australia. She is also Faculty-at-Large at Victor Chang Cardiac Research Institute, Sydney.

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