Latest research shows impact of COVID-19 on other health care

Several recent studies evaluated the effects of the COVID-19 pandemic on other components of health care.

The pandemic was associated with a decline in the number of patients presenting to hospitals with ischemic strokes, according to a study published by Stroke on July 31. The analysis of three Connecticut hospitals found that stroke codes decreased by 12.8 per week from February 18 to March 16 (P=0.0360), bottoming out at 39.6% of expected stroke codes from March 10 to 16 compared to 2019. Stroke patients presenting during the pandemic (versus before) had similar severity but were more likely to live in cities rather than surrounding areas. Results underscore “the need to remind individuals of the importance of seeking emergency medical attention for symptoms concerning for stroke,” the study authors said. “This may be particularly relevant for those who live further from large hospitals, which are typically located in population-dense areas which patients may be reluctant to approach these during a pandemic.”

The start of the pandemic was associated with a drop in hospitalizations for myocardial infarction, but an increase in mortality among the patients hospitalized, according to a brief report published Aug. 7 by JAMA Cardiology. The analysis of 49 hospitals in six states included 4,955 hospitalizations for ST-segment elevation myocardial infarction (STEMI) and 10,289 for NSTEMI. Beginning Feb. 23, the rate of hospitalization decreased by 19.0 cases per week for five weeks, after which it increased by 10.5 cases per week. There were no significant changes in patient demographics, cardiovascular comorbidities, or treatment approaches, yet the observed-to-expected mortality ratio increased in those first five weeks (1.27; 95% CI, 1.07 to 1.48), disproportionately among patients with STEMI (1.96; 95% CI, 1.22 to 2.70). After that period, the overall ratio normalized, but the higher mortality remained among patients with STEMI and in risk-adjusted results. “In the weeks and months to come, clinicians may see greater numbers of patients with more severe manifestations” of myocardial infarction, said the study authors. “Future studies are needed to identify contributors to the increased mortality rate among patients with STEMI.”

ED visits dropped generally, according to an analysis of 24 EDs in five states, published by JAMA Internal Medicine on Aug. 3. From January to the end of April, decreases ranged from 41.5% in Colorado to 63.5% in New York, with the most rapid rates of decrease in all areas occurring in March. Hospital admissions from the ED varied more locally, remaining stable before rising in tandem with increases in COVID-19 cases. “These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings,” the study authors concluded.

Fewer patients were diagnosed with cancer, according to a research letter published by JAMA Network Open on Aug. 4. The analysis compared weekly counts of breast, colorectal, lung, pancreatic, gastric, and esophageal cancer diagnoses from Jan. 1, 2018, to April 18, 2020 (258,598 pre-pandemic diagnoses and 20,180 from the COVID-19 period). During the pandemic, the weekly count fell 46.4% (from 4,310 to 2,310) for the six cancers combined, with significant declines in all cancer types, ranging from 24.7% for pancreatic cancer to 51.8% for breast cancer. “The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes,” said the study authors, who called for solutions including strengthening of “clinical telehealth offerings and other patient-clinician interactions, including self-service scheduling across specialties and well-designed collection processes.”

COVID-19 also reduced clinical research on other topics, according to a research letter published by the Journal of the American College of Cardiology on July 31. It analyzed clinicaltrials.gov for trials that were reported as stopped, finding 22,934 such trials in 2017 through 2019 (an average of 638 per month) and 5,758 that did not mention COVID-19 and were stopped between Jan. 1 and May 31, 2020 (an average of 1,147 month). In 2020, the number of stopped trials increased significantly over time and almost all (95.4%) had non-governmental funding. “The COVID-19 pandemic has led to unprecedented challenges for clinical research activity,” said the study authors. “Of concern, the number of trials stopped per month increased significantly with time during the pandemic, suggesting that the consequences of the crisis may be worse than suggested by our data.”

In a recent column at KevinMD.com, ACP's Vice President of Membership and Global Engagement, Philip A. Masters, MD, FACP, addressed the effects of the ongoing pandemic on the physician workforce, discussing the unimaginable stresses and emotional trauma that come with being a physician in a COVID-19 world. Dr. Masters writes, “Treating patients with a highly infectious disease we are just beginning to understand, and at times being confronted with an overwhelming number of extremely sick patients, has altered our ability to practice in the way we were taught and what most of us have been used to over the course of our careers.” He encouraged physicians to focus on their own health and feelings and acknowledge when they need help, noting also that health care systems must provide support to manage the effects of the pandemic on well-being. ACP's Physician Well-being and Professional Fulfillment webpage offers well-being resources for members, including a section specifically related to COVID-19.