Jason: Hi. I'm with Professor Robert Graham, Cardiologist from the Victor Chang
Cardiac Research Institute. I'm Professor Jason Kovacic, Executive Director of the
We want to talk to you today about COVID-19 and some of the issues
that are arising from that. Bob, let me start off by asking you: We've seen a lot
of changes in the way patients are coming to the department, coming into the emergency
room. What's been your perception on what's happening? I heard that we’re seeing less
people coming to the ER because they stay at home scared of the hospital. Bob: Well, certainly
that's happening in other countries in a big way. Up to forty percent of people in
in the United States are not coming in to see doctors when they should be coming in.
They're leaving their illness until it is very advanced and they're obviously getting into
trouble. Heart disease is often a chronic
condition that needs to be looked at by your doctor on a regular basis and if you
don't have that done then your medications can’t be monitored and you can get real problems. So
I would urge people to continue to at least contact their
doctor and make sure they at least have a telehealth consult. Jason, I'll let you
explain to people what that is, but it's very important that patients
keep up their visits to their doctor and continue to get their treatments
adjusted appropriately. Jason: Right. It's a great point. So I've just come back from
New York City where I actually still see some patients. Telehealth has really
exploded in the COVID-19 era. What it is, is basically a Skyping
or Zooming or doing some other sort of video meeting in conference with a
patient in the place of what would normally be a clinic consult visit. So a lot of
the information can still be gathered by your doctor through a teleconference
Obviously one of the limitations is there isn't a physical examination, but
even without that most of the consult can still be effectively done by
by telehealth, by connecting with your doctors. So certainly it is a safer way of
doing things if there is a lot of virus a lot of infection going around and
it keeps both your doctor and you protected from any possible
transmissions, and it can keep you off public transport in some cases. So Bob, back to these
patients and who needs to be careful specifically which patients with
different diseases need to be careful in this COVID-19 era, who's at risk?
Bob: People who are at risk are those obviously who are immunosuppressed, those who have had a
heart transplant or any organ transplant. People with underlying heart disease
where their heart function is not normal. That is, it's less than a hundred percent.
People who've got diabetes. People who are overweight. Obesity seems to be a risk, a recently
identified risk factor. It seems that if you get COVID with obesity, you're going to do worse.
And one of the other things, Jason, is I know a lot of people are worried about
coming in and having tests done if they need to go into a hospital or GP. What is your
response to that? Jason: Right. Especially now that the number of
infected people with COVID-19 in Australia is so low, people really don't need to
be concerned about coming into the hospital. In fact, we really encourage people
to come in because patients would have been away from their healthcare providers
or a good number of weeks now. The hospital systems are very well set up to
triage people and point them in the right direction as to whether
they've got COVID or whether they come in for their routine tests.
So really the risk of getting an infection of COVID if you're coming into hospital
to have a test is extremely low. People really need to be taking
care of their other longstanding health issues at this time. So Bob, let me ask you, one
of the things coming through COVID-19 is a possibility of treatments and
therapies and one of those aspects is a vaccine. Where do you think we
stand with the vaccine? Bob: Look, I think, I hate to be a pessimist because one hopes
that the vaccine is the way forward. It is the way forward if you get a good one,
but I think all the indications at the moment are that it’s very difficult and it's going to take a long time.
At least I would say at best 12 to 18 months. That's optimistic. We don't
have a vaccine for any of the coronavirus family as of yet that's effective.
So it's going to be a challenge. In terms of other treatments, yes- lots of
other treatments are being looked at. You've probably heard of one and I'll actually
call up one of them, which can potentially cause heart problems. So it has to be used
carefully. And that’s Hydroxy Chloroquine which is an anti-malarial drug. You've probably heard about that.
Yes. So that’s where the Victor Chang Cardiac Research Institute gets involved in a couple of initiatives against COVID-19
and one of those is looking at this drug Hydroxy Chloroquine. It is a form of immune suppressant
drug. It's used in people with lupus and sarcoidosis and periodic various
other conditions but it potentially at least in certain experiments has been
shown to have some effect in suppressing the virus, but it really is unproven at
this time. A lot of people are receiving it, but we at the Victor Chang Cardiac Research Institute are
looking into seeing how it can affect the cardiac electrical system because
there's definitely been reports of changes in the electrical pattern in the
heart, which can lead to the situation as Long QT Interval syndrome. So again, something
important we're looking into at the Victor Chang at the moment. Bob: And I think
that's a really important issue, Jason, because while the problems you get
these heart problems may not occur very frequently, you
can imagine if you've got hundreds of thousands of people on it,
then you're going to get hundreds of styles in cases and side effects.
So we have to be very careful.
Jason: Great point. One of the other interesting things I wanted to raise that we are doing at the Victor Chang
through Bob, is through stem cell therapy. We're investigating the possibility that,
that might be helpful for patients with severe COVID-19 infections. Could you update us on that Bob?
Yes. It turns out there's a type of stem cell, which first of all, is very useful because you don't need to
have it matched like a donor organ match and you don't need any more
immunosuppression. You can give it from one patient to another. So we can take these
stem cells from a healthy person and put it into someone who's got very severe
respiratory disease due to COVID-19 and try and dampen down the hyperimmune system
activation these patients get. Now these cells, have a nice ability to try
to be able to dampen down the immune system and we've now been able to give them to
ten people on compassionate grounds in New York who've had very severe COVID
disease and were on a ventilator for respiratory disease
and they seem to have done extremely well, but it's early days. That's an
uncontrolled study and we need to look at it very formally and carefully to
make sure they're safe and they use. Jason: One of the interesting positives to come
out of this, is if while this is something we're hoping to do at the Victor
Chang, we've actually got so few patients in
the hospital system here that, we may not be able to get it going. Is that reality?
Bob: Yes. That's reality. What a nice situation to be in. Jason: Exactly, that's great.
So look, one of the final key points I think we need to touch on is what symptoms
people need to be careful of. If you seem breathless, do you need to come
immediately to hospital or how do you work through that as a patient?
Bob: Yeah. Look, I think if you're a heart disease patient and you know you've got
underlying heart disease and if you start to get breathless, you certainly should consult your Cardiologist.
If that's not something you normally have, especially if it's getting worse or you've
had it for the first time. The other things that would
make you think you have heart disease as opposed to COVID-19 is if you get
breathlessness in the absence of a temperature and the absence of a cough or in
the absence of muscle aches, which are all the symptoms you get from coronavirus.
Or in the presence of chest pain, which one might be thinking you've got a heart disease
called Bristol's breathlessness, then you certainly should consult the doctor and
n either case, I think you shouldn't wait until things have got too far. It's
easier to treat people when the disease is not that severe. Jason: Right. One of
the main questions I wanted to address. Anything else from you, Bob?
Bob: No. Look I just encourage patients not to be scared or worried about coming in. Chances of getting
coronavirus are very, very small. We take extreme precautions and we're in this wonderful
situation in Australia where we're better off than actually any country in the world,
in the fewest number of cases worldwide and hopefully, that continues.
Jason: We'll end it there and encourage you we've got several videos up on our website at the
moment. Please check them out. There's a lot of information there. There's also a Q and A,
we've got on our website about COVID-19, please take a look, a lot of
information there for you. Thanks for watching the video and we
look forward to getting back to you again soon with more updates