Dr. Leo Miana: Our Experience During COVID-19

Dr. Leonardo Miana, a pediatric cardiac surgeon at Instituto do Coração (InCor) in São Paulo, answers our questions about the current situation with COVID-19 in Brazil and the challenges his hospital, team and patients have experienced during the pandemic.

Can you provide a brief overview of the current situation with COVID-19 in São Paolo and in Brazil?

Brazil is still having an escalating number of COVID-19 cases and deaths. São Paulo is the largest city, with 12 million inhabitants. It reports the highest number of cases and deaths in the country in absolute numbers. On the other hand, we haven’t seen much inadequacy in dealing with the number of patients and hospital beds. Elective cases were canceled or postponed in order to leave enough space and ICU beds for COVID-19 cases. We are still longing to see the number of new daily cases decrease. Hopefully, this is expected to take place in a couple of weeks. In Brazil, we had concerns about hospital bed scarcity and escalating deaths (probably due to a hospital bed shortage) in the North (Amazon region) and in some Northeast states.

Have you had COVID-19 patients admitted to your hospital or unit?

Unfortunately yes, the hospital had nine confirmed cases out of 28 suspected cases in our cardiac program.

Here is our data for these cases:

How has your hospital and cardiac program been impacted due to the pandemic? 

We had a 75% decrement in our patient volume. We have been performing only urgent and emergency cases. Because of that, the complexity of cases has increased. InCor and our staff (especially surgeons) are experiencing financial losses due to the small number of surgical cases. At the beginning of the pandemic, we noticed a lot of alarm and stress coming from nurses, and also from some physicians and respiratory therapists, because of the fear of getting infected and infecting patients. As time passed, things got better regarding this concern. So far, PPE is not a problem at our hospital. InCor is part of a huge complex (the biggest one in Latin America) that did its preparation, and things are okay regarding the protective gear supply.

What challenges have your patients and their families had accessing the care they need?

Outpatient clinics were closed at first and then decreased their capacity by 75%-80%. People are afraid of going to emergency rooms. At InCor, patients with congenital heart disease and patients with suspected COVID-19 infection are sharing the same environment.

Do you have any positive experiences to share about patients who had heart surgery during the pandemic?

As I have mentioned, we have had a high number of complex cases during the pandemic. The good news is that we were able to maintain good outcomes, even though we were short on staff (especially nurses). We had several neonatal cases that went home in good condition.