Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
The SARS-CoV was transmitted from palm masks civet to humans in 2003 in the local market in Guangdong, China and MERS-CoV from dromedary camels to humans in 2012 in Saudi Arabia. Also, the novel coronavirus had some link to the seafood and animal market in Wuhan, China, so the virus is thought to have a zoonotic origin, most likely bat-to-human infection.
On December 31st, 2019, the World Health Organization (WHO) Regional Office in China was informed of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China. On January 7th, 2020, the Chinese authorities announced they had identified a new virus (SARS-CoV2) that causes these cases and the disease was called Covid-19: ‘CO’ stands for corona, ‘VI’ for virus, ‘D’ for disease and ‘19’ for the year started. The WHO declared as a pandemic on 11 March 2020. As of 22 June 2020, more than 9,067 million cases of COVID-19 have been reported in more than 188 countries and territories, resulting in more than 471,000 deaths; more than 4,8 million people have recovered.
SARS-CoV2 follows the replication strategy typical of the coronavirus subfamily. The primary human receptor of the virus is angiotensin-converting enzyme 2 (ACE2), first identified in 2003. This receptor is less present in children and it could be the reason of the lower numbers of children affected, a difference with other virus.
What is the COVID-19?
COVID-19 affects different people in different ways. Most infected people will develop mild to moderate illness and recover without hospitalization but in others cases (around 1-4%) provokes severe acute respiratory syndrome, requiring mechanical ventilation or ECMO (extracorporeal membrane oxygenation) support to help to the lungs recovery. Most common symptoms are: fever, dry, cough, tiredness and Less common symptoms: aches and pains, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell, a rash on skin, or discoloration of fingers or toes. Lastly, a Kawasaki-like syndrome has been described in some children and in adults a pro-thrombotic status which complicate the outcome of the patients affected. There is not at the moment any effective treatment or vaccination, and some trials are ongoing with different types of medications (antiviral or anti-inflammatory effects).
Which is the risk of COVID-19 infection in patients with Congenital Heart Disease?
There are many different congenital heart diseases (CHD) and your child (or you) risk from Covid-19 will depend on individual situation. Most children with CHD don’t seem to be at particular risk of becoming seriously ill from coronavirus infection. Some of them are classified as higher risk if their condition is complex (such as Fontan circulation, single ventricle or cyanosis or recently surgery) or if they also have lung disease, heart failure or pulmonary hypertension, and if your child or you have had a heart transplant you are classed as “clinically extremely vulnerable” and in case of covid-19 infection your medication has to be reduced. We’d strongly advise people to continue taking all their medications unless advised differently by your doctor. Medical experts and worldwide cardiac societies are agreed there is no evidence that ACE inhibitors (Captopril, Enalapril, Lisinopril) and angiotensin receptor blockers (Losartan) increase the chances of severe Covid-19 infections.
If you are at high risk because of your condition, you’re advised to follow all the guidance carefully, including social distancing and to wear a surgical mask is recommendable. If you are concerned about your child or you condition, get in touch with your pediatric cardiologist or adult cardiologist to stablish the best advises.