5 | FUTURE PERSPECTIVES
With the further understanding of its etiology and potential mechanisms, epidemiology, risk factors, clinical features, diagnosis, treatment, care and rehabilitation (84-86), cardiovascular protection will be done better during the Covid-19 pandemic (87-90) and the post-Covid-19 era. Although sedentary behaviors may increase cardiovascular risk, isolation for confirmed or suspected cases is still necessary. New models and recommendations are worthy of conducting for better prevention and treatment of MACCE (1, 91). Because viral RNAaemia is highly associated with clinical prognosis of severe Covid-19, it provides a basis for the early identification and management of critically ill patients (92).
A new clinical trial showed that a single immunization with the Ad26.COV2.S vaccine in humans can induce rapid binding and NA responses as well as cellular immune responses (93), but its safety and efficacy need to be confirmed by further clinical trials. Currently, more novel vaccines including mRNA vaccines (94-97) are being developed, but we should also carefully evaluate their safety and efficacy before emergency use authorization or licensing of SARS-CoV-2 vaccines, and whether they are still effective for those variants of SARS-CoV-2. Hence, due to the ability to escape natural or vaccine-induced immunity, new variants may add the risk of combating the Covid-19 pandemic (98). However, several novel vaccines developed in China had already been highly recommended by the WHO for emergency use and wide coverage in the globe (99).
Since there are some cases with depression and stress (100), and related C-type hypertension and MACCE (101, 102), to screen positively asymptomatic cases (103), and identify high-risk cardiovascular individuals early according to visual and measured clinical phenotypes (104), psychological prevention (105), vitamin D supplementation (106), and a tiered model of care learned from lessons in London (107), will be very helpful to their recovery. In addition, a living WHO guideline on drugs to prevent Covid-19 is also recommended (108). As a vital preventative strategy for reducing the risk of the cytokine storm (109), healthy E(e)SEEDi lifestyle is highly recommended because of improvement of human immunity (86), particularly in the pandemic and post-Covid-19 era, because there are high risk of MACCE and adverse cardiovascular outcomes (110).
Currently, there are a number of asymptomatic carriers of SARS-CoV-2 in the pandemic or post-Covid-19 era (111), these cases have the risk of developing future CVD (fCVD). Novel strategies of rehabilitation and public health are needed to reduce overall morbidity and improve and prevent long-term adverse outcomes of Covid-19 (112). As a good choice, the remote cardiac rehabilitation will help to protect individuals from SARS-CoV-2 infection and improve the short-term prognosis of CVD (113). And a novel clinical assay by a quantitative ELISA to detect anti-SARS-CoV-2 spike antibodies is applicable and reliable (114).
In the pandemic and post-Covid-19 era, more precise and rapid test will help to improve the diagnosis of SARS-CoV-2 infection and CVD outcomes, such as extensive usage of point-of-care cardiac ultrasound (115). And digital health (telemedicine services, robotic telemedicine carts, use of artificial intelligence and machine learning, use of digital gadgets like smartwatches and web-based applications) is a safe alternative for the management of CVD (116, 117). In addition, due to the anti-viral, anti-inflammatory, cardioprotective and anti-coagulatory activity, bromelain, a biomolecule, is suitable for protection of cardiovascular health (118), but its potential needs to be confirmed by further studies.
All in all, these novel strategies will lead to a paradigm shift (119) in cardiac care delivery in the pandemic and post-Covid-19 era. And it’s believed that we will finally combat Covid-19 for protection of human cardiovascular health by these comprehensive “ISISI” strategies (120), which include effective antiviral candidates or agents for Covid-19 and SARS-CoV-2 infection (Table 4) as well as vaccines and clinical trials. Whatever, “Healthy, Opening, Peaceful, and Excellent innovation and clinical studies will bring us more benefits”.