#[1]alternate [2]alternate [3]Where Have All the Heart Attacks Gone?

#[1]alternate [2]alternate [3]Where Have All the Heart Attacks Gone?

(BUTTON)
(BUTTON) Sections
(BUTTON) SEARCH
[4]Skip to content[5]Skip to site index
[6]Live
[7](BUTTON) Log In
(BUTTON)

[8]Log In
[9]Today’s Paper

[10]Live|Where Have All the Heart Attacks Gone?
https://nyti.ms/2UN1tNN
*
*
*
* (BUTTON)
*
*

[11]The Coronavirus Outbreak

debugid:204
* • [12]Latest Updates
* [13]Maps
* [14]Markets
* [15]What You Can Do
* [16]Newsletter

Advertisement
[17]Continue reading the main story

Supported by
[18]Continue reading the main story

Doctors

Where Have All the Heart Attacks Gone?

Except for treating Covid-19, many hospitals seem to be eerily quiet.
[well_doctors_bradford-articleLarge.jpg?quality=75&auto=webp&di
sable=upscale]
Credit...Stuart Bradford

By Harlan M. Krumholz, M.D.
* April 6, 2020
*
+
+
+
+ (BUTTON)
+
+

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.

Our hospital is usually so full that patients wait in gurneys along the
walls of the emergency department for a bed to become available on the
general wards or even in the intensive care unit. We send people home
from the hospital as soon as possible so we can free up beds for those
who are waiting. But the pandemic has caused a previously unimaginable
shift in the demand for hospital services.

Some of the excess capacity is indeed by design. We canceled elective
procedures, though many of those patients never needed hospitalization.
We are now providing care at home through telemedicine, but those
services are for stable outpatients, not for those who are acutely ill.

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 [19]informal
Twitter poll by [20]@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.

[21]Latest Updates: Coronavirus Outbreak in the U.S.

* [22]White House and Democrats propose additional emergency funds to
help the economy.
* [23]A jail in Chicago is now the largest-known source of U.S.
infections.
* [24]Bernie Sanders dropped out of the presidential race.

[25]See more updates
Updated 10m ago
More live coverage: [26]Global [27]Markets [28]New York

And this is not a phenomenon specific to the United States.
Investigators [29]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. [30]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 [31]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. This theory merits
research but seems unlikely to explain the dramatic changes we’re
observing.

We actually expected to see more heart attacks during this time.
Respiratory infections typically increase the risk of heart attacks.
[32]Studies suggest that recent respiratory infections can double the
risk of a heart attack or stroke. The risk seems to begin soon after
the respiratory infection develops, so any rise in heart attacks or
strokes should be evident by now. We [33]urge people to get flu
vaccines every year, in part, to protect their hearts.

Also, times of stress increase the risk of heart attacks and strokes.
Depression, anxiety and frustration, feelings that the pandemic might
exacerbate, are all associated with a doubling or more of heart attack
risks. Work and life stress, which also may be higher with the acute
disruptions we’ve all been going through, can markedly increase the
risk of a heart attack. Moreover, events like earthquakes or terrorist
attacks or war, in which an entire society is exposed to a stressor,
are risk factors for heart attacks. Finally, Covid-19 can actually
affect the heart, which should be increasing the number of patients
with heart problems.

Experts are bringing together data to confirm these patterns. We hope
to gain a greater understanding of their causes and consequences.

Meanwhile, the immediate message to patients is clear: Don’t delay
needed treatment. If fear of the pandemic leads people to delay or
avoid care, then the death rate will extend far beyond those directly
infected by the virus. Time to treatment dictates the outcomes for
people with heart attacks and strokes. These deaths may not be labeled
Covid-19 deaths, but surely, they are collateral damage.

The public needs to know that hospitals are equipped not only to care
for people with Covid-19 but also those who have other life-threatening
health problems. Yes, we in health care are working to keep people out
of the hospital if we can, but we can safely provide care for those
people who are not sick from Covid-19. Masks and protective gear for
health care workers and patients go a long way to ensure a safe
environment. Also, people with chronic conditions need to know that
avoidance of needed care could ultimately be as big a threat as the
virus itself.

As we fight coronavirus, we need to combat perceptions that everyone
else must stay away from the hospital. The pandemic toll will be much
worse if it leads people to avoid care for life-threatening, yet
treatable, conditions like heart attacks and strokes.
__________________________________________________________________

Harlan Krumholz, M.D., is professor of medicine at Yale and director of
the Yale New Haven Hospital Center for Outcomes Research and
Evaluation.

[34]The Coronavirus Outbreak

* Frequently Asked Questions and Advice
Updated April 4, 2020
+ Should I wear a mask?
The C.D.C. has [35]recommended that all Americans wear cloth
masks if they go out in public. This is a shift in federal
guidance reflecting[36] new concerns that the coronavirus is
being spread by infected people who have no symptoms. Until
now, the C.D.C., like the W.H.O., has advised that ordinary
people don’t need to wear masks unless they are sick and
coughing. Part of the reason was to preserve medical-grade
masks for health care workers who desperately need them at a
time when they are in continuously short supply. Masks don’t
replace hand washing and social distancing.
+ What should I do if I feel sick?
[37]If you’ve been exposed to the coronavirus or think you
have, and have a fever or symptoms like a cough or difficulty
breathing, call a doctor. They should give you advice on
whether you should be tested, how to get tested, and how to
seek medical treatment without potentially infecting or
exposing others.
+ How do I get tested?
If you’re sick and you think you’ve been exposed to the new
coronavirus, [38]the C.D.C. recommends that you call your
healthcare provider and explain your symptoms and fears. They
will decide if you need to be tested. Keep in mind that
there’s a chance — because of a lack of testing kits or
because you’re asymptomatic, for instance — you won’t be able
to get tested.
+ How does coronavirus spread?
It seems to spread [39]very easily from person to person,
especially in homes, hospitals and other confined spaces. The
pathogen can be carried on tiny respiratory droplets that fall
as they are coughed or sneezed out. It may also be transmitted
when we touch a contaminated surface and then touch our face.
+ Is there a vaccine yet?
No. [40]The first testing in humans of an experimental vaccine
began in mid-March. Such rapid development of a potential
vaccine is unprecedented, but even if it is proved safe and
effective, it probably will not be available for 12 to18
months.
+ What makes this outbreak so different?
Unlike the flu, there is no known treatment or vaccine, and
[41]little is known about this particular virus so far. It
seems to be more lethal than the flu, but the numbers are
still uncertain. And it hits the elderly and those with
underlying conditions — not just those with respiratory
diseases — particularly hard.
+ What if somebody in my family gets sick?
If the family member doesn’t need hospitalization and can be
cared for at home, you should help him or her with basic needs
and monitor the symptoms, while also keeping as much distance
as possible, [42]according to guidelines issued by the C.D.C.
If there’s space, the sick family member should stay in a
separate room and use a separate bathroom. If masks are
available, both the sick person and the caregiver should wear
them when the caregiver enters the room. Make sure not to
share any dishes or other household items and to regularly
clean surfaces like counters, doorknobs, toilets and tables.
Don’t forget to wash your hands frequently.
+ Should I stock up on groceries?
Plan two weeks of meals if possible. But people should not
hoard food or supplies. Despite the empty shelves, [43]the
supply chain remains strong. And remember to wipe the handle
of the grocery cart with a disinfecting wipe and wash your
hands as soon as you get home.
+ Can I go to the park?
Yes, but make sure you keep six feet of distance between you
and people who don’t live in your home. [44]Even if you just
hang out in a park, rather than go for a jog or a walk,
getting some fresh air, and hopefully sunshine, is a good
idea.
+ Should I pull my money from the markets?
[45]That’s not a good idea. Even if you’re retired, having a
balanced portfolio of stocks and bonds so that your money
keeps up with inflation, or even grows, makes sense. But
retirees may want to think about having enough cash set aside
for a year’s worth of living expenses and big payments needed
over the next five years.
+ What should I do with my 401(k)?
Watching your balance go up and down can be scary. [46]You may
be wondering if you should decrease your contributions —
don’t! If your employer matches any part of your
contributions, make sure you’re at least saving as much as you
can to get that “free money.”
__________________________________________________________________

[BUTTON Input] (not implemented)_________

Advertisement
[47]Continue reading the main story

Site Index

Site Information Navigation

* [48]© 2020 The New York Times Company

* [49]NYTCo
* [50]Contact Us
* [51]Work with us
* [52]Advertise
* [53]T Brand Studio
* [54]Your Ad Choices
* [55]Privacy
* [56]Terms of Service
* [57]Terms of Sale
* [58]Site Map
* [59]Help
* [60]Subscriptions
*

IFRAME:
[61]https://www.googletagmanager.com/ns.html?id=GTM-P528B3&gtm_auth=tfA
zqo1rYDLgYhmTnSjPqw&gtm_preview=env-130&gtm_cookies_win=x

References

Visible links
1. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html
2. nyt://article/852f0dae-2a56-51e6-838b-4b2e76b8a34b
3. https://www.nytimes.com/svc/oembed/json/?url=https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html
4. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html#site-content
5. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html#site-index
6. https://www.nytimes.com/section/well/live
7. https://myaccount.nytimes.com/auth/login?response_type=cookie&client_id=vi
8. https://myaccount.nytimes.com/auth/login?response_type=cookie&client_id=vi
9. https://www.nytimes.com/section/todayspaper
10. https://www.nytimes.com/section/well/live
11. https://www.nytimes.com/news-event/coronavirus?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=TOP_BANNER&context=storyline_menu
12. https://www.nytimes.com/2020/04/08/us/coronavirus-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=TOP_BANNER&context=storyline_menu
13. https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=TOP_BANNER&context=storyline_menu
14. https://www.nytimes.com/2020/04/08/business/stock-market-today-coronavirus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=TOP_BANNER&context=storyline_menu
15. https://www.nytimes.com/interactive/2020/world/coronavirus-preparation-preparedness.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=TOP_BANNER&context=storyline_menu
16. https://www.nytimes.com/newsletters/coronavirus-briefing?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=TOP_BANNER&context=storyline_menu
17. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html#after-top
18. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html#after-sponsor
19. https://twitter.com/angioplastyorg/status/1245892249101074432?s=20
20. http://angioplasty.org/
21. https://www.nytimes.com/2020/04/08/us/coronavirus-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national
22. https://www.nytimes.com/2020/04/08/us/coronavirus-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national#link-1d1d7f46
23. https://www.nytimes.com/2020/04/08/us/coronavirus-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national#link-7634e187
24. https://www.nytimes.com/2020/04/08/us/coronavirus-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national#link-6fff5854
25. https://www.nytimes.com/2020/04/08/us/coronavirus-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national
26. https://www.nytimes.com/2020/04/08/world/coronavirus-live-news-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national
27. https://www.nytimes.com/2020/04/08/business/live-stock-market-coronavirus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national
28. https://www.nytimes.com/2020/04/08/nyregion/coronavirus-new-york-update.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=MID_MAIN_CONTENT&context=storyline_updates_national
29. https://www.recintervcardiol.org/es/?option=com_content&view=article&id=344&catid=14
30. https://twitter.com/MandaChelednik/status/1246793095032852480?s=20
31. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.006631
32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139921/
33. https://www.cardiosmart.org/News-and-Events/2019/03/Flu-Shot-Helps-Prevent-Heart-Attack
34. https://www.nytimes.com/news-event/coronavirus?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
35. https://www.nytimes.com/2020/04/03/world/coronavirus-news-updates.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
36. https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
37. https://www.nytimes.com/2020/03/22/well/what-if-i-have-coronavirus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
38. https://www.nytimes.com/2020/03/22/well/what-if-i-have-coronavirus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
39. https://www.nytimes.com/interactive/2020/03/22/world/coronavirus-spread.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
40. https://www.nytimes.com/2020/03/19/us/politics/coronavirus-vaccine-competition.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
41. https://www.nytimes.com/article/what-is-coronavirus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
42. https://www.nytimes.com/2020/03/22/well/what-if-i-have-coronavirus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
43. https://www.nytimes.com/2020/03/15/business/coronavirus-food-shortages.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
44. https://www.nytimes.com/2020/03/19/well/move/coronavirus-covid-exercise-outdoors-infection-fitness.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
45. https://www.nytimes.com/2020/02/26/your-money/stock-market-changes-virus.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
46. https://www.nytimes.com/2020/03/07/your-money/target-date-funds-stock-market.html?action=click&pgtype=Article&state=default&module=styln-coronavirus-national&region=BELOW_MAIN_CONTENT&context=storyline_faq
47. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html#after-bottom
48. https://help.nytimes.com/hc/en-us/articles/115014792127-Copyright-notice
49. https://www.nytco.com/
50. https://help.nytimes.com/hc/en-us/articles/115015385887-Contact-Us
51. https://www.nytco.com/careers/
52. https://nytmediakit.com/
53. http://www.tbrandstudio.com/
54. https://help.nytimes.com/hc/en-us/articles/115014892108-Privacy-policy
55. https://help.nytimes.com/hc/en-us/articles/115014892108-Privacy-policy
56. https://help.nytimes.com/hc/en-us/articles/115014893428-Terms-of-service
57. https://help.nytimes.com/hc/en-us/articles/115014893968-Terms-of-sale
58. https://spiderbites.nytimes.com/
59. https://help.nytimes.com/hc/en-us
60. https://www.nytimes.com/subscription?campaignId=37WXW
61. https://www.googletagmanager.com/ns.html?id=GTM-P528B3&gtm_auth=tfAzqo1rYDLgYhmTnSjPqw&gtm_preview=env-130&gtm_cookies_win=x

Hidden links:
63. https://www.nytimes.com/
64. https://www.nytimes.com/
65. https://www.nytimes.com/
66. https://www.facebook.com/dialog/feed?app_id=9869919170&link=https%3A%2F%2Fwww.nytimes.com%2F2020%2F04%2F06%2Fwell%2Flive%2Fcoronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html%3Fsmid%3Dfb-share&name=Where%20Have%20All%20the%20Heart%20Attacks%20Gone%3F&redirect_uri=https%3A%2F%2Fwww.facebook.com%2F
67. https://twitter.com/intent/tweet?url=https%3A%2F%2Fnyti.ms%2F2UN1tNN&text=Where%20Have%20All%20the%20Heart%20Attacks%20Gone%3F
68. mailto:?subject=NYTimes.com%3A%20Where%20Have%20All%20the%20Heart%20Attacks%20Gone%3F&body=From%20The%20New%20York%20Times%3A%0A%0AWhere%20Have%20All%20the%20Heart%20Attacks%20Gone%3F%0A%0AExcept%20for%20treating%20Covid-19%2C%20many%20hospitals%20seem%20to%20be%20eerily%20quiet.%0A%0Ahttps%3A%2F%2Fwww.nytimes.com%2F2020%2F04%2F06%2Fwell%2Flive%2Fcoronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html%3Fsmid%3Dem-share
69. https://www.facebook.com/dialog/feed?app_id=9869919170&link=https%3A%2F%2Fwww.nytimes.com%2F2020%2F04%2F06%2Fwell%2Flive%2Fcoronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html%3Fsmid%3Dfb-share&name=Where%20Have%20All%20the%20Heart%20Attacks%20Gone%3F&redirect_uri=https%3A%2F%2Fwww.facebook.com%2F
70. https://twitter.com/intent/tweet?url=https%3A%2F%2Fnyti.ms%2F2UN1tNN&text=Where%20Have%20All%20the%20Heart%20Attacks%20Gone%3F
71. mailto:?subject=NYTimes.com%3A%20Where%20Have%20All%20the%20Heart%20Attacks%20Gone%3F&body=From%20The%20New%20York%20Times%3A%0A%0AWhere%20Have%20All%20the%20Heart%20Attacks%20Gone%3F%0A%0AExcept%20for%20treating%20Covid-19%2C%20many%20hospitals%20seem%20to%20be%20eerily%20quiet.%0A%0Ahttps%3A%2F%2Fwww.nytimes.com%2F2020%2F04%2F06%2Fwell%2Flive%2Fcoronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html%3Fsmid%3Dem-share