On the frontline of coronavirus battle

Though they are not leading the battle against COVID-19, cardiologists and healthcare workers in the Cardiology department of hospitals are not having an easy time. The patients they see – those with heart diseases – are facing higher risk of severe complications if they contract COVID-19. Committee member of the Singapore Heart Foundation’s Cardiac Rehabilitation and Heart Wellness Centres, Dr Yeo Tee Joo, a cardiologist and the Director of the Cardiac Rehabilitation Unit at the National University Heart Centre, Singapore, shares how they are keeping up with the fight on the frontline.

SHF: What is the role of the cardiology department in the fight against COVID-19?
Dr Yeo: Patients sometimes present symptoms such as shortness of breath and cough. These symptoms are common to both heart failure and pneumonia (possibly from COVID-19) and may prove challenging to differentiate. It is our duty to treat our patients’ cardiac conditions promptly, while ensuring rapid referral for those with suspected COVID-19. The safety of all – including staff and patients alike – remains the overriding priority.

How are your patients reacting to the situation?
With the suspension of cardiac rehabilitation classes, some patients had expressed their concern about their heart health. However, we are trying our best to reassure them by checking in on them via phone or other alternatives. We also remind them to do simple exercises at home to stay active.

My team is working hard to create alternatives to centre-based exercise classes for our patients, such as telephone, internet and even video-based consultations, in order to benefit our patients.

Patients can refer to currently available resources by the Singapore Heart Foundation and Health Promotion Board. These include a series of exercise videos for home-based physical activity.

Doing the #plankthecurve challenge to show that one can keep fit anytime and anywhere.

How will the suspension of cardiac rehab affect the lives of recovering heart patients?
Before the COVID-19 outbreak in Singapore, hospitalised patients who were eligible for cardiac rehab could participate in outpatient exercise classes within two weeks of discharge, but these classes are now adjourned by up to six months. Regrettably, these delays are likely to result in suboptimal patient outcomes.

If the pandemic runs a protracted course, these prolonged periods of reduction in physical activity will negatively impact cardiovascular health, more so in those with established cardiovascular disease. The detrimental consequences are further exacerbated in patients who postpone their cardiology clinic appointments and choose not to refill their prescriptions.

How is the cardiac rehab unit reacting to “circuit breaker” measures put in place by the government?
At the cardiac rehabilitation unit, we aim to convert our cardiac rehab services into telehealth-based as much as possible. There is truly multidisciplinary teamwork and interdepartmental cooperation needed to make this happen.

Given how COVID-19 has affected the whole world and likely to stay around for a long time to come, there is a high chance that we will need to adapt to a new norm of social distancing and infection control, especially for cardiac rehabilitation.

My team is putting together a free online resource page which patients can access easily for exercise and heart healthy advice. In addition, we will be providing telephone consultations for patients to check on their progress from the exercise point of view.

What’s the greatest challenge you face as a healthcare worker during this period and how do you overcome it?
To ensure that my family remains safe throughout this period. It is imperative that I observe strict personal hygiene and minimise the risk of bringing any possible infection back home. As a father to a 3-year-old boy, I have been educating him on the importance of hand washing and basic practices (eg. covering his nose and mouth when coughing or sneezing) to reduce transmission of disease.

Outdoor social distancing run to stay active

Do you have any words of encouragement for fellow frontline workers?
This is a most trying and challenging time for everyone, but we are all in this together.
Over and above all, please keep safe and sane! Only then can we ensure we look after our patients and our loved ones during this difficult period.

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