The COVID-19 pandemic was a wake-up call for us all. As the flood of disease swept through the world, we braced ourselves for it to hit home. While most South Africans locked down, medical services scurried to get everything in place to deal with the expected tsunami of cases.
As cardiologists, we were dismayed by the reports received from China, Europe and the USA that patients with underlying cardiac disease, especially those with associated diabetes and hypertension, had a much higher mortality when they contracted the coronavirus infection. How were we going to fare in South Africa?
Our population has a high incidence of so-called lifestyle-induced cardiac disease, with the numbers of patients treated for diabetes, hypertension and ischaemic heart disease rising exponentially in the past decade. Would our patients still have access to their vital medications? Now more than ever, their cardiac disease needed to be perfectly controlled, we thought at the time. Would they still be able to travel across provincial borders to receive the specialised treatment they needed? In the Paediatric Cardiology unit at Steve Biko Academic Hospital, nearly two-thirds of our patients travel from outside Gauteng to be treated here, so many would be without appropriate treatment and miss their planned procedures.
Yet we’ve found that diabetes and hypertension are not the only causes of increased morbidity and mortality in cardiac patients during this time. As coronavirus takes its toll on resources such as staff, hospital beds, intensive care equipment and ventilators, patients that desperately need cardiac care and surgeries are side-lined. Our waiting list for paediatric cardiac catheterisation and open-heart surgery was already in excess of six months; it has now been stretched to more than a year. While there is no such thing as an “elective” heart operation, children will now have to wait many months for these life-saving interventions.
We have become experts in juggling theatre time and ICU beds, making a plan, then another and another, trying to help as many of our cardiac children as we can, while still treating COVID-19 patients. Fortunately, children, even those with serious heart disease, have a lower incidence of severe COVID-19 disease than adults do. However, a small subset develops a life-threatening complication known as PIMS – paediatric inflammatory multisystem syndrome – with heart, kidney and liver failure. These children present two to three weeks after their coronavirus infection with a myriad of symptoms that rapidly progress to multi-organ dysfunction and death, unless treated timeously. Our clinical skills have been stretched to the maximum, and we have experienced a rapid learning curve in multidisciplinary treatment. Thankfully, most of these children have recovered, but the long-term effects remain to be seen.
The COVID-19 pandemic has also reinforced the importance of care and consideration for one another. Doctors, nurses, physiotherapists, dieticians, radiographers, technicians and our ever-cheerful cleaners have tackled each new challenge as a team. Yet while caring for sick children who are away from their families, we are also faced with concern over the well-being of our own families, friends and colleagues.
We lost a very good friend last month. Professor Lungile Pepeta was a force of nature not only in the paediatric cardiology community, but in the entire medical teaching service of South Africa. He was an inspiration to us all. He was a husband, father, teacher and friend, and we will miss him terribly. Perhaps the greatest tribute we can give him as the COVID-19 pandemic ebbs and flows is to emulate his tireless care for our cardiac patients and our community. In the words of Dr Martin Luther King, Jr: “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. The true neighbour will risk his position, his prestige and even his life for the welfare of others.”
So this Heart Awareness Month, please take the time to check your cholesterol, sugar and blood pressure levels, but also take the time to check on those around you. Let this month mean more than just awareness of your cardiac health. Rather, be a true neighbour and take all those around you into your heart. Because matters of the heart matter.
Professor Lindy Mitchell is a paediatric cardiologist at UP’s Paediatric Cardiology Unit at Steve Biko Academic Hospital. She is also Vice-President of the Paediatric Cardiac Society of South Africa. Heart Awareness Month is observed annually in South Africa every September.