The Cardiologist at the Time of Coronavirus: A Perfect Storm

Claudio Rapezzi; Roberto Ferrari

Disclosures

Eur Heart J. 2020;41(13):1320-1322. 

In This Article

Effects on the Organization of Cardiology Wards—New Priorities

Most European hospitals are unprepared to manage such an intense and sudden request of beds dedicated to the treatment of severe respiratory failure and are necessarily trying to convert other wards to the treatment of those infected. In Northern Italy, the emergency is progressively involving all cardiology ICUs, not in order to manage cardiovascular complications of the viral infection, but simply to offer beds for treatment of the severe respiratory failure caused by viral interstitial pneumonia. However, the net effect of this reorganization that has been imposed by local and national health authorities is a significant reduction of sites and staff committed to the 'usual' treatment of cardiovascular disease. In particular, elective cardiothoracic operations and interventional procedures are being cancelled. The restriction of free movement between regions imposed by the central government adds to this, with a reduction of cardiology outpatients who—despite everything—decide to access our clinics. This viral emergency, limiting our ability to manage the medical repercussions in the first instance, could have detrimental effects on the entire health system.

However, the issue also has difficult ethical implications. With what criteria should we establish the allocation of resources to a specific hospital or geographic area? Based on the likelihood of benefitting from treatment? Chronological age? Geographic proximity? Bearing in mind the dramatic economic cost, how severely should restrictions to free movement, public venue and working place closures be enforced? As physicians, our decision-making is generally based on the risk–benefit assessment of the single individual, but in this case three elements are involved, each with a different degree of validity and vicinity to the decision-maker:

  • the first is the cardiac patient who has been (or should be) admitted under my care (very concrete),

  • the second is the patient with Coronavirus to whom I should allocate an ICU bed (who is not in contact with me yet, or in any case, is not part of my usual clinical setting), and

  • the third is the population of a specific area that I need to protect from the infection.

Making decisions for the good of a second-tier entity (such as the population to be protected) is not usual for the cardiologist who works in a hospital, who is intellectually more inclined to focus on and safeguard the here and now.

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