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Should COVID still force us to postpone elective surgery or forgo a trip to the ER?



a truck that is sitting on a bus: Should COVID still force us to postpone elective surgery or forgo a trip to the ER?


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Should COVID still force us to postpone elective surgery or forgo a trip to the ER?

In March, the Centers for Disease Control and Prevention (CDC) urged people to stay away from crowded emergency rooms and put-off elective surgery, including heart procedures, to reduce potential coronavirus exposure. As early as April, doctors worried that people experiencing life-threatening emergencies were avoiding hospitals. Those fears were validated.

In Boston, Beth Israel Deaconess Medical Center’s March/April data showed heart attack hospitalizations down by 33 percent, stroke hospitalizations down by 58 percent, and referrals for breast and blood cancers down by more than 60 percent from the two months prior. Even those who experienced a heart attack or stroke avoided hospitals; one study showed a 38 percent drop in patients treated for ST-Elevation Myocardial Infarction, a life-threatening narrowing of a vital artery to the heart.

By June, 41 percent of Americans reported having had avoided some care due to Covid fears. The CDC found that emergency visits across the U.S. declined 23 percent for heart attacks from March to May and 20 percent for strokes. Though the World Health Organization (WHO) still urges people to avoid routine dental and health care visits, following that guidance can produce unintended consequences, some long term.

With ailments such as cardiovascular disease, delay in treatment can lead to preventable deaths or permanent disabilities. Virginia Commonwealth University and Yale University researchers looked at excess deaths – the number of deaths over what would be expected based on previous years – in March and April. They concluded that overall. 56,246 (65 percent) of the 87,001 excess deaths in the U.S. during those two months were attributed to COVID-19.

However, in 14 states, including populous California and Texas, more than 50 percent of excess deaths were attributed to other causes, most commonly heart disease, the leading cause of death in America. A person whose primary cause of death is cardiovascular or pulmonary may have also had COVID 19. The five states with the most COVID-19 deaths also experienced large proportional increases in deaths due to pre-existing chronic conditions: diabetes (96 percent), heart diseases (89 percent), Alzheimer’s disease (64 percent), and cerebrovascular diseases (35 percent). New York City experienced the largest increases, notably those due to heart disease (398 percent) and diabetes (356 percent).

But with diseases like cancers, delayed treatment and delayed diagnoses cause impacts that won’t be felt immediately. Those delays are mounting up. One national study of U.S. patients who received testing from Quest Diagnostics between January and April found the mean weekly number of new diagnoses for six common cancers dropped by 46 percent, with breast cancer diagnoses in March and April declining the most (52 percent), compared to the two months prior. Data from 20 U.S. health care institutions found breast cancer screenings down by 89 percent and colorectal cancer screenings down by 85 percent in the first four months of 2020, compared to the same period last year.

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