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. The German Society for Pediatric Infectious Diseases (DGPI) recorded 1,819 cases of children with covid-19 requiring hospitalization through September 2021. 88 children (about 5 percent) ended up in intensive care, and 0.3 percent died. According to DGPI data, about a quarter of those with the disease had residual signs of disease at discharge.

In addition to the new delta variant, which has been spreading rapidly in Germany since 2021, both the secondary diseases known as long covid and complications such as PIMS/MIS-C are a cause for concern. Pediatric cardiologists therefore urgently recommend following the recommendations of the Ständige Impfkommission (STIKO) and getting vaccinated from the age of twelve.

  • 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 with BioNTech or Moderna recommended by the Ständige Impfkommission (STIKO) from the age of twelve, 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.

    In addition, 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, for all patients with congenital heart defects aged twelve years and older, as for heart-healthy people, the urgent recommendation is to take advantage of the free vaccination and thus protect even the youngest. For patients at risk who are younger than twelve years of age, there is currently no approved and recommended vaccination.


How about the risk factors for a severe covid 19 course?

In particular, 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. On the other hand, the data available on the course of disease in the case of a delta infection, the variant that has been prevalent since 2021 and is considered to be more aggressive, is not yet sufficiently informative.

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.

In addition, the new viral variants may be less well defended against by the immune system of already recovered or fully vaccinated individuals. Also from this point of view, adherence to the AHA+L+A rules (A = distance, H = hygiene, A = everyday mask, L = ventilation, A = Corona Warning App,) remains important for everyone, regardless of whether they are recovered, vaccinated or not yet vaccinated.

  • Good to know

    Which Corona variants are present in Germany?

    According to the Robert Koch Institute, the Delta variant overtook the Alpha 2021 Corona variant in Germany within ten weeks. It is followed by Alpha, Gamma and Beta in terms of frequency. The latter, Beta and Gamma, 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.

Fully vaccinated people are better protected

It is suspected that even in fully vaccinated individuals, the probability of contracting the disease again is increased by the delta variant. Nevertheless, experts estimate the risk of severe disease progression in such vaccine breakthroughs to be extremely low. This is supported, for example, by the results of a study from India that was published in advance in July 2021 but has not yet received peer review. Researchers from Hyderabad had compared the Covid-19 courses of a total of 1,161 vaccinated, partially vaccinated and unvaccinated patients. According to the study, 90 percent of those infected had contracted the delta variant. In the 495 people who were partially or fully vaccinated, the infection was less severe. In addition, the mortality rate was half lower among the fully vaccinated than among the unvaccinated or those vaccinated only once.

Recommendations according to risk groups

  • Moderate risk

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

    Basic recommendation

    From the age of twelve, be sure to get vaccinated.
    For children under twelve: As soon as the EMA approval for corresponding mRNA vaccines and vaccine doses is available, as well as the vaccination recommendation of the Standing Commission on Vaccination (STIKO), the same applies to the youngest: Vaccination is the best protection.

    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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