COVID-19 & STEMI – Day 16, Thoughts About The Pandemic

Where are all the STEMIs?

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden.

After my tuesday night shift I was in our locker room where I met one of our cardiologists that was back from his night shift too.

They have seen, as we have in the ER, significantly less STEMIs during their shifts since the COVID-19 pandemic, so the question we discussed was: where are all the STEMIs?

Apparently what is happening in Stockholm, like most COVID-19 phenomenon, also seems to be happening elsewhere:

From Milan to Madrid to Massachusetts, everyone is asking: as the COVID-19 pandemic drags on, where have all the STEMIs gone? In the Lombardy region of Italy, said Bernhard Reimers, MD (Humanitas Research Hospital, Milan), STEMI cases are down by an estimated 70%. “If symptoms are not too bad, they don’t call the ambulance because they are afraid to go into hospital,” Reimers speculated. *

What’s happening in Stockholm is happening in Lombardy is happening in Washington is happening in Liverpool:

The stories are eerily similar around the globe. At George Washington University Hospital in Washington, DC, Jonathan Reiner, MD, estimated they’ve had just two or three STEMI cases in the last 3 weeks; they usually see three a week, with a yearly volume of 120-150 cases. This has been coupled with a “dramatic decrease” in ACS admissions, he added. At the Liverpool Heart and Chest Hospital in England, Rod Stables, MD, characterized his hospital as experiencing the “calm before the storm.” Yet during the night spent on call before speaking with TCTMD, he did three cases between 5 and 10 PM, then not a single call all night. “That’s unheard of in our place,” he said. Even lower are the hospital-to-hospital urgent referrals for non-STEMI. “We are really feeling the absence of cases there,” he said. *

Nobody knows why STEMIs are so absent in our hospitals during this pandemic. Speculation range from patients not seeking medical attention when they have chest pain to less stressors (unlikely) to doctors missing the diagnosis due to the focus and overwhelm of the COVID-19 patients (and decreased contact/diagnosis by health care personal to save on protective material on the patients in the hospital).

Source:

TCTMED: The Mystery of the Missing STEMIs During the COVID-19 Pandemic

COVID-19 Numbers Sweden 2020-04-09 *

793 deaths nationally
- 486 of them in Stockholm
9 141 confirmed cases nationally
DEATHS [SWE]

New confirmed deaths daily in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
ICU [SWE]

New Covid-19 patients Being Treated at the ICU in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
NEW CONFIRMED CASES [SWE]

New confirmed cases daily in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
TOTAL CONFIRMED CASES [SWE]

New confirmed cases accumulated over time in Sweden.
(Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
Intensive care Sweden: *
- 722 COVID-19 confirmed patients treated in the ICU in total so far
- 10,3 days from symptoms to ICU
- 24,4 % women
  
  Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week for the first 4 weeks. From week ten: 5 → 24 → 129 → 423 → 746 → (903 this week up until now, however since it’s only thursday this weeks numbers are yet incomplete)