Meanwhile, What’s Happened to Heart Attacks?

Photo by Daan Stevens on Unsplash

There is a drastic decrease in heart attack and stroke since the pandemic hit — maybe

Judging by hospital admissions, it looks that way. Stories in news outlets including the New York Timesthe U.K.’s Daily Mail and California’s Sacramento Bee describe a surprising amount of ER beds sitting empty as doctors wonder what’s become of the typical influx of heart attack and stroke admissions.

Both the New York Times and Daily Mail articles reference a recent Twitter poll conducted by Angioplasty.org, in which close to half the respondents (all cardiologists) reported a drop of between 40% to 60% in heart attack admissions. This is a pattern reportedly being seen in other countries as well, including Spain. Moreover, as Harlan M. Krumholz, M.D. at Yale-New Haven Hospital reports in the Times, it’s not just ER admissions due to heart attack and stroke that have declined so dramatically:

Colleagues on Twitter report a decline in many other emergencies, including acute appendicitis and acute gall bladder disease.

What’s really going on?

It seems logical there would be a reduction in medical emergencies due to accidents during this time, with so many people staying at home. Fewer people driving means fewer car accidents; fewer people playing sports is bound to result in fewer injuries, and so on. And by now we’re all aware that hospitals have postponed elective procedures, both to free up resources and keep people out of the hospital who don’t really need to be there.

But a precipitous decline in strokes and heart attacks? That’s a head-scratcher for doctors, and a worrisome one. As Dr. Krumholz writes:

We actually expected to see more heart attacks during this time. Respiratory infections typically increase the risk of heart attacks. . . . Also, times of stress increase the risk of heart attacks and strokes. . . 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.

The fear among medical professionals is that people may be avoiding going to the hospital when they should, or dangerously delaying seeking treatment. As reporter Summer Lin notes in the Sacramento Bee story,

Doctors in Hong Kong wrote in the journal Circulation: Cardiovascular Quality and Outcomes that patients with heart attack symptoms delayed getting treatment, according to the letter.

If you need to go to the hospital, GO to the hospital

That is the primary takeaway here. None of us wants to chance a visit to an ER right now, much less be admitted to a hospital at a time when coronavirus means we may be further exposing ourselves to danger, and that we face the prospect of spending our time there without benefit of loved ones at our sides.

But if you are having symptoms of a heart attack or stroke — the hospital is exactly where you need to be. Your best chance of survival depends on getting there without delay.

Fear, especially long-drawn-out, semi-chronic dread like we’re all experiencing these days, can make us a little nuts. But don’t allow it to keep you from saving your own life, or the life of someone you care about.

But what if there are other factors involved?

You don’t need me to tell you we’re living in stressful times. If neither your personal health nor personal economy has yet to be impacted by the COVID crisis, chances are you know and care about someone who isn’t so lucky. And none of us can tell where this situation is headed or how long it will be before we can find our way to some kind of new normal.

Lots of us are out of a job. Some of us have lost businesses we spent years building. Who knows how many of us have had to cancel or forego life events: weddings, graduations, trips of a lifetime, visits to distant relatives whom we fear we may never see again if the lockdown drags on for many more months.

Some of us have already lost people we love to COVID, and more of us will grieve such losses as time goes on. We don’t know which of us that will be, and that uncertainty is one of the most dreadful aspects of the crisis.

You would think we’d all be about two inches away from a physical meltdown.

And yet, so many of our familiar stressors are suddenly absent

Not that we wouldn’t all love for life to return to pre-COVID normal tomorrow if only we had the power to make that happen. But our previous “normal” included a fair amount of tension-inducing aspects that we are no longer contending with these days.

Rush hour, gone. Getting the kids off to school, over. Juggling a punishing schedule of commuting, office time, errands, driving kids to practice, and getting home in time to change for the social function we committed to back when it sounded like a good idea — none of that is happening right now. Just because we were familiar with all of those stressors doesn’t mean they didn’t take their toll.

Right now, if we’re lucky enough to not be financially desperate (yet) and we don’t work in a front-line or essential occupation, our work hours, if we still have them, are suddenly bookended with more free time than we’ve had since we were little kids.

Our streets are quieter. The air is cleaner. Birds are singing more now, or maybe we’re just noticing them more. The people in their masks and gloves that we pass so at a distance wave to us in gestures of friendly commiseration. Many of us are reaching out in whatever way we can to friends and relatives we haven’t connected with for too long because we’ve been so busy being busy.

And while many of us are more isolated and physically distant from other people than we’ve ever been, we’re also noticing a global sense of community, a knowledge that no matter who or where we are, we are all sharing this experience. We are truly all in this together.

This crisis will have so much to teach us, once we’re through it

The data on the decrease in non-COVID hospital admissions is just beginning to be collected, let alone analyzed. It will most likely be years before we understand the ramifications of both the disease and the worldwide hiatus it has forced on us.

Perhaps the apparent decrease in heart attacks and strokes will turn out to be nothing more than a tragic side effect, a result of fear-of-hospitals run rampant. Or maybe we will find that some of the downturn in those hospital admissions is due to other factors — factors that we should pay attention to, especially if we’re confronted with hard evidence of what we already know in our overtaxed hearts.

Namely, that our frenetic pre-COVID lifestyle — multitasking, spiraling productivity hacks, cramming more work into our days than our days have room for —robs us of too much. And that doing less could mean we get more. More life, that is. Life that we register and pay attention to. Life that is worth living.

If that is indeed one of the lessons of the pandemic, let’s not miss it.

I’d love to know your thoughts on this! Comments strenuously encouraged and deeply appreciated . . .

6 Replies to “Meanwhile, What’s Happened to Heart Attacks?”

  1. Laurie

    I was wondering about just that thing, Jan – what about all of the serious medical conditions like heart attack, stroke, cancer, etc. that must still be happening now during the crisis? You are right. Many of the everyday stressors (other than financial ones) are gone and there is not much we can do other than keep on keepin’ on.

    Let’s hope we do keep some of these good lessons the crisis can teach us. I don’t want to forget in the frenetic rush to “normalcy”.

    • Jan M Flynn Post author

      Right there with you, Laurie. I think our former “normal” could use some conscious editing!

  2. Anni

    Interesting questions and observations, Jan! So… my friend in NYC points out that cardiac arrests are usually 30-50 a day there, but are now 200-300 a day. They happen on site and in ambulances when the patient dies before reaching the hospital. Many are probably due to Covid-19 complications but without post-mortem testing we will never know. So perhaps in NYC it is a different stress equation? In any event, we are so lucky to have some space and access to the outdoors right outside our own doors…

    • Jan M Flynn Post author

      Indeed, Anni — I feel so bad for the folks in New York, and almost guilty for how much our experience differs from theirs.

  3. A.S. Akkalon

    Our politicians have repeatedly been urging people who need medical help to go out and get it, but this idea that many of our normal stressors are absent hadn’t fully struck me until now. It’s entirely true. I no longer commute, and finishing work now means getting up from my desk. Many of the things I was meant to be doing I now can’t, and I have the best excuse in the world: the PM told me not to. I’ve also cut back my work hours, which gives me more free time for meaningful things like watching the cat eat grass. I wouldn’t choose the pandemic, but not all its side effects are entirely bad.

    • Jan M Flynn Post author

      And I am sure your cat appreciates the fact that you’ve finally come to your senses about the proper use of your time 🙂

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