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CDC–MMWR report shows a 23% drop in ED visits for symptoms of MI and 20% fall for symptoms of CVA during early weeks of COVID-19 pandemic; more than 60,000 excess deaths in US have not been explained…

2020-07-02

(Figure 1 from CDC article about reduction in ED visits)

The Centers for Disease Control published a study online on June 22 showing a 23% reduction in emergency department (ED) visits for myocardial infarction (MI–heart attack) and a 20% drop in cerebrovascular accident (CVA–stroke) related ED visits during the early weeks of the declared pandemic.  ED visits for hyperglycemia and ketoacidosis only fell by 10% in the same period.  See the above figure, showing a precipitous drop.

Other sources have reported larger decreases, as the study states:

For example, a study of nine high-volume U.S. cardiac catheterization laboratories found a 38% decrease in activations for heart attacks during March 2020 compared with the 14 months before the pandemic (2). Further, large hospital systems in California, Massachusetts, and New York City have reported 43%–50% reductions in admissions for MI and other acute cardiovascular conditions during the pandemic (35), and neuroimaging data from approximately 850 U.S. hospitals indicate a 39% reduction in the number of patients who were evaluated for signs of stroke

The smaller drops reported in this study were not explained.  They might reflect differences in how the data is reported; the CDC study used a system-wide automatic report that covered 73% of all ED visits in the US.  The hospital systems that reported large drops were in areas hard hit by the pandemic, while the CDC sources cover most of the US, including areas little affected in the early weeks of the pandemic.

The CDC study suggests that a large part of the increase in deaths not related to positive tests for COVID-19 were due to patients not reporting to the ED for symptoms of stroke or heart attack and thus dying at home.  This is a sad reflection upon the fear and panic caused by news of the virus that prevents patients who may need life-saving care from accessing it.  Patients with hyperglycemia are driven by the numbers they see on their home glucose testing machines and thus forced to respond.

Patients with symptoms of chest pain or sudden weakness have no objective means of determining that they face a life-threatening situation.  Their response in the face of virus fear is to minimize or deny their symptoms and die at home as a result.  Those who did not perish likely face increased disability due to lack of treatment.  One long-term consequence of untreated MI is loss of heart muscle and subsequent congestive heart failure or at least reduced exercise tolerance.

The CDC article states:

Communication from public health and health care professionals should reinforce the importance of timely care for acute health conditions and assure the public that EDs are implementing infection prevention and control guidelines to ensure the safety of patients and health care personnel.

In a separate study and data analysis, the CDC reported (as of July 1) that an estimate of between 20,000 and 49,000 excess deaths were seen between February 1 and the present, not caused directly by the virus.

The Journal of the American Medical Association on July 1 published an estimate indicating that, during the first eight weeks of the pandemic, only 2/3 of the excess deaths in the US could be attributed directly to the virus.  The rest were either due to lack of medical treatment for other conditions or to deaths that could have been attributed to the virus if sufficient information had been available (such as a test for the virus.)   Between March 1 and April 25, of the deaths reported, “87 001 (95% CI, 86 578-87 423) were excess deaths, of which 56 246 (65%) were attributed to COVID-19.”  That means that about 30,000 deaths in the US in those 8 weeks were unexplained.

The Washington Post analysis published July 2 shows an excess of 8,300 deaths due to heart disease in March, April, and May in the five hardest-hit states plus New York City– an increase of roughly 27% over historical averages.  The five states– Illinois, Massachusetts, Michigan, New Jersey, and New York state and the city– had 17,000 deaths more than the number officially attributed to COVID-19, out of a total of 75,000 excess deaths.

If you add up those numbers and extrapolate for March 1 through July 1, there may be 60,000 deaths in the US that were not counted as directly due to COVID-19 but are in excess of historical averages.  Many of these deaths would be for untreated myocardial infarctions, but some probably are due to undiagnosed COVID-19.  The actual numbers will have to wait months or even a year for full information to filter down the system of death certificates to the CDC.

 

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