The COVID-19 pandemic is hitting the world hard. Egypt, the most populous country in the Middle East and North Africa (MENA) region, is no exception. With more than 2,500 confirmed cases and a preliminary case fatality rate of 7% (at the time of writing), the figures in Egypt are alarming, albeit with a relatively benign course compared to what is being seen in the USA and Europe. Ahmed Bendary reviews how cardiology departments in Egypt are handling the virus.
Since SARS-Cov-2 was declared to be a public health emergency of international concern by the WHO on 3 January 2020, the Egyptian ministry of health (MOH) has promptly responded by developing a strict protocol for diagnosing and quarantining the suspected cases together with a mass media campaign to increase public awareness. Two toll-free hotlines (105 and 15335) were provided to report any suspected case to health authorities. Moreover, a dedicated website (Egypt Cares) was launched containing all these educative materials in addition to daily updates about the current Egyptian status. A partial curfew (from 7pm to 6am) to promote societal distancing was declared by the prime minister on 24 March 2020 and is still active till now (time of writing: 16 April 2020).
Patients with cardiovascular diseases are more prone to poorer outcomes after COVID-19 infection, with mortality rates reaching up to 10.5%. Importantly, COVID-19 has been linked in some case reports with “direct” myocardial damage, and the interplay between this infection and cardiovascular sequelae remains unclear. Therefore, that cardiology departments in Egyptian hospitals have taken steps forward to protect their patients and healthcare providers amid this crisis is not surprising.
Health workers at risk; cardiology departments ready
Some healthcare providers at a few cardiac centres in Egypt have caught COVID-19 infection. Mohamed Osama, the dean of National Heart Institute (Egypt’s largest governmental cardiac center), announced on 8 April 2020 the temporary shutdown of the institute’s admission department (re-opened now) after a nurse tested positive for COVID-19. The institute’s director said in a press release that all the institute’s facilities have been sterilised and the 16 medical workers who came in contact with the patient have tested negative for the virus. A cardiac patient and three security guards at the Magdi Yacoub Heart Foundation in Aswan governorate have also been recently diagnosed with the novel coronavirus. The foundation said in an official statement that it took the required precautionary measures at the hospital since the coronavirus emerged in Egypt to ensure the safety of its healthcare workers and patients. Ahmed Elguindy (Aswan Heart Center) pointed, in an interview with me, to their protocol with Aswan University Hospital for patients with STEMI undergoing primary PCI.
Many university hospital cardiology departments have taken precautionary measures as well. At Benha University hospital cardiology department (led by Khalid El-rabbat), all elective procedures, including non-emergent echocardiography, have been suspended. The staff and nurses are being supplied by personal protective equipment (PPE). A dedicated fever room has been established at the hospital emergency department for triaging the acute patients upon presentation (under the supervision of expert pulmonary consultants).
Speaking with Mohamed Sobhy (ex-head of the cardiology department at Alexandria University and current director of International Cardiac Center “ICC” in Alexandria city, Egypt), he said: “We are using telehealth visits now and we are training our staff on using precautionary measure during intubation and mechanical ventilation.” His cardiac center has not recorded any cases till now, nonetheless “we are restricting visitors of patients to only one for each.” he added.
Major cardiology bodies respond
The Egyptian Society of Cardiology (EgSC) has taken a leadership role by drafting a rapid guidance document for managing cardiac patients during the COVID-19 pandemic in Egypt. Reaching out to Kahlid Shoukry (current president of the EgSC and director of Kobry El-kobba military medical center), he said: “We are working in a close collaboration with the official health authorities to apply this protocol to all governmental hospitals.”
Other important cardiac associations in Egypt shifted to virtual platforms for the purpose of continuous medical education. Ashraf Reda (chairman and founder of the Egyptian Association for Vascular biology and Atherosclerosis (EAVA) has recently led a webinar for increasing healthcare providers’ awareness about COVID-19 and cardiovascular diseases.
Ahmed Bendary is at Cardiology department, Benha faculty of medicine, Benha University, Egypt.