“The new variant will not be heavy”

Dr. Naresh Trehan needs no introduction. He is one of the leading cardiovascular and cardiothoracic surgeons in the world today. After graduating from King George’s Medical College, Lucknow, India, he went on to practice at New York University Medical Center in Manhattan, USA. After returning to India, he became a leading light at the Escorts Heart Institute and Research Center. He is the Chairman, Managing Director and Chief Cardiac Surgeon at Medanta – The Medicity. Dr. Trehan has served as personal surgeon to the President of India since 1991 and has received numerous awards including the Padma Shri, Padma Bhushan, Lal Bahadur Shastri National Award and Dr. BC Roy Award.

Anjali Bhatia caught up with Dr Trehan to find out more about the prevailing pandemic fear and more.

Question: New Covid variant emerges as a threat to the world. Should we be afraid of this option?

A: The current variant, the BF.7, is a sub-variant of the Omicron BA5. Cases of BF.7 are increasing in Japan, the United States, and several other countries besides China. Conditions in China and India are different. In India we have good vaccine acquired immunity and natural immunity due to the previous three waves of Covid infection. I think we have significant herd immunity at the moment and this particular variant will not cause a severe infection, although the number of cases in the next week may increase.

Q: What precautions should one take to protect oneself from infection and do we need a booster dose?

A: To prevent corona or any respiratory infection, the most effective way is to wear the mask properly in all cases of exposure, especially when traveling or in public places on public transport. This will prevent Covid as well as the flu also circulating in the population. Vaccination against influenza and corona is effective in reducing severity and mortality. The new nasal corona vaccine appears promising, preventing infection by boosting local immunity.

Q: How do you explain sudden cardiac death?

A: Sudden cardiac death is death without preceding symptoms. This can happen due to an irregular heart rhythm or sudden cardiac arrest. This may or may not be related to reduced blood supply to the heart. Predisposing factors may be underlying heart disease, family heart problems, drug abuse or viral infection, including Covid. Cases of sudden cardiac death are more prominent post-Covid. It may be related to heart muscle inflammation, but needs more research to link it to Covid and find a cure.

Q: How can one cope with post-covid syndrome?

A: Most of the studies on Covid infection show that some patients have residual lung dysfunction, heart problems or memory problems. There is no specific treatment or antidote for the onset of Covid symptoms, but gradual, paced exercise along with a healthy diet, nutrition and sometimes medical support for heart and memory related problems can be helpful.

Question: Some experts say that the rational use of steroids is also harmful to the heart. Some deaths are due to fitness. What is your opinion?

A: Steroids are an effective drug when used in the right amount for the right reason and for the right duration under medical supervision. But steroids are also abused for recreational activities like fitness and should be discouraged. In severe cases of Covid, steroids are helpful. It was the first drug to reduce mortality. Unwise overuse and abuse of steroids should be discouraged. In the case of sudden death in the gym while dancing or doing sports activities, there may be underlying asymptomatic silent heart diseases such as occlusion of blood vessels, muscle thickness or inflammation in the muscle. These conditions show no symptoms at rest or during light activity, so they are not diagnosed in time. Sudden and heavy exertion causes sudden heart problems. Regular health check-ups under the guidance of a family doctor are very useful before starting fitness activities, after Covid or after the age of 40.

Q: Do you think there is a need for more research into the effects of Covid on health?

A: Yes of course. The effect of Covid19 on health needs to be studied, both acute and long-term, and in this way we will be able to understand how to recover and be able to make better predictions. Not only that, it can give us insight into the pathology of many viral infections and could be very useful in the future. I would like to clarify one point here. Heart attack and cardiac arrest are two things. A heart attack or myocardial infarction refers to a reduction or cessation of blood supply to a certain part of the heart, which we usually call in technical terms coronary heart disease and in lay terms a heart attack. Cardiac arrest is a different term. Cardiac arrest means that the heart stops beating, there may be no blockage of the blood vessels but the heart stops beating due to some problems in the electrical functioning of the heart which leads to sudden cardiac arrest. This can happen in a patient with a history of heart attack, but it can also happen in someone without ischemic heart disease or because of a decrease in blood flow to the heart. Blood pressure or hypertension or high blood pressure is one of the high risk factors for heart attack or ischemic heart disease or reduced blood supply to heart vessels. Other risk factors are diabetes, smoking, high cholesterol, etc. So yes, uncontrolled or poorly controlled high blood pressure is an important cause of heart attack.

Question: Can we say that the heart of Indians becomes weaker than the citizens of other countries?

A: I would say that Indians are more prone to occlusion of heart vessels because we are the capital of diabetes; we are more likely to be diabetic. Second, we have more visceral fat, even if we look thin, our cholesterol levels are higher than other people’s, and our livers are fattier. Over time, due to the abundance of food, obesity rates have increased dramatically compared to other countries. Indians are getting less sleep, stress is on the rise and pollution is on the rise. All these factors put Indian hearts at risk and we are likely to have more heart attacks and sudden cardiac arrests.

Q: Can vaccinees get Covid due to BF 0.7?

A: BF 0.7 is a variant of concern and indicates immune escape. Immune escape means that already vaccinated or already infected people can get this infection. However, natural and vaccine-acquired immunity will reduce disease severity and transmission, so we should get vaccinated, including a booster dose.

Q: How can we prevent sudden heart attacks?

A: Preventing a sudden heart attack needs strategies at different levels. People should stop smoking and go for regular health check-ups, especially those who have had a history of heart attack or sudden death in the family. Try to maintain an ideal weight, one hour of moderate-intensity exercise after consulting a doctor, and six to seven hours of good sleep. If there is a family history of any arrhythmias or irregular heart rhythm, they should consult a doctor. At the community level, people should be made aware of the basic maintenance of life. If someone suffers a sudden cardiac arrest, which is a cardiac arrest, then what should be done and how should it be done? This should be taught in the community and schools at the government level. If there is a sudden cardiac arrest in which the heart’s activity is impaired, a defibrillator and well-done CPR are very helpful. So defibrillators should be available in public areas like airports, schools, railway stations and bus stops in all these areas.