When Justice Archie Campbell summarized the 2003 SARS crisis, he called his report Spring of Fear. Today, 17 years later, we are in a new such spring — one grounded in fear of COVID-19 but also fear of action, even in times of medical emergencies.
COVID-19 is a crisis. It merits our immediate attention, but it cannot be our only focus.
We know what happens when people do not manage existing conditions like high blood pressure – it puts them at risk for a bigger, potentially catastrophic health event such as stroke or heart attack.
Wuhan China, ground zero for COVID-19, is reporting a decrease in COVID-19 cases. Yet hospitals there are now seeing an influx of critical patients who put off seeking treatment. Patients with serious issues that could have been treated and managed are now severely ill and may have lasting disabilities that could potentially have been mitigated with timely treatment.
Serious issues become the new emergencies after the crisis has subsided. These can have an even greater long-term impact on an individual’s health and on the health system.
Cardiac centres in Ontario reveal a close to 30% reduction in emergency room visits.
Heart & Stroke and Canadian Cardiovascular Society
What was an emergency before a pandemic is still an emergency during a pandemic, yet medical colleagues across the country are reporting that case loads for stroke and cardiac patients are at worryingly low levels. In fact new data collated by Heart & Stroke and Canadian Cardiovascular Society confirm this: cardiac centres in Ontario reveal a close to 30% reduction in visits to the emergency department between March 16 to April 12 due to STEMIs (the most serious type of heart attack) compared to the same period last year. Vancouver Coastal Health has seen an approximate 40% drop in STEMI patients during a similar time period.
We are seeing reports from around the world that people are delaying or avoiding treatment for medical emergencies such as stroke and heart attacks.
A recent study out of Italy observed a 50% reduction in hospital admissions for minor stroke and transient ischemic attacks (TIA) – sometimes referred to as mini or warning strokes. The same study noted that many patients were arriving too late to be eligible for acute stroke treatment; life-saving clot busting treatment that must be administered within the first few hours of stroke onset was down 26%.
The European Stroke Organization (ESO) recently revealed that in a survey of 426 stroke care providers in 55 countries, only one in five reported stroke patients are currently receiving the usual acute and post-acute care at their hospitals. Like other organizations, ESO is perplexed by this reduction in stroke cases as there is no reason to believe that stroke incidence has declined during the pandemic.
The story is no different with heart conditions. The Journal of the American College of Cardiology reported a 38% reduction in STEMIs – a very serious type of heart attack – presenting in hospitals in the U.S. during the early days of the COVID-19 pandemic. A similar reduction – 40% – had been observed in Spain. Anecdotal reports echo this pattern in Canada.
Heart & Stroke is reminding Canadians that medical emergencies still require immediate medical attention. Anyone witnessing or experiencing signs of stroke, heart attack or cardiac arrest must call 9-1-1 (or local emergency medical services) immediately.
Fear is impacting decision-making. People are worried about adding to the burden of the healthcare system or coming into contact with the virus. This fear is amplified for those with underlying conditions who are most vulnerable. For everyone, ignoring the signs of a serious health crisis can lead to worse outcomes: greater disability or death.
The healthcare system is still in place to respond appropriately. First responders, emergency departments and hospitals have precautions in place to protect patients and staff. Heart & Stroke has released guidance on implementing evidence-based stroke care during the COVID-19 pandemic. Other groups such as the Canadian Cardiovascular Society have also updated recommendations for practitioners.
The experience and aftermath of SARS in 2003 taught us how to act during a pandemic and how to better prepare for the next one. Other pandemics like H1N1 allowed us to apply what we learned from SARS. Much of those improvements live on today and help guide us through COVID-19.
We learned other lessons during past pandemics besides how to deal with an infectious outbreak. We learned that our response to a crisis cannot happen at the expense of everything else.
We are all rightly focused on coming together to flatten the COVID-19 curve. But we also need to remember the pandemic could result in many victims who are not infected with the coronavirus: those with chronic and emergency medical conditions who did not get the attention they require.
The impact of delayed responses will create serious new strains on all sectors of the healthcare system as we try to recover from COVID and will set us back even further.
Dr. David Butler-Jones was Canada’s first Chief Public Health Officer and a recent Heart & Stroke board member. He has lived experience with stroke.
Anne Simard is Chief Mission and Research Officer at Heart & Stroke. Previously, she held leadership positions at Public Health Ontario and was part of the Ontario government's response to SARS.
This article appeared in the Winnipeg Free Press on May 6, 2020.