Dr Metzler and collaborators carried out a retrospective search to find out the impact of the Covid-19 pandemic on diagnosis and treatment of acute coronary syndromes during March 2020 in Austria. Basically, they tried to account for the collateral damage we all imagine, but no government reports. 

During March we observed a significant drop in the number of ACS patients admitted to the emergency rooms. This drop is close to 40% and is even bigger when it comes to Non-STEMI patients.

It came as a surprise to the authors, who had speculated with an increase in the number of cases, according to their experience with other viral infections, natural disasters, or profound financial crisis. We could say Covid-19 is a combination of all three.

The strict health care protocols that undoubtedly helped and keep helping to control this pandemic might have unintentionally affected the attention paid to other diseases. 

Read also: Special Articles on COVID-19.

ACS symptoms such as dyspnea and chest discomfort might easily be mistaken for acute respiratory infections. 

In addition, strict instructions to stay at home and fear of catching the disease might have caused many patients to avoid hospitals despite clearly manifesting symptoms. 

Regardless possible reasons and speculations, the smaller number of patients being treated will eventually translate into increased early and late cardiovascular mortality. This is the unaccounted, and therefore unreported, death toll no government will address.

Read also: Cardiovascular Sequelae Associated with COVID-19.

Compared against similar periods in a pre-pandemic context, and considering  1950 MI mortality rates (times we had nothing to offer, just like the present context, with untreated CAD patients undergoing an ACS at home) we can easily assume there have been 110 unaccounted ACS deaths during March alone for a population of 8.8 million people, such as Austria’s.

The government of Austria has informed 86 deaths due to coronavirus in this same month. However, collateral damage from the virus protocols can be worse yet than the virus itself. 

Original Title: Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage.

Reference: Bernhard Metzler et al. European Heart Journal (2020) 41, 1852–1853. doi:10.1093/eurheartj/ehaa314.

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