Stayc Simpson’s blood pressure readings are all over the place. Her heart rate is fluctuating wildly. After struggling with heart failure and coronary artery disease for 15 years, undergoing a double bypass, and living with an implanted pacemaker and defibrillator, she knows her numbers aren’t good. She’s really worried. But fears about infection with the novel coronavirus, and a terrifying recent experience in an emergency room, have her steadfastly refusing to return to the hospital.
“At what point do I think it’s OK to go to the ER?” asked the Miami resident. “I just don’t know. If there were no Covid, there’s no question I’d go.”
Simpson is not alone. A survey of nine major hospitals earlier this month showed the number of severe heart attacks being treated in U.S hospitals had dropped 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: patients so afraid to enter hospitals that they are dying at home or waiting so long to seek care that they’re going to suffer massive damage to their hearts or brains. Some call it “a virus of fear.”
advertisement
“The whole community is discussing this, asking where are all of our patients?” said Martha Gulati, chief of cardiology at the University of Arizona. “There’s nothing we’ve done overnight that has cured heart disease.”
The same is true for appendicitis and stroke. Clinicians say patients with these life-threatening conditions have also stopped seeking treatment in large numbers. “My worry is some of these people are dying at home because they’re too scared to go to the hospital,” Gulati said.
advertisement
Others are coming in so late, she added, that some are presenting with massively damaged hearts, including heart muscles that have ruptured. “That was something I’d only seen before in textbooks, to study for exam questions,” she said. “Now we’re seeing those cases because people are putting off care.”
Mitchell S.V. Elkind is an attending neurologist at NewYork-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. Yet the stroke unit has been oddly quiet.
“Our stroke service is smaller by about half,” said Elkind, the incoming president of the American Heart Association and a professor of neurology and epidemiology at Columbia University. “People with stroke symptoms really need to know they should come in for treatment” immediately to limit brain damage and the risk of permanent paralysis, he said. “We have a limited time window and we know time is brain.”
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 decreases 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 other experts caution that even if those factors exist, they are outweighed by the stress, isolation, lack of regular exercise, and higher intake of salty, processed, shelf-stable foods resulting from stay-at-home orders.
”If anything, we would expect higher rates,” said Biykem Bozkurt, president of the Heart Failure Society of America and professor of medicine at Baylor College of Medicine. “We are not seeing the number of patients we should be seeing.”
Stress is definitely a factor for Simpson, 53, who had to close her business, a youth gymnastics studio, and is worried about being at high risk of complications if she does become infected with the new virus. She’s also stressed about not receiving her regular level of care. “I can’t go and get any of the normal procedures because going in puts me at risk,” said Simpson.
The main reason for the dropoff in patients, Bozkurt thinks, is that fear. “I think patients are scared to be exposed. Their perception is that hospitals are hotbeds for exposure and contamination,” she said. She and other physicians think many may be ignoring or dismissing their symptoms of chest pain, shortness of breath, or weakness.
The danger to patients from dela