|Year : 2020 | Volume
| Issue : 3 | Page : 151-152
Challenges of acute coronary syndrome during COVID-19 pandemic in Yemen
Ahmed Lutf Al-Motarreb1, Ahmed Yahya Al-Ansi2
1 Department of Medicine, Faculty of Medicine, Sana'a University, Yemen
2 Cardiac Center, Al.Thawra Hospital, Sanafa, Yemen
|Date of Submission||22-Aug-2020|
|Date of Acceptance||24-Aug-2020|
|Date of Web Publication||13-Oct-2020|
Dr. Ahmed Lutf Al-Motarreb
Department of Medicine, Faculty of Medicine, Sanaa University,, Sanaa 00967
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Motarreb AL, Al-Ansi AY. Challenges of acute coronary syndrome during COVID-19 pandemic in Yemen. Heart Views 2020;21:151-2
Acute coronary syndrome is an emergency situation that needs a quick diagnosis and management. In Yemen, there is a shortage of intensive care unit (ICU) for these patients. The WHO reports that during war time the health system is overstretched and there is a critical shortage of beds and workforce. Yemen is a country at war since 2015.
COVID-19 pandemic has spread worldwide and caused people to be afraid of contracting the disease. There is lack of information about the exact nature of the disease and its way of spreading. Lockdown and preventive measures were undertaken to control its spread among the population in all countries.
In Yemen, while the world was panic of the disease, there was no case recorded during 1st month of the year 2020 at least officially. The Ministry of Health formed a supreme committee for epidemiology. The committee followed passengers coming from outside Yemen with testing. There were initially four countries, and this was later increased to 21 countries. Later, every passenger coming to Yemen must be tested for COVID-19 disease and must self-quarantine for 14 days at home.
The goal of the supreme committee was people awareness. Most Yemeni doctors worked hard to inform people about prevention. The committee has banned people crowding, including wedding receptions and restaurants, Turkish baths, public transport, schools, and universities. They gave 80% of the government employees a vacation to stay home. Mosques in Yemen were not closed and many people did not follow the advices on prevention, such as in small shopping places, including khat markets.
The Ministry of Health has allocated two hospitals in Sana'a for SARS COV-II cases and has assigned one hospital each in the big provinces. Later, private hospitals were asked to prepare special places for SARS COV-II patients. Although most of the Yemenis believe that the international media exaggerates the issue of SARS COV-II in the world, most of them believe strongly that no one will be affected except by the will of Allah. Therefore, many of them did not follow the preventive measures properly.
Screening for SARS COV-II was performed for passengers who were coming in from outside Yemen. No screening was performed even for the medical staffs who work in the hospitals. A rapid response team was formed who used to go to any district or house reported to have a person infected with SARS COV-II. The suspected person and all people whom he contacted were subjected to heavy SAR COV-II testing and isolation of the positive cases.
Patients with symptoms of chest pain and shortness of breath hesitated to present themselves to the hospital because of their idea that hospitals are sites where you could get infected with SARS COV-II. In the beginning, there were no isolated beds in the ICU for COVID-19 patients; then, isolated beds were available in the government hospitals as well as in the private hospitals. Tests for COVID-19 in particular polymerase chain reaction (PCR) was available in one place only-Sana'a city.
In the emergency room, there was no rapid test for COVID-19 and diagnosis was made based on clinical suspicion, blood test, and chest X-ray. In many situations, chest pain and shortness of breath of acute coronary syndrome (ACS) were interpreted as respiratory infection. Suspicion of COVID-19 cases was shifted to the two isolation hospitals but most of the patients preferred to go home at the peak of the pandemic. When there were no available ICU beds, patients died outside the hospitals.
Patients with definite acute MI were delayed in the emergency room because of careful assessment for COVID-19, including a request for a negative test for SARS COV-II. Ruling out a negative PCR was available only in Sana'a city. Most of the hospitals refused to admit any suspected cases of COVID-19. The rate of admission of ACS to the cardiac ICUs was very low.
The Ministry of Health passed a decree for all hospitals to receive COVID-19 cases in their ICU and consequently, almost all cases would find a place in the ICUs. Intensivists had a very difficult mental and physical situation dealing with these critical patients. The lack of medical diagnostic tools and drugs were very stressful for medical staff and health workers. In addition to lack of personal protection equipment, the fear of getting infected and transfer the infection to their families made their stress worse. Many medical staff in Yemen died from COVID-19 disease. Patients with acute coronary syndrome with COVID-19 disease were isolated in a special room in the ICU and managed for both diseases. Intensivists in Yemen changed the management of COVID-19 protocol according to the situation, adapting the WHO guideline.
Some patients with ACS who were free of COVID-19 symptoms got infected with COVID-19 during their stay in the hospital. This can be explained by either they have been admitted during COVID-19 incubation period or they got infected from their visiting relatives who did not follow the preventive measures for COVID-19.
Furthermore, patients who had been admitted with COVID-19 disease developed acute MI during their stay to the ICUs. Shortage of beds was in the peak of the pandemic; but later on ICU beds were available and the hospital stay of ACS patients was adequate. Treating ST-elevation myocardial infarction patients who were eligible for primary percutaneous coronary intervention (PCI) was very low because of the low admission of the ACS patients; in addition, most of the cardiologists stayed home, especially those who worked in the private hospitals.
In conclusion, Yemen experience in dealing with COVID-19 pandemic was discussed. We reported a few ACS admissions during the pandemic and few primary PCI procedures in Yemen. More researches are needed to figure out the nature of this disease in Yemen, in particular, the morbidity and mortality rates among Yemeni People. There may be low of incidence of COVID-19 in Yemen despite Yemenis not following the preventive measures which have been applied worldwide.