Simpson had seen constant changes in her blood pressure readings along with a fluctuating heart rate. After struggling with heart failure for 15 years, undergoing a double bypass, and living with an implanted pacemaker and defibrillator, she was really worried. But fear about being infected with the novel Coronavirus, and terrifying experiences in emergency rooms, had her refusing to return to the hospital. “If there was no Coronavirus, there was no question, I’d go immediately,” she said.
She is not alone. A survey of nine major hospitals earlier this month showed the number of severe heart attacks being treated in US hospitals dropping by nearly 40% since the novel Coronavirus took hold in March, leaving cardiologists worried about a second wave of deaths caused “indirectly” by COVID-19.
In other words, patients afraid to enter hospitals die at home or wait so long to seek care that they end up suffering massive damage to their hearts or brains. According to the study, patients with life-threatening conditions are no longer seeking treatment in large numbers. COVID-phobia has obviously been keeping people with serious heart and brain symptoms away from ERs (emergency rooms) what doctors now call the “virus of fear”.
It’s not just the United States. Dr Valentin Fuster, editor of the Journal of American College of Cardiology, said he is getting so many papers from around the world on the steep decline in heart attack patients in hospitals that he simply cannot publish them all.
Closer home, a hospital in Jaipur, treated 45 heart attack patients in January. In February, there were 32, and in March, 12. In April, so far the number is just six.
Elkind, an attending neurologist at New York-Presbyterian, a hospital at the epicenter of the current pandemic that’s operating at surge capacity, with Covid-19 patients filling makeshift ICUs throughout the facility admits that the stroke unit, too, has been oddly quiet.
“People with stroke symptoms really need to know they should come in for treatment immediately to limit brain damage and severe paralysis, but don’t,” he said.
The steep reduction in patients coming to hospitals is puzzling, even shocking, to many clinicians. Some have floated the idea that aspects of the pandemic shutdown, including a decline in air pollution, fewer heavy restaurant meals, and less exertion from work might be leading to a reduction in heart attack and stroke incidence. But others caution that even if these factors exist, they are outweighed by the stress, isolation, lack of regular exercise, and higher intake of processed foods resulting from stay-at-home urge.
The main reason for the drop in patients, Dr. Elkind agrees is “fear”. “I think patients are scared to be exposed. Their perception is that hospitals are “hotbeds” for exposure and contamination.”
The danger to patients from delaying treatment is so extreme that leaders of major heart organisations are responding with outreach programs to encourage patients to come in early for treatment. A cardiologist from Connecticut tweeted that his 50-year-old brother died of a heart attack, at home alone. “Not COVID positive but COVID-phobic,” he regretted.
Cardiologists say they understand the fear among their patients with heart disease is because they have been told since the start of the pandemic that they are at the highest risk of complication and death if they do contract the new virus. Now, they worry that the cautionary public health messaging may have been “too effective”.
“We want them to stay at home and be socially distant. But we didn’t mean stay at home if you’re having symptoms of a heart attack or stroke,” said Gulati, who also serves as editor of the American College of Cardiology’s patient education portal CardioSmart. “We want to keep patients safe, but we also want to keep them alive.”
There is the erroneous perception that there are no resources or staff to provide urgent or emergency care for non-COVID patients or that everything is deferred. That is wrong. And the deferral of care with heart failure can be deadly.
Today, hospitals have better procedures in place to segregate COVID-19 patients from the rest of the population. There are different units, different floors, and different staff for non-COVID-19 patients now. Patients should not be afraid to come in for care when they need. Globally, we are going to see adverse trends in cardiovascular deaths due to our patients not seeking care because of COVID-19.
Many are working to spread awareness of heart disease through a support group called Heart Sisters, urging anyone with heart symptoms to call 911 with the message “You need to go assured that emergency rooms are working hard to prevent exposure to the corona virus”. Closer in India, the authorities must make concerted efforts to dispel the stigma around COVID-19.
All said and done COVID-19 has thought us a lot about life… and death. First, shared adversity can foster a sense of community and affinity with others that can be masked in normal times. Second, even as we like to think we are masters of the world, now nature in the form of a tiny virus, is giving us a taste of our own medicine. Finally, facing up to mortality also has some simple practical implications. Death’s lesson is more than all about the limits we can exercise to control over our own life.
It’s true, COVID-19 is highly infectious. But its mortality rate is still low. Phobia makes the disease bigger, forcing us into counterproductive overreactions.
(Dr. Francisco Colaço is a seniormost consulting physician.)
