FAQ: Coronavirus and Adults with Congenital Heart Disease
Last updated April 27, 2020
If you or one of your loved ones is a UCSF congenital heart disease patient, get answers here to important questions about coronavirus (COVID-19) and how to minimize your risk of infection.
What is COVID-19?
COVID-19 is a newly recognized disease caused by a novel coronavirus that has not previously been seen in humans. The viral infection primarily causes severe respiratory illness, and can be spread from person to person. Information gathered thus far suggests that older adults and those with underlying cardiovascular or pulmonary disease may be susceptible to more severe COVID-19 disease when they become infected. This is particularly true for patients with uncontrolled or suboptimally controlled congestive heart failure, hypertension, asthma, chronic obstructive pulmonary disease (COPD) and pulmonary hypertension.
What is known about how COVID-19 affects patients with congenital heart disease (CHD)?
At this early point in the history of the disease, we do not yet have comprehensive data on its behavior in children or adults with congenital heart disease. There is no evidence that having an underlying congenital heart defect increases the chances of being infected. However, based on observations made in older adults with underlying congestive heart failure, it is likely that patients with underlying CHD may be at risk for more severe disease related to the viral infection. It is important to recognize that there is a broad range of anatomical and physiological abnormalities among patients with CHD, and it is likely that not all are at similar risk for severe disease. The UCSF Adult Congenital Heart Disease (ACHD) Program has therefore attempted to classify patients in higher-risk and lower-risk groups. In general, patients with impaired systemic ventricular function and those with abnormal pulmonary blood flow/pulmonary hemodynamics are believed to be at higher risk.
- Unpalliated cyanotic CHD
- Unpalliated shunt lesions with significantly elevated pulmonary blood flow
- Lesions associated with sequestered lung segments (abnormal venous drainage with arterial supply coming from bronchial vessels)
- Fontan physiology
- Congenitally corrected transposition of the great arteries (CCTGA)
- Dextro-transposition of the great arteries (d-TGA) palliated by atrial switch procedures (Mustard or Senning)
- Eisenmenger syndrome or pulmonary arterial hypertension (PAH)-CHD
- Any lesion with poor systemic ventricular function
- Corrected septal defects and other shunt lesions with no residual defect, absence of pulmonary hypertension, and normal systemic ventricular systolic function
- Palliated tetralogy of Fallot with good ventricular function and competent pulmonic valve
- D-TGA palliated with arterial switch and normal ventricular function
- Isolated bicuspid aortic valve (BAV) or valvar pulmonary stenosis (PS) with normal ventricular function and no symptoms
At this point, data are insufficient to suggest specific preventive measures in patients with congenital heart disease, and we are recommending that all patients with CHD, irrespective of which group they are in, follow routine public health guidelines with regard to social distancing, scrupulous handwashing and avoiding unnecessary contact. We have also recommended that whenever possible, patients be allowed to work from home. Patients in the high-risk group whose jobs entail work in crowded areas or prolonged close contact with potentially infected individuals (particularly those in health care) should either be allowed to work from home or excused from work with leave pay.
I have CHD. What precautions do I need to take?
Based on experience with other viral respiratory infections, it is possible that COVID-19 will be more severe for patients with congenital heart disease. These patients should follow the following precautions:
- Wash your hands often with soap and warm water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Avoid close contact with people outside of your home.
- Do not come to work if you are sick.
- Avoid all nonessential travel.
- Cover your mouth and nose with a tissue when you cough or sneeze, and throw the tissue in the trash. Then wash your hands with soap and water.
- Clean and disinfect frequently touched objects and surfaces.
- Stay home as much as possible. If you need to go out, avoid crowded public spaces, staying at least 6 feet away from all other persons.
- Wear a mask or cloth face covering when you are in public places, such as the grocery store. Please do not wear a mask with a valve, as these masks allow droplet release and do not protect others who may be nearby.
Should I continue to take my medications?
Yes, if you are taking medications, continue taking them. If you are sick with fever or respiratory symptoms, contact your medical team for guidance on continuing your medications. Check with your doctor if you have any questions.