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The gods of copybook headings

1 Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
2 Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India

Date of Submission09-May-2020
Date of Decision30-May-2020
Date of Acceptance21-Jun-2020
Date of Web Publication16-Jul-2020

Correspondence Address:
Amit Malviya,
Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcs.jpcs_47_20

How to cite this URL:
Gupta A, Malviya A. The gods of copybook headings. J Pract Cardiovasc Sci [Epub ahead of print] [cited 2022 Jul 1]. Available from: https://www.j-pcs.org/preprintarticle.asp?id=289924

Dear Editor,

The SARS-CoV-2 pandemic has made the world a vulnerable place and especially for those who are being considered at high risk of mortality with the disease. Patients with “cardiovascular disease” are one of these vulnerable populations and public awareness/education for such patients is being done on universal portals.[1] However, going across the published data and publicized information both for the physicians and the public; the term “cardiovascular disease” broadly implies hypertension, coronary heart disease, and cardiomyopathy. The children and adults with congenital heart disease (CHD) find no mention as high-risk population. In the current pandemic, the data about children and their underlying conditions/comorbidities are far less available than the adult population[2],[3] but scanty epidemiologic data should not be a factor to deny this group of patients, for receiving proper attention and classification under high-risk population. The most common reported underlying conditions in infected children were underlying chronic pulmonary diseases, cardiac disease and immunosuppression.[2] Children with CHD represent a high-risk group because of the limited cardiopulmonary reserve, just as other cardiovascular disorders, but they have received scant attention because of the small size of the patient population. Furthermore, there is less availability data related to SARS-CoV-2 infection and its complications in them. CHD patients, especially those classified in higher anatomic or physiologic staging in ACHD AP classification[4] have decreased cardiopulmonary reserve and are at least equally vulnerable to complications of SARS-CoV-2 infection as other cardiovascular disorders.[5] For instance, respiratory syncytial virus, which is the most common etiologic agent of acute lower respiratory tract infection in neonates and children under 5 years of age worldwide; have higher rates of hospitalization, a longer length of stay, and risk of death in children with CHD compared to those without CHD.[6],[7] Furthermore, we know from experience of previous epidemics of H1N1 influenza and SARS-CoV that patients with congenital or acquired heart disease have increased morbidity and mortality related to viral infections[8],[9] such that, as a standard of care, influenza vaccination in CHD patients is recommended. Currently, there are no studies available in children with CHD and COVID-19 and the actual effect of the virus in CHD population is not clear; thus, any recommendation remains deduced and speculative, based on studies from the past and current data from the adult population.

Although pre-emptive, the organizations or governments issuing information to public/primary care physicians must include this group in “heart disease” category. There is an urgent need to disseminate this message. The gods of copybook headings must once again overtake the gods of marketplace.[10] Copybook headings were short phrases or expressions of traditional wisdom about life, written by teachers (19th century British schools) at the top of a piece of papers, for the students to copy over and over to imbibe good values. “The Gods of Copybook Headings” by Rudyard Kipling speaks on the malevolent nature of progress and humanity's eventual return to basic principles of a good life. We must not forget our primary commitment to look after our patients especially with life-long diseases like CHD and their needs should not be neglected. These patients are as important as patients with other “cardiovascular disease” which drain most of the attention of physicians and resources of industry. Although some guidelines are being developed for diagnosis, treatment, and prevention of COVID-19 in children, none of them specifically addressed CHD patients.[11],[12],[13],[14],[15]

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  References Top

The World Health Organization. Corona Virus Situation Report. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10. [Last accessed on 2020 May 02].  Back to cited text no. 1
CDC COVID-19 Response Team. Coronavirus disease 2019 in children United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422-6.  Back to cited text no. 2
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020;145:e20200702.  Back to cited text no. 3
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 2018;73:e81-192.  Back to cited text no. 4
Tan W, Aboulhosn J. The cardiovascular burden of coronavirus disease 2019 (COVID-19) with a focus on congenital heart disease. Int J Cardiol 2020;309:70-7.  Back to cited text no. 5
Feltes TF, Cabalka AK, Meissner HC, Piazza FM, Carlin DA, Top FH Jr., et al. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003;143:532-40.  Back to cited text no. 6
Thorburn K. Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection. Arch Dis Child 2009;94:99-103.  Back to cited text no. 7
Gilca R, De Serres G, Boulianne N, Ouhoummane N, Papenburg J, Douville-Fradet M, et al. Risk factors for hospitalization and severe outcomes of 2009 pandemic H1N1 influenza in Quebec, Canada. Influenza Other Respir Viruses 2011;5:247-55.  Back to cited text no. 8
Yu M, Wong RS, Wu EB, Kong SL, Wong J, Yip GW, et al. Cardiovascular complications of severe acute respiratory syndrome, Postgrad. Med J 2006;82:140-4.  Back to cited text no. 9
Kipling R. The gods of the copybook headings. In: Kipling Collection (Library of Congress), Carpenter Kipling Collection (Library of Congress), & Colt Kipling Collection (Library of Congress). Garden City, N.Y: Doubleday, Page & Co.; 1919.  Back to cited text no. 10
World Health Organization. Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 Disease is Suspected. Interim Guidance, World Health Organization. Available from: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf. [Last accessed on 2020 Apr 27].  Back to cited text no. 11
Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: Experts' consensus statement. World J Pediatr 2020. PMID: 32034659; PMCID: PMC7090771.  Back to cited text no. 12
Wang Y, Zhu LQ. Pharmaceutical care recommendations for antiviral treatments in children with coronavirus disease 2019. World J Pediatr 2020;16:271-274. doi: 10.1007/s12519-020-00353-5.  Back to cited text no. 13
Wood DA, Sathananthan J, Gin K, Mansour S, Ly HQ, Quraishi AU, et al. Precautions and procedures for coronary and structural cardiac interventions during the COVID-19 pandemic: Guidance from Canadian Association of Interventional Cardiology. Canadian J Cardiol 2020;36:780-783. doi: 10.1016/j.cjca.2020.03.027.  Back to cited text no. 14
Ravikumar N, Nallasamy K, Bansal A, Angurana SK, Basavaraja GV, Sundaram M, et al. Novel coronavirus 2019 (2019-nCoV) infection: Part I Preparedness and management in the pediatric intensive care unit in resource-limited settings. Indian Pediatr 2020;57:324-34.  Back to cited text no. 15


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