Global Statistics

All countries
94,309,732
Confirmed
Updated on January 16, 2021 2:53 am
All countries
67,122,010
Recovered
Updated on January 16, 2021 2:53 am
All countries
2,017,798
Deaths
Updated on January 16, 2021 2:53 am

Global Statistics

All countries
94,309,732
Confirmed
Updated on January 16, 2021 2:53 am
All countries
67,122,010
Recovered
Updated on January 16, 2021 2:53 am
All countries
2,017,798
Deaths
Updated on January 16, 2021 2:53 am

Amid the Coronavirus Crisis, Heart and Stroke Patients Go Missing

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Gina Kolata

Bishnu Virachan was a bicycle deliveryman for a grocery store in Queens. With New York City locked down, he was busier than ever.

But in early April, as he was watching television, he felt “a pain in my heart.” It frightened him, but he did not go to the emergency room. Mr. Virachan, 43, was even more afraid of that.

“What can I do? What can I do?” he asked. “Everywhere, the coronavirus.”

After a few days, pain overrode fear and he went to Mount Sinai Hospital in Manhattan. Doctors discovered a nearly complete blockage of his left main coronary artery.

A surgeon opened the artery, but Mr. Virachan was left with a weakened heart. Had he waited much longer, doctors said, he would have died.

Fear of the coronavirus is leading people with life-threatening emergencies, like a heart attack or stroke, to stay home when ordinarily they would have rushed to the emergency room, preliminary research suggests. Without prompt treatment, some patients, like Mr. Virachan, have suffered permanent damage or have died.

Emergency rooms have about half the normal number of patients, and heart and stroke units are nearly empty, according to doctors at many urban medical centers. Some medical experts fear more people are dying from untreated emergencies than from the coronavirus.

A recent paper by cardiologists at nine large medical centers estimated a 38 percent reduction since March 1 in the number patients with serious heart attacks coming in to have urgently needed procedures to open their arteries.

On a recent day at the Cleveland Clinic, there were only seven patients in the 24-bed coronary care unit. Usually the unit is full.

“Where are the patients?” asked Dr. Steven Nissen, a cardiologist there. “That can’t be normal.”

One of the few was a man who lives in Cleveland. According to Dr. Nissen, the man felt chest pain while doing push-ups, but feared going to the hospital because there might be coronavirus patients there. He stayed home for a week, growing weaker — out of breath with the slightest exertion, his legs swelling. Finally, on April 16, he went to the Cleveland Clinic.

What should have been an easily treated heart attack had progressed to a life-threatening disaster. He survived after a dicey operation and spent nearly a week in intensive care, including several days on a ventilator, Dr. Nissen said.

The inpatient stroke unit at Stanford University Medical Center in California usually has 12 to 15 patients, said its director, Dr. Gregory Albers. On one recent day in April, there were none at all, something that had never happened.

“It’s frightening,” Dr. Albers said. Yet few Covid-19 patients have been admitted to the hospital, and people needing emergency treatment have little to fear.

“We prepared for an onslaught, but it has not arrived,” Dr. Albers said.

According to Dr. Samin Sharma, who heads the cardiac catheterization lab at Mount Sinai Hospital in New York, the number of heart attack patients fell from seven in February to three in March. So far in April there have been only two.

It’s not just the United States. Dr. Valentin Fuster, editor of the Journal of American College of Cardiology, said he is getting so many papers from around the world on the steep decline in heart attack patients in hospitals that he simply cannot publish them all.

A hospital in Jaipur, India, for example, that Dr. Sharma owns, treated 45 heart attack patients in January, he said. In February, there were 32, and in March, 12. In April, so far the number is just six.

“I am very very worried that we are creating a problem that will have long-term consequences for the health of the community,” said Dr. Richard A. Chazal, medical director of the Heart and Vascular Institute at Lee Health in Fort Myers, Fla., and a past president of the American College of Cardiology.

Could it be that there actually are fewer medical emergencies now? Dr. Fuster speculated that perhaps people are healthier because they are eating better, exercising more and under less stress now that so many are working from home. And, of course, the air is cleaner in urban areas.

Other experts doubt that better health habits could have such dramatic and immediate effects. Far from eating better, Dr. Nissen said, many patients tell him they are overeating comfort food. There is no evidence that people are exercising more, and people are hardly under less stress.

“They are scared to death,” Dr. Nissen said.

And, he said, even if some people changed their habits, studies have failed to find any immediate effects of short-term lifestyle changes on heart attack rates.

At the moment, it is nearly impossible to know who is not showing up in emergency rooms, and why, said Dr. Harlan Krumholz, a cardiologist at Yale University. “You can’t find the dog that doesn’t bark,” he said.

But you can get a sense from the patients who do show up, even belatedly.

Kaplana Jain, 60, of Cresskill, N.J, was watching CNN late at night on April 18. She got up to go to the bathroom and collapsed on the floor. Her blood sugar was elevated, and her family called 911.

When the paramedics arrived, Ms. Jain told them she did not want to go to the hospital. “I was scared because of the coronavirus going on,” she said.

The next day, unable to walk, she called Dr. Sharma, a family friend. He urged her to go to the hospital, but still fearful, she insisted on going to his office the next day.

When she arrived, Dr. Sharma did an EKG that confirmed she was having a heart attack. He rushed her to the hospital and opened a blocked artery.

“She is one of the lucky people with this kind of heart attack who didn’t develop cardiac arrest or go into shock,” he said. Had she not gone to the hospital, she likely would have died at home.

Back at the Cleveland Clinic, a man arrived with stroke symptoms on April 15. According to Dr. Thomas Waters, an emergency room physician, the man had waited two days to come in because he was afraid of the coronavirus. There was nothing doctors could do to prevent permanent brain damage.

“What’s done is done,” Dr. Waters said. “Now we are at a point where we have nothing to offer but rehab.”

  • Updated April 11, 2020

    • When will this end?

      This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.

    • How can I help?

      The Times Neediest Cases Fund has started a special campaign to help those who have been affected, which accepts donations here. Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)

    • What should I do if I feel sick?

      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.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting 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.

    • How do I get tested?

      If you’re sick and you think you’ve been exposed to the new coronavirus, 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 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. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.

    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and 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, 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, 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. 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?

      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. 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.”


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