Participating in an intern'l webinar with the Chinese Cardiology Association to discuss lessons learned with #COVID-19. Learning from our colleagues. Helping us to prepare. Teamwork. @ACCinTouch #ACCIntl All welcome. From 8-10 EDT. Today March 18.heartm.docbook.com.cn/#/meeting_noti… #COVID19 
@ACCinTouch Chinese colleagues making strong point about the asymptomatic transmission. Bin Cao emphasizing the importance of using the N95 masks. For healthcare workers. [Implication: importance for us to solve the shortage problem - he is giving a warning; talking about risk to HCWs.]
@ACCinTouch Chinese colleagues sharing clinical features of #COVID19; one distinctive thing is that dry cough common; but little difference in presentation with flu. In Wuhan experience… 12% had acute cardiac injury. 7% acute kidney injury.
@ACCinTouch In Wuhan…according to Bin Cao, many people had persistent cough after discharge from the hospital - and symptoms were lasting 30 days or more for many. Mean days of shedding virus was 20 days in one sample of patients. Much of this published in @TheLancet.
@ACCinTouch @TheLancet Based on experience in Wuhan, Bin Cao says should not call it a respiratory disease, it is really a multi-organ damage disease - much like sepsis when it manifests as severe disease, involves many organ systems.
@ACCinTouch @TheLancet Also, from Wuhan, abnormal coagulation is common in severe #COVID19. Significantly increased D-Dimer and FDP assoc with poor prognosis. Vascular endothelium inflammation extensive. Bin Cao recommends that anticoagulation should be commonly used for people with severe disease.
@ACCinTouch @TheLancet So from China, #COVID19 is ‘a respiratory disease, it is a whole body disease.’ Virus detected in many places in the body.
@ACCinTouch @TheLancet From Wuhan…many patients with rapid deterioration - ‘you cannot imagine how how fast the disease can progress’; Bin Cao describing the frontline experience. He describes someone who became much worse between day 9 and day 13. So stability at day 9 was no guarantee of recovery.
@ACCinTouch @TheLancet Lessons learned from Bin Cao in Wuhan… all confirmed patients should be in isolation. Critical strategy in his opinion. Rx was usual supportive treatment. He makes clear no specific antiviral shown beneficial. He is leading 3 clinical trials. Lopinavir/ritonavir; Remdesivir x2.
@ACCinTouch @TheLancet From Wuhan, use of steroids in severe #COVID19 still controversial. They were commonly using short-term and low-moderate dose in people w/o contraindications. But no one knows if helpful.
@ACCinTouch @TheLancet Bin Cao, from the frontlines in Wuhan, talking about the uncertainty about the use of ARB/ACEi; he acknowledges that we do not know for sure. Having hypertension did seem to be a risk factor for death among those with #COVID19. He calls for more research.
@ACCinTouch @TheLancet Final comments Cao Bin, from Wuhan, you have to get used to a new life - it is pandemic life now - precautions are necessary. It is different & will be going forward. That is the lesson from #China. Prof Cao is one of the leading doctors in China. Extensive experience w/#COVID19.
@ACCinTouch Sobering indeed, and from the frontlines of the pandemic. He speaks from real-world experience. The majority of people recovery, but catastrophic in many.
@ACCinTouch @TheLancet Now listening to Chen Yundai; she is a leading cardiologist in #China. Highlighting the frequency of cardiac injury in patients with #COVID19. Also emphasizing that this is a multi-organ disease. And inflammatory storm.
@ACCinTouch @TheLancet Great to see Chen Yundai, expert from #China, highlighting her @medrxivpreprint #preprint on this webinar. Many in China are using this mechanism to rapidly share their science. #openscience
@ACCinTouch @TheLancet Chen Yundai, expert from #China, now describing coronavirus fulminant myocarditis; 37y man with chest pain and dyspnea. High troponins. No coronary artery disease. Ejection fraction 27%. Recovered one week later. Ejection fraction 67%. So, in this person, transient.
@ACCinTouch @TheLancet Another example from Chen Yundai, #COVID19 and STEMI. 60y man with cough for 1 week and chest pain for 26 hours. ST-segment elevation. Example of how we may need to be treating people with #COVID19 plus other acute illness - maybe or maybe not related. But need plan for that.
@ACCinTouch @TheLancet Are there questions that you would like the Chinese experts to answer about #COVID19? What are the questions that are most pressing? @ACCinTouch #ACCIntl #WeAreInThisTogether
@ACCinTouch @TheLancet Now listening to Xu Yawei, another expert from #China, talking about infection in healthcare personnel. Incidence in China decreased after Feb 1; healthcare workers started protecting themselves more.
@ACCinTouch @TheLancet Chinese experts telling us that #COVID19 is currently largely under control. Not just government statistics, but from trusted colleagues that we know well. Their measures have worked to control spread.
Message from #China frontlines… keep stable patients at home. Confirmed patients in isolation. Use remote consultation as possible. [this is changing medicine]
