After the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, the adoption of specific personal protection measures has been immediately required in every type of community, following specific indications by the Centers for Disease Controls and Prevention, both in the USA and in Europe.1,2 Similar guidelines have been released in every single country.
Healthcare professionals, working in close contact with patients, are among the personnel at the highest risk both for infection and the spreading of the disease. Several clinical routine procedures involve the generation of aerosol and droplets, the vectors that spread the virus. Despite the valid suggestion of making use of telemedicine to avoid direct contact with the patients, in many cases the management of subjects at risk of thromboembolic events needs intervention in person. Therefore, it is mandatory to use personal protective equipment (PPE) with additional protection, in some cases. Attention has to be paid to the following situations:
- In-person visits: detailed calendar organization with timely appointments allows to avoid gathering of groups of people;
- Urgent procedures, such as acute coronary syndrome interventions, high-risk pulmonary embolism or critical limb ischemia: organize the intervention to involve the minimum number of staff;
- Visits to non-COVID-19 patients: use of the PPE is mandatory;
- Routine procedures: after the procedure, disinfection techniques are always recommended3;
- Urgent interventions in patients with unknown COVID-19 status: use of airborne PPE with an N95 respirator and/or powered air-purifying respirator is recommended.
Health systems play a leading role in planning the right interventions to assure patient care during the pandemic4 and its following phases, when the risk of contagion is less perceived, but still high in probability. For this reason, it is important that the protocols and general guideline procedures are constantly updated and implemented with all information that is collected by the clinical routine. Lately, the acquisition of new evidence and its immediate introduction in everyday practice has become very fast and efficient.
Not to be forgotten, the pandemic had a psychological impact not only on the patients and their relatives, but also on caregivers and healthcare professionals. Some institutions have organized counseling services to provide psychological support and assistance. In the areas that were mainly affected by the infections, this aspect has been considered of central importance, since the fate of the patients and of the general health system strongly depended upon their psychological balance5.
Considering the implementation of guidelines, professional societies acquired an even more central role for the generation and dissemination of knowledge and practical tips related to COVID-19. A clear example has been provided by the rapid release of the International Society on Thrombosis and Hemostasis (ISTH) interim guidance on recognition and management of coagulopathy in COVID-19,6 which – amid the peak of the health emergency – allowed a fast-risk stratification at admission for a COVID-19 patient on the basis on easily available laboratory parameters. One other example is the work of Bikdeli et al.,7 which is a comprehensive source of information in different settings for anti-thrombotic issues.
Now, more than ever, the fast circulation of information has been crucial in the support of the daily practical activity of healthcare professionals.
Considerations for thrombotic disease for patients, healthcare providers, and health systems and professional societies during the COVID-19 pandemic are summarized in Figure 17.
- Implementation of mitigation strategies for communities with local COVID-19 transmission. https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf
- Using face masks in the community – Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks. https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission
- Welt FGP, Shah PB, Aronow HD, et al. Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From the ACC’s Interventional Council and SCAI. J Am Coll Cardiol. 2020;75(18):2372‐2375. doi:10.1016/j.jacc.2020.03.021
- Strengthening the health system response to COVID-19. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance-OLD/coronavirus-disease-covid-19-outbreak-technical-guidance-europe-OLD/strengthening-the-health-system-response-to-covid-19
- Blake H, Bermingham F, Johnson G, Tabner A. Mitigating the psychological impact of COVID-19 on healthcare workers: A digital learning package. Int J Environ Res Public Health. 2020;17(9):E2997. doi:10.3390/ijerph17092997
- Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023‐1026. doi:10.1111/jth.14810
- Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. 2020;S0735-1097(20)35008-7. doi:10.1016/j.jacc.2020.04.031