Transcription:
Commentary on COVID-19 and Heart Care From CMO Cardiologist

Scott Webb: Today on Heart Speak, the podcast for Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. We welcome Dr. Kevin Wheelan, Baylor Scott and White Heart and Vascular Hospital's Chief Medical Officer as well as the Medical Director, Division of Cardiology, Baylor University Medical Center in Dallas, a part of Baylor Scott and White Health. So Dr. Wheelan, thanks so much for joining me today. First, how are you and the team doing at Baylor Scott and White Heart and Vascular Hospital Dallas at this point in time with the COVID-19 pandemic?

Dr. Wheelan: Fortunately at Baylor in Dallas we're doing quite well. We have a number of patients in the hospital with COVID, many critically ill. We're blessed to be able to be participating in a number of research studies so that we're able to bring the latest innovative treatment strategies to our patients and we have not suffered some of the overload capacity that has occurred in other parts of the country. So we and our staff are doing well. Clearly it's a very emotional time for everyone in the country. But I think our biggest concerns are about patients who are remaining at home, not coming in to seek medical care until very late in the disease process because they're afraid of the, you know, the COVID environment and whether they may be worse off coming through the emergency room than just staying at home. That's led to a few tragedies.

Host: Undoubtedly. And I've done a few of these, and are hearing similar things from other Doctors and hospitals that emergency departments are noticing a decline in people that are seeking care, especially for heart attacks. And we know that in the US a person dies every 37 seconds from heart disease. So it is the number one cause of death according to the CDC for both men and women. So is your Heart and Vascular Medical staff seeing a decline in patients seeking care for heart conditions including heart attacks?

Dr. Wheelan: Yes, unfortunately, we have in the Dallas Fort Worth Metropolis, there are several ambulance services and one that we work closely with has recorded a 40% reduction in calls for heart related problems. And we think that there are a number of patients who are staying at home having heart attacks. We have seen individuals come in after the fact when they've damaged their heart muscle, and are developing congestive heart failure. And that's too late in the disease process for us to open the artery and restore blood flow and preserve that muscle function. So it is a reality. The exact percentage may vary in different areas around the country, but it's significant. It's also affecting the same problems in the stroke area where patients, it's critical to get in as soon as possible. Certainly within a couple of hours is best to be benefited by some really amazing treatment options that are available.

Host: It's such a difficult thing to get my mind around, this is what people are confronting, that they're so afraid of COVID-19 that they're not seeking medical treatment for emergent conditions. You know anything that's different, right? Whether it's stroke, heart attack, or even COVID-19 symptoms. The fear is so great and yet you know, we know I don't need to tell you. We know that the hospital is the safest place to be. It is the place where people are most protected and waiting there to help save people's lives and yet people are going through this sort of struggle in their heads. I am sure you have some thoughts about that.

Dr. Wheelan: Absolutely. It really is a tragedy that that there's a lot of mixed messaging occurring in the news media and consistency of the messaging. We have over 220 individuals who are frontline physicians, nurses, technicians, respiratory therapists, taking care of COVID positive patients on a daily basis, and over the last five weeks, none of them have contracted COVID themselves. What we've learned is by using the appropriate protective gear, it's very safe to take care of these individuals and we've had no patients who've come into our hospital who have contracted COVID from another hospital situation. They've all come in with the infection. So I think that the message is twofold. The use of simple face masks by everyone in situations where a sneeze or just clearing your throat could project virus that you don't know you have because you haven't gotten sick yet is a common courtesy to everyone else.

And simply, you know, washing your hands frequently. The face mask also keeps you from scratching your nose, rubbing your eye, which is something individuals do 94 times on average every single day without thinking about it. So there are ways that we can break that chain by getting everybody to be on board. But the hospital is safer than going to the grocery store. Every patient, and we limit the number of visitors that come in the front door, screen, their temperatures checked, they immediately, most people now are all wearing masks, but if they're not, they're fitted with a mask, hand sanitizer, and they enter the building and they go on to get whatever needed care is appropriate. All of the employees are in that same mindset. And you have individuals who are very focused on health, wellness, sanitation, because that's part of what we do every day.

And so what we want the message to be is if you're having cardiovascular symptoms, don't delay, seek attention. And this is a message that we had difficulty with even prior to all of the concerns that have been raised by COVID, particularly in women. We know that the symptoms don't always manifest with the traditional intensity, that that is characteristic of a man having a heart attack, gripping their chest with crushing chest pain and sweating. It can be mild symptoms such as shortness of breath at rest. So the message is don't neglect your health for fear of a situation in which we have pretty darn good handle on how to prevent the spread from one person to another. If everybody just practices these safe policies.

Host: You said it best, you know, the hospital is where people are trained, and whose job it is to make sure the place is clean and sanitized, right? That's not in the wheelhouse of some of those businesses we talked about. And so of course it just makes sense. The grocery store versus the hospital. I'd rather be at the hospital if I needed to be there. Of course. And one of the things that's really taken off during this time Doctor, is telehealth. Right. And I've even had visits with my own Doctor and it was so amazing. I had this little video visit on my phone with my Doctor and she sees me, I see her and it was so great and we were just catching up going over things renewing my medications and things. So wanted to get your thoughts about that. How telehealth, the role it's playing in communicating with people so that if they're on medications, they have a plan you know, for refills and things.

Dr. Wheelan: Well, out of every tragedy, good things occur. That's been true of the entire history of our civilization. And one of the benefits will be a broader embracement of telehealth for us as physicians, we've been very frustrated for the past several decades where we've seen sophisticated technology. The problem has been the insurance company industry hasn't been willing to provide reimbursement for that. The reality is if you're spending time taking care of a person on the telephone or you're spending the time taking care of a person face to face in the office, that's still a valuable service and what's more valuable if you can do that and the person doesn't have to take off from work and drive 20 miles in traffic to get to their Doctor, drive back, etcetera. A daughter doesn't have to take off to go pick up their mother and bring them in. I was just doing a clinic yesterday. We have home devices where they can monitor their blood pressure, they can check their pulse and more sophisticated situations, devices that they can record, an EKG, heart rhythm from home. I can look at that information on the computer, interact with them, make adjustments in their blood pressure medications. It's not a substitute, but it's a wonderful enhancement, especially when a Doctor patient relationship has already been established through a initial, you know, comprehensive visit. I think it's clearly going to be the, you know, the wave of the future of a combination of services that benefit and improve the efficiency of care for everyone.

Host: I couldn't agree more and it's just one more sort of tool in the tool belt if you will. Right? There's no substitute for a face to face visit for physicians primaries. You know, that's the gold standard of course, especially when you really need to be in the same room with the Doctor. But if you don't need to be in the same room, especially during COVID-19, as you say, maybe some good, you know, can come out of this. So what's your advice for patients who have an existing heart condition during this time?

Dr. Wheelan: Don't neglect all of the things that your physician has told you to continue to do. One of the things, best things for COVID is getting out and getting some fresh air, opening the windows in your house when the weather is appropriate. Let the air clear and continue to do that exercising, walking around the block doing a little bit of cardio. Don't neglect eating properly. There have been disruptions in the food supply in different parts of the country, but now's not the time to focus on just consuming junk food. Try to stay diligent about maintaining a good cardiovascular diet. There's perhaps less meat availability, which is actually a good thing. We all know that plant based diets are much better for patients with cardiovascular disease. So eating more fruits, nuts and vegetables, and this is a very stressful time. It, you know, it's important to get enough sleep. That's where our bodies rejuvenate. So trying to keep that routine of wellness is appropriate and keep your regular medical visits. Every single Doctor I know in this country is now able to substitute a telehealth visit or a video visit when that's more appropriate. And we don't want patients who are having mild changes in their symptoms that may be a harbinger of something worse, getting ready to happen, not to be in contact with their health providers so that the appropriate interventions can be done before heart attack occurs.

Host: Absolutely. There's so much that's come out of this. First of all, we've all learned apparently that people weren't washing their hands as much as they should have before or weren't washing their hands properly. So we're all washing our hands a lot, which is great. We're learning to not touch our faces, you know, which is something that's kind of come up a lot as you say 94 times a day at least, you know, touching our faces, wearing masks, you know, is just as simple courtesy to everyone else because you may have COVID-19 and not realize it. So a lot of good information today. A lot of great advice. Just lastly today, Doctor, what are the next steps at the hospital?

Dr. Wheelan: It's clearly improving the ability to test larger numbers of individuals and determine who may have been infected previously and who has built up immunity. You've heard a lot of discussion about antibody testing. It's a very complicated field. A lot of the simple and there's a lot of false tests out there that are being, you know, sort of like these pregnancy tests. You can dip it in and check it and get an answer immediately. Those are bogus. They're not going to give valid information that's actionable, but that that's where the frontier is developing a vaccine, continuing to work on different treatment strategies with these various research protocols and figuring out testing strategies to identify individuals who are becoming infected very early in the disease process so they can isolate at home, minimize chance of spread to others. And a way that we can define individuals who may have already been exposed and have immunity and can be safer to return to a more normal lifestyle and work environment.

Host: Yeah, I have heard a lot about the antibody testing and the value in that and I'm glad you kind of set the record straight that the quick tests are not the not the answer. And I think that that's what troubles so many of us about COVID-19 is there's still so much we don't know, but you guys are doing great work, open and safe and the best place to be. And Dr. Wheelan. Thanks so much for your time today. I really appreciate it.

Dr. Wheelan: Thank you, Scott.

Host: That's Dr. Kevin Wheelan, Baylor Scott and White Heart and Vascular Hospital's chief medical officer. Go to Baylorhearthospital.com or BSWhealth.com for the latest information. To find a cardiologist, please call 1-844-BSW-DOCS. That's 1 844-279-3627 and thanks for listening to Heart Speak, the podcast from Baylor Scott and white Heart and Vascular Hospital in Dallas and Fort Worth. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library for topics of interest to you. I'm Scott Webb. Thanks for listening.