The Ministry of Health (MOH) is unable to definitively conclude if Covid-19 patients experience cardiovascular events, such as heart attacks and blood clots, at a higher rate on average than non-Covid patients in Singapore due to the small number of related cases, said Minister for Health Gan Kim Yong on Thursday (Jun. 4).

Still, MOH has advised doctors in Singapore to be watchful for cardiovascular symptoms in Covid-19 patients.

This was stated by Gan in a written reply to a question by Non-Constituency Member of Parliament (NCMP) Leon Perera about the extent to which Covid-19 patients are experiencing above-average rates of blood clots and heart disease.

No definitive conclusion

Gan stated that amongst local cases, around one in every 1,000 experienced cardiovascular events, such as heart attacks and blood clots.

Hence, MOH is "unable to definitively conclude" if this is higher on average compared to non-Covid patients in Singapore, "due to small numbers", he said.

However, Gan shared that MOH has been monitoring the emerging global data on the increased risks of blood clots and heart disease in Covid-19 patients.

Gan also said that MOH will support studies on this ongoing area of research.

Gan said,

"As Covid-19 is a new disease, we are learning more about it as we go along.

MOH will continue to monitor the emerging evidence, and work with our clinical experts to ensure the best possible care and outcomes for our COVID-19 patients."

MOH issued an advisory on May 20 to all doctors to highlight the emerging data on these risks.

The advisory also instructed them to be watchful for cardiovascular symptoms in Covid-19 patients, and provided guidance on the evaluation and management of such patients, said Gan.

Advice for doctors and migrant workers

Gan stated that based on international data, MOH is aware that patients admitted to the Intensive Care Unit (ICU) are at higher risk due to being immobile for prolonged periods of time and possibly having other conditions.

In these cases, he said, doctors take extra precautions, such as by monitoring closely their coagulation status and the propensity for their blood to clot, in some cases using anti-coagulants to prevent the formation of blood clots.

"However, use of anti-coagulants must be weighed against the risk of bleeding, and our doctors will decide on a case by case basis," said Gan.

He also added that in dormitories, community care facilities, and community recovery facilities, the government has been educating workers and patients on preventative measures for cardiovascular complications.

These measures include practising good hydration, staying active, ceasing smoking, and recognising symptoms early.

Workers and patients are advised to seek medical attention immediately if they feel unwell, he said.

Deaths of six Covid-19 patients from cardiovascular issues

So far, six migrant workers in Singapore who tested positive for Covid-19 have died of heart-related causes rather than Covid-19.

Case 1604, who has been identified as Suppiah Shanmuganathan, was a 32-year-old Indian national who died while awaiting his swab test results, and was confirmed to have Covid-19 after his death on Apr. 8.

The cause of his death was found to be ischaemic heart disease, also known as coronary artery disease, and "not due to complications from Covid-19 infection", according to the MOH press release on Apr. 9.

Case 4754, a 40-year-old male Malaysian national, passed away on Apr. 18, one day after he was confirmed to have Covid-19.

His cause of death was identified as acute myocardial infarction with cardiogenic shock, or a heart attack with cardiogenic shock (where your heart suddenly can't pump enough blood to to meet your body's needs), not due to complications from Covid-19 infection.

Case 17410, a 47-year-old male Bangladeshi national, passed away on May 1.

The cause of his death was deemed to be ischaemic heart disease, or coronary artery disease, and he was confirmed to have Covid-19 infection after his death.

Case 16370, a 44-year-old male Bangladeshi national, passed away on May 5.

He was admitted to Khoo Teck Puat Hospital on Apr. 29 to be treated for a heart attack, and was confirmed to have Covid-19 on the same day.

He was announced to have died from a heart attack.

Case 23550, a 53-year-old Indian national, passed away on May 9.

He had been sent to the emergency department at Sengkang General Hospital after suffering a cardiac arrest on May 9, and was confirmed to have Covid-19 infection the following day, after his death.

The cause of death was announced to be ruptured myocardial infarction due to coronary thrombosis, or a heart attack due to the formation of a blood clot inside a blood vessel of the heart.

Case 24013, a 31-year-old male Indian national identified as Ramachandran Chandhiramohan, passed away on May 10.

He had collapsed after complaining of chest pain while at his dormitory, and was confirmed to have Covid-19 infection after his death, on May 11.

The cause of his death was stated as coronary thrombosis, the formation of a blood clot inside a blood vessel of the heart.

Speaking on May 8 about how a Covid-19 patient's cause of death is determined, MOH's Director of Medical Services Kenneth Mak explained that the government follows the information provided to them by medical authorities, and stressed that Singapore is "quite transparent" with its announcements of deaths:

"So, in relation to Covid-19 cases that unfortunately have passed on, our approach really is first to ask ourselves, 'Is this directly attributable to Covid-19 infection or complications related to Covid-19 infection?'

In which case, if they are, we will report them as such.

And this comes out in our press statement that comes out every day. In fact, we are quite transparent in announcing and reporting all the deaths that we have, even if they were not due to Covid-19 infection, then they would be reported still.

But we will not necessarily ascribe them to Covid-19 unless we have been informed by the medical authorities, whether the doctors attending to the patient, or the coroner, if these were made coroner's cases, if they were telling us directly that these were deaths attributable to Covid-19 infection, then we will be reporting them as such."

In response to Mothership's queries, an MOH spokesperson gave the following statement on May 9:

"The Ministry of Health reports all deaths in patients infected with Covid-19. However, we add to the Covid-19 death count the cases where the attending doctor or pathologist attribute the primary or underlying cause of death as due to Covid-19 infection.

This has been our consistent practice, applied for both Singaporeans and foreigners in Singapore. It is consistent with international practice for classifying deaths.

In 2018, 86 male foreign workers aged 25 to 59 passed away due to heart disease in Singapore."

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Top photos via YouTube / govsingapore and Jesse Orrico on Unsplash.