Heart Block in patients with COVID-19

BackgroundSince the emergence of the SARS COV-19 pandemic, multiple extrapulmonary manifestations of the virus have been reported from around the world. Cardiovascular complications including arrhythmias in patients with COVID-19 have been described in multiple studies. Our aim was to review various case reports detailing the new onset of heart block in COVID-19 patients and to summarise the clinical course of these patients. MethodsWe systematically reviewed all reports published and indexed in PubMed, Scopus, and Embase between March 2020 to May 2021, analyzing the relation between the demographics of the patients, pre-existing comorbidities, and the progression of heart block in patients infected with COVID-19. ResultsWe identified and included in this study 30 relevant articles describing 49 COVID-19 patients with heart block. Among them, 69.3% (n=34) of patients suffered from at least one comorbidity. 36.73% (n=18) of the patients showed spontaneous resolution of the heart block. Conversely, 63.26% (n=31) of the patients had persistent heart block, out of which 16.33% (n=8) and 42.86% (n=21) were implanted with a temporary and permanent pacemaker respectively. The reported mortality rate was 22.45% (n=11) during hospitalization. We noted that 45.45% (n=5) of the patients who died had complete heart block. 24.49% (n=12) of the patients in the studies we reviewed were suspected of having myocarditis. However, none were confirmed with MRI or cardiac biopsy. ConclusionsAdditional research is necessary to unearth the mechanism of development of heart block in COVID-19 patients as well as its implications on the clinical course and prognosis. Physicians must be aware of the importance of monitoring patients hospitalized for COVID-19 for arrhythmias including heart blocks, especially in the presence of comorbidities. Early detection can improve the prognosis of the patient.

Peritraumatic Distress of COVID-19 on Physicians in Bangladesh: Implications and Policy Recommendations

COVID-19 pandemic has been an ultimate test of resource management for any governance, especially in the healthcare system. Bangladesh, being a developing country and with very limited resources, is fighting the COVID-19 pandemic. The frontline workers, especially the physicians and nurses are going through immense physical and psychological stress during the pandemic. Social unawareness, the absence of strict preventive policies, increasing workload, and the lack of resource management are making the frontline healthcare workers extremely vulnerable to COVID-19. In this paper, we present the outcome of our study on peritraumatic distress of COVID-19 among physicians in Bangladesh. Based on the user study, we have identified a number of key factors behind the peritraumatic distress and psychological stress caused by COVID-19. Our study shows, more than 78% respondents are suffering from peritraumatic psychological distress. We also recommended some very important and yet easy to implement policies to reduce the peritraumatic stress of the physicians of Bangladesh. These policy recommendations were a result of the survey analysis and the suggestions from the COVID-19 designated physicians.