What People With Pulmonary Hypertension Should Know About COVID-19

In this special edition episode, Roham Zamanian, M.D., from Stanford University Medical Center discusses the coronavirus (COVID-19) and gives specific advice for the pulmonary hypertension community.

My name is Roham Zamanian. I’m the medical director of the Adult Pulmonary Hypertension Program at Stanford University Medical Center and I’m here talk to you a little bit about what’s going on with the coronavirus and the specifics of what our pulmonary hypertension (PH) community and pulmonary hypertension patients should be thinking about.

I think the first place that we have to start with is the patients in the community should know that there’s a lot of concern out there and there’s a lot of stuff in the media and there’s a lot of stuff on social media. The first place that they should really refer to for information, in general, should be the CDC website and their own county healthcare system website. Those will be the most up to date on the CDC website, if they look up coronavirus, CDC or COVID-19 CDC, they’ll be able to find very specific information, both for patients and physicians.

I think that the second thing that patients should realize is this is a viral infection and it is one that is moderately contagious and moderately impactful on their health. It seems to be one that is probably more dangerous for susceptible patients and therefore that’s why PH patients should be careful about it and also the elderly. There is a lot of panic out there to some extent, but I think patients and caregivers, everyone, all of us, the physicians, should start off with the point where taking responsibility for your own hygiene and hand washing is of utmost importance. Hand sanitizers are good, but they’re not necessary. The basic are good hand washing techniques. There’s plenty of videos online that they could look up that and just basically employ it as often as possible.

The second thing I’m telling my patients to do is to avoid unnecessary environments. Whether you visit a friend, it’s up to you or not, but really I think that at this point in time, there’s universities that have changed their classes to online. If you’re planning on taking a trip, it’s worthwhile looking into delaying that trip. If you’re thinking of going to a large event where you won’t have a lot of control over who and how you come in contact with other people, it’s wise to rethink that. I’m doing that for my own family, I’m doing it for my patients and I think that’s the first place we have to start off with.

Some of the other things to think about are who are the points of contact for you for your healthcare. I’m sure each patient who is part of a pulmonary hypertension center should have access to their PH experts. Really, I think what we would begin with, is the idea is, do have an upper respiratory tract symptom? Do you have fevers and have you had any recent travel or contact with people who have either traveled to areas that are suspicious? The international destinations that are currently listed by the CDC The hardest thing about this is it isn’t just a common variety flu and upper respiratory tract infection. But I think being vigilant and making sure to communicate with the healthcare system. Getting your information from reputable sources is a good place to start.

It’s always good to have hygiene products available. The hand sanitizers have become ridiculously difficult to find and they’re not necessary. First of all, the hand sanitizers that you have to find are the recommended ones that have 60% or more of alcohol. It’s obvious, but patients should not be using drinking alcohol like vodka or any of those spirits to make solutions to wash hands with. The reality of it is you don’t need that. You could really use antibacterial soap along with lukewarm water, and hand-washing techniques. Again, you could look up the duration and how to do proper hand washing out there. So I think a supply of a product like that.

Patients may be told by their physicians to isolate themselves. They may be told to self-quarantine in their home, for either their own safety or other people’s safety. If that happens, obviously they’re going to have to have supplies that could last them seven to 14 days, whatever duration that they’re told to do so. But make sure you have a plan, both a communication plan and a support plan. A lot of the PH patients that we take care of have family that support them as well. So I think you should be thinking about some of those support mechanisms that could help you get through it.

There’s nothing magical. You don’t need to run out and buy all the toilet paper in the world. You don’t need to go buy all the water bottles in the world. It’s more that you should have some plans in case you are required to quarantine. Then I guess the bigger thing is avoidance of any ill contact or situations where they can get exposed to other people who they don’t know if they have had ill contact.

The Stanford team is inclined to say that our stable patients with pulmonary hypertension who haven’t had any change in their medications or change in their symptoms for a very long time, we are considering asking them not to travel to the clinic and come to a healthcare environment where there’s potential exposure. But again, I think it’s very difficult to get specifics on this and I think that the patients return to their primary pulmonologist or primary care physician, whoever’s caring for them for their pulmonary hypertension to decide on that.

In terms of the flu shot and flu vaccine, while the vaccine is not for this strain of coronavirus, I still encourage my patients to seek and get flu shots if they have not done so already. We have to think that there are multiple viruses that are traveling around, and this happens to be something that we’re very focused on, coronavirus, but there are other pathogens, other viruses that are respiratory viruses that we still want to make sure our patients are vaccinated against. So our recommendation stays the same. But the other aspect of this is that patients who are on routine medications through mail order that need to be filled, they should stay on top of it. Again, not giving any specific advice, but it’s good habit and good practice to make sure you plan ahead for your refills and have those in hand.

I think the only other thing to say is that the situation continues to be evolving. Patients should continue to stay up to date with, as I mentioned, appropriate sources and make sure that they follow the advice of their primary or pulmonary cardiology physicians. This is a dynamic situation, things are changing and as protocols and procedures change or if there are any significant updates, patients should continue to be engaged and look at the CDC. Obviously, we’re glad to have another follow-up interview and give you any updates, whether we have some at Stanford or in the broad sense for patients with pulmonary hypertension.

My name is Roham Zamanian, I am a PH physician and I am aware that my patients are rare and lovely.