番茄社区

For 番茄社区's "After the Pandemic" series, we asked our to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.

Here, we interview Mary "Minnow" Walsh, MD, heart failure cardiologist at St. Vincent Heart Center in Indianapolis, Indiana, and past president of the American College of Cardiology.

Check out some of our other articles in the series here.

Can you share an anecdote about a patient of yours and how the pandemic influenced their situation? What was the outcome?

Walsh: We had a patient, for whom we had a donor heart, decline transplantation during the early part of the pandemic. He was overwhelmed by the possible risk to him and the prospect that visitor restrictions would result in him being in the hospital without family. He is stable and still awaiting transplant.

Organ transplantation took a dive along with elective surgeries at the beginning of the pandemic. Has that entirely bounced back?

Walsh: The decline in transplantation rate varied from center to center. Early on, centers in the Northeast that were hard-hit put a pause on transplants, while other centers in other geographic locations took a business-as-usual approach. Most centers are now back up and running at their pre-pandemic volumes.

We will be back to the previous transplant volumes pretty quickly. With COVID hospitalization rates lower in most parts of the country, hospitals have plenty of ICU capacity again, so the barriers are gone.

We've heard about COVID infection of an organ recipient and COVID-to-COVID transplantation. What precautions should be taken for donors and recipients over the next year?

Walsh: First, patients awaiting cardiac transplantation will all need to be vaccinated to be listed, and COVID testing of both donor and recipient is an absolute necessity. Rapid testing is becoming more accessible and accurate, so we can be reassuring to our patients. Listed patients already make decisions about accepting CDC high risk and hepatitis C-positive organs, so COVID risks are layered onto that.

Post-COVID cardiomyopathy concerns have centered on sports participation. Are there implications for organ transplantation as well over the longer term?

Walsh: Right now, we are assessing donors who have previously had COVID with standard imaging with echocardiograms, coronary angiography, and serologies. Whether or not MRI imaging of donors who have had COVID will help in donor decisions is yet to be determined.

Which questions about the coronavirus are you most looking forward to being answered within a year?

Walsh: How long does vaccine protection last? Will we be getting annual vaccines or boosters that incorporate data on the variants? What will be the public's appetite for long-term masking and social distancing?

I suspect it will still be unknown in a year how many variants we will see in the future. By then, we may still be asking what are the sequelae for those with "long COVID" syndrome, and whether we'll have better ways to diagnose and treat them.

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