When avoiding hospitals can be deadly
May 26, 2020
Thomas suffered a stroke at the beginning of April, at a time when the dramatic scenes in Italian intensive care wards shocked the German public and restrictions aimed at slowing the spread of the novel coronavirus were starting to impact everyday life.
He is 50 years old and at high risk of suffering a stroke. Having survived a heart attack at the age of 45, five years later he was still smoking, still overweight with high blood sugar levels.
When suddenly he was unable to write WhatsApp messages, he was worried, but refused to go to the emergency room: "I'm not going there," he told a friend on the phone. "I've seen what it is like there: Hospitals are where you catch corona."
Indeed high blood pressure, smoking, high blood sugar along with diabetes, cancer and asthma had also been identified as factors likely to make a COVID-19 infection turn dangerous.
Read more: How the coronavirus attacks our entire body
In his fear of contracting the virus at a hospital, Thomas was not alone. April figures from German health insurers show a 30% reduction in the number both of stroke and heart attack patients in emergency wards around the country over the past three months.
Every minute counts
This week German doctors sounded alarm bells: Cardiologists and oncologists reported that 50% of their patients had cancelled appointments, including people with severe cardiovascular disorders and cancer sufferers. Many said they wanted to postpone essential, life-saving therapy because they were afraid they might get infected with COVID-19 in the doctor's waiting room.
The German figures correlate with those from other countries. A World Stroke Organization survey of 100 countries shows a median decrease of 50-70% in doctor's visits or hospital admissions brought on by stroke or transient ischemic attacks (TIA) since February 2020.
"Strokes and heart attacks are acute emergencies in which every minute counts — even at the time of a pandemic," the chief physician at the neurological department of the University Medical Center Hamburg-Eppendorf warned in an interview with German weekly Der Spiegel in early April, when the drop in numbers first became apparent. He urged patients not to avoid hospitals out of fear of contracting COVID-19.
Read more: Coronavirus crisis rekindles hospital debate in Germany
In Germany, some 47,000 people die of a heart attack each year. Some 30% of these deaths occur outside a hospital, because the sufferers or those around them call the emergency services too late or not at all. Some 280,000 people in Germany suffer a stroke each year; after cardiovascular diseases and cancer, a stroke is the third most common cause of death in Germany. Of those who survive a stroke, some 20% remain disabled and the number of stroke sufferers under the age of 55 — now at one in five — is predicted to grow.
In Thomas' case, a friend took him to a specialized stroke unit hours after the first symptoms. By then he could not speak beyond a simple "yes" or "no."
Germany has 330 specialized stroke units in hospitals, where multidisciplinary teams of doctors and nurses work together. Even amidst the peak of the coronavirus pandemic in April, these units were functioning. "Although several beds in intensive care units had been set aside for COVID-19 sufferers, there was no impact on emergency care," says Mario Leisle from the German stroke aid foundation. But COVID-19 has led hospitals to report a different problem: "Because of coronavirus restrictions, family members may no longer accompany the patients to the emergency ward. This means there is often no one to give the neurologist important information about medication and existing preconditions," he says.
Read more. Stroke — when you lose your mother tongue
Long-term corona effect
14 million people worldwide die from stroke each yearand over 50 million survivors will live with permanent disability. In Germany alone there are 1 million stroke survivors in constant need of care.
Rapid treatment and regular rehabilitation therapy is vital for heart attack, cancer and stroke survivors once they have made it out of hospital. But the coronavirus outbreak has had a noticeable impact there too. Several patients cancelled or postponed planned treatment, citing fears of contracting the virus —a delay that can adversely affect the path to recovery.
Relatives and friends offer vital support for patients whose lives are changed by severe illness. Currently, however, hospitals do not allow visitors. For patients like Thomas, who are unable to speak, phone contact is not a satisfactory option.
"Coronavirus restrictions have severely hampered rehabilitation efforts," says Mario Leisle of the German stroke aid foundation. Therapy centers have been closed and face-to-face contact with helpers and fellow survivors has been reduced to a minimum or temporarily halted altogether, as recovering stroke patients are put in isolation to shield them from infection.
On the plus side, the lack of social interaction has given a boost to existing digital tools for survivors to meet in group chats, and to use personalized rehabilitation and fitness apps, which are becoming increasingly popular. Whatever the measures used, experts remain steadfast that continuity of care is paramount. "If therapy is interrupted, progress already made can be reversed," Leisle warns.