04/08/2020
From The New York Times:
Where Have All the Heart Attacks Gone?
Except for treating Covid-19, many hospitals seem to be eerily quiet.By Harlan M. Krumholz, M.D., April 6, 2020
Harlan Krumholz, M.D., is professor of medicine at Yale and director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation.
The hospitals are eerily quiet, except for Covid-19.
I have heard this sentiment from fellow doctors across the United States and in many other countries. We are all asking: Where are all the patients with heart attacks and stroke? They are missing from our hospitals.
Yale New Haven Hospital, where I work, has almost 300 people stricken with Covid-19, and the numbers keep rising — and yet we are not yet at capacity because of a marked decline in our usual types of patients. In more normal times, we never have so many empty beds. …
What is striking is that many of the emergencies have disappeared. Heart attack and stroke teams, always poised to rush in and save lives, are mostly idle. This is not just at my hospital. My fellow cardiologists have shared with me that their cardiology consultations have shrunk, except those related to Covid-19. In an informal Twitter poll by @angioplastyorg, an online community of cardiologists, almost half of the respondents reported that they are seeing a 40 percent to 60 percent reduction in admissions for heart attacks; about 20 percent reported more than a 60 percent reduction.
Worldwide reports show significant reduction in STEMI/ACS admissions because patients are too afraid of #COVID19 to come to the hospital. How much reduction are you seeing? What do you advise someone experiencing MI symptoms? *DM me to be contacted for an article I’m working on.*
— Angioplasty.Org (@angioplastyorg) April 3, 2020
And this is not a phenomenon specific to the United States. Investigators from Spain reported a 40 percent reduction in emergency procedures for heart attacks during the last week of March compared with the period just before the pandemic hit.
And it may not just be heart attacks and strokes. Colleagues on Twitter report a decline in many other emergencies, including acute appendicitis and acute gall bladder disease.
The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with coronavirus. This theory suggests that Covid-19 has instilled fear of face-to-face medical care. As a result, many people with urgent health problems may be opting to remain at home rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened. Doctors from Hong Kong reported an increase in patients coming to the hospital late in the course of their heart attack, when treatment is less likely to be lifesaving.
There are other possible explanations for the missing patients. In this time of social distancing, our meals, social interactions and physical activity patterns tend to be very different. Maybe we have removed some of the triggers for heart attacks and strokes, like excessive eating and drinking or abrupt periods of physical exertion.
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