Pandemic sees declines in ED, cardiology, stroke presentations

Three studies suggest significant declines in acute cardiology, neurology and emergency presentations during the COVID-19 pandemic.

Welcome to The Medical Republic‘s COVID Catch-Up.

It’s the day’s COVID-19 news into one convenient post. Email bianca@biancanogrady.com with any tips, comments or feedback.

27 August

• Studies point to significant declines in cardiology, neurology and ED presentations during COVID-19.
• Obesity linked to higher risk of COVID-19 infection, hospitalisation, intensive care admission and mortality.
• Hydroxychloroquine plus azithromycin = increased COVID-19 mortality.
• Latest confirmed COVID-19 infection numbers around Australia.

• Where have all my patients gone? It seems to be a common sentiment, particularly among cardiologists, neurologists and emergency physicians, as three studies suggest significant declines in acute cardiology, neurology and emergency presentations during the COVID-19 pandemic.
  First, a study published in Stroke and Vascular Neurology compared weekly hospital admissions at five tertiary stroke centers in the US from January-April 2019 and January-April 2020. At the peak of the pandemic, from mid-March to mid-April, there was around a 31% drop in TIA admissions and 46% decline in stroke alerts compared to the previous year.
  A second study published in Open Heart looked at cardiology services at a single UK hospital and found that the first month of COVID-19 lockdown was associated with a 53% reduction in cardiology ward and coronary care admissions, and a 40% drop in the number of patients diagnosed with myocardial infarction. These reductions persisted, albeit less drastically, in the second month of lockdown.
  Finally, a retrospective audit of presentations to Royal Melbourne Hospital’s acute medical unit from 1-31 March 2020 were compared with admissions from the same period in 2019. This analysis, published in Internal Medicine Journal, revealed a shift during the pandemic towards patients with more comorbidities, such that there was approximately one extra comorbid condition per three patients during the pandemic.
  “These findings, if reflected in the general population, suggest that patients with milder illnesses and/or more modest degrees of comorbidity than our current inpatients, may not be presenting to hospital for admission, potentially resulting in late presentations of treatable illness and poor outcomes,” the authors wrote.
• Obesity is associated with significantly greater risks of developing COVID-19, being hospitalised with it, being admitted to ICU and dying from it, new research suggests.
  A systematic review and meta-analysis of 75 studies, published in Obesity Reviews, suggested individuals with obesity had at least a 46% higher odds of being COVID-19-positive, 113% higher odds for hospitalisation, 74% higher odds of ICU admission and 48% higher odds of death.
• Hammering another nail in the coffin of hydroxychloroquine – with or without azithromycin – a systematic review and meta-analysis of 29 studies has found that the combination of the two drugs is associated with a significant increase in COVID-19 mortality.
  The analysis, published in Clinical Microbiology and Infection, found hydroxychloroquine wasn’t associated with a significant increase or decrease in mortality, but when combined with azithromycin, mortality was a significant 27% higher compared to standard care.
• Here are the confirmed COVID-19 infection numbers around Australia to 9pm Wednesday:
  National – 25,205
  ACT – 113 (0)
  NSW – 3997 (6)
  NT – 33 (0)
  QLD – 1108 (1)
  SA – 463 (0)
  TAS – 230 (0)
  VIC – 18,608 (149)
  WA – 653 (0)