May 19 2020
infarction (n.)
1680s, noun of action from Latin infarcire "to stuff into," from in- "into" (from PIE root *en "in") + farcire "to stuff" (see farce)
Myocardial infarction (MI, also commonly known as a “heart attack”) became the second prominent victim of the virus, shortly after its “siamese twin” stroke! See my blog from May 12th “Stroke On Strike”. Of note, stroke is an infarction of the brain! These two diseases are the main killers of both men and women.
Today, NEJM published letter to the editor titled “The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction”.
Researchers from Kaiser Permanente - one of the largest health insurers in the United States with 21 medical centers and 255 clinics that provides comprehensive care to more than 4.4 million people in Northern California alone - looked into weekly rates of hospitalization for acute MI before and after the first reported death from COVID-19 in Northern California on March 6th of 2019. The comparison was made with incidence of hospitalization for MI from January 1st to March 3rd of 2019 and with the same period in 2019.
The study evaluated impressive 43+ million person-weeks from January 1st of 2020 through April 14th of 2020.
Are you ready? The weekly rates of hospitalization for acute MI decreased by to 48% during the Covid-19 period (see figure below). I am no prophet, but many of you I talked to remember that I predicted that heart attacks will follow the trend!
Just as authors who published the letter about decrease of referrals for neuroimaging in patients with ischemic stroke, Kaiser researches included no explanation for the findings. I guess, the explanation is too obvious…
Importantly, Kaiser looked not into a surrogate marker such as referrals for neuroimaging, but into incidence of hospitalizations, which leave no space for maneuver: if one can fantom a stroke patient who is denied neuroimaging (which is a malpractice), the hospitalization for acute MI is not optional. It is hard to imagine one being denied hospitalization for disease which can be immediately fatal.
Also, Kaiser is a very tightly run organization where members must go through their primary care physician to receive services, and, even if patient ends up in non-Kaiser hospital in a case of true emergency, he will be yanked back to Kaiser within 24-hours or less. This effectively eliminates the possibility that case of MI or any other admission will go missing from statistics unless patient pay non-Kaiser provider out-of-pocket.
I would like to ask the same questions as I did for patients with suspected stroke:
Does this mean that number of patients experiencing MI dropped 48% or heart attack patients refuse hospitalization? This is hard to believe because:
How many of us would stay home while experiencing a heart attack? Only those who are unconscious and alone, or those who would rather die from a heart attack than COVID-19. Dr. Why: It is kind of cool to be able to pick the way one dies!
How many family members seeing a loved one experiencing a heart attack would not call an ambulance? Only those who are ignorant…
How many ambulance crews would leave patient at home when a heart attack is suspected? None;
How many doctors who got a call from a patient or a family member would advise do nothing? None;
How many ER doctors and/or cardiologists would refuse to admit a patient with a heart attack? None;
Got the point?
If not, here are the explanations which come to mind:
Heart attack patients were misdiagnosed as … COVID-19;
Heart attack patients were counted as … probable COVID-19;
Heart attack patients were intentionally misclassified as … COVID-19.
Do you have a better explanation? I am eager to hear it.
The only question, who is next? I do not mean who of us is next. I mean which disease is next? I am quite confident it will be cancer.