Aaron Rothstein in The New Atlantis:
Before Covid-19 hit the United States, I saw many patients who, alas, presented too late for treatment. Occasionally they couldn’t even use their dominant arm, but they waited hours or days to seek help. Some said they thought their deficits would improve, others worried about the hospital bill, or were skeptical of physicians. The data over the past few decades corroborates this experience. In a 1997 study in the Annals of Internal Medicine, physicians examined patients with myocardial infarction, or heart attack, and the delay between the onset of symptoms and hospital presentation. Forty percent delayed their presentation for over six hours. In a 2001 study, one-third of patients with symptoms like abdominal pain, chest pain, and shortness of breath – all potentially serious – delayed seeking care. And over two-thirds of these patients waited because they thought the problem would go away. In a 2019 study, Greek physicians found that of patients presenting to the hospital with acute stroke symptoms nearly one third arrived over four and a half hours after their symptoms started, putting them outside the window for tPA eligibility. In other words, even prior to the pandemic, many patients either chose not to come or physically could not come to the hospital despite life-threatening symptoms.
Covid-19 directly causes physical devastation and in so doing exacerbates the kinds of delays described above. The exact death rate from coronavirus alone is unclear given our lack of widespread testing and our ignorance about how many people actually have it. At one point, the case-fatality rate in China was 2.3%, in Italy at another point 7.2%, while some estimate 1-2% and lower. Whatever it ends up being, it is highly significant and crippling. As of this writing, notwithstanding drastic quarantine measures, the virus has claimed over two hundred thousand lives worldwide, and that number continues to increase. Most of us understand the risk and we seclude ourselves to mitigate the disease’s damage. However, there are unintended effects of the current mitigation campaigns. There will likely be an increase in morbidity and mortality from other diseases. For instance, other hospitals and our own emergency room call us less frequently.