Heart attack patients leaving it too late to get help amid coronavirus crisis
Royal Free lets the cameras in as BBC films response to Covid-19
07 May, 2020 — By Tom Foot
Dr Tim Lockie at the Royal Free, one of the staff who features in a new BBC documentary [Photo: BBC]
A TOP consultant cardiologist has warned that patients suffering heart attacks during the coronavirus crisis have been putting their lives at risk by delaying medical help.
Dr Tim Lockie said some had been reluctant to go into the Royal Free Hospital due to fears of Covid-19 infection. And he said coronavirus symptoms could “mimic” and “look and feel like a heart attack”, leading patients to isolate rather than call 999. For several weeks government advice has been to steer clear of hospitals unless in an emergency, and this has caused a dramatic drop-off in A&E admissions across the country.
Dr Lockie said his team at the hospital in Hampstead had been coping with a “distressing” surge in patients in the past two weeks presenting with “late complications” from heart failure, which were by then often almost impossible to treat.
He said: “The thing with heart attacks is that they are a lethal condition, Covid or no Covid. The later you present, the more dangerous it is. There has been a big drop-off in patients coming in. We know people are still having heart attacks and strokes, but they have been reluctant to come to hospitals. They haven’t come to seek help, and have been underplaying their symptoms.”
Dr Lockie added: “So what we are seeing is a lot of people presenting with late complications of heart attacks – it is something we haven’t seen for many years. It has been frustrating, because we had up until this been treating heart attacks very successfully. Many people had been leaving hospital without any problems at all, but the late presenting, it has been very distressing. “It has been a problem for us, because there is a lot less we can do.”
Dr Lockie features in a BBC documentary due to air on Monday and Tuesday, Hospital: Fighting Covid-19, which shows how Royal Free staff have been coping in the crisis.
“The adage is ‘time is muscle’,” he said. “If you have a coronary artery blood clot there is only a certain time before the heart muscle can be rescued. We have teams on standby to extract that clot from the artery, and there is a target to try to do it. “very half-hour delay can increase a person’s mortality by 10 or 15 per cent.”
The BBC’s reporters have been at the hospital for three weeks following staff on Covid-19 wards and behind the scenes.
In the programme, Dr Lockie helps an 88-year-old who is struggling for breath and is moved to the coronary care unit where he has “a difficult conversation with him and his family about his prognosis”.
Speaking ahead of the broadcast – which the Radio Times has called “the most important documentary you will see this year” – Dr Lockie said: “A guy last night, he came in at 5am with a heart attack, but it also became clear he had a Covid infection. Covid can kind of bring out the heart attack. So he was not only having a heart attack, but his lungs were also really bad.”
He added: “What is also difficult is that the symptoms of Covid-19 can mimic a heart attack. Covid looks and feels like a heart attack. “It is a tricky situation for us to pick out those people with Covid and strike that balance. “We have to think about the safety of the team.”
Dr Lockie said there was now “full PPE” – personal protective equipment – in the hospital and that it had been fully prepared with “a lot of drills”, adding: “We have still been very busy. It has been a challenging time, almost like being in the Army. We very, very quickly realised the seriousness of the situation and completely rearranged. It has been unprecedented, the way the hospital has responded, come together and reconfigured.
“The management has left it to us, we haven’t been dictated to. I’m really very grateful for the organisation. My mother-in-law was admitted, as a nasty postscript to this. To be a patient relative I saw things from the other side, but she had phenomenal treatment.”
The British Heart Foundation said it has been “hearing that fewer people are being seen in hospital with heart attacks in recent weeks, which suggests that people are not seeking help when they should do”. It added: “Don’t delay because you think hospitals are too busy.”
The BBC said it had been “privileged to have been allowed into the Royal Free London, at a time of national emergency to document the remarkable work of their teams”.
The Royal Free said: “This documentary captures a small sample of the amazing work going on across the NHS and health and social care every day.”
Earlier births for women with Covid-19
SOME pregnant Covid-19 patients are giving birth early by emergency C-section to help maintain oxygen levels in their blood, writes Tom Foot.
Experts say it has helped expectant mothers who have fallen ill with the disease and then struggled for air. The case of the Royal Free’s first pregnant coronavirus patient – a 22-year-old woman who was 36 weeks pregnant – is featured in the BBC’s upcoming film on the crisis.
Dr Maggie Blott, a consultant obstetrician at the Hampstead hospital, told the New Journal that staff had been constantly weighing up the risk an early delivery can cause to mother and baby.
She said: “There is still a lot of research going on into this, and we are still learning all the time of the effects of coronavirus on pregnancy. What seems clear is that, for an otherwise fit and healthy woman, the risks [of Covid-19] don’t seem to be increased and it is not a major problem.”
A man gets up high for his NHS tribute close to the hospital [Photo: Linda Grove]
Dr Blott added: “We have had several Covid-positive women in the hospital and all have pretty much done well. But if a woman gets very sick we have been delivering a bit early. It is because of pressure on the lungs in the later stage of the pregnancy. We found that it does improve the condition of the mother.”She spoke about how her team had adapted to meet the needs of “shielding” maternity patients who are not supposed to leave home under any circumstances during the lockdown.
Dr Blott said: “A woman who was shielding who had very severe health problems, and was pregnant, should not leave the house at all. “So we were bringing them in at the very start of the morning, before anyone else is in the clinic. When we had a woman with Covid-19 we had to isolate her, we had to use PPE during our interactions with her. With the C-sections, we knew we might need general anaesthetic – and that was a full-risk situation.”
She added: “We also had to reduce the need for women to come in for routine visits. So we started telephone consultations, calling women at home so they didn’t need to set foot inside the hospital.”
The Royal Free, like other hospitals, took the decision to suspend home births to “consolidate staff” during the peak of the crisis. Home births are due to restart in coming weeks.
Dr Blott, who has been an obstetrician for 30 years, said: “I have never had to do anything like this in my lifetime. This has been unprecedented in terms of volume of patients coming into the hospital and, partly, because we don’t understand the effects of the virus. What has really made me proud is the way we have responded – nurses, doctors, midwives, porters, cleaners – all staff critical to running the hospital have stepped up. It has been really heartening working in this environment, in this stressful situation.”