Koronavirüs ve Doğumsal Kalp Hastalıkları Bilgilendirme

 

Koronavirüs (Covid-19) pandemisi tüm dünyayı etkileyen ve devam etmekte olan, aktif bir durumdur. Hastalığın ilerleyişi, yeni bulgular, semptomlar ve mutasyonlar hala daha pekçok bilinmezi barındırmaktadır. Hastalığın çocukları daha az etkiliyor olması, en sevindirici özelliği olmakla birlikte, az sayıda da olsa, bazı çocuklarda ciddi hastalık belirtilerine yol açabilmektedir.Kronik hastalığı olan bireylerde hastalığın daha şiddetli seyrediyor olması bağlamında, doğumsal kalp hastalığına sahip çocuk ve erişkinlerin de riskli grupta yer aldığı bilinmektedir.  Özellikle aşağıdaki hastalık grupları en yüksek risk grubundadır:

  • Pulmoner hipertansiyon
  • Siyanoz (morarma) bulunan (oksijen satürasyonu <%85) hastalıklar ve tamir edilmemiş kompleks kalp anomalileri
  • Kalp fonksiyon bozukluğu olan hastalar
  • Kalp nakli geçirmiş hastalar
  • Genetik bozukluğu olan (Down sendromu, DiGeorge sendromu, Heterotaksi sendromu gibi) ve immune yetersizliği bulunan hastalar
  • Böbrek ve akciğer gibi diğer ilave organ sistemi hastalıkları buunanlar

Doğumsal kalp hastalığının tipi dışında, hastanın fiziksel kapasitesi ve ilave tıbbi problemleri de riski etkilemektedir. Örneğin, obesite ve diyabeti bulunan daha basit bir doğumsal kalp hastası, genel durumu ve fonksiyonel kapasitesi iyi olan daha kompleks bir kalp hastasından daha riskli olabilir.

Sağlık Bakanlığı tarafından önerilen (maske, sosyal mesafe ve temizlik) önlemleri koruyuculukta en önemli basamaklardır ve mutlaka azami dikkat gerektirmektedir. Salgının boyutları, vaka sayıları, bölgesel özellikler dikkatle takip edilmelidir.

Doğumsal kalp hastalarına hizmet veren hastanelerin, ilgili bölümlerini Covid-19 hastalarından olabildiğince izole etmesi ve hijyenik standartlarını en üst düzeyde tutması gereklidir. Hastane kontrolleri olabildiğince kısa tutulmalı, diğer hastalarla yakın temastan kaçınılmalıdır. İmkan olduğunca online görüşmelere ağırlık verilebilir. Erken ve acil ameliyat veya girişim gerektiren durumlar, azami korunma tedbirlerine uyularak gerçekleştirilmektedir. Elektif işlemler ise, mümkünse ertelenebilir. Hastalığın durumu, beklemenin olumsuz etkileri ve alınacak Covid riskinin doktorunuz ile konuşarak düzenlenmesi yerinde olur. Bir kalp ameliyatı ya da girişim öncesinde en az 14 gün evde ciddi izolasyon uygulanmasında fayda vardır. Yatış öncesi PCR testi zorunludur.  Hastaneye yatış gerektiren durumlarda ziyaretçi kısıtlamasına uyulmalıdır.

Hastaneye gelme konusunda ciddi tereddütler yaşamanız doğaldır. Tüm dünyada benzer durumlardaki hastalar için bu endişe geçerlidir. Bu durumda doktorunuz ile iletişim halinde olmalısınız. Online görüntülü görüşmeler faydalı olabilir. Hastanenizin salgına karşı aldığı önlemleri sorgulayabilirsiniz. Ancak unutmayınız ki, herşeye rağmen, öncelikle kendi kişisel önlemlerinizi en üst seviyede tutmalısınız.

Daha fazla bilgi için:

https://ailevecalisma.gov.tr/media/42385/c-hgm-koronaviru-s-bilgilendirme-doku-mani.pdf

 

 

 

Doctor/Clinic Visits

  • Safety is a top priority, and COVID-19 safety measures are in place across Michigan Medicine clinics including face mask use for patients, family members, and the medical team. We are taking action to keep our patients safe from exposure to COVID-19.  Read more about how we are keeping our patients safe during COVID-19.
  • Michigan Medicine outpatient clinics are open for patients with urgent medical concerns and for follow-up visits your provider recommends take place in person.
  • Michigan Medicine Providers are reviewing all upcoming patient appointments and will make recommendations regarding whether you should come at this time, have a video visit, or be rescheduled. If you have a scheduled visit, your provider believes that it is in your best interest to come in person with the safety measures in place.
  • We continue to change in person visits to video visits when appropriate. We encourage all patients to enroll in the Michigan Medicine Patient Portal, as this allows patients to participate in video visits from a smartphone, tablet or computer.
  • Restrictions on the number of family members or guardians accompanying a patient are in place for the safety of our patients, staff and community. Please refer to the Michigan Medicine website for updated Visitor Policy
  • If you believe that the planned visit and/or testing are not in your best interest, please contact your provider.
  • If you have a planned visit but have symptoms of being sick or have had an exposure to someone with COVID-19 within the past 2 weeks, please notify the clinic prior to arriving so that the visit can be rescheduled or additional safety measures can be arranged.

Use of Face Masks

  • The CDC and Michigan Health and Human Services recommend that everyone wear masks when around other people including for infection protection for clinical encounters.
  • Masks should cover the nose and mouth unless not medically tolerated. Almost all patients with heart issues are able to safely wear a mask over both nose and mouth.
  • You will be greeted by staff as you enter the hospital or clinic, and be asked to wear a mask for the duration of your visit to the medical center. The Center for Disease Control is recommending mask use for infection protection for clinical encounters. View our policy here.
  • Personal masks from home can be worn by patients and family members, but they are also provided at the clinic and hospital entrances at this time. We discourage the use of masks with plastic exhaust valves.
  • All staff in the clinic will also be masked to keep everyone as safe as possible.

 

Heart Medications including ACE Inhibitors

  • Early in the pandemic, concerns were raised about the impact of ACE-Inhibitors and Angiotensin Receptor Blockers (ARBs) on COVID-19 infection. Examples of ACE-Inhibitors include lisinopril, enalapril, and captopril. Examples of ARBs include losartan, valsartan, and candesartan. Multiple studies have now shown that it is safe to continue these medications.
  • We are currently recommending that patients continue taking these medications as no increased risk has been found, and this is consistent with national and international recommendations.

Aspirin

  • We are recommending that patients continue aspirin.

Remdesivir

  • Remdesivir appears to be safe for patients with heart problems with severe COVID-19 infection. It should be considered for use based on the recommendation of an infectious disease specialist.

Dexamethasone

  • Dexamethasone is safe for patients with heart problems. It may be indicated for patients with severe infection at the recommendation of an infectious disease specialist.

Hydroxychloroquine (Plaquenil) and Azithromycin

  • We do not recommend use of these drugs to prevent or treat COVID-19 infection as the risks appear to outweigh the benefits.

School Attendance

  • Schools across the state have had different approaches, ranging from entirely online teaching, to hybrid approaches, to entirely face-to-face programs.
  • Most patients with congenital heart disease can safely attend school if procedures such as mask wearing and social distancing are followed. We recommend that patients contact their provider with specific questions or concerns.

Work

  • Consistent with State of Michigan guidelines, all individuals currently advised to work from home when possible.
  • Generally, it is reasonable to return to workplaces that are following COVID-19 safety practices as outlined by the CDC.
  • Individualized work recommendations can be discussed with your cardiologist.
  • We encourage patients or family members to discuss their concerns and options with their individual employers.
  • Please contact your health-care provider if you are concerned about your work situation.

 Immunizations

  • We are currently recommending that all patients remain up to date on required immunizations, specifically influenza and pneumonia when appropriate.

Additional Information

Preparation

Frequently Asked Questions

  • I’ve heard that doctors are really busy handling issues related to COVID-19, so I’m kind of afraid to call or come into the clinic. Should I wait?

Your Congenital Heart Center at the C.S. Mott Children’s Hospital remains open, and we are ready to care for your family in multiple ways including by phone, virtual video visits, and in-person visits.  We are doing imaging and other testing to diagnose heart problems, as well as procedures and surgeries. We have already made changes to maximize your and your family’s safety when coming to the medical center including screening for symptoms, waiting room separation and extra cleaning measures, and masks for all patients, visitors, and care providers.  Please do not hesitate to call if there is anything you are worried about including if you have concerns about whether you should come to see your medical team.  Your provider will work through the best option for you whether that’s a phone call to check in, a virtual video visit, or an in-person visit like usual.

  • What’s going to happen for my next clinic visit and echocardiogram?

Clinics across Michigan Medicine are progressively opening to more people for medical care.  Providers are reviewing all referrals and scheduled visits on a case by case basis to determine the best way to provide your care in these circumstances.  You may be asked to “meet” by phone or video visit, or you may be asked to come into the medical center for testing and visit on your regular schedule.  If you are uncomfortable with the decision and recommendation from your provider, please call.  Safety precautions are in place across the clinic, testing areas, and the entire facility.

  • I’ve heard that patients with heart problems can get sicker than other patients with COVID-19. What do we know about this virus in patients with congenital heart disease?

Higher risk for severe COVID-19 illness is connected to multiple health issues including older age, high blood pressure, diabetes, and obesity.  The CDC includes heart conditions including congenital heart conditions on the list of risk factors for a severe COVID-19 illness.  To put this “higher risk” in perspective, for those with congenital heart disease COVID-19 is much more likely to be only of mild or moderate severity.  We are contributing to multiple research studies to better understand the specific risks and treatments.

Please call the program if you have questions or concerns related to your specific situation.  If you think you may be ill with COVID-19 please seek medical care.

  • Are there any medications I can take to prevent COVID-19 or treat its early stages?

Clinical studies for most medical treatments have not shown benefit.  In the event of illness, most care is supporting your body’s own immune and other organ systems through illness to recovery.  University of Michigan faculty are closely monitoring a number of potential treatments in development around the world, including several therapies currently being investigated here at Michigan Medicine.

  • I’m tired of social distancing and masks! Can I get back out there and do my thing?

Your providers are tired of this too, but we continue to follow the CDC.gov recommendations including wearing masks in public and in the medical center.  We have seen an enormously positive impact on the spread of disease with the measures that individuals and our communities have taken so far. The longer we can all keep it up the better.  We encourage our patients to follow the directions of the CDC, the Michigan Department of Health and Human Services, and both state and local leaders.

  • I’m afraid to come to the clinic and hospital for my heart care because of this virus.

You are not alone.  Many people in similar shoes are also afraid of coming to the medical center.  Your providers are reviewing the clinic and hospital schedules very carefully for who should come in for a visit and who can at least start with a telephone call or video visit.  If you are worried, please call us and talk to us about it!  The risk of catching the virus during a visit to our center is very low; we have many measures in place to maintain social distancing and implement cleaning and hygiene practices.  More detailed information about how we are maintaining a safe environment can be found at: https://www.uofmhealth.org/coronavirus/keeping-patients-safe.

  • I’m scheduled for a procedure or surgery in the near future. Will that still happen?

Just like for clinic visits, heart procedures and surgeries are reviewed on a case by case basis to make sure this is still the best time to proceed.  In most cases, it is.  Your team will work with you to make these decisions.  There may be visitor restrictions that will be important to you and your family, so please check the Michigan Medicine website for the most up to date visitor policies.  You may be asked to have a COVID-19 test prior to your scheduled procedure or surgery as part of new policies that will continue to adapt to our local situation.  Our medical team is working with your safety and the safety of all our patients and family members as a top priority.

Please contact your healthcare provider’s office with additional questions.

 

 

 

Safe Places, Trusted Care

Michigan Medicine has a long-standing commitment to the health care needs of our communities. Your safety is our highest priority. During this global COVID-19 pandemic, our commitment to giving you a safe, reliable place to receive care is even more important to us.

Reopening Our Clinics and Services

During the height of the pandemic in Michigan, some of our clinics temporarily paused services, or scaled back in-person appointments. Thanks to the efforts of Michigan residents to stay home, effectively controlling the spread of the virus, we are able to begin offering broader services to meet the needs of our communities, starting with patients whose care needs are most urgent.

How We’re Keeping Patients Safe During the COVID-19 Recovery

Guided by our internationally respected infection prevention experts and recommendations from the Centers for Disease Control and Prevention (CDC), we have taken a number of steps in addition to our standard rigorous infection control measures to ensure our facilities remain safe places for you to confidently receive care.

In-Person Appointments and Procedures

For some of our patients, safety means being seen in-person or scheduled for a procedure as quickly as possible. Our commitment to you is to provide the care you need, when you need it, as safely and conveniently as possible. Each patient’s individual circumstances will be evaluated by their provider to determine how soon that patient should return for in-person care or a scheduled procedure, or if their care needs could be handled through E-Visits or Video Visits. Learn more about how we can help you get the type of care you need.

Restricting Visitors

Our temporary visitor policy restricts visitors to reduce the number of people in our facilities and, therefore, the risk of exposure between patients, visitors and staff.  We understand this can be difficult and appreciate your understanding.

Masks and Hand Sanitizer

  • Masks for Staff:  All staff wear masks. The type of mask staff members wear is determined by the type of care they provide, to best ensure their safety and the safety of our patients.
  • Masks for Patients and Visitors: All patients and anyone with them will be asked to wear a mask or cloth face covering while in our health care facilities. You may bring your own, or if you don’t have one, face masks are available at each entrance,
  • Hand Sanitizer: Hand sanitizer is available at each entrance and at numerous locations throughout each building. Everyone is asked to sanitize their hands when they enter the building. In addition, each member of our health care staff sanitizes their hands before and after each patient encounter.

Screening and Testing

  • Screening for COVID-19 Symptoms: We screen all patients and visitors for COVID-19 symptoms. You will be contacted by your clinic prior to an appointment to ask whether you are experiencing any symptoms. In addition, when you arrive for your appointment, you and anyone with you will also be asked about any cough, fever and other symptoms of respiratory virus infection that you or others in your household may be experiencing. Staff are also screened for COVID-19 symptoms each day.
  • COVID-19 Testing: We test all patients admitted to our hospitals for COVID-19, as well as any patient scheduled for surgery, regardless of whether or not they have symptoms. Patients are admitted to designated units based on their test results.

Cleaning, Reorganization and Check-In Options

  • Common Areas: Areas such as waiting rooms, lobbies and restrooms are cleaned often with special attention to frequently touched surfaces including doorknobs, armrests and handrails.
  • Exam Rooms: These are fully cleaned and disinfected between each patient.
  • Floor Markings and Furniture Rearrangement: We have made special arrangements to support social distancing. You may see markers on the floors to show where people should stand for check-in and check-out. We have rearranged furniture in some waiting areas to create more space between patients, and are scheduling appointments to ensure that fewer people are in our clinics at any given time.
  • Waiting Room Organization: Waiting rooms are organized to keep patients with respiratory symptoms separate from patients receiving other types of care. Special arrangements are made for patients being evaluated for COVID-19 or possible COVID-19 to arrive through a specific process and be immediately settled into a private exam room to reduce the chances of other patients being exposed to the virus.
  • E-Check-In: Many clinics are offering E-check-in to further limit your exposure to others, and some clinics are offering patients the option to wait outside or in their vehicle for their appointment to begin. You must have a free account with our patient portal, MyUofMHealth, to use E-check-in features.

Every Patient Safety Decision Guided by Experts

You can be confident that you will receive safe, high-quality, compassionate care from the extraordinary health care teams at any of our hospitals and health centers.

Michigan Medicine has been recognized year after year for overall patient safety and the highest quality standards.

Our safety precautions are guided by experts in the field of infectious diseases, infection prevention, public health and quality improvement.

These experts monitor the latest recommendations from state and national organizations, including the Michigan Department of Health and Human Services, U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization (WHO), and adapt our processes to meet best practices that limit exposure and prevent the spread of disease.

In many cases, the people designing ways to keep you safe in our hospitals and health centers are the same people advising state and national efforts to keep our country safe during the COVID-19 pandemic.  Our faculty and staff are leading a number of innovative research projects on COVID-19 treatment and recovery.

Every member of our teams are committed to keeping our patients, staff and community safe.

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