THE COVID-19 international border closures delayed cardiac interventions for young patients with rheumatic heart disease in Timor-Leste by at least 18 months, causing the death of at least three of them, according to research published today by the Medical Journal of Australia.
“At the start of the COVID-19 pandemic, both Australia and Timor-Leste closed their international borders, and no Timorese patients have undergone cardiac surgery in Australia since March 2020,” wrote the authors, led by Dr Elizabeth Paratz, a cardiologist at Baker Heart and Diabetes Institute.
“However, the East Timor Hearts Fund has continued to provide remote care in the form of telehealth clinics.”
Paratz and colleagues assessed the status of East Timorese people on the ETHF waiting list for cardiac procedures in Australia in both March 2020, and August 2021.
“On 1 March 2020, 35 Timorese people were waiting for cardiac procedures in Australia, including 26 with rheumatic heart disease and nine with congenital cardiac disease,” they wrote.
“By 31 August 2021, three people had died, and thirteen had been admitted to hospital with decompensated heart failure. The median New York Heart Association score declined from II (mild limitation of physical activity) in March 2020 to III (marked limitation) for the 15 people who attended ETHF online telehealth clinics during 2020 or 2021 (seven with lower, eight with stable scores).
“Of 13 people who could not be contacted for follow-up, three had died suddenly; the status of ten whose phone numbers were no longer current was unknown.”
Timor-Leste has one of the highest rates of rheumatic heart disease in the world.
“The poor outcomes for many East Timorese people with cardiac disease during the pandemic also highlight the inherent uncertainty of fly-in/fly-out volunteer medical services,” Paratz and colleagues wrote.
“One-quarter of our young patients waiting for cardiac surgery experienced major adverse cardiovascular events during the pandemic, including three who died,” they concluded.
“Sudden border closures that remove access to humanitarian surgery highlight the vulnerabilities of short term medical mission models, and raise concerns that levels of undiagnosed disease in Timor-Leste may be higher after the COVID-19 pandemic has ended.”
- Cate Swannell