Despite mostly mild courses, corona can be particularly dangerous for young at-risk patients., | FamVeld © | FamVeld

Important Patient Information

Corona: Courses, Consequences and Complications

What we know from research so far

Since the outbreak of the pandemic, intensive research has been conducted, both internationally and nationally, on the consequences of covid-19 infection and the associated sequelae and complications, also with regard to patients with congenital heart defects.

Various scientific analyses, also supported by the National Registry of the Competence Network for Congenital Heart Defects, are also concerned with the indirect health consequences of the pandemic, such as its impact on quality of life.

In General, Unproblematic Courses Predominate

According to the Corona information page of the German Federal Ministry of Health (BMG), about 80 percent of all those infected with Covid-19 feel little to nothing from their Corona infection. A SARS-CoV-2 infection lasts about two to three weeks in a mild course. The BMG estimates a maximum of four weeks for the acute phase of the disease, and eight weeks for a severe course. After intensive treatment, organ-specific long-term consequences can often be observed, the site continues. And even less severely ill patients may have symptoms of the disease or develop new symptoms beyond the acute phase of the disease. But which of these apply to a congenital heart defect?

Not To be Taken Lightly

Current research confirms that Corona virus infection, especially in children and adolescents, is mild in most cases and often without signs of illness, even in congenital heart disease. Common symptoms include cough, runny nose, fever, sore throat, and loss of smell or taste.

However, researchers caution against taking infection lightly. According to a U.S. study, covid 19 hospitalizations in this age group, while rare, are still three times more common than hospitalizations resulting from influenza. 2,443 cases (including 2,411 in Germany) of children with covid-19 who required hospitalization were recorded by the German Society for Pediatric Infectious Diseases (DGPI) for Germany and Austria for the months up to and including November 2021. 114 children (about 5 percent) entered intensive care, and 0.3 percent died. According to the DGPI, more than a quarter of those with the disease had residual signs of illness at the time of hospital discharge.

Besides the delta variant, which had spread rapidly since spring 2021, and the new omicron variant, which has been increasingly prevalent since January 2022, both the secondary diseases known as long covid and complications such as PIMS/MIS-C are causing concern. Pediatric cardiologists therefore urgently advise following the recommendations of the Ständige Impfkommission (STIKO) and getting vaccinated from the age of five, especially if risk factors are present.

  • Our Recommendation

    Vaccinate, AHA-L-A, Verify Vaccination Protection.

    Despite mostly mild courses, corona can be particularly dangerous for young at-risk patients. © | FamVeld
    Despite mostly mild courses, corona can be particularly dangerous for young at-risk patients.

    In addition to the mRNA vaccination recommended by the Ständige Impfkommission (STIKO) from twelve years of age and for risk patients from five years of age and the booster vaccination three months after complete vaccination, we continue to advise unconditional compliance with the current instructions of the competent authorities and the AHA+L+A rules (A = distance, H = hygiene, A = everyday mask, L = ventilation, A = Corona Warning App) even for those who have recovered and have been fully vaccinated.

    Also, if you have congenital heart defects, we strongly recommend that you also review your flu and pneumococcal vaccine coverage or your child's appropriate vaccine coverage. Normally, this vaccination is performed by the attending pediatrician as part of routine preventive care. Vaccination against pneumococcus and influenza is generally part of the vaccinations recommended by the STIKO for children with congenital heart defects. Cases of corona and influenza infections have also been reported as dual infections. Since pneumonia is the main complication of Covid-19/SARS-CoV infection, the recommended vaccination against pneumococcus should be checked and, if necessary, refreshed in adult AHF patients as well.

    Overall, the urgent recommendation for all patients with congenital heart defects aged twelve years and older, as for heart-healthy people, is to take advantage of the free protective and booster vaccinations and thus protect even the youngest. At-risk patients younger than twelve years of age should also be urgently vaccinated with BioNTech's Comirnaty mRNA vaccine starting at age five.


How About the Risk Factors for a Severe Covid 19 Course?

Studies from the USA and Great Britain, but also from Germany, have shown that in connection with the generally rare severe courses of the disease, it was less a congenital heart defect alone than the combination with concomitant diseases of the lungs and other organs as well as with risk factors independent of these, such as diabetes, male gender and overweight, that were decisive. The study situation for children and adolescents under 18 years of age shows a similar picture. The strongest risk factors for hospitalization were type 1 diabetes and severe obesity. Severe disease progression was observed in type 1 diabetes and congenital heart disease. You can find out more about these studies and the current state of research on Long Covid and PIMS/MIS-C in the German Heart Foundation's fact check with Professor Dietmar Schranz.

Severe Congenital Heart Defects are Among the Major Risk Factors

The group of AHF patients at highest risk for severe Covid 19 infection includes children, adolescents, and adults with single-ventricle hearts (Fontan circulation), severely reduced lung function (cyanosis), severe heart failure, severe pulmonary hypertension, post-heart transplantation, and chronic lung, liver, or kidney disease, immunodeficiency (including Di George syndrome, asplenia, trisomy 21), and pre-existing coronary artery disease.

Which Virus Variants have been and are being Researched?

The current facts on the consequences of infection are based predominantly on results from data collection and analysis from lockdown times, which also take into account primarily infections with the initially widespread alpha variant of SARS-CoV-2. However, the data available on the course of the disease in the case of delta infection, the variant that has been prevalent since spring 2021 and is considered to be more aggressive, is not yet sufficiently conclusive. This also applies to the omicron variant, which is even more contagious and is currently causing experts the greatest concern.

So far, in contrast to its predecessors, the delta variant has been observed to be more easily transmissible, to have an increased ability to cause disease (virulence), to have a more severe course of disease, and also to have a higher mortality rate in unvaccinated or incompletely vaccinated individuals.

Vaccination Booster is Highly Advisable

In addition, the new viral variants may be less well defended against by the immune system of already recovered or fully vaccinated individuals. A booster vaccination is therefore highly advisable. Research is currently underway to develop an adapted vaccine that also offers reliable protection against the omicron variant.

Drugs are No Substitute for Vaccination

Intensive research is also underway on drugs to combat Corona. By mid-December 2021, the European Medicines Agency (EMA) had recommended approval for a total of five Covid medicines. Others are to follow quickly. Final approvals are still pending, for example for Paxlovid, which has so far only been used in the USA following emergency approval. However, among experts, drugs such as Paxlovid, which are intended to help contain severe disease progression, are considered only one pillar of treatment for coronavirus disease. Accordingly, the U.S. Food and Drug Administration (FDA) has stated that the drug is not a substitute for vaccination.

  • Good to know

    Which Corona variants are present in Germany?

    According to the Robert Koch Institute, the Delta variant had overtaken the Corona variant Alpha within ten weeks in spring 2021. Since December 2021, the omicron variant has been gaining ground at an increasing rate. Since January 2022, it has also dominated the infection incidence in Germany. These are followed by Delta, Alpha, Gamma and Beta in order of frequency. The latter two are comparatively rare in this country.

    The scientific names for the discovered corona variants are a combination of letters and numbers. But these are hard to remember. For a while, therefore, they were named after the country in which they were first discovered. To prevent associated discrimination, the World Health Organization (WHO) renamed the Corona variants under surveillance in May 2021. The Corona variants of concern (VOCs) are now called:

    • Variant Alpha (B.1.1.7), known as the British variant since September 2020.
    • Variant Beta (B.1.351), known since May 2020, so-called South African mutant.
    • Variant Delta (B.1.617.2), so-called Indian variant line known since October 2020.
    • Variant Gamma (P.1), so-called Brazilian variant known since November 2020.
    • Variant Omicron (B.1.1.529), so-called South African variant known since the end of November 2021.

Fully Vaccinated and Boostered Persons are Best Protected

It must be assumed that even those who have been fully vaccinated are more likely to contract the disease again as a result of the delta variant. This was supported, for example, by the results of a study from India that was published in advance in July 2021 but has not yet been peer-reviewed. Initial analyses from the United Kingdom also reflect a similar picture for the Omikron variant, which is now widespread. Experts estimate that the risk of severe disease progression with such vaccine breakthroughs is extremely low. However, the data from Great Britain also indicate an even higher transmissibility of Omikron compared to the Delta variant.

At the same time, laboratory analyses suggest that vaccination protection decreases over time after basic immunization has been completed, but that it can be at least partially restored by booster vaccination even against the Omikron variant. Therefore, the Ständige Impfkommission (STIKO) recommends a booster vaccination starting three months after completion of basic immunization. Those who have already recovered should be vaccinated once at intervals of three months after infection.

Recommendations According to Risk Groups

  • Moderate Risk

    All patients whose diagnoses do not fall under those of low or high risk.

    Basic recommendation

    Vaccinate from the age of twelve and have the vaccination booster from three months after basic immunization. For children five years and older, adolescents and adults up to 30 years of age, vaccination with BioNTech's Comirnaty mRNA vaccine is recommended.

    Recommendations for work, kindergarten, after-school care, school and leisure activities

    Avoid contact with sick persons or persons suspected of having the disease. Observe AHA+L+A rules (A = distance, H = hygiene, A = everyday mask, L = ventilate, A = corona warning app) and state pandemic regulations.

    Medical care for illness from Covid-19

    Even if symptoms are mild, seek medical evaluation from pediatric cardiologist/EMAH cardiologist. If shortness of breath or lack of fluids or increase in symptoms, seek early hospitalization and consultation with pediatric cardiologist/EMAH cardiologist.


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