June 25 2020
"Eureka" εὕρηκα, ancient Greek "I have found (it)."
The exclamation "Eureka!" is attributed to the ancient Greek scholar Archimedes. He reportedly proclaimed, "Eureka! Eureka!" after he had stepped into a bath and noticed that the water level rose, he suddenly understood that the amount of water displaced must be equal to the part of his body he had submerged. He then realized that this allows measuring the volume of irregular objects with precision, a previously intractable problem. He is said to have been so eager to share his discovery that he leaped out of his bathtub and ran naked through the streets of Syracuse.
We can exclaim, "Eureka! We found missing heart attack patients!". At least the ones who went missing in New York City. I do not advise running naked through the city, although, even in this time of tolerance to everyone and everything. The news is no reason for the celebration!
On June 19, JAMA Cardiology published an original investigation titled "Characteristics Associated With Out-of-Hospital Cardiac Arrest and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City." The study included 5325 patients with out-of-hospital cardiac arrests. It excluded traumatic cardiac arrests.
Are you sitting?
The study found that the number of patients undergoing resuscitation was three-fold higher during the 2020 COVID-19 epidemic compared with 2019. From March 1 to April 25 of 2020, New York City reported 17,118 COVID-19 related deaths. On April 6, 2020, out-of-hospital cardiac arrests picked at 305 cases - nearly a ten-fold increase from the prior year.
The odds of finding a patient with a heart in asystole (with no heart contractions) increased 3.5 times, the same as the odds of finding a patient without a pulse, but with some electrical heart activity. The probability of the resumption of spontaneous circulation reduced from approximately 35% to 18%, while the likelihood of a return to sustained spontaneous circulation reduced from 25% to 10%!
The number of traumatic cardiac arrests was similar between two periods: 42 versus 43, respectively, despite the apparent reduction of traffic and self-isolation.
Are you still sitting?
The out-of-hospital fatality rate exceeded 90%!
What is the fatality rate from Covid-19? Please tell me the highest one you've heard. The most aggressive doomsayers expected it to be 10%, but the most recent data indicate that this is well below 1% and may be as low as 0.1%.
In Northern Italy, the increase was lower, just "meager" 58%. Italy had a rise in out-of-hospital mortality from 67.3% to 82.2% and an increase of initial non-shockable rhythms from 83% to 90%.
The source of data was the New York 911 EMS system, which is the largest in the United States. It serves a population of more than 8.4 million and responds to more than 1.5 million medical calls annually. The study only included those who received EMS resuscitation. In plain English, if someone is found dead or pronounced dead on the scene before paramedics arrived and attempted resuscitation, he would not make a "cut." We have yet to find out how many unfortunate patients did not make the statistics.
The authors point out that postmortem testing to confirm COVID-19 was rare but shied away from how often it occurred. May be never? Therefore they cannot determine if COVID-19 played a role, directly or indirectly. They admit that, ultimately, autopsies are required to determine the proportion of out-of-hospital cardiac arrest and deaths related to COVID-19. Despite that, the article contains a thinly veiled statement that COVID-19 played a direct role in the observed increase. The opposite conclusion would be politically incorrect.
The authors acknowledge that the increase in out-of-hospital cardiac arrests and resulting deaths may be related to:
hesitancy or delay in seeking care during the epidemic;
fear of contracting infection;
poor management of chronic conditions;
difficulty making doctor appointments;
moratorium on "elective care";
noncompliance with life-style recommendations and medication regimen;
lack of care access due to the absence of insurance;
inability to get to a doctor or hospital on time.
This tragedy has been happening while hospitals cut emergency room services, laid-off emergency room physicians and other staff, and decreased medical personnel compensation. All over the world, most hospitals stayed half empty.
The truth will come out sooner rather than later but do not hold your breath, hoping that anyone will punish those responsible for this disaster.
We already know that it is ok to riot, loot, topple statues, damage property, attack and even kill police, and kill innocent bystanders.
Or is it?
What would Archimedes say? Search streets and houses to find missing lives. The system spilled them like water and let them "dry."