Disappearance and Return of Heart Attack and Stroke Patients To Emergency Departments

Where did all the patients go? This was a common refrain among emergency physicians in the spring of 2020. Research investigating the early effects of the covid-19 pandemic on heart attack, also known as myocardial infarction (or "MI") and stroke visits to emergency departments published last year verified these concerns. The question as to whether these conditions were less common during the shelter-in-place periods or were equally common but treated less often remains an open one. Regardless, healthcare providers attempted to reassure patients with any concerning symptoms not to fear going to hospitals out of a perceived risk of contracting covid-19. 

Now, the same researchers looked at whether decreased rates of treatment for MI and stroke recorded during the initial US outbreak were again noted during the covid-19 surges in late 2020, when covid-19 case numbers exceeded the early days of the pandemic. Published in JAMA, a new research letter analyzing data again from Kaiser Permanente hospitals in Northern California provides answers. Weekly rates of MI and stroke hospitalizations among adult patients were compared to pre-covid-19 rates during a similar time period in 2019. Three surge periods were identified: the previously studied spring (weeks 8-15), summer (weeks 23-30) and winter (weeks 42-52). As reported previously, rates declined during the spring period with a 41 percent drop in MI hospitalizations. In the summer and winter surges, though, no such decline was seen for patients presenting with heart attacks. When looking at stroke hospitalizations, rates declined in the spring and modestly during the summer. But by the winter surge, no declines in treatment rates were seen when compared to previous yearly trends. 

There are many possibilities for why the rebound in MI and stroke treatment rates occurred during the summer and winter surges, despite the increased number of covid-19 hospitalizations which might have scared patients out of seeking emergency care. One suggestion is patient attitudes towards the dangers of the pandemic changed. Another contributor may have been successful health system and public health campaigns that messaged the notion that seeking emergency care, even during a covid-19 surge, was safe, if PPE was used assiduously. Indeed many such campaigns focused on the importance of emergency departments in treating emergencies and the safety of patients who sought treatment. If so, the messaging worked. An alternative possibility is that people's lives during the summer and winter surges were "closer to normal" than they had been during the initial spring outbreak, meaning that some of the usual MI and stroke triggers, such as pollution and stress, were more prevalent.


The final push to reach vaccination goal in the US

It seems like every week, if not every day, there are more initiatives being announced to help reach President Biden's goal to have 70 percent of the United States' population vaccinated by July 4. 

In the past, ideas to encourage vaccination have included small business incentives, free transportation, increased public health support, and mobilization of vaccination teams to reach underserved populations, to name a few. Now, as we are exactly one month away from Biden's goal date, the administration has started its final sprint.

Announced on Wednesday, a "month of action" for June aims to incorporate public-private partnerships. For example, Anheuser-Busch has committed to "buying a round" of drinks for Americans over age 21 once the goal is met. Some national education companies have announced a provision of free childcare coverage for those being vaccinated or recovering from any related side effects, and dozens more. While it is unclear if 70 percent will be enough to reach herd immunity, or something like it, it is clear that the administration is doing whatever it can to maximize vaccine uptake. Various

  • Rapid testing highly accurate in children. Important implications for getting back to "regular life."
  • Most vulnerable saw mildest gain in vaccination rates

  • Adolescent myocarditis cases after Pfizer/BioNtech vaccination appear mild
  • Fighting to preserve telehealth in the post-pandemic era