> The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” 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, through telemedicine when practical: “Hospitals have safety measures to protect you from infection,” it reads.
> “The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.”
> There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”
Should the media have some of the blame for these deaths by scaring people? Cherry picking young corona deaths, up playing tenuous studies saying corona causes diabetes and strokes, replaying stock footage of overloaded hospitals.
If they gave people accurate statistics they could make an informed decision whether they want to go to a hospital.
Right, they're likely dying at home, and being counted as COVID-19 deaths. That's the safest guess, in the absence of epidemiologic data.
Even so, medical systems and coroners ought to be archiving samples for testing. Eventually there'll be adequate RNA and antibody testing capabilities. Without that data, we won't know what happened.
Could relaxing still home and cooking your own meals reduce activity-causing heart attacks? It’s a trope in the North-East that middle aged men die shoveling snow.
Where's the source of "excess mortality is way up"? I didn't see it in the article, though it does suggest there may be fewer heart attacks and strokes because of "a decrease in air pollution and fewer high-fat restaurant meals".
There is also another opinion: that many people go to the ER who don't really need to go there.
I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go.
The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen.
Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place.
Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.
A lot of people don’t have insurance. You can’t go to a doctor for a $150 appointment without insurance. But you can go to the ER when it gets really bad for a $2000 appointment (which you don’t pay. May go to court against you but if you are poor, they won’t collect)
The article addresses this. They expect fewer trauma patients as there are fewer people on the road, etc. but they expect the number of stroke, heart attack, etc. patients to remain constant, which hasn't been the case.
You not have overlooked these details when you read the article:
> One study collected data from nine hospitals across the country, focusing on a crucial procedure used to reopen a blocked cardiac artery after a heart attack. The hospitals performed 38% fewer of those procedures in March, compared with previous months.
> At Harborview Medical Center in Seattle, Dr. Malveeka Sharma has tracked a 60% decline in stroke admissions in the first half of April compared with the previous year
> MUSC, a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery.
This is not just happening at ERs, this is happening at the places ERs will refer you to, usually after checking whether you do in fact need immediate care.
Doctors in California went on strike and mortality dropped.
One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related.
"The third-leading cause of death in US most doctors don’t want you to know about"
My personal take on this based on statistics and observation is that many medical procedures are not very effective.
Or trade short term risk, for long term benefit.
Eg. Those that survive a bypass surgery may live longer. But it will shorten the life of those that it kills.
Chemo therapy can kill you immediately, but if you survive the procedure, it may have also killed the cancer that then will increase your life expectancy.
I also think many medical procedures are not really changing the course of the disease.
And being in a hospital is inherently risky. You are exposing yourself to other very sick people, and possible human errors in treatment.
ITs easy to fool yourself into thinking that what you are doing is having an effect. Consider the thousands of football fans in stadiums thinking they are changing the course of the game with cheering or booing.
IMO, there is a lot of hocus pocus going on in the "medical error is the 3rd leading cause of death" statistic, and the case they chose to highlight is extremely atypical. The vast majority of health care spending and the vast majority of medical resources are spent on old people in their last 18 months of life. Most deaths due to medical error are very old people undergoing risky and invasive surgeries they demand to have and are unlikely to have a great outcome in, not children. How much of the blame should be placed on the doctor when the patient is 80+ years old, has comorbidities, has been counseled on the risks, and wants to proceed with treatment? Bypass surgery is quite effective on someone younger than 60 who is also put on a diet and exercise regimen, and doesn't have diabetes. Bypass surgery is not effective for someone over 60 who is obese and has diabetes and will not change their diet habits.
Most interventions are for something that's not going to kill you right away, so I would guess that seeking intervention for a medical problem I'm having would increase my odds of dying right now (due to a mistake, or exposure to other wick people) while increasing my long term odds. I would not expect an increase in mortality when non-emergency doctors go on strike.
And I hope to someday live in a world where medical error is the #1 cause of death. I hope we also focus on quality of life and not just quantity -- but if medicine seeks to continue extending life then the success case is that error is essentially the only cause of death.
Those articles, and especially their headlines, are sensational and misleading.
This is really frustrating, as we were told over and over again from the media of this huge surge of cases that would overload hospitals. Stay away from the hospital we were told over and over, the "worried well" are overloading our medical system and its professionals. Well guess what, people did just that, they avoided the hospitals to allow for a surge. That's why these hospitals are ghost towns now. I had a tele-visit with my physician and he said both covid cases and visits themselves in his location have dropped off a cliff in recent weeks(sfbay area location). The tents they erected in the hospital parking lot to treat the legions of sick are being taken down at another hospital in San Jose. A friend who worked in radiology is now on partial furlough due to such low patient counts(Stanford, Palo Alto) so I guess this avalanche of cases never materialized at least not in the bay area(NY is a different story).
Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well. What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).
In New South Wales, Australia the medical sector had 1000 ICU bed capacity in January. When covid hit, it was rapidly expanded and currently over 2000 ICU beds are available.
At the same time all elective surgeries got banned (e.g. hip replacements etc) because some of those would end up in ICU.
At the peak of the outbreak NSW used 100 of those 2000 beds. Currently only about two dozen ICU beds are occupied. About 1% of capacity.
No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.
I'm going to keep repeating this until people understand the risks: Opening up too early without adequate testing in place means we go through the same problem that Hokkaido did. Which is that you get a second wave of infections and are forced to back into lockdown.
As for the article itself: Reopening the country wouldn't fix that either because it's a catch-22 situation. The people most at risk of dying from COVID-19 don't want to go to the hospital because of the risk. So they put off emergencies until it's too late. You don't solve this problem by reopening the country because the fear and the risk for said people is still there.
My parents are a great example. They have breathing issues which makes them especially at risk. They're afraid of getting routine tests done because catching the coronavirus could be very deadly.
[IANAD] Diabetes, hypertension and cardiovascular issues are among the frequent issues in serious covid cases. If covid is that widespread as some studies suggests, may it be that covid triggers the hospitalization earlier than the heart attack/stroke/etc. would have happened to that person otherwise. US heart attack rate is 2K/day, ie. on a scale of covid deaths and significantly less than covid hospitalizations.
Some other factors to consider - much cleaner air these days, no traffic/noise/rush and associated stress, and you can even hear birds singing through the day. Personally i find it very relaxing to not spend the days in our tightly packed badly air-conditioned to the point of serious sweating (our BigCo. is very big about its "green" energy saving chops) horrendously lit (those lights burn the eyes and make bright spot reflections on monitor, and the half-transparent blinds kill when afternoon Sun gets into those windows) "collaboration and communication stimulating" (read - very stressful) very modern open floor office.
I would assume indeed that your first point is the most important-one: people already in bad health, susceptible to heart attacks and strokes also have a much higher chance of getting seriously affected by covid with fatal consequences in the first place.
This is also something you see in statistics, that after any large flu epidemic, the general population mortality figure drops to something significantly below average, especially for people in the 65+ age group.
You can see this very well on EuroMOMO [1] - check out the numbers for the Netherlands in 2018 from week 10 throughout 13. This is a flu epidemic there, and the aftermath.
Yes, Stanford Hospitals actually sent about 20% of their staff home.[1]
Stanford was prepared for a huge influx of coronavirus patients, but they only have 20-30 in the hospital. This despite a steadily climbing death toll. My own GP says, if you get it, go to Stanford; they have the investigational drugs, and they're not overloaded.
Nationally, the US death toll continues to climb. Currently somewhere between 69,000 and 74,000, depending on the source. The SF Bay Area's shelter-in-place thing seems to have helped. We need to get more people wearing masks, though. Seeing too many people without masks. More of the good masks, too. You really need N95 or ASTM Level 3 masks to protect yourself; the cheapies only protect other people. That only works if almost everybody wears the things.
What's happening outside the US? The Financial Times tracker, which has been updated every day for months, shows the US death rate flat. Most other countries have peaked and decreased substantially.[2]
Don't discount the impact of reduction of air pollution on all causes of mortality. It's not often discussed, but every so often someone makes the connection between small particulates and heart attacks, etc.
Pretty sure any impact from that would be a very long-term thing. A lifetime without particulates might have an effect; a month seems pretty far-fetched.
Cars kill us: Far fewer car crashes, more sleep as no need to commute so early in the morning, no horrible drive into the office screaming and honking at the idiot driver, no horrible drive home while texting.
Alcohol kills us: no drunk fights at bars, drunk driving, falling in front of moving vehicles.
Not saying it explains it, but a lot of people get hurt and die for stupid reasons.
How is that related to the lockdown? Hospitals are open. People are staying home because they're scared of getting sick, that's not something that can be fixed by public policy.
"In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks.
Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement."
Of course, people hesitate to go to the doctor. But I see a second factor: Maybe it’s because of a slowing down in many regards. Hence, less stress, and less heart attacks?
My first thought was more sleep. Without a commute in the morning I have to imagine most people are getting an extra 30 minutes at least. Maybe even an hour.
Were people going to the doctor and ER less before covid? As employers move to offer only high deductible health insurance, the cost to see a doctor is increasing quickly. When a single doctor visit can cost from $150 to $1500 depending on what they talk about and you're paying that entire amount, one tends to put of seeing a doctor unless it's a true emergency.
It'd be interesting if the quarantine from the coronavirus has also quarantined us from the ravages and stresses of day to day life, leading to improved cardiovascular outcomes.
I'd be curious about suicide statistics as well--would they be going up or down right now?
Anecdotally, I feel like stress has gone way up for most people, not down. Not sure it's that's true or not on the larger scale, but it definitely seems true for me and most of the people I know.
It's early days, but I suspect suicides will approach actual COVID-19 deaths in the end, at least in places and cultures where suicide is "acceptable". Even the most stable will have trouble with financial ruin and watching their children go hungry, and most of the newly jobless are not that stable.
if you go to the ER, is it still the case you could up alone in the hospital without ever seeing a family member? and possibly die alone?
i wonder if a “bad death” is also a deterrent if you thought you were dying. or if emergencies don’t come with those kinds of calculations. not sure if/why covid calculation would be any more likely, though.
Maybe working from home is just less stressful. Or, maybe they are finally getting time to exercise, thus putting of the strokes (I don't know if exercise will put off a stroke, but maybe). I know I see a magnitude more people around my neighborhood out walking, jogging, etc. than I ever saw before.
If CoViD-19 turns out to primarily be a pathogen that most negatively affects people with CardioVascular Disease then the short answer is, they're probably already dead.
(CVD - CVD, uncanny coincidence?)
guscost|5 years ago
https://www.washingtonpost.com/health/patients-with-heart-at...
> The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” 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, through telemedicine when practical: “Hospitals have safety measures to protect you from infection,” it reads.
> “The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.”
> There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”
mrfusion|5 years ago
If they gave people accurate statistics they could make an informed decision whether they want to go to a hospital.
mirimir|5 years ago
Even so, medical systems and coroners ought to be archiving samples for testing. Eventually there'll be adequate RNA and antibody testing capabilities. Without that data, we won't know what happened.
Guest42|5 years ago
seibelj|5 years ago
unknown|5 years ago
[deleted]
calibas|5 years ago
downerending|5 years ago
Some of this is inevitable. Some of this is due to economic lockdown, which will simply crush third-world economies.
aluminussoma|5 years ago
I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go.
The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen.
Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place.
Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.
brianwawok|5 years ago
sushid|5 years ago
SkyPuncher|5 years ago
The amount of non-emergencies the ER department sees is astounding.
treeman79|5 years ago
Kept avoiding ER, I felt bad wasting time. Plus money.
Finally went in and they ran an extra test and found the issue. Probably had seen 30 doctors during all of this.
Some of the doctors were amazed I hadn’t dropped dead yet.
lonelappde|5 years ago
> One study collected data from nine hospitals across the country, focusing on a crucial procedure used to reopen a blocked cardiac artery after a heart attack. The hospitals performed 38% fewer of those procedures in March, compared with previous months.
> At Harborview Medical Center in Seattle, Dr. Malveeka Sharma has tracked a 60% decline in stroke admissions in the first half of April compared with the previous year
guscost|5 years ago
> MUSC, a major stroke center, averaged 550 calls per month over the past four months about possible stroke patients from the 45 to 50 emergency rooms that refer patients. But it has seen just 100 in the first half of April, said Alex Spiotta, director of neurovascular surgery.
This is not just happening at ERs, this is happening at the places ERs will refer you to, usually after checking whether you do in fact need immediate care.
abalone|5 years ago
JJMcJ|5 years ago
Not giving details, but he turned out to be just fine.
jungletime|5 years ago
One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related.
"The third-leading cause of death in US most doctors don’t want you to know about"
https://www.cnbc.com/2018/02/22/medical-errors-third-leading...
"Why Do Patients Stop Dying When Doctors Go on Strike?"
https://www.psychologytoday.com/ca/blog/slightly-blighty/201...
My personal take on this based on statistics and observation is that many medical procedures are not very effective.
Or trade short term risk, for long term benefit. Eg. Those that survive a bypass surgery may live longer. But it will shorten the life of those that it kills. Chemo therapy can kill you immediately, but if you survive the procedure, it may have also killed the cancer that then will increase your life expectancy.
I also think many medical procedures are not really changing the course of the disease. And being in a hospital is inherently risky. You are exposing yourself to other very sick people, and possible human errors in treatment.
ITs easy to fool yourself into thinking that what you are doing is having an effect. Consider the thousands of football fans in stadiums thinking they are changing the course of the game with cheering or booing.
tmh79|5 years ago
WalterSear|5 years ago
furyofantares|5 years ago
And I hope to someday live in a world where medical error is the #1 cause of death. I hope we also focus on quality of life and not just quantity -- but if medicine seeks to continue extending life then the success case is that error is essentially the only cause of death. Those articles, and especially their headlines, are sensational and misleading.
subsubzero|5 years ago
umvi|5 years ago
6nf|5 years ago
In New South Wales, Australia the medical sector had 1000 ICU bed capacity in January. When covid hit, it was rapidly expanded and currently over 2000 ICU beds are available.
At the same time all elective surgeries got banned (e.g. hip replacements etc) because some of those would end up in ICU.
At the peak of the outbreak NSW used 100 of those 2000 beds. Currently only about two dozen ICU beds are occupied. About 1% of capacity.
pmiller2|5 years ago
rconti|5 years ago
So, generally, they're less busy than normal.
The problem with opening back up is, we've already seen the growth curve, and that was 2 months ago.
What happens when you multiple that same growth rate against a much higher baseline number of infected people?
fzeroracer|5 years ago
As for the article itself: Reopening the country wouldn't fix that either because it's a catch-22 situation. The people most at risk of dying from COVID-19 don't want to go to the hospital because of the risk. So they put off emergencies until it's too late. You don't solve this problem by reopening the country because the fear and the risk for said people is still there.
My parents are a great example. They have breathing issues which makes them especially at risk. They're afraid of getting routine tests done because catching the coronavirus could be very deadly.
trhway|5 years ago
Some other factors to consider - much cleaner air these days, no traffic/noise/rush and associated stress, and you can even hear birds singing through the day. Personally i find it very relaxing to not spend the days in our tightly packed badly air-conditioned to the point of serious sweating (our BigCo. is very big about its "green" energy saving chops) horrendously lit (those lights burn the eyes and make bright spot reflections on monitor, and the half-transparent blinds kill when afternoon Sun gets into those windows) "collaboration and communication stimulating" (read - very stressful) very modern open floor office.
koffiezet|5 years ago
This is also something you see in statistics, that after any large flu epidemic, the general population mortality figure drops to something significantly below average, especially for people in the 65+ age group.
You can see this very well on EuroMOMO [1] - check out the numbers for the Netherlands in 2018 from week 10 throughout 13. This is a flu epidemic there, and the aftermath.
[1] https://www.euromomo.eu/graphs-and-maps/
Animats|5 years ago
Stanford was prepared for a huge influx of coronavirus patients, but they only have 20-30 in the hospital. This despite a steadily climbing death toll. My own GP says, if you get it, go to Stanford; they have the investigational drugs, and they're not overloaded.
Nationally, the US death toll continues to climb. Currently somewhere between 69,000 and 74,000, depending on the source. The SF Bay Area's shelter-in-place thing seems to have helped. We need to get more people wearing masks, though. Seeing too many people without masks. More of the good masks, too. You really need N95 or ASTM Level 3 masks to protect yourself; the cheapies only protect other people. That only works if almost everybody wears the things.
What's happening outside the US? The Financial Times tracker, which has been updated every day for months, shows the US death rate flat. Most other countries have peaked and decreased substantially.[2]
[1] https://www.mercurynews.com/2020/04/27/coronavirus-14000-sta...
[2] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cum...
drtillberg|5 years ago
_bxg1|5 years ago
dade_|5 years ago
chapium|5 years ago
https://www.theladders.com/career-advice/38-of-new-yorkers-a...
JackFr|5 years ago
sacks2k|5 years ago
newacct583|5 years ago
34679|5 years ago
https://www.sciencedirect.com/science/article/pii/S003537871...
"In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks.
Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement."
https://www.heart.org/en/health-topics/consumer-healthcare/w...
xenonite|5 years ago
sdan|5 years ago
elliekelly|5 years ago
bryan11|5 years ago
scarmig|5 years ago
I'd be curious about suicide statistics as well--would they be going up or down right now?
Trasmatta|5 years ago
6nf|5 years ago
exmadscientist|5 years ago
This lockdown is very hard on many people's mental health.
downerending|5 years ago
diN0bot|5 years ago
i wonder if a “bad death” is also a deterrent if you thought you were dying. or if emergencies don’t come with those kinds of calculations. not sure if/why covid calculation would be any more likely, though.
olalonde|5 years ago
thinkingemote|5 years ago
irrational|5 years ago
lsaac|5 years ago
> "They still want patients to avoid hospitals yet not hesitate to go if there are signs of an emergency"
doggydogs94|5 years ago
unknown|5 years ago
[deleted]
unknown|5 years ago
[deleted]
krtong|5 years ago
[deleted]
arkh|5 years ago
More like one of the tragedies of fearmongering.
anonAndOn|5 years ago