Covid-19’s impact on Congenital Heart Defect patients: In conversation with Dr. Vijay Kumar

Dr. Vijay Kumar is a pediatric cardiothoracic surgeon at the G. Kuppuswamy Naidu Memorial Hospital (GKNM) in Coimbatore, Tamil Nadu. One of the chief medical associates with Genesis Foundation, he works meticulously in providing care for critically ill-children battling congenital heart defects (CHD).
*This interview has been edited and condensed for clarity

Could you simplify what is Covid-19?
Covid-19 is nothing but a simple terminology for the disease where ‘Co’ is for Corona, ‘vi’ is for virus, ‘d’ is for disease and ‘19’ stands for the year it happened in. Coronavirus is a family of viruses that can range from the simple flu like symptoms of a common cold to Middle East Respiratory Syndrome (MERS) coronavirus or SARS, i.e. severe acute respiratory syndrome coronavirus.

Are kids with Congenital Heart Defects (CHD) more vulnerable to Covid-19 than the rest?
Research on coronavirus is an ongoing process because we’re all dealing with a new virus. But until now there is no study to point towards kids with CHD being more vulnerable. However, it is clear now that adults with comorbidities of cardio-vascular diseases, diabetes, asthma, hypertension, cancer and the like have a greater risk of being infected with the virus, especially those above the age of 65. For reasons that nobody fully understands yet, COVID-19 does not appear to cause severe disease in children, but precautions need to be taken for kids with CHD and without.

A child gets tested for body temperature during Coronavirus pandemic.
[Creator: ARI JALAL Credit: Reuters]

What if a family member of a CHD child contracts Covid-19?
A. Now you see, there lies a real problem. Because when someone within the family home falls sick, it leaves the children in a highly vulnerable spot. And practicing social distancing within the four walls of the house might be a difficult task, but is not impossible. Children need to be educated about social distancing and for the infants, it has to be the parents taking precautions. But at the end of the day, adults need to be vigilant because coming close to a child with CHD is not the best practice during this pandemic.

A mother feeds her baby taking all possible precautions.

But what if a mother who is pregnant or has given birth to a child with CHD contracts the disease? Do the same rules of social distancing still apply?
Absolutely! For any pregnant woman or a mother, who has been infected with COVID-19, the same rules of social distancing apply whether the child has CHD or not. They should avoid being with the child as much as possible, only when the baby requires colostrum or breastfeeding. Even in that situation, the mother should avoid touching the baby’s face or her own and kissing. Any mother, who tests positive for coronavirus, will have to be kept in isolation. Until now, there is no evidence for intrauterine infection caused by vertical transmission in women i.e. the spreading of the virus from the mother to the child inside the womb through the placenta. So the chances of a child with CHD contracting the virus increase once it’s born. The family members are also not allowed to interact with the mother and baby if they’re in quarantine, until the test results are negative.

Speaking of quarantine, do you think that it has affected the number of CHD cases that the Genesis Foundation is associated with?
It is natural that during a lockdown situation in India, the number of cases we’re getting for CHD have dipped because of lack of transport and the economic setback. At the moment, we’re only operating on cases that fall under the category of critical congenital heart defect. The baby has to be operated on within 3-6 months of being born, in order to save it’s life. Other patients who can wait for a year or more for their surgery have been pushed further down in the line. Even with all the support received by Genesis Foundation, we’re only operating on extremely critical little hearts during this Covid-19 lockdown.

And while operating these on critical cases, are there any specific procedures that you’re following keeping in mind the pandemic?
As a doctor, who is about to operate on a child with CHD, it is me and the patient who are the most vulnerable at that moment and capable of transmitting the COVID-19 virus. Thus, keeping that in mind, we’re following all the procedures laid out by the government. Any and every patient is tested for COVID-19 before an operation, and only once the test comes back negative for them, do we proceed. And this is mandatory even for children with CHD. Rest we follow the standard sanitization routines before and after the operation, including the standard Personal Protective Equipment (PPE) kits for the medical staff.

So with all the precautions in place, what is your opinion of the CHD screening camps organized by Genesis Foundation? How soon can that be resumed?
To answer that absolutely honestly, I think we will have to wait for the lockdown to get over. As you know, there is a steady increase in the number of coronavirus cases all over the country even in the lockdown phase. Now imagine, once it is lifted, the asymptomatic patients of coronavirus might spread it at a larger scale increasing the number of patients, or it might not happen like that as we achieve herd immunity and become immune to the virus, or somebody develops the vaccine and produces it at a mass level for easy availability to all. So I can’t really give a definitive reply when we can resume screening camps. In either situation, for the next 3-6 months, a large gathering like a screening camp has very bleak chances of happening.

It is mandatory for all kids to wear a mask while stepping out from homes.

The whole country is grappling with the effects of this COVID-19 pandemic, but we’re hopeful because vaccines are already being tested. Since the coronaviruses typically cause respiratory symptoms, we request all readers to practice basic hygiene, such as washing hands with soap and water or covering the mouth when sneezing.

While the Doctors play their superhero roles and researchers strive towards a solution, we can all only hope and pray for a speedy recovery for all the kids with CHD who had to undergo surgery even in these stressful times.

You can read their stories here.