Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBCgqSTbhrWwK8LS8kxK6nLFXmS0066-782X2020001300871abc.2020093510.36660/abc.20200935MinieditorialAs Consequências Não Aparentes Fora do Espectro da COVID da Pandemia de COVID-190000-0003-4122-0264FeitosaGilson12Escola Bahiana de MedicinaSalvadorBABrasilEscola Bahiana de Medicina, Salvador, BA - BrasilHospital Santa Izabel da Santa Casa da BahiaSalvadorBABrasilHospital Santa Izabel da Santa Casa da Bahia, Salvador, BA – BrasilCorrespondência: Gilson Feitosa • Rua Florida, 211 apt 302 CEP 40480-000 Salvador, BA - Brasil. E-mail: gilson-feitosa@uol.com.br071220201120201155871872This is an open-access article distributed under the terms of the Creative Commons Attribution LicensePalavras-chavePandemiaCOVID-19BetacoronavírusCardiologiaOncologiaHospitalizaçãoServiços Médicos de Emergência
O mundo tem enfrentado uma pandemia de COVID-19 de enormes proporções. A maioria dos lugares estava despreparada para lidar com essa situação1 e considerando sua ocorrência no atual estágio de informações rápidas, generalizadas e ocasionalmente não filtradas, o aumento considerável do medo afetou a maioria das pessoas no mundo. Principalmente com a rápida contaminação de pessoas nos hospitais e nas comunidades, conforme anunciado no noticiário, e potencializado por fotos de pacientes esperando, desassistidos, fora dos centros médicos, por falta de suporte adequado.
Este cenário apocalíptico foi visto em muitos lugares considerados como adequadamente equipados para o atendimento regular dos problemas de saúde do dia a dia. Todas as atenções foram desviadas para fornecer instalações e equipamentos para o atendimento dos pacientes afetados pela COVID-19 e seus familiares.2
Entretanto, um problema invisível estava surgindo no meio de tudo isso. O atendimento aos pacientes precisando de cuidados devido a outras doenças que não COVID, mas ainda assim graves.
Almeida et al.3 nesta edição dos Arquivos Brasileiros de Cardiologia, demonstraram uma visão acurada para o problema quando, em sua cidade de Feira de Santana na Bahia-Brasil, foram um dos primeiros a documentar tal problema analisando a redução considerável no atendimento a doenças cardíacas, oncológicas e outras condições potencialmente incapacitantes. Outros têm identificado esse problema em muitas partes do mundo, com graves consequências de morte súbita fora do hospital, infarto do miocárdio (IM) não tratado, chegada tardia ao hospital por IM e, como consequência, ruptura ventricular, como há muito tempo não se via, choque cardiogênico, insuficiência cardíaca4 cirurgia cardíaca,5,6 entre outras consequências, sem contar a perda de oportunidade do diagnóstico precoce do câncer, bem como quimioterapia e radioterapia adequadas. Apendicite supurativa, úlceras gástricas perfuradas também foram documentadas.
À medida que as instalações hospitalares iam adquirindo progressivamente o suporte necessário e a transmissão se estabilizava e, em muitos casos, diminuía, a conscientização trazida por observações como a relatada neste número dos Arquivos Brasileiros de Cardiologia suscitou atitudes imediatas para facilitar a captação de casos não-COVID que necessitam dessa atenção.7,8
Essa nem sempre é uma tarefa simples9 e a proteção dos pacientes e seus familiares deve ser garantida por meio de questionários, exames para COVID em pacientes, familiares e pessoal médico, higienização adequada do ambiente e, sempre que possível, com fluxos distintos para esses pacientes.
Até que a muito esperada chegada de uma vacina eficaz aconteça, deve-se lembrar que a humanidade tem esperanças de uma situação pós-pandêmica, mas deve ser lembrada que em termos populacionais não haverá um Pós-COVID 19. Essa ameaça nos acompanhará por muitos anos e, portanto, sempre haverá a necessidade de precauções de contaminação e adoção de melhores condições de saneamento.
Minieditortial referente ao artigo: Repercussões da Pandemia de COVID-19 na Prática Assistencial de um Hospital Terciário
ReferênciasPetrilliCMJonesSAYangJRajagopalanHO'DonnellLChernyakYTobin KA, Cerfolio RJ, Francois F and Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort studyBMJ2020369m1966m19661. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Tobin KA, Cerfolio RJ, Francois F and Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966.TamDYNaimarkDNatarajanMKWoodwardGOakesGRahalMBarrettKKhanYAXimenesRMacMSSanderB and WijeysunderaHCThe Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 PandemicCan J Cardiol20202. Tam DY, Naimark D, Natarajan MK, Woodward G, Oakes G, Rahal M, Barrett K, Khan YA, Ximenes R, Mac MS, Sander B and Wijeysundera HC. The Use of Decision Modelling to Inform Timely Policy Decisions on Cardiac Resource Capacity During the COVID-19 Pandemic. Can J Cardiol. 2020.AlmeidaALCSantoTMEMelloMSSCedroAVLopesNLRibeiroAPMRRepercussions of the COVID-19 Pandemic on the Care Practices of a Tertiary HospitalArq Bras Cardiol202011558628703. Almeida ALC, Santo TME, Mello MSS, Cedro AV, Lopes NL, Ribeiro APMR. Repercussions of the COVID-19 Pandemic on the Care Practices of a Tertiary Hospital. Arq Bras Cardiol. 2020; 115(5):862-870AnderssonCGerdsTFosbolEPhelpsMAndersenJLambertsMIncidence of New-Onset and Worsening Heart Failure Before and After the COVID-19 Epidemic Lockdown in Denmark: A Nationwide Cohort StudyCirc Heart Fail202013e0072744. Andersson C, Gerds T, Fosbol E, Phelps M, Andersen J, Lamberts M,et al. Incidence of New-Onset and Worsening Heart Failure Before and After the COVID-19 Epidemic Lockdown in Denmark: A Nationwide Cohort Study. Circ Heart Fail. 2020;13:e007274.YoganathanASajjadMSHarkyACardiovascular disease and the impact of COVID-19J Card Surg202035211321135. Yoganathan A, Sajjad MS, Harky A. Cardiovascular disease and the impact of COVID-19. J Card Surg. 2020;35:2113.WahadatARSadeghiAHTanisWHeart Team meetings during COVID-19Eur Heart J202041187218746. Wahadat AR, Sadeghi AH, Tanis W. Heart Team meetings during COVID-19. Eur Heart J. 2020;41:1872-4.WoodDAMahmudEThouraniVHSathananthanJViraniAPoppasASafe Reintroduction of Cardiovascular Services during the COVID-19 Pandemic: Guidance from North American Society LeadershipAnn Thorac Surg20201107337407. Wood DA, Mahmud E, Thourani VH, Sathananthan J, Virani A, Poppas A, et al. Safe Reintroduction of Cardiovascular Services during the COVID-19 Pandemic: Guidance from North American Society Leadership. Ann Thorac Surg. 2020;110:733-40.AgostoniPMapelliMConteEBaggianoAAssanelliEApostoloACardiac patient care during a pandemic: how to reorganise a heart failure unit at the time of COVID-19Eur J Prev Cardiol202020474873209256328. Agostoni P, Mapelli M, Conte E, Baggiano A, Assanelli E, Apostolo A, et al. Cardiac patient care during a pandemic: how to reorganise a heart failure unit at the time of COVID-19. Eur J Prev Cardiol. 2020:2047487320925632.PatelVJimenezECornwellLTranTPaniaguaDDenktasAECardiac Surgery During the Coronavirus Disease 2019 Pandemic: Perioperative Considerations and Triage RecommendationsJ Am Heart Assoc20209e0170429. Patel V, Jimenez E, Cornwell L, Tran T, Paniagua D, Denktas AE, et al. Cardiac Surgery During the Coronavirus Disease 2019 Pandemic: Perioperative Considerations and Triage Recommendations. J Am Heart Assoc. 2020; 9:e017042.Short EditorialThe Unapparent Non-COVID Consequences of the COVID-19 Pandemic0000-0003-4122-0264FeitosaGilson12SalvadorBABrazilEscola Bahiana de Medicina, Salvador, BA - BrazilSalvadorBABrazilHospital Santa Izabel da Santa Casa da Bahia, Salvador, BA – BrazilMailing Address: Gilson Feitosa • Rua Florida, 211 apt 302 CEP 40480-000 Salvador, BA - Brazil. E-mail: gilson-feitosa@uol.com.brKeywordsPandemicsCOVID-19BetacoronavirusCardiologyOncologyHospitalizationEmergency Medical Services
The world has been facing a COVID-19 pandemics of enormous proportion. Most places were unprepared to cope with this situation1 and considering its occurrence in the current scenario of fast, widespread and occasionally unfiltered information, the considerable growth of fear has affected most people worldwide. Mainly considering the rapid contamination of people in the hospitals and in the communities, as announced by the news, and potentialized by pictures of unassisted patients waiting outside the medical facilities, due to the lack of adequate support.
This apocalyptic scenario was seen in many places that were considered as adequately equipped for the regular treatment of ordinary health problems. All attention was diverted to provide installations and equipment to take care of the COVID-19 affected patients and their relatives.2
However, an unseen problem was emerging in the middle of all this. The care for the patients in need of attention for non-COVID and yet, severe conditions.
Almeida et al.,3 in this issue of Arquivos Brasileiros de Cardiologia, demonstrate an accurate view of the problem, as they were among the first to document such a problem in their municipality of Feira de Santana in Bahia, Brazil, by analyzing a considerable reduction in the treatment of heart disease, oncologic disease and other potentially incapacitating conditions. Others have identified such problems in many parts of the world, with severe consequences of out-of-the-hospital sudden death, untreated myocardial infarction (MI), late hospital arrival for MI and as a consequence, ventricular rupture, as it had not been seen for a long time, and cardiogenic shock, heart failure4 cardiac surgery,5,6 and other consequences, not mentioning the loss of opportunity for early diagnosis of cancer, as well as appropriate chemotherapy and radiotherapy. Suppurative appendicitis and perforated gastric ulcers have also been documented.
As the hospital facilities progressively acquired the necessary support and the transmission stabilized, and in many cases declined, the awareness brought on by observations such as the one reported in this issue of the Arquivos Brasileiros de Cardiologia prompted immediate attitudes toward facilitating the treatment of non-COVID cases in need of such care.7,8
This is not always a simple task9 and the protection of the patients and their relatives have to be guaranteed by means of questionnaires, COVID testing for the patients, relatives and medical personnel, adequate hygienization of the environment and whenever possible, with distinct flows for these patients.
Until the arrival of a much expected effective vaccine, one must remember that humanity hopes for a post-pandemic situation but must be reminded that, in populational terms, there will not be a Post-COVID 19 era. This threat will accompany us for many years and, therefore, there will always be a need for precautions against contamination and the adoption of better sanitation conditions.
Short Editorial related to the article: Repercussions of the COVID-19 Pandemic on the Care Practices of a Tertiary Hospital