Maybe this explains why hospitals are seeing fewer heart attack patients right now

I wrote about this earlier in the context of the lower coronavirus death toll reported in New York State over the weekend. (Today’s toll was higher, unfortunately.) A cardiologist at Yale claims that he and his colleagues are seeing a strange, counterintuitive decline in the number of non-COVID emergencies at their hospitals. You wouldn’t expect heart attacks to be less likely at a time like this. You’d expect them to be more likely due to the stress of the moment plus the fact that respiratory illness can aggravate preexisting heart conditions.

The ER should be inundated with coronavirus patients *and* cardiac patients. But it isn’t. There are lots of the former lately but far fewer of the latter. What gives?

Chuck Todd aired this new data from the FDNY on his show this afternoon. The raw numbers were quoted in my earlier post but not that eye-popping percentage. It’s pretty clear from this why there aren’t as many cardiac patients for doctors to treat lately. Many of them aren’t lasting long enough to make it to the hospital.

Remember that, under new rules in NYC, a patient who can’t be revived by EMTs in their home doesn’t even get taken to the ER. They call the medical examiner to come pick up the body.

I’m tempted to blame the higher fatality rate on longer response times by EMTs as they cope with a much higher patient surge, and no doubt that’s a factor at the margins. But this story dated a few days ago claimed that the average response time to urgent calls was just 10 minutes and 7 seconds compared to seven minutes and 15 seconds last year. That difference will be fatal in some cases but I wouldn’t think it explains the difference between 72 percent and 38 percent.

What we don’t know (yet) is how many New Yorkers who are dying in their homes are dying of true cardiac issues and how many are dying from complications related to COVID-19. “In some cases, the virus caused the patient’s lungs to fill up with fluid, straining their hearts,” EMTs told the New York Daily News. “Other cases may later be linked to the stress New Yorkers are undergoing as they shelter in place, worrying about their health, families and finances as the pandemic enters its second month.” As for why they’re dying at home, I can easily imagine an older person experiencing tightness in their chest, maybe even some pain, and deciding that going to the hospital is a death sentence given the risk of infection. Better to cross their fingers, hope that the discomfort is due to heartburn or a muscle pull or some innocuous reason, and wait it out at home. Even if the pain gets worse and they ultimately end up deciding to call 911 anyway, the delay may prove fatal.

And the kicker, per this morning’s post, is that people in both categories might go uncounted in the official COVID-19 death toll. The true cardiac patient who’s afraid to go to the hospital isn’t part of the toll because he’s uninfected. And the patient with the virus won’t be counted unless he tested positive before dying or he tests positive postmortem via the medical examiner, who may not have the time or tests available to take that extra step.

Things are getting hairy outside New York too:

That doesn’t mean social distancing isn’t working, notes Nate Silver. It absolutely is working per the data showing declining rates of growth in new cases in major cities. National new case counts are beginning to flatten out, which is what we’d expect right now since we’re about two to three weeks removed from lockdown orders being issued in many states. The surge in deaths may be explained by a time lag too: If you assume three to four weeks from infection to death in a severe case then many of the people dying right now were likely infected before those lockdown orders were given. We should see deaths begin to decline soon.

Probably the biggest success story in the United States is California. You wouldn’t have expected the country’s most populous state and a major hub for traffic to and from China to have a low body count, but as of right now just 374 people have died statewide and the daily death toll has actually shrunk a bit in the last few days. The peak in California per the IHME model is expected on April 17, when 70 people are projected to die of the disease. New York registered more than 10 times that number yesterday. California officials moved quickly to shut down things down relative to New York, with the mayor of San Francisco declaring a state of emergency as far back as February 25. Gavin Newsom noted today that the state’s curve is flattening but also stretching, his hint to residents that the lower death toll doesn’t mean they’ll be back to normal anytime soon. Neither will New Yorkers, of course, and they’ll have many more victims.

I’ll leave you with this. Still not at the peak, it seems.

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