准备可能避免的——来自巴黎
本文译自：ESC官网
华中科技大学同济医学院附属协和医院 程翔 翻译并供稿
每天我们都期待着敌人的到来。现在，我们准备着并等待着。法国落后意大利几周，但仍在走弯路。医院里只有不到100名COVID阳性的病人。在心脏科，我们有两个疑似病例是从其他病人中分离出来的。
最严重的COVID患者去重症监护室，较轻的去普通病房。目前这些科室接受所有的COVID病人。当这两个区域都满了，我们就开始在心脏科治疗病人。这个部门有三层楼。到时候，我们会为COVID病人腾出一层楼。我们在冠状动脉护理室有12张病床，其中三到四张将专门用于确诊或疑似感染的患者。这些床将被放在一个单独的房间里。
心脏病学工作人员的主要恐惧是完全被病人压倒了。我们正在为此做准备。工作人员正在接受如何保护自己和病人不受感染的培训，包括如何隔离病人和穿防护服。
我们正在逐步停止选择性手术。一夜之间改变我们做事的方式是很有挑战性的。进展缓慢，因为我们必须平衡推迟手术的风险，即使是在病情稳定的病人中，也要平衡感染病毒的风险。我们决定对无症状患者和病变稳定的患者推迟所有手术。
从本周开始，我们取消了所有门诊就诊。心脏科和医院都没有电话会议软件，所以我们是通过电话咨询的。首先，医疗秘书打电话给慢性病患者，询问他们是否稳定和感觉良好。如果是的话，心脏病专家会给他们打电话咨询，然后邮寄他们的处方。如果病人不稳定，他们就来医院。每天来的慢性病患者不到10人，而正常情况下有70人。
我们为护士和医生提供了防护服，他们将与COVID患者接触。我们定期与传染病学家开会，检查我们目前正在采取和计划的措施是否足够。
从星期一开始，我们每天下午1点为所有的医生和护士长举行一次心血管病会议。我们花了30分钟回顾情况。我们决定推迟哪些程序，并决定是否必须清理和清空病房，以接受COVID患者。我们还可以从其他科室得到他们的COVID病人状态的最新信息，因此我们可以全面了解正在发生的事情。
每个人都想积极参与这项工作。工作人员继续照常工作。我们需要所有的医生随时待命，因为在任何时候，我们可能有一个急性事件发生。
我从来没有参与过这样的事情。以前的感染对老年人和合并症患者是有风险的。但任何人都可能感染冠状病毒，甚至是健康人。感染迅速，病例数量空前。
我们从中国和意大利的同事那里看到，死亡的风险不仅是由于缺氧，而且是由于心源性休克。目前证据水平较低，因为我们仍在发现该病的特征，我们不知道该病毒的短期和中期影响。面对这种不寻常、不可预料的情况，将有助于我们今后的实践。它将加强我们限制感染传播的方式，以及我们与欧洲同事共享数据和实践的方式。它加强了心脏病学界之间的联系。这些可能是COVID-19大流行的少数积极作用之一。
原文：
Preparing for the Inevitable – Paris
Dr. Stéphane Manzo-Silberman
Cardiology Department
Hopital Lariboisiere, Paris
Every day we expect the enemy to arrive. For now, we prepare and wait. France is a couple of weeks behind Italy but following the curve. There are less than 100 COVID positive patients in the hospital. In the cardiology department, we have two suspected cases who have been isolated from other patients.
The most severe COVID patients go to the intensive care unit and the less severe go to the general medical ward. Currently these departments accept all the COVID patients. When both areas are completely full, we will start taking patients here in the cardiology unit. This department has three levels. When the time comes, we will empty one floor for the COVID patients. We have 12 beds in the coronary care unit and will dedicate three or four of those to patients with confirmed or suspected infection. These beds will be put in a separate room.
The main fear of the cardiology staff is becoming completely overwhelmed with patients. We are preparing for that. Staff are being trained on how to protect themselves and their patients from being infected – how to isolate patients, and the protective clothing to wear.
We are progressively stopping elective procedures. It’s challenging to change the way we do things overnight. It’s going slowly because we have to balance the risk of postponing procedures even in stable patients with the risk of contamination with the virus. We have decided to postpone all procedures in asymptomatic patients and in patients with stable lesions.
Since the beginning of the week we have cancelled all outpatient visits. The cardiology department and the hospital are not equipped with teleconferencing software, so we are doing consultations by phone. First the medical secretary calls chronic patients to ask if they are stable and feeling fine. If yes, a cardiologist calls them for the consultation and sends their prescriptions by mail. If patients are unstable, they come to the hospital. Less than 10 chronic patients are coming per day compared to 70 in a normal situation.
We have protective clothing for the nurses and doctors who will be in contact with COVID patients. And we hold regular meetings with the infectiologists to check if the measures we are taking and planning are sufficient for now.
Since Monday, we have been holding a COVID cardiology meeting every day at 1pm for all the doctors and the head of nursing. We spend 30 minutes reviewing the situation. We decide which procedures to postpone and determine whether we have to clean and empty a ward to accept COVID patients. We also get an update from other departments on their COVID patient status, so we have a full picture of what’s happening.
Everyone wants to be active and participate in the effort. Staff continue to work their usual hours. We need all the doctors to be available because at any time we may have a rapid increase in cases.
I have never been part of anything like this. Previous infections have been risky for older people and patients with comorbidities. But anyone can catch coronavirus, even healthy people. Contamination is rapid and the number of cases is unprecedented.
We have seen from Chinese and Italian colleagues that the risk of death is not only due to hypoxia but also from cardiogenic shock. For the moment the level of evidence is low because we are still discovering the characteristics of the disease and we don’t know about the short and medium-term effects of the virus.
Facing this unusual and unexpected situation will improve our practice going forward. It will enhance the way we limit the spread of infection and the way we share data and practice with our European colleagues. It tightens the links between the cardiology community. These could be some of the few positive side effects of the COVID-19 pandemic.