The impact of COVID-19 on cardiology training

The coronavirus disease 2019 (COVID-19) pandemic has produced a dramatic shift in how we practise medicine, with changes in working patterns, clinical commitments and training. Cardiology trainees in the UK have experienced a significant loss in training opportunities due to the loss of specialist outpatient clinics and reduction in procedural work, with those on subspecialty fellowships perhaps losing out the most. Training days, courses and conferences have also been cancelled or postponed. Many trainees have been redeployed during the crisis, and routes of career progression have been greatly affected, prompting concerns about extensions in training time, along with effects on mental health. With the pandemic ongoing and its effects on training likely long-lasting, we examine areas for improvement and opportunities for change in preparation for the ‘new normal’, including how other specialties have adapted. The increasingly routine use of video conferencing and online education has been a rare positive of the pandemic, and simulation will play a larger role. A more coordinated, national approach will need to be introduced to ensure curriculum components are covered and trainees around the country have equal access to ensure cardiology training in the UK remains world class.

COVID-19 outbreak, lockdown, and air quality: fresh insights from New York City.

The outbreak of the COVID-19 pandemic has adversely affected all aspects of life and poses a severe threat to human health and economic development. New York City administration enacted a strict isolation decision at the end of March 2020 to tackle the COVID-19, creating a unique opportunity to assess air quality. Therefore, we investigated the impact of the lockdown on air quality in New York City. We evaluated the air pollutants concentration, i.e., PM2.5, CO, NO2, SO2, and O3, during the lockdown and compared them with pre-COVID-19. We explored the first phase of lockdown through a spatial approach, then formulated the air quality index (AQI) of each pollutant before and during the lockdown. Our findings revealed that (1) there was a significant decline in the concentration level of PM2.5 from 10.3 to 4.0 µg/m3 during phase one of lockdown. (2) NO2 concentrations have been decreased by up to 52% in 1st phase of lockdown. (3) O3 concentration has been increased by 44.4%. (4) Brooklyn, Manhattan, Queens, and Staten Island County encountered 18.75%, 55.62%, 47.14%, and 47% diminution in AQI due to lockdown as compared to 2018, respectively. Our key findings can provide critical environmental implications for policymakers, researchers, academics, and the US government.

COVID-19 and its cardiovascular effects: a systematic review of prevalence studies.

BACKGROUND: A small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. OBJECTIVES: To assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. SEARCH METHODS: We conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. SELECTION CRITERIA: We included prospective and retrospective cohort studies, controlled before-and-after, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peer-reviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results and extracted data. Given substantial variation in study designs, reported outcomes and outcome metrics, we undertook a narrative synthesis of data, without conducting a meta-analysis. We critically appraised all included studies using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the JBI checklist for case series. MAIN RESULTS: We included 220 studies. Most of the studies originated from China (47.7%) or the USA (20.9%); 9.5% were from Italy. A large proportion of the studies were retrospective (89.5%), but three (1.4%) were RCTs and 20 (9.1%) were prospective. Using JBI's critical appraisal checklist tool for prevalence studies, 75 studies attained a full score of 9, 57 studies a score of 8, 31 studies a score of 7, 5 studies a score of 6, three studies a score of 5 and one a score of 3; using JBI's checklist tool for case series, 30 studies received a full score of 10, six studies a score of 9, 11 studies a score of 8, and one study a score of 5 We found that hypertension (189 studies, n = 174,414, weighted mean prevalence (WMP): 36.1%), diabetes (197 studies, n = 569,188, WMP: 22.1%) and ischaemic heart disease (94 studies, n = 100,765, WMP: 10.5%)  are highly prevalent in people hospitalised with COVID-19, and are associated with an increased risk of death. In those admitted to hospital, biomarkers of cardiac stress or injury are often abnormal, and the incidence of a wide range of cardiovascular complications is substantial, particularly arrhythmias (22 studies, n = 13,115, weighted mean incidence (WMI) 9.3%), heart failure (20 studies, n = 29,317, WMI: 6.8%) and thrombotic complications (VTE: 16 studies, n = 7700, WMI: 7.4%). AUTHORS' CONCLUSIONS: This systematic literature review indicates that cardiometabolic comorbidities are common in people who are hospitalised with a COVID-19 infection, and cardiovascular complications are frequent. We plan to update this review and to conduct a formal meta-analysis of outcomes based on a more homogeneous selected subsample of high-certainty studies.

Does air pollution upsurge in megacities after Covid-19 lockdown? A spatial approach.

The current coronavirus (COVID-19) pandemic has a high spreading and fatality rate. To control the rapid spreading of the COVID-19 virus, the government of India imposed lockdown policies, which creates a unique opportunity to analyze the impact of lockdown on air quality in the two most populous cities of India, i.e., Delhi and Mumbai. To do this, the study employed a spatial approach to examine the concentration of seven criteria pollutants, i.e., PM2.5, PM10, NH3, CO, NO2, O3, and SO2, before, during, and after a lockdown in Delhi and Mumbai. Overall, around 42%, 50%, 21%, 37%, 53%, and 41% declines in PM2.5, PM10, NH3, CO, NO2, and SO2 were observed during the lockdown period as compared to previous years. On the other hand, a 2% increase in O3 concentration was observed. However, the study analyzed the National Air Quality Index (NAQI) for Delhi and Mumbai and found that lockdown does not improve the air quality in the long term period. Our key findings provide essential information to the cities' administration to develop rules and regulations to enhance air quality.

Hydroxychloroquine use in COVID-19: is the risk of cardiovascular toxicity justified?

The outbreak of COVID-19 in Wuhan, China and its declaration as a global pandemic by WHO has left the medical community under significant pressure to rapidly identify effective therapeutic and preventative strategies. Chloroquine (CQ) and its analogue hydroxychloroquine (HCQ) were found to be efficacious against SARS-CoV-2 when investigated in preliminary in vitro experiments. Reports of success in early clinical studies were widely publicised by news outlets, politicians and on social media. These results led several countries to approve the use of these drugs for the treatment of patients with COVID-19. Despite having reasonable safety profiles in the treatment of malaria and certain autoimmune conditions, both drugs are known to have potential cardiotoxic side effects. There is a high incidence of myocardial injury and arrhythmia reported with COVID-19 infection, and as such this population may be more susceptible to this side-effect profile. Studies to date have now demonstrated that in patients with COVID-19, these drugs are associated with significant QTc prolongation, as well as reports of ventricular arrhythmias. Furthermore, subsequent studies have failed to demonstrate clinical benefit from either drug. Indeed, clinical trials have also been stopped early due to safety concerns over HCQ. There is an urgent need for credible solutions to the global pandemic, but we argue that in the absence of high-quality evidence, there needs to be greater caution over the routine use or authorisation of drugs for which efficacy and safety is unproven.