By Dr. Sanjay Mehta, MDCM, FRCPC
Founding Board Member, Eternal PHriend, Director & Past-Chair, PHA Canada
Director, Southwest Ontario PH Clinic, London, ON
As we approach the conclusion of the second year following the arrival of SARS-CoV-2 in Canada, it remains vital for PH patients to understand how COVID-19 may affect them.
In this research review, we address four questions of relevance to PH patients and their caregivers, specifically around life with PH in the context of the COVID-19 pandemic.
Are PH patients at higher risk of being infected with SARS-CoV-2 virus?
Since COVID-19 is a respiratory condition, patients with respiratory diseases, such as PH, may be at higher risk for SARS-CoV-2 infection. Some PH patients may also be at higher risk based on older age, non-white ethnicity, and other medical conditions.
However, health promoting behaviors of the PH community may lower risk of SARS-CoV-2 infection. PH patients and their caregivers’ high level of medical education and attention to their own care may make them more likely to follow public health guidelines, e.g., wearing a mask, social distancing, and isolating from others when appropriate.
Are PH patients at risk of more severe COVID-19?
In some patients, COVID-19 is a serious illness, characterized by pneumonia and respiratory failure, requiring hospitalization, oxygen, possibly artificial respiration in the intensive care unit (ICU), and with a high risk of death.
COVID-19 and PH share two key parallels. There is inflammation in the lungs and damage to pulmonary blood vessels, including endothelial cells (EC), the innermost lining of blood vessels. EC and blood vessel damage in COVID-19 can cause blood clots and may place PH patients at higher risk of more severe COVID-19.
However, other factors may lower the severity of COVID-19 in PH patients. For example, some PH patients have lower levels of angiotensin converting enzyme-2 (ACE-2), which may decrease the entry of SARS-CoV-2 virus into cells. As well, some PH medications decrease lung inflammation, which may lessen COVID-19 severity.
How has the COVID-19 pandemic affected the care of PH patients?
The COVID-19 pandemic significantly disrupted medical care, with fewer in-person visits and reduced access to testing. However, a rapid transition to virtual care largely mitigated care disruption and provides an opportunity for more comprehensive and novel assessment of PH patients.
What are the other effects of the COVID-19 pandemic on PH patients?
The COVID-19 pandemic has exacerbated existing healthcare inequalities. For example, PH patients who are elderly or lower socio-economic status may not be able to access virtual care as easily. Furthermore, social isolation and restricted physical activities have negatively affected the mental health of PH patients.
Learn More: The Effects of COVID-19 on Patients with Pulmonary Hypertension, written by Camden De Sanctis, David JG Wainwright HBA BEd Med, and Sanjay Mehta MDCM, FRCPC.
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