Learn from the experience in the front line!

We republish here a letter to the European Society of Cardiology from Prof. Xiang Cheng, Director of Department of Cardiology, Union Hospital, Wuhan. The letter was published on the 26.03.2020

Prof. Xiang Cheng
Director of Department of Cardiology
Union Hospital, Wuhan
Deputy Chairman of Youth Committee of Chinese Society of Cardiology (CSC)

As the fight against COVID-19 in Wuhan is turning a corner, cases are surging outside of China. We are saddened to hear of infection, as well as death, of medical staff in other countries. As a cardiologist working in the COVID-19 epicenter of Wuhan, I would like to share my experience with my fellow cardiologists. 

Designated hospitals and non-COVID-19 hospitals

During the epidemic, our hospitals were divided into COVID-19 designated hospitals and non-COVID-19 hospitals for patients in critical condition, such as cardiovascular and cerebrovascular diseases, hemodialysis, blood tumor, etc.

The designated hospitals needed a large staff to provide medical support, including cardiologists to manage COVID-19 patients, according to the unified management of the hospital. All doctors needed to undergo rigorous nosocomial infection training before they started work. High quality personal protection equipment (PPE) are provided to all those doctors who are on the front lines with critically ill patients. So far, none of the more than 42,000 medical staff from all over the country supporting the designated hospitals in Wuhan was infected, indicating that strict hospital training and effective protection can protect medical staff from infection.

The cardiovascular departments of non-designated hospitals were used to treat non-COVID-19 patients with critical cardiovascular diseases. However, due to the long incubation period of the virus and the presence of asymptomatic infection, the potential infection risk of medical staff in non-designated hospitals still exists.

Cardiology clinic:

Because some symptoms of COVID-19 are similar to cardiovascular disease, exposure risk exists in outpatient settings. All cardiologists needed to take proper protection (including gloves, protection suits, N95 masks, work caps, goggles/protective screens, etc.) to avoid cross infection when they received patients in the outpatient department. Patients would take a temperature measurement first, and only those with a normal temperature could enter the waiting area. Patients in the waiting area should be as dispersed as possible, more than one meter apart. During the consultation, the number calling system was used, and the numbers were called in order. Strict implementation of "one doctor, one patient, and one consultation room" was performed to avoid the accumulation of calling for multiple people to wait in the consultation room. Patients and their family members needed to wear masks and keep a distance. Infusion was not allowed in the general clinic. The medical staff of the outpatient electrocardiogram room was in close contact with patients when doing electrocardiogram, so they needed proper protection.

Cardiology inpatient care:

For patients who require cardiology inpatient care, our hospital has established an admission system for patients, which minimised delays in patient treatment and avoided nosocomial infections. Patients who needed to be hospitalised should undergo COVID-19 screening (CT lung screening, nucleic acid and specific IgM and IgG antibody tests) immediately. If COVID-19 was diagnosed, he/she would be immediately transferred to the designated hospital. If COVID-19 cannot be ruled out, he/she would be transferred to an isolation ward in infectious department for treatment. If COVID-19 was "excluded" temporarily, he/she would be transferred to the emergency buffer ward for treatment. Cardiologists were on duty in the emergency department, the isolation ward and the emergency buffer ward. After admission, these patients would be re-examined for COVID-19 to comprehensively assess whether there was a risk of COVID-19. If COVID-19 was still “excluded,” he/she would be transferred to CCU in cardiology department.

The CCU ward

The CCU ward adopted the strict principle of single room admission. After 5-7 days of observation in the CCU, a comprehensive assessment of COVID-19 was performed. If COVID-19 was excluded and the cardiovascular condition was stable, he/she could be transferred to regular medicine floor ward with shared rooms. 

The management of family members of inpatients was particularly important. Inpatients can only be accompanied by at most one family member, and the accompanying family member must complete the COVID-19 investigation and no other visits during hospitalisation. We would provide masks to patients and family members, monitor body temperature daily and screening COVID-19 related symptoms, and a special person would report to the medical office every day. 

Special free hotels for medical staff participating in the management of COVID-19

In addition to self-protection, we should learn to protect our families. The government provided special free hotels for medical staff participating in the management of COVID-19 during the pandemic to minimise the spreading to their family members.
 

Again, during this pandemic, although the main presentation of COVID-19 is not cardiovascular, all cardiologists need to remain vigilant and protect ourselves. Wearing PPE is crucial. The temporary medical management system we established has effectively prevented cross-infection, and we hope that it can help the current severely affected areas.