World Health Organization has declared Corona Virus Disease (COVID-19) as a global pandemic in March. Since then world is struggling to contain this disease. Every nation has calibrated its strategy to prevent the spread of the virus and protect its vulnerable population. The Indian government has also declared an unprecedented national lockdown of three weeks barring essential services.
Social Distancing was recommended weeks prior to this lockdown. We are completing two weeks of lockdown and there is a clamor to extend lockdown to contain viral spread further. These weeks were unusual for healthcare professionals. Some were busy in understanding the disease and its implications on patients of their specialty. Some were deciding on their part what is an emergency and what is routine. Public healthcare professionals were hectically involved in containing virus spread and treating an overgrowing number of corona patients.
Everyone is convinced nothing is routine now and healthcare will never be the same again. Cardiologists like me observed an unusual phenomenon, a drastic reduction in heart attack patients. There are various grades of a heart attack. Milder can respond to rest and routine medications but severe are hard to miss. Where are these missing heart attack patients?
The same sentiments were echoed in various social media platforms involving nationwide cardiologists. Across the forum involving cardiologists of private setup, government setup, urban and rural background consensus is there that heart attack patients presenting to healthcare facilities have drastically reduced among Covid19 pandemic. This is not regional or Indian experience but internationally also same experience is being shared by cardiologists involved in heart attack care.
Everyone is experiencing the same fact that since the outbreak of coronavirus disease all grades of heart attack patients are not reaching hospitals in same frequency as the used to be. There can be two possibilities either heart attack patients not presenting to hospitals because of various reasons or heart attack is happening with reduced frequency.
Because of travel ban, lack of public transport facilities has definitely reduced the tendency to reach to distant hospitals. But heart attack patients are serious enough to dodge travel ban and everyone is aware that emergency medical facilities are operational all over. So this is unlikely to be major factor.
I have enquired with physicians who primarily receive these patients and stabilize them with initial medications but their experience is also consistent with finding of reduced frequency of heart attack. Some milder heart attack patients and their families may be fearful of contracting coronavirus if they visit hospitals hence may be bearing with discomfort is a genuine possibility.
Severe heart attack mystery is still unexplained. That leaves us to possibility of major reduction in heart attack frequency. What could be possible reasons?
As all of us are aware stress is important factor for occurrence of cardiovascular disease. With compulsory lockdown, job stress and stress of commuting has drastically reduced and may be contributing to improved outcome in population. Competitiveness, deadlines, meetings all can wait till lockdown is open. Majority of people are spending quality time with their near and dear one this also leading to happiness and reduced anxiety and stress. Many people are finding time to pursue their hobby. Thus, possibly our stress hormone level is at its lowest concentration. Heart rate variability which occurs with stressful condition is often touted as final nail in plaque rupture leading to heart attack. It is also happening less frequently because of calm life. This results in non-conversion of mild attack into severe one. With no deadlines people are having adequate rest and night time sleep.
With lockdown smoking and tobacco chewing has gone down thereby reducing blood thickness and reduction in heart attack. Some disciplined people are taking advantage of available time for home exercising and maintaining their fitness. With few vehicles on the road air pollution has reached to its nadir. Air was never so pure. May be air pollution is leading to less pulmonary problems leading to reduced cardiac ailments. Of-course some of us are less fortunate and have to feel a pinch of lockdown. It is a very stressful experience for them.
Life, it seems is back to basics and bare minimum. Coronavirus has made humanity to press the reset button. If heart attacks are genuinely less because of this reset, it’s great positive happening among all negative.
Covid19 will of course linger for some time and it will have drastic social and economic consequences. Humanity will never be same again. But definitely it has made us to realize few important values we all were missing in hustle bustle of competitive world. Even if same rat race begins again we should never go back to socalled normal. Let this be reminder of what we need to value in our life!
Dr Pankaj Harkut