Covid 19, fewer hospitalizations and more victims of heart attacks
New GMOs, the big bluff
4 July 2020
Disability and work, meeting with the Undersecretary for Welfare
24 July 2020
The Covid-19 alarm - in putting the Italian health system is in crisis, as many others - caused a drastic increase in heart attack victims.
This phenomenon has been the subject of several studies. By the SIC, Italian Society of Cardiology. (1) And other research groups in Spain, USA, Hong Kong. (2) Studies converge in detecting the decline and delay in hospital admissions, on the one hand, and the consequent surge in mortality and other complications. A lesson to learn.
Italian Society of Cardiology, the study
The Italian Society of Cardiology he oversaw the multicenter study Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era, published on European Heart Journal. The research, conducted on 54 Italian hospitals associated with Coronary Care Unit - Academy Investigator Group, analyzed the number of hospitalizations for acute myocardial infarction (Acute myocardial infarction, AMI) in the week 12-19.3.20, immediately after the lockdown. Comparing them with those of the same week in 2019.
'While health systems together with public opinion, the media and patients were focused on the COVID-19 pandemic, a worrying reduction in hospitalizations for acute myocardial infarction was observed throughout Italy with a parallel increase in mortality rates and complications. Prompt adoption of countermeasures must be considered to avoid a long-standing and large social impact. ' (1)
Half admissions
A systematic review Italian shows how at the dawn of the pandemic hospitalizations for myocardial infarction, in the 54 hospitals analyzed, have halved (319 vs 618, -48,4%). With a homogeneous trend between the Northern, Central and Southern Regions. Although the new coronavirus from the beginning has spread mainly to the North.
'The hospitalizations for heart attack acute myocardial during the Covid 19 pandemic decreased significantly throughout Italy, with a parallel increase in mortality and complication rates. This represents a serious social problem, requiring attention from the scientific and health communities and public regulatory agencies. '
Healthcare 'non-Covid' has however run aground in the most varied contexts, as further studies will demonstrate. Discontinuity in oncological therapies, postponement of scheduled surgical interventions, blocking of most of the medical and paramedical activities considered 'not essential'.
Heart attack, mortality tripled
Mortality for heart attack in the period considered by the study (12-19.3) it more than tripled. For all types of acute myocardial infarction, from 2,8% in 2019 to 9,7% in 2020. For STEMI (ST-Elevation Myocardial Infarction), from 4,1% to 13,7%. The most serious non-fatal complications, on the other hand, almost doubled, from 10,4% to 18,8%.
Delay access to medical care increased significantly during the epidemic. Too much for these pathologies where timing is crucial. The period between the onset of symptoms and coronary angiography is extremely dilated, + 39,2%, compared to the previous year.
Women at higher risk
It is noted in addition, a gender gap, as the greatest decline in hospitalizations for heart attacks involved women. But
'The greatest reduction of STEMI admissions among women (41,2%) versus men (25,4%) extends the proportion of the problem, as the already intolerable gender gap in the treatment of AMI is further widened by this social emergency and most likely will result in a further increase in cardiovascular mortality and morbidity among women. '
More heart attacks, the possible causes
'The main result of the present study is the dramatic reduction in the number of hospitalizations for AMI throughout Italy during the COVID-19 pandemic. In fact, admissions to the AMI halved during the pandemic compared to the equivalent period of the previous year. '
Researchers Italians attribute the phenomenon in question to two main causes, among the various factors that contributed to it:
- the patients they kept away from hospitals. 'First, it is possible that the fear of contagion in the hospital has discouraged access to emergency medical services, particularly after the media spread the news that the infection had spread widely among hospitalized patients and healthcare professionals. due to the lack of personal protective equipment’,
- services sanitary ware are not functioning properly. 'A second hypothesis is related to the fact that the emergency medical system was focused on COVID-19 and that most of the health resources were transferred to manage the pandemic.'.
The critical element what emerges from the research is the failure to reach the hospital, for various reasons, by half of the patients affected by acute myocardial infarction. The significant increase in mortality and the prevalence of complications during hospitalization 'must sound like a wake-up call for health care professionals and public regulatory agencies'.
The unspoken words
Privatization and the cuts in public health - in addition to the absence of Essential Levels of Assistance worthy of the name, in the various Regions - are the macro-causes of the disaster. Shamefully to be attributed to every political part of the national scenario. From an operational point of view, however, it is useful to insert some unspoken words:
- crisis management. Organizations producing goods and providing essential services to the community must adopt, test and update emergency management procedures. Precisely to avoid being unprepared for events such as Covid-19 which, as seen, can and must be foreseen. However, the culture of crisis management escapes the majority of operators, in the public sector as well as in the private sector,
- telemedicine. It is only now being talked about in Italy, following the pandemic, while in the Democratic People's Republic of Korea over 200 medical and hospital facilities have been interconnected for a decade. Prevention medicine, tele-assistance, monitoring, timely interception of symptoms are just some of the functions that telemedicine can already perform. With a view to interconnecting territorial and specialist medicine with treatment centers.
Dario Dongo and Sabrina Bergamini
Note
(1) Salvatore De Rosa, Carmen Spaccarotella, Cristina Basso, Maria Pia Calabrò, Antonio Curcio, Pasquale Perrone Filardi, Massimo Mancone, Giuseppe Mercuro, Saverio Muscoli, Savina Nodari, Roberto Pedrinelli, Gianfranco Sinagra, Ciro Indolfi, Italian Society of Cardiology and the CCU Academy investigators group. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. European Heart Journal, Volume 41, Issue 22, 7.6.20, Pages 2083–2088, https://doi.org/10.1093/eurheartj/ehaa409
(2) Said Ashraf, Suleman Ilyas, M Chadi Alraies. Acute coronary syndrome in the time of the COVID-19 pandemic. European Heart Journal, Volume 41, Issue 22, Pages 2089–2091, https://doi.org/10.1093/eurheartj/ehaa454
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
