9 ms·

Eerie emptiness of ERs worries doctors: where are the heart attacks and strokes?

128 points by harambaebae69 6y ago

olalonde 6y ago
This pandemic will surely produce a lot of material for economists and social scientists who study the law of unintended consequences.
- thinkingemote 6y ago
  And documentaries with titles such as The Power of Nightmares
  - deleted 6y ago
    [deleted]
deleted 6y ago
[deleted]
aluminussoma 6y ago
There is also another opinion: that many people go to the ER who don't really need to go there. I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go. The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen. Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place. Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.
- sushid 6y ago
  The article addresses this. They expect fewer trauma patients as there are fewer people on the road, etc. but they expect the number of stroke, heart attack, etc. patients to remain constant, which hasn't been the case.
  - aluminussoma 6y ago
    The article doesn't address the opinion that my doctor relative expressed: there were a lot of ER visits, not trauma related, that probably didn't need to happen.
    - empath75 6y ago
      Strokes and heart attacks don’t fall into they category.
      - jerzyt 6y ago
        Medically, they are different, but the risk factors are very similar, and I can't see why the quarantine would change the ratio of the two.
    - gknoy 6y ago
      But, of the normal ER visits, one would expect to have the same scalar number of emergency (stroke, heart attack) visits to STILL be happening, and we would expect those people to still be going to the ER. These are not "no insurance" people, they're people having an emergency situation. If we don't see them in the ER, it makes sense that they're staying home on purpose, or not handling symptoms until it's too late (?).
    - look_lookatme 6y ago
      Great that's also not the point of the article, that heart attacks and strokes aren't being seen at the same rate. Your point is orthogonal to the point of the article.
xenonite 6y ago
Of course, people hesitate to go to the doctor. But I see a second factor: Maybe it’s because of a slowing down in many regards. Hence, less stress, and less heart attacks?
- sdan 6y ago
  Fairly sure the country as a whole is more stressed. Economy and media at least portray that.
  - social_quotient 6y ago
    But fewer externalities like bars, parties, stupid accidents with friends, rushing to meetings, traffic, physical work env stress, in some cases work altogether. Not to minimize the mental torment some people feel but I think o there is a huge reduction in certain kinds of stress.
    - sdan 6y ago
      Here's some context: both you, me and a majority of HN readers have decent lives and cushy tech jobs (I'm a student and have the luxury of coding all day). Think of everyone else: those relatively regular/average people in America, the average Joe. They have bills to pay for, but living paycheck to paycheck, they can't pay any of it. So now they're seeing whats the best way to get income. Unemployment check? Website is down. Where to get food? Food banks are barely sustaining. Yes, there's definitely a reduction of stress in some areas, but I believe that thinking of everyone, I mean everyone not just in tech, makes you realize that as a whole, a lot of people are stressed out of their minds when this can end.
      - dividedbyzero 6y ago
        My mental stress level is wayyy up – but I think I still feel less stressed overall, because I get more and better exercise, I cook a lot more and that means cheaper but somewhat healthier food on a schedule that better suits me in portion sizes that I choose myself (as opposed to the guy at the cafeteria counter), I have a lot less work-related stress due to remote work (everything feels somewhat more distant), no stressful commute, more flexibility with bedtimes (which suits me as a total owl) ... there might be lots other things, lots other external stressors, hard to tell. It's at the same time nerve-shredding and very relaxing. I wouldn't be totally surprised if a lot of people were living lives so unhealthy and harmful that the current situation would end up being a net improvement in that one way, terrible as it is in lots of others.
guscost 6y ago
Dying at home, many of them. Excess mortality is way up, and it’s not all COVID-19: https://www.washingtonpost.com/health/patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals/2020/04/19/9ca3ef24-7eb4-11ea-9040-68981f488eed_story.html https://www.washingtonpost.com/health/patients-with-heart-at... > The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to call 911 for urgent care and to continue routine appointments, through telemedicine when practical: “Hospitals have safety measures to protect you from infection,” it reads. > “The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.” > There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”
- seibelj 6y ago
  Could relaxing still home and cooking your own meals reduce activity-causing heart attacks? It’s a trope in the North-East that middle aged men die shoveling snow.
  - munk-a 6y ago
    Possibly in the short term - in the long term the quarantine is likely going to increase heart disease due to people having more sedentary life styles... It's quite likely this is just a result of the math of going to a hospital shifting - a lot of folks decide not to go to the hospital with minor chest pain due to other obligations[1] and the addition of the outbreak likely adds to the reasons not to go to the hospital. 1. Don't do this, go to the hospital if you feel something different in your chest.
    - benburleson 6y ago
      This is anecdotal, but I've never seen more people out walking around town than the last couple months. Is there research showing people are more sedentary now?
trhway 6y ago
[IANAD] Diabetes, hypertension and cardiovascular issues are among the frequent issues in serious covid cases. If covid is that widespread as some studies suggests, may it be that covid triggers the hospitalization earlier than the heart attack/stroke/etc. would have happened to that person otherwise. US heart attack rate is 2K/day, ie. on a scale of covid deaths and significantly less than covid hospitalizations. Some other factors to consider - much cleaner air these days, no traffic/noise/rush and associated stress, and you can even hear birds singing through the day. Personally i find it very relaxing to not spend the days in our tightly packed badly air-conditioned to the point of serious sweating (our BigCo. is very big about its "green" energy saving chops) horrendously lit (those lights burn the eyes and make bright spot reflections on monitor, and the half-transparent blinds kill when afternoon Sun gets into those windows) "collaboration and communication stimulating" (read - very stressful) very modern open floor office.
- koffiezet 6y ago
  I would assume indeed that your first point is the most important-one: people already in bad health, susceptible to heart attacks and strokes also have a much higher chance of getting seriously affected by covid with fatal consequences in the first place. This is also something you see in statistics, that after any large flu epidemic, the general population mortality figure drops to something significantly below average, especially for people in the 65+ age group. You can see this very well on EuroMOMO [1] - check out the numbers for the Netherlands in 2018 from week 10 throughout 13. This is a flu epidemic there, and the aftermath. [1] https://www.euromomo.eu/graphs-and-maps/ https://www.euromomo.eu/graphs-and-maps/
scarmig 6y ago
It'd be interesting if the quarantine from the coronavirus has also quarantined us from the ravages and stresses of day to day life, leading to improved cardiovascular outcomes. I'd be curious about suicide statistics as well--would they be going up or down right now?
- exmadscientist 6y ago
  Suicides are definitely up, though I haven't been able to find numbers. This lockdown is very hard on many people's mental health.
- Trasmatta 6y ago
  Anecdotally, I feel like stress has gone way up for most people, not down. Not sure it's that's true or not on the larger scale, but it definitely seems true for me and most of the people I know.
  - scarmig 6y ago
    Interesting. For me, it's involved a sharp decrease in stress, though that's overlapped with quitting my job and having a substantial financial cushion.
    - Trasmatta 6y ago
      That's a pretty rare situation to be in.
    - 6nf 6y ago
      Millions of people are out of a job and nobody is hiring. You have to recognise that your situation is much more fortunate than most.
- 6nf 6y ago
  Suicide helpline calls are up about 50% from early reports.
- downerending 6y ago
deleted 6y ago
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jungletime 6y ago
Doctors in California went on strike and mortality dropped. One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related. "The third-leading cause of death in US most doctors don’t want you to know about" https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html https://www.cnbc.com/2018/02/22/medical-errors-third-leading... "Why Do Patients Stop Dying When Doctors Go on Strike?" https://www.psychologytoday.com/ca/blog/slightly-blighty/201510/why-do-patients-stop-dying-when-doctors-go-strike https://www.psychologytoday.com/ca/blog/slightly-blighty/201... My personal take on this based on statistics and observation is that many medical procedures are not very effective. Or trade short term risk, for long term benefit. Eg. Those that survive a bypass surgery may live longer. But it will shorten the life of those that it kills. Chemo therapy can kill you immediately, but if you survive the procedure, it may have also killed the cancer that then will increase your life expectancy. I also think many medical procedures are not really changing the course of the disease. And being in a hospital is inherently risky. You are exposing yourself to other very sick people, and possible human errors in treatment. ITs easy to fool yourself into thinking that what you are doing is having an effect. Consider the thousands of football fans in stadiums thinking they are changing the course of the game with cheering or booing.
- WalterSear 6y ago
  If you have an accident in a hospital they don't send you to the ER department.
- tmh79 6y ago
  IMO, there is a lot of hocus pocus going on in the "medical error is the 3rd leading cause of death" statistic, and the case they chose to highlight is extremely atypical. The vast majority of health care spending and the vast majority of medical resources are spent on old people in their last 18 months of life. Most deaths due to medical error are very old people undergoing risky and invasive surgeries they demand to have and are unlikely to have a great outcome in, not children. How much of the blame should be placed on the doctor when the patient is 80+ years old, has comorbidities, has been counseled on the risks, and wants to proceed with treatment? Bypass surgery is quite effective on someone younger than 60 who is also put on a diet and exercise regimen, and doesn't have diabetes. Bypass surgery is not effective for someone over 60 who is obese and has diabetes and will not change their diet habits.
dade_ 6y ago
Cars kill us: Far fewer car crashes, more sleep as no need to commute so early in the morning, no horrible drive into the office screaming and honking at the idiot driver, no horrible drive home while texting. Alcohol kills us: no drunk fights at bars, drunk driving, falling in front of moving vehicles. Not saying it explains it, but a lot of people get hurt and die for stupid reasons.
- chapium 6y ago
  I don't know if you are in on this, but... https://www.theladders.com/career-advice/38-of-new-yorkers-are-drinking-while-working-remotely https://www.theladders.com/career-advice/38-of-new-yorkers-a...
  - drdeadringer 6y ago
    Then they're "just" pickling their liver at home instead of also getting into fights at bars, driving drunk, and falling down in front of moving vehicles on top of that.
- JackFr 6y ago
  The article focuses on strokes and heart attacks which presumably should remain constant.
  - mmortal03 6y ago
    It wouldn't reduce all of the incidents, but heart attack risk is higher in those who don't get enough sleep, so he's not wrong on that, if people are getting more sleep at the moment.
arkh 6y ago
> That's really one of the tragedies of COVID-19 More like one of the tragedies of fearmongering.
drtillberg 6y ago
Don't discount the impact of reduction of air pollution on all causes of mortality. It's not often discussed, but every so often someone makes the connection between small particulates and heart attacks, etc.
- _bxg1 6y ago
  Pretty sure any impact from that would be a very long-term thing. A lifetime without particulates might have an effect; a month seems pretty far-fetched.
  - pmorici 6y ago
    Why do you think that the effect is only long term exposure?
    - _bxg1 6y ago
      Seems like a pretty subtle and non-acute thing. Maybe even analogous to smoking: something that gradually erodes your health, not something that suddenly kills you.
      - loopz 6y ago
        https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/health-risks-of-smoking-tobacco.html https://www.cancer.org/cancer/cancer-causes/tobacco-and-canc... Risks are generally thought to be immediate, but very low.
      - pmorici 6y ago
        I would tend to think there is both long term damage and chance of increased immediate death due to things like asthma and heart attack triggered by polluted air.
  - 34679 6y ago
    "In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks. Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement." https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/air-pollution-and-heart-disease-stroke https://www.heart.org/en/health-topics/consumer-healthcare/w...
umvi 6y ago
Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well. What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).
- pmiller2 6y ago
  No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.
  - manigandham 6y ago
    Why do cases matter? It should be the death rate that peaks, and that's measurable without testing. In fact it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.
    - pmiller2 6y ago
      Death rate is the proxy for cases. What matters when attempting to contain the disease is prevalence of the disease.
      - jfnixon 6y ago
        I think this is backwards. We have been using infection rates as a proxy for death rates, since deaths are a lagging indicator. It is certain we are missing a huge percentage of cases, and expanding testing will uncover those. It is completely unclear that uncovering more mild and asymptomatic cases will result in more deaths, so new cases are a bad proxy for future deaths.
sacks2k 6y ago
People are staying home and dying. This is one of the major trade offs no government official is talking about regarding re-opening the economy.
- newacct583 6y ago
  How is that related to the lockdown? Hospitals are open. People are staying home because they're scared of getting sick, that's not something that can be fixed by public policy.
  - sacks2k 6y ago
    "fixed by public policy" Public policy right now is to stay home or die of Covid 19. Many people are scared to even go outside or go to a hospital if they don't have the virus. Starting to open businesses again and requiring social distancing would definitely help with the fear and more people would actually go to the hospital for non-covid health issues.
    - newacct583 6y ago
      I don't follow that. Can you walk me through how making people go to work is going to make them less afraid? You make people less afraid by reducing the risk they'll get sick, not increasing it. Releasing lockdowns before the pandemic is controlled increases risk, by definition. This is the big flaw with the "open up" notion: it fundamentally won't work anyway. How is "opening up" the economy going to help Jet Blue when no one is willing to fly? Who is expected to fill those movie theaters and sports arenas? Who's going to sit in a crowded restaurant? At best, opening up will get us a half-alive economy. And at the price of a much longer time until a true recovery starts. Stay home. We can beat this. The regions that started lockdowns early (c.f. Europe, New York, the west coast) are well on their way to containment. It's the "open up" regions and the ones with partial lockdowns[1] that are the stragglers. [1] I make this point every time it comes up: but for goodness sake something needs to happen in Nebraska. It's right on the cusp of exploding into a worst-than-NY disaster and no one is talking about it.
diN0bot 6y ago
if you go to the ER, is it still the case you could up alone in the hospital without ever seeing a family member? and possibly die alone? i wonder if a “bad death” is also a deterrent if you thought you were dying. or if emergencies don’t come with those kinds of calculations. not sure if/why covid calculation would be any more likely, though.
anonAndOn 6y ago
If CoViD-19 turns out to primarily be a pathogen that most negatively affects people with CardioVascular Disease then the short answer is, they're probably already dead. (CVD - CVD, uncanny coincidence?)
34679 6y ago
"Air pollution, of which whose small particulate matter are the most toxic, contributes to about one-third of the global burden of stroke." https://www.sciencedirect.com/science/article/pii/S0035378718309767 https://www.sciencedirect.com/science/article/pii/S003537871... "In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks. Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement." https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/air-pollution-and-heart-disease-stroke https://www.heart.org/en/health-topics/consumer-healthcare/w...
subsubzero 6y ago
This is really frustrating, as we were told over and over again from the media of this huge surge of cases that would overload hospitals. Stay away from the hospital we were told over and over, the "worried well" are overloading our medical system and its professionals. Well guess what, people did just that, they avoided the hospitals to allow for a surge. That's why these hospitals are ghost towns now. I had a tele-visit with my physician and he said both covid cases and visits themselves in his location have dropped off a cliff in recent weeks(sfbay area location). The tents they erected in the hospital parking lot to treat the legions of sick are being taken down at another hospital in San Jose. A friend who worked in radiology is now on partial furlough due to such low patient counts(Stanford, Palo Alto) so I guess this avalanche of cases never materialized at least not in the bay area(NY is a different story).
krtong 6y ago
What if there was an actual decrease in heart attacks and strokes because of the change in lifestyle during lockdown?
Animats 6y ago
Yes, Stanford Hospitals actually sent about 20% of their staff home.[1] Stanford was prepared for a huge influx of coronavirus patients, but they only have 20-30 in the hospital. This despite a steadily climbing death toll. My own GP says, if you get it, go to Stanford; they have the investigational drugs, and they're not overloaded. Nationally, the US death toll continues to climb. Currently somewhere between 69,000 and 74,000, depending on the source. The SF Bay Area's shelter-in-place thing seems to have helped. We need to get more people wearing masks, though. Seeing too many people without masks. More of the good masks, too. You really need N95 or ASTM Level 3 masks to protect yourself; the cheapies only protect other people. That only works if almost everybody wears the things. What's happening outside the US? The Financial Times tracker, which has been updated every day for months, shows the US death rate flat. Most other countries have peaked and decreased substantially.[2] [1] https://www.mercurynews.com/2020/04/27/coronavirus-14000-stanford-health-care-workers-hit-with-furloughs-pay-cuts/ https://www.mercurynews.com/2020/04/27/coronavirus-14000-sta... [2] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cumulative=0&logScale=0&perMillion=1&values=deaths https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cum...
lsaac 6y ago
Best quote: > "They still want patients to avoid hospitals yet not hesitate to go if there are signs of an emergency"
doggydogs94 6y ago
In other words, all of the Covid emergency is not happening.
irrational 6y ago
Maybe working from home is just less stressful. Or, maybe they are finally getting time to exercise, thus putting of the strokes (I don't know if exercise will put off a stroke, but maybe). I know I see a magnitude more people around my neighborhood out walking, jogging, etc. than I ever saw before.

128 points by harambaebae69 6y ago

This pandemic will surely produce a lot of material for economists and social scientists who study the law of unintended consequences.

thinkingemote 6y ago
And documentaries with titles such as The Power of Nightmares
- deleted 6y ago
  [deleted]

deleted 6y ago

[deleted]

aluminussoma 6y ago

There is also another opinion: that many people go to the ER who don't really need to go there. I had to visit the ER recently. I did not want to go but my doctor insisted. A family member who is also a doctor also insisted I go. The ER was eerily empty. The ER doctor saw me immediately. There were only a couple of other patients that I could see. This contrasts to prior experiences in the ER where there is a long wait as I get triaged, with lots of people waiting to be seen. Fortunately my situation was nothing serious. When I returned home and told my relative, he said his hospital's emergency department was also very light. In his opinion, there were a lot of people going to the ER who didn't need to go in the first place. Edit: I am referring to non-trauma related admissions to the ER. E.g. I have a headache and I am going to the ER to be seen now.

sushid 6y ago
The article addresses this. They expect fewer trauma patients as there are fewer people on the road, etc. but they expect the number of stroke, heart attack, etc. patients to remain constant, which hasn't been the case.
- aluminussoma 6y ago
  The article doesn't address the opinion that my doctor relative expressed: there were a lot of ER visits, not trauma related, that probably didn't need to happen.
  - empath75 6y ago
    Strokes and heart attacks don’t fall into they category.
    - jerzyt 6y ago
      Medically, they are different, but the risk factors are very similar, and I can't see why the quarantine would change the ratio of the two.
  - gknoy 6y ago
    But, of the normal ER visits, one would expect to have the same scalar number of emergency (stroke, heart attack) visits to STILL be happening, and we would expect those people to still be going to the ER. These are not "no insurance" people, they're people having an emergency situation. If we don't see them in the ER, it makes sense that they're staying home on purpose, or not handling symptoms until it's too late (?).
  - look_lookatme 6y ago
    Great that's also not the point of the article, that heart attacks and strokes aren't being seen at the same rate. Your point is orthogonal to the point of the article.

xenonite 6y ago

Of course, people hesitate to go to the doctor. But I see a second factor: Maybe it’s because of a slowing down in many regards. Hence, less stress, and less heart attacks?

sdan 6y ago
Fairly sure the country as a whole is more stressed. Economy and media at least portray that.
- social_quotient 6y ago
  But fewer externalities like bars, parties, stupid accidents with friends, rushing to meetings, traffic, physical work env stress, in some cases work altogether. Not to minimize the mental torment some people feel but I think o there is a huge reduction in certain kinds of stress.
  - sdan 6y ago
    Here's some context: both you, me and a majority of HN readers have decent lives and cushy tech jobs (I'm a student and have the luxury of coding all day). Think of everyone else: those relatively regular/average people in America, the average Joe. They have bills to pay for, but living paycheck to paycheck, they can't pay any of it. So now they're seeing whats the best way to get income. Unemployment check? Website is down. Where to get food? Food banks are barely sustaining. Yes, there's definitely a reduction of stress in some areas, but I believe that thinking of everyone, I mean everyone not just in tech, makes you realize that as a whole, a lot of people are stressed out of their minds when this can end.
    - dividedbyzero 6y ago
      My mental stress level is wayyy up – but I think I still feel less stressed overall, because I get more and better exercise, I cook a lot more and that means cheaper but somewhat healthier food on a schedule that better suits me in portion sizes that I choose myself (as opposed to the guy at the cafeteria counter), I have a lot less work-related stress due to remote work (everything feels somewhat more distant), no stressful commute, more flexibility with bedtimes (which suits me as a total owl) ... there might be lots other things, lots other external stressors, hard to tell. It's at the same time nerve-shredding and very relaxing. I wouldn't be totally surprised if a lot of people were living lives so unhealthy and harmful that the current situation would end up being a net improvement in that one way, terrible as it is in lots of others.

guscost 6y ago

Dying at home, many of them. Excess mortality is way up, and it’s not all COVID-19: https://www.washingtonpost.com/health/patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals/2020/04/19/9ca3ef24-7eb4-11ea-9040-68981f488eed_story.html https://www.washingtonpost.com/health/patients-with-heart-at... > The possibility that patients may be suffering — and even dying — at home rather than going to a hospital led the American College of Cardiology to launch a “Cardiosmart” campaign last week, attempting to reassure a wary population and encourage those with symptoms to call 911 for urgent care and to continue routine appointments, through telemedicine when practical: “Hospitals have safety measures to protect you from infection,” it reads. > “The emphasis here is safety,” said Harlan Krumholz, a cardiologist and health care researcher at Yale University and Yale New Haven Hospital, who advised on the campaign. “We want to make sure preventable deaths aren’t happening.” > There is no pill, no action, no behavior, he said, that could account for the almost 40 percent drop in STEMI patients. “We don’t have a means to cut your risk in half,” he said. “Not even primary angioplasty or stopping smoking.”

seibelj 6y ago
Could relaxing still home and cooking your own meals reduce activity-causing heart attacks? It’s a trope in the North-East that middle aged men die shoveling snow.
- munk-a 6y ago
  Possibly in the short term - in the long term the quarantine is likely going to increase heart disease due to people having more sedentary life styles... It's quite likely this is just a result of the math of going to a hospital shifting - a lot of folks decide not to go to the hospital with minor chest pain due to other obligations[1] and the addition of the outbreak likely adds to the reasons not to go to the hospital. 1. Don't do this, go to the hospital if you feel something different in your chest.
  - benburleson 6y ago
    This is anecdotal, but I've never seen more people out walking around town than the last couple months. Is there research showing people are more sedentary now?

trhway 6y ago

[IANAD] Diabetes, hypertension and cardiovascular issues are among the frequent issues in serious covid cases. If covid is that widespread as some studies suggests, may it be that covid triggers the hospitalization earlier than the heart attack/stroke/etc. would have happened to that person otherwise. US heart attack rate is 2K/day, ie. on a scale of covid deaths and significantly less than covid hospitalizations. Some other factors to consider - much cleaner air these days, no traffic/noise/rush and associated stress, and you can even hear birds singing through the day. Personally i find it very relaxing to not spend the days in our tightly packed badly air-conditioned to the point of serious sweating (our BigCo. is very big about its "green" energy saving chops) horrendously lit (those lights burn the eyes and make bright spot reflections on monitor, and the half-transparent blinds kill when afternoon Sun gets into those windows) "collaboration and communication stimulating" (read - very stressful) very modern open floor office.

koffiezet 6y ago
I would assume indeed that your first point is the most important-one: people already in bad health, susceptible to heart attacks and strokes also have a much higher chance of getting seriously affected by covid with fatal consequences in the first place. This is also something you see in statistics, that after any large flu epidemic, the general population mortality figure drops to something significantly below average, especially for people in the 65+ age group. You can see this very well on EuroMOMO [1] - check out the numbers for the Netherlands in 2018 from week 10 throughout 13. This is a flu epidemic there, and the aftermath. [1] https://www.euromomo.eu/graphs-and-maps/ https://www.euromomo.eu/graphs-and-maps/

scarmig 6y ago

It'd be interesting if the quarantine from the coronavirus has also quarantined us from the ravages and stresses of day to day life, leading to improved cardiovascular outcomes. I'd be curious about suicide statistics as well--would they be going up or down right now?

exmadscientist 6y ago
Suicides are definitely up, though I haven't been able to find numbers. This lockdown is very hard on many people's mental health.
Trasmatta 6y ago
Anecdotally, I feel like stress has gone way up for most people, not down. Not sure it's that's true or not on the larger scale, but it definitely seems true for me and most of the people I know.
- scarmig 6y ago
  Interesting. For me, it's involved a sharp decrease in stress, though that's overlapped with quitting my job and having a substantial financial cushion.
  - Trasmatta 6y ago
    That's a pretty rare situation to be in.
  - 6nf 6y ago
    Millions of people are out of a job and nobody is hiring. You have to recognise that your situation is much more fortunate than most.
6nf 6y ago
Suicide helpline calls are up about 50% from early reports.
downerending 6y ago

deleted 6y ago

[deleted]

jungletime 6y ago

Doctors in California went on strike and mortality dropped. One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related. "The third-leading cause of death in US most doctors don’t want you to know about" https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html https://www.cnbc.com/2018/02/22/medical-errors-third-leading... "Why Do Patients Stop Dying When Doctors Go on Strike?" https://www.psychologytoday.com/ca/blog/slightly-blighty/201510/why-do-patients-stop-dying-when-doctors-go-strike https://www.psychologytoday.com/ca/blog/slightly-blighty/201... My personal take on this based on statistics and observation is that many medical procedures are not very effective. Or trade short term risk, for long term benefit. Eg. Those that survive a bypass surgery may live longer. But it will shorten the life of those that it kills. Chemo therapy can kill you immediately, but if you survive the procedure, it may have also killed the cancer that then will increase your life expectancy. I also think many medical procedures are not really changing the course of the disease. And being in a hospital is inherently risky. You are exposing yourself to other very sick people, and possible human errors in treatment. ITs easy to fool yourself into thinking that what you are doing is having an effect. Consider the thousands of football fans in stadiums thinking they are changing the course of the game with cheering or booing.

WalterSear 6y ago
If you have an accident in a hospital they don't send you to the ER department.
tmh79 6y ago
IMO, there is a lot of hocus pocus going on in the "medical error is the 3rd leading cause of death" statistic, and the case they chose to highlight is extremely atypical. The vast majority of health care spending and the vast majority of medical resources are spent on old people in their last 18 months of life. Most deaths due to medical error are very old people undergoing risky and invasive surgeries they demand to have and are unlikely to have a great outcome in, not children. How much of the blame should be placed on the doctor when the patient is 80+ years old, has comorbidities, has been counseled on the risks, and wants to proceed with treatment? Bypass surgery is quite effective on someone younger than 60 who is also put on a diet and exercise regimen, and doesn't have diabetes. Bypass surgery is not effective for someone over 60 who is obese and has diabetes and will not change their diet habits.

dade_ 6y ago

Cars kill us: Far fewer car crashes, more sleep as no need to commute so early in the morning, no horrible drive into the office screaming and honking at the idiot driver, no horrible drive home while texting. Alcohol kills us: no drunk fights at bars, drunk driving, falling in front of moving vehicles. Not saying it explains it, but a lot of people get hurt and die for stupid reasons.

chapium 6y ago
I don't know if you are in on this, but... https://www.theladders.com/career-advice/38-of-new-yorkers-are-drinking-while-working-remotely https://www.theladders.com/career-advice/38-of-new-yorkers-a...
- drdeadringer 6y ago
  Then they're "just" pickling their liver at home instead of also getting into fights at bars, driving drunk, and falling down in front of moving vehicles on top of that.
JackFr 6y ago
The article focuses on strokes and heart attacks which presumably should remain constant.
- mmortal03 6y ago
  It wouldn't reduce all of the incidents, but heart attack risk is higher in those who don't get enough sleep, so he's not wrong on that, if people are getting more sleep at the moment.

arkh 6y ago

> That's really one of the tragedies of COVID-19 More like one of the tragedies of fearmongering.

drtillberg 6y ago

Don't discount the impact of reduction of air pollution on all causes of mortality. It's not often discussed, but every so often someone makes the connection between small particulates and heart attacks, etc.

_bxg1 6y ago
Pretty sure any impact from that would be a very long-term thing. A lifetime without particulates might have an effect; a month seems pretty far-fetched.
- pmorici 6y ago
  Why do you think that the effect is only long term exposure?
  - _bxg1 6y ago
    Seems like a pretty subtle and non-acute thing. Maybe even analogous to smoking: something that gradually erodes your health, not something that suddenly kills you.
    - loopz 6y ago
      https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/health-risks-of-smoking-tobacco.html https://www.cancer.org/cancer/cancer-causes/tobacco-and-canc... Risks are generally thought to be immediate, but very low.
    - pmorici 6y ago
      I would tend to think there is both long term damage and chance of increased immediate death due to things like asthma and heart attack triggered by polluted air.
- 34679 6y ago
  "In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks. Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement." https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/air-pollution-and-heart-disease-stroke https://www.heart.org/en/health-topics/consumer-healthcare/w...

umvi 6y ago

Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well. What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).

pmiller2 6y ago
No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.
- manigandham 6y ago
  Why do cases matter? It should be the death rate that peaks, and that's measurable without testing. In fact it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.
  - pmiller2 6y ago
    Death rate is the proxy for cases. What matters when attempting to contain the disease is prevalence of the disease.
    - jfnixon 6y ago
      I think this is backwards. We have been using infection rates as a proxy for death rates, since deaths are a lagging indicator. It is certain we are missing a huge percentage of cases, and expanding testing will uncover those. It is completely unclear that uncovering more mild and asymptomatic cases will result in more deaths, so new cases are a bad proxy for future deaths.

sacks2k 6y ago

People are staying home and dying. This is one of the major trade offs no government official is talking about regarding re-opening the economy.

newacct583 6y ago
How is that related to the lockdown? Hospitals are open. People are staying home because they're scared of getting sick, that's not something that can be fixed by public policy.
- sacks2k 6y ago
  "fixed by public policy" Public policy right now is to stay home or die of Covid 19. Many people are scared to even go outside or go to a hospital if they don't have the virus. Starting to open businesses again and requiring social distancing would definitely help with the fear and more people would actually go to the hospital for non-covid health issues.
  - newacct583 6y ago
    I don't follow that. Can you walk me through how making people go to work is going to make them less afraid? You make people less afraid by reducing the risk they'll get sick, not increasing it. Releasing lockdowns before the pandemic is controlled increases risk, by definition. This is the big flaw with the "open up" notion: it fundamentally won't work anyway. How is "opening up" the economy going to help Jet Blue when no one is willing to fly? Who is expected to fill those movie theaters and sports arenas? Who's going to sit in a crowded restaurant? At best, opening up will get us a half-alive economy. And at the price of a much longer time until a true recovery starts. Stay home. We can beat this. The regions that started lockdowns early (c.f. Europe, New York, the west coast) are well on their way to containment. It's the "open up" regions and the ones with partial lockdowns[1] that are the stragglers. [1] I make this point every time it comes up: but for goodness sake something needs to happen in Nebraska. It's right on the cusp of exploding into a worst-than-NY disaster and no one is talking about it.

diN0bot 6y ago

if you go to the ER, is it still the case you could up alone in the hospital without ever seeing a family member? and possibly die alone? i wonder if a “bad death” is also a deterrent if you thought you were dying. or if emergencies don’t come with those kinds of calculations. not sure if/why covid calculation would be any more likely, though.

anonAndOn 6y ago

If CoViD-19 turns out to primarily be a pathogen that most negatively affects people with CardioVascular Disease then the short answer is, they're probably already dead. (CVD - CVD, uncanny coincidence?)

34679 6y ago

"Air pollution, of which whose small particulate matter are the most toxic, contributes to about one-third of the global burden of stroke." https://www.sciencedirect.com/science/article/pii/S0035378718309767 https://www.sciencedirect.com/science/article/pii/S003537871... "In 2004, the American Heart Association issued a scientific statement concluding that exposure to air pollution contributes to cardiovascular illness and mortality. A 2010 update elaborated on those risks. Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, such as the elderly or those with pre-existing medical conditions, according to the statement." https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/air-pollution-and-heart-disease-stroke https://www.heart.org/en/health-topics/consumer-healthcare/w...

subsubzero 6y ago

This is really frustrating, as we were told over and over again from the media of this huge surge of cases that would overload hospitals. Stay away from the hospital we were told over and over, the "worried well" are overloading our medical system and its professionals. Well guess what, people did just that, they avoided the hospitals to allow for a surge. That's why these hospitals are ghost towns now. I had a tele-visit with my physician and he said both covid cases and visits themselves in his location have dropped off a cliff in recent weeks(sfbay area location). The tents they erected in the hospital parking lot to treat the legions of sick are being taken down at another hospital in San Jose. A friend who worked in radiology is now on partial furlough due to such low patient counts(Stanford, Palo Alto) so I guess this avalanche of cases never materialized at least not in the bay area(NY is a different story).

krtong 6y ago

What if there was an actual decrease in heart attacks and strokes because of the change in lifestyle during lockdown?

Animats 6y ago

Yes, Stanford Hospitals actually sent about 20% of their staff home.[1] Stanford was prepared for a huge influx of coronavirus patients, but they only have 20-30 in the hospital. This despite a steadily climbing death toll. My own GP says, if you get it, go to Stanford; they have the investigational drugs, and they're not overloaded. Nationally, the US death toll continues to climb. Currently somewhere between 69,000 and 74,000, depending on the source. The SF Bay Area's shelter-in-place thing seems to have helped. We need to get more people wearing masks, though. Seeing too many people without masks. More of the good masks, too. You really need N95 or ASTM Level 3 masks to protect yourself; the cheapies only protect other people. That only works if almost everybody wears the things. What's happening outside the US? The Financial Times tracker, which has been updated every day for months, shows the US death rate flat. Most other countries have peaked and decreased substantially.[2] [1] https://www.mercurynews.com/2020/04/27/coronavirus-14000-stanford-health-care-workers-hit-with-furloughs-pay-cuts/ https://www.mercurynews.com/2020/04/27/coronavirus-14000-sta... [2] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cumulative=0&logScale=0&perMillion=1&values=deaths https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&cum...

lsaac 6y ago

Best quote: > "They still want patients to avoid hospitals yet not hesitate to go if there are signs of an emergency"

doggydogs94 6y ago

In other words, all of the Covid emergency is not happening.

irrational 6y ago

Maybe working from home is just less stressful. Or, maybe they are finally getting time to exercise, thus putting of the strokes (I don't know if exercise will put off a stroke, but maybe). I know I see a magnitude more people around my neighborhood out walking, jogging, etc. than I ever saw before.