{"id":46459,"date":"2020-04-20T14:29:34","date_gmt":"2020-04-20T18:29:34","guid":{"rendered":"https:\/\/thelehighacresgazette.com\/news\/?p=46459"},"modified":"2020-04-20T14:29:39","modified_gmt":"2020-04-20T18:29:39","slug":"patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals","status":"publish","type":"post","link":"https:\/\/thelehighacresgazette.com\/news\/2020\/04\/patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals\/","title":{"rendered":"Patients with heart attacks, strokes, and even appendicitis vanish from hospitals"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"888\" height=\"470\" src=\"https:\/\/thelehighacresgazette.com\/news\/wp-content\/uploads\/2020\/04\/Screenshot-5.png\" alt=\"\" class=\"wp-image-46460\" srcset=\"https:\/\/thelehighacresgazette.com\/news\/wp-content\/uploads\/2020\/04\/Screenshot-5.png 888w, https:\/\/thelehighacresgazette.com\/news\/wp-content\/uploads\/2020\/04\/Screenshot-5-300x159.png 300w, https:\/\/thelehighacresgazette.com\/news\/wp-content\/uploads\/2020\/04\/Screenshot-5-768x406.png 768w\" sizes=\"(max-width: 888px) 100vw, 888px\" \/><\/figure>\n\n\n\n<p>Soon after he repurposed his 60-bed cardiac unit to accommodate COVID-19 patients, Mount Sinai cardiovascular surgeon John Puskas was stumped: With nearly all the beds now occupied by victims of the novel&nbsp;coronavirus, where had all the heart patients gone? Even those left almost speechless by crushing chest pain weren\u2019t coming through the ER.<\/p>\n\n\n\n<p>Variations on that question have puzzled clinicians not only in New York, the epicenter of the coronavirus outbreak, but across the countryand in Spain, the United Kingdom and China. Five weeks into a nationwide coronavirus lockdown, many doctors believe the pandemic has produced a silent sub-epidemic of people who need care at hospitals but dare not come in. They include people with inflamed appendixes, infected gall bladders and bowel obstructions, and more ominously, chest pains and stroke symptoms, according to these physicians and early research.<\/p>\n\n\n\n<p>\u201cEverybody is frightened to come to the ER,\u201d Puskas said.<\/p>\n\n\n\n<p>Some doctors worry that illness and mortality from unaddressed health issues may rival the carnage produced by the virus in regions less affected by covid-19. And some expect they will soon see patients who have dangerously delayed seeking care as ongoing symptoms force them to overcome their fear.<\/p>\n\n\n\n<p>Evert Eriksson, trauma medical director at the Medical University of South Carolina, described a man in his 20s who tried to ignore the growing pain in his belly, toughing it out at home with the aid of over-the-counter painkillers. By the time he showed up at the hospital, perhaps 10 days after he should have, he had developed a large abscess, one that was gnawing through the muscle in his abdominal wall.<\/p>\n\n\n\n<p>Fairly routine surgery and a night in the hospital had become a lengthy and difficult inpatient stay, with doctors operating and using antibiotics to control the widespread infection, according to Eriksson. Only after they succeed in vanquishing the infection can they address the appendix itself.<\/p>\n\n\n\n<iframe width='480' height='290' scrolling='no' src='https:\/\/www.washingtonpost.com\/video\/c\/embed\/8e637169-783b-45f5-9411-2cb0f6871370' frameborder='0' webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe>\n\n\n\n<p>On-shift in a New York hospital overwhelmed by coronavirus patients Maimonides Medical Center on April 1, more than 80 percent of patients were infected with COVID-19, and doctors and nurses feared the worst is yet to come. (Jon Gerberg\/The Washington Post)<\/p>\n\n\n\n<p>\u201cThat\u2019s going to be a real wound-care challenge for him moving forward,\u201d said Eriksson, who is caring for the patient. \u201cHe said to me he could [imagine] the virus crawling on the hospital. He was just scared to come.\u201d<\/p>\n\n\n\n<p>At MUSC, Eriksson\u2019s general surgery floor, which has 20 beds, housed as few as three people for two to three weeks, he said. Now the census is back over 20.<\/p>\n\n\n\n<p>\u201cWhat we\u2019re seeing is late presentation,\u201d he said. \u201cI would say 70&nbsp;percent of the appendicitis on my service right now are late presentations. What happens when you present late with appendicitis is we can\u2019t operate on you safely.\u201d<\/p>\n\n\n\n<p>Yet the 700-bed hospital in Charleston is only about 60&nbsp;percent full because, like most facilities, MUSC discharged everyone it could to make room for the expected coronavirus surge. So far that hasn\u2019t materialized. The hospital has not had more than 10 COVID-19 patients admitted at any time, he said.<\/p>\n\n\n\n<p>\u201cWe have five covid patients in the hospital right now, and we have five appendicitis cases\u201d with complications from waiting too long to come in for care, Eriksson said.<\/p>\n\n\n\n<p>Much of the reporting about missing patients is anecdotal \u2014 in medical chat rooms and on doctors\u2019&nbsp;<a href=\"https:\/\/twitter.com\/WCInvestor\/status\/1246486725863636996\">social media&nbsp;<\/a>accounts. Doctors say it\u2019s unlikely there has been a decline in most of these conditions, which suggests that at least a few people may be dying at home, although there is no data yet to corroborate that.<\/p>\n\n\n\n<p>In the case of severe heart attacks, the evidence is mounting that a large percentage of patients with symptoms that typically prompt urgent interventions are simply not showing up.<\/p>\n\n\n\n<p>A&nbsp;<a href=\"http:\/\/www.onlinejacc.org\/content\/accj\/early\/2020\/04\/07\/j.jacc.2020.04.011.full.pdf\">report<\/a>&nbsp;to be published in the Journal of the American College of Cardiology on nine high-volume cardiac catheterization labs across the country found a 38&nbsp;percent drop in patients being treated for a life-threatening event known as a STEMI \u2014 the blockage of one of the major arteries that supply oxygen-rich blood to the heart. The study compared what happened this past March, when COVID-19 cases were climbing, with the treatments delivered from Jan.&nbsp;1, 2019, through February 2020.AD<\/p>\n\n\n\n<p>Those results \u2014 from hospitals across the country \u2014 are counterintuitive, physicians say. The stress caused by the pandemic would lead them to anticipate an increase in heart attacks. Covid-19 is also an inflammatory disease that can damage the heart muscle.<\/p>\n\n\n\n<p>\u201cWe should have higher incidences of these events, but we are seeing dramatically fewer in the hospital system,\u201d Puskas said. \u201cThat has to mean they are at home or in the morgue.\u201d<\/p>\n\n\n\n<p>A Gallup online poll taken March&nbsp;28 to April&nbsp;2 asked people with different conditions how concerned they would be about exposure to coronavirus if they needed \u201cmedical treatment right now\u201d at a hospital or doctor\u2019s office. Eighty-six percent of people with heart disease said they would be either \u201cvery concerned\u201d or \u201cmoderately concerned.\u201d Among people with high blood pressure, the figure was 83&nbsp;percent.AD<\/p>\n\n\n\n<p>With elective surgeries on hold, many hospitals such as Brigham and Women\u2019s in Boston have found themselves trading treatment of traditional heart attacks for the complex assaults the novel coronavirus is making on the organ and the body\u2019s ability to clot blood.<\/p>\n\n\n\n<p>\u201cPeople with smaller heart attacks, they may say, \u2018Well I hope this is just indigestion.\u2019\u2009\u201d said, Gregory Piazza, one of the hospital\u2019s cardiovascular specialists.<\/p>\n\n\n\n<p>At MUSC, another doctor worried that mild stroke patients are enduring symptoms such as numbness, loss of sensation or weakness on one side of their body at home. Symptoms of small strokes can be transient, but they also can be warnings of larger strokes to come.<\/p>\n\n\n\n<p>MUSC, a major stroke center, averaged 550 calls per month over the past four months&nbsp;about possible stroke patients from the 45 to 50 emergency rooms that refer patients. Butit has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery. Phone calls from patients to MUSC\u2019s telestroke program dropped from as many as 20 daily to about nine in mid-April.AD<\/p>\n\n\n\n<p>\u201cThat\u2019s literally patients and their families who fear that it\u2019s dangerous\u201d to go to the hospital, he said. \u201cWe are worried that there might be a higher death toll from neglect of other diseases\u201d than from covid-19.<\/p>\n\n\n\n<p>At the University of Miami-Jackson Memorial Comprehensive Stroke Center, the March census of stroke patients is down almost 30&nbsp;percent from February\u2019s, said Ralph Sacco, chairman of neurology and former president of the American Academy of Neurology.<\/p>\n\n\n\n<p>\u201cWhat we would surmise is that more mild to moderate cases are not calling 911, or are afraid to come into the hospitals,\u201d Sacco said.<\/p>\n\n\n\n<p>The hospitals are beginning to reach out to the public through social media and public service announcements to ease fears about hospital safety.<\/p>\n\n\n\n<p><strong>\u201c<\/strong>We\u2019ve changed what we do,\u201d to keep patients safe from the virus, Sacco said. \u201cBut we\u2019re still able to care for people.\u201dAD<\/p>\n\n\n\n<p>The possibility that patients may be suffering \u2014 and even dying \u2014 at home rather than going to the hospital led the American College of Cardiology to launch a \u201cCardiosmart\u201d campaign last week, attempting to reassure a wary population and encourage those with symptoms to call 911 for urgent care and to continue routine appointments, when practical through telemedicine: \u201cHospitals have safety measures to protect you from infection,\u201d it reads.<\/p>\n\n\n\n<p>\u201cThe emphasis here is safety,\u201d said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. \u201cWe want to make sure preventable deaths aren\u2019t happening.\u201d<\/p>\n\n\n\n<p>There is no pill, no action, no behavior, he said, that could account for the almost 40&nbsp;percent drop in STEMI patients. \u201cWe don\u2019t have the means to cut your risk in half,\u201d he said. \u201cNot even primary angioplasty or stopping smoking.\u201dAD<\/p>\n\n\n\n<p>Still the shift has many doctors looking for other explanations, including the massive behavioral overhaul caused by the lockdown.<\/p>\n\n\n\n<p>MUSC has seen a steep drop in trauma from car accidents, for example, because fewer people are driving, but no reduction in domestic violence or assaults among people who don\u2019t live together, Eriksson said.<\/p>\n\n\n\n<p>Many people who suffer from exertional angina are now sitting at home rather than climbing the subway stairs every day, and the threshold of discomfort that would drive them to seek care is likely far higher.<\/p>\n\n\n\n<p>Joseph Puma, an interventional cardiologist at Mount Sinai, believes multiple changes created by the lockdown may be playing a role, including a decrease in air pollution and fewer high-fat restaurant meals after work.<\/p>\n\n\n\n<p>\u201cThe plaques in arteries have not gone away,\u201d he said. \u201cYou can argue that forced behavioral modifications may have taken away the triggers\u201d that release them into the bloodstream.<\/p>\n\n\n\n<p>And these days, some people who suffer cardiac arrests never make it to the hospital in New York, where EMTs and paramedics transport patients only if their pulse returns after CPR or defibrillation.<\/p>\n\n\n\n<p>Puskas, the Mount Sinai cardiovascular surgeon, whose unit is now occupied entirely by covid-19 patients<strong>,&nbsp;<\/strong>suspects a few of the heart patients may not be missing but right thereamong the most seriously ill people in his new unit.<\/p>\n\n\n\n<p>The virus strikes most harshly among people suffering from diabetes, obesity and high blood pressure \u2014 the very same conditions that predispose people to strokes and heart attacks and that are most prevalent among blacks and Hispanics.<\/p>\n\n\n\n<p>\u201cSome of them may be under our noses,\u201d he said.<\/p>\n\n\n\n<p>The role those factors may be playing will emerge over time from studies and shoe-leather epidemiology. But for now, Krumholz said, the key is to make sure people with symptoms overcome their fears and get prompt treatment that may save their lives or avoid long-term complications.<\/p>\n\n\n\n<p>\u201cDon\u2019t delay,\u201d he said.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Soon after he repurposed his 60-bed cardiac unit to accommodate COVID-19 patients, Mount Sinai cardiovascular surgeon John Puskas was stumped: With nearly all the beds now occupied by victims of&hellip; <\/p>\n","protected":false},"author":8,"featured_media":46460,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[128],"tags":[],"_links":{"self":[{"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/posts\/46459"}],"collection":[{"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/comments?post=46459"}],"version-history":[{"count":0,"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/posts\/46459\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/media\/46460"}],"wp:attachment":[{"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/media?parent=46459"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/categories?post=46459"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thelehighacresgazette.com\/news\/wp-json\/wp\/v2\/tags?post=46459"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}