'Amid the Coronavirus Crisis, Heart and Stroke Patients Go Missing' diff viewer (14/15)

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Amid the Coronavirus Crisis, Heart and Stroke Patients Go Missing	Amid the Coronavirus Crisis, Heart and Stroke Patients Go Missing
2020-06-25 04:48:17 UTC	2020-07-02 00:26:19 UTC (7 days later)
Bishnu Virachan was a bicycle deliveryman for a grocery store in Queens. With New York City locked down, he was busier than ever.	Bishnu Virachan was a bicycle deliveryman for a grocery store in Queens. With New York City locked down, he was busier than ever.
But in early April, as he was watching television, he felt “a pain in my heart.” It frightened him, but he did not go to the emergency room. Mr. Virachan, 43, was even more afraid of that.	But in early April, as he was watching television, he felt “a pain in my heart.” It frightened him, but he did not go to the emergency room. Mr. Virachan, 43, was even more afraid of that.
“What can I do? What can I do?” he asked. “Everywhere, the coronavirus.”	“What can I do? What can I do?” he asked. “Everywhere, the coronavirus.”
After a few days, pain overrode fear and he went to Mount Sinai Hospital in Manhattan. Doctors discovered a nearly complete blockage of his left main coronary artery.	After a few days, pain overrode fear and he went to Mount Sinai Hospital in Manhattan. Doctors discovered a nearly complete blockage of his left main coronary artery.
A surgeon opened the artery, but Mr. Virachan was left with a weakened heart. Had he waited much longer, doctors said, he would have died.	A surgeon opened the artery, but Mr. Virachan was left with a weakened heart. Had he waited much longer, doctors said, he would have died.
Fear of the coronavirus is leading people with life-threatening emergencies, like a heart attack or stroke, to stay home when ordinarily they would have rushed to the emergency room, preliminary research suggests. Without prompt treatment, some patients, like Mr. Virachan, have suffered permanent damage or have died.	Fear of the coronavirus is leading people with life-threatening emergencies, like a heart attack or stroke, to stay home when ordinarily they would have rushed to the emergency room, preliminary research suggests. Without prompt treatment, some patients, like Mr. Virachan, have suffered permanent damage or have died.
Emergency rooms have about half the normal number of patients, and heart and stroke units are nearly empty, according to doctors at many urban medical centers. Some medical experts fear more people are dying from untreated emergencies than from the coronavirus.	Emergency rooms have about half the normal number of patients, and heart and stroke units are nearly empty, according to doctors at many urban medical centers. Some medical experts fear more people are dying from untreated emergencies than from the coronavirus.
A recent paper by cardiologists at nine large medical centers estimated a 38 percent reduction since March 1 in the number patients with serious heart attacks coming in to have urgently needed procedures to open their arteries.	A recent paper by cardiologists at nine large medical centers estimated a 38 percent reduction since March 1 in the number patients with serious heart attacks coming in to have urgently needed procedures to open their arteries.
On a recent day at the Cleveland Clinic, there were only seven patients in the 24-bed coronary care unit. Usually the unit is full.	On a recent day at the Cleveland Clinic, there were only seven patients in the 24-bed coronary care unit. Usually the unit is full.
“Where are the patients?” asked Dr. Steven Nissen, a cardiologist there. “That can’t be normal.”	“Where are the patients?” asked Dr. Steven Nissen, a cardiologist there. “That can’t be normal.”
One of the few was a man who lives in Cleveland. According to Dr. Nissen, the man felt chest pain while doing push-ups, but feared going to the hospital because there might be coronavirus patients there. He stayed home for a week, growing weaker — out of breath with the slightest exertion, his legs swelling. Finally, on April 16, he went to the Cleveland Clinic.	One of the few was a man who lives in Cleveland. According to Dr. Nissen, the man felt chest pain while doing push-ups, but feared going to the hospital because there might be coronavirus patients there. He stayed home for a week, growing weaker — out of breath with the slightest exertion, his legs swelling. Finally, on April 16, he went to the Cleveland Clinic.
What should have been an easily treated heart attack had progressed to a life-threatening disaster. He survived after a dicey operation and spent nearly a week in intensive care, including several days on a ventilator, Dr. Nissen said.	What should have been an easily treated heart attack had progressed to a life-threatening disaster. He survived after a dicey operation and spent nearly a week in intensive care, including several days on a ventilator, Dr. Nissen said.
The inpatient stroke unit at Stanford University Medical Center in California usually has 12 to 15 patients, said its director, Dr. Gregory Albers. On one recent day in April, there were none at all, something that had never happened.	The inpatient stroke unit at Stanford University Medical Center in California usually has 12 to 15 patients, said its director, Dr. Gregory Albers. On one recent day in April, there were none at all, something that had never happened.
“It’s frightening,” Dr. Albers said. Yet few Covid-19 patients have been admitted to the hospital, and people needing emergency treatment have little to fear.	“It’s frightening,” Dr. Albers said. Yet few Covid-19 patients have been admitted to the hospital, and people needing emergency treatment have little to fear.
“We prepared for an onslaught, but it has not arrived,” Dr. Albers said.	“We prepared for an onslaught, but it has not arrived,” Dr. Albers said.
According to Dr. Samin Sharma, who heads the cardiac catheterization lab at Mount Sinai Hospital in New York, the number of heart attack patients fell from seven in February to three in March. So far in April there have been only two.	According to Dr. Samin Sharma, who heads the cardiac catheterization lab at Mount Sinai Hospital in New York, the number of heart attack patients fell from seven in February to three in March. So far in April there have been only two.
It’s not just the United States. Dr. Valentin Fuster, editor of the Journal of American College of Cardiology, said he is getting so many papers from around the world on the steep decline in heart attack patients in hospitals that he simply cannot publish them all.	It’s not just the United States. Dr. Valentin Fuster, editor of the Journal of American College of Cardiology, said he is getting so many papers from around the world on the steep decline in heart attack patients in hospitals that he simply cannot publish them all.
A hospital in Jaipur, India, for example, that Dr. Sharma owns, treated 45 heart attack patients in January, he said. In February, there were 32, and in March, 12. In April, so far the number is just six.	A hospital in Jaipur, India, for example, that Dr. Sharma owns, treated 45 heart attack patients in January, he said. In February, there were 32, and in March, 12. In April, so far the number is just six.
Researchers in Austria estimated that in March 110 citizens died from untreated heart attacks, compared with 86 who died of Covid-19. They based their calculations on a precipitous decline in patients going to hospitals, the expected number of heart attacks in Austria, and the mortality rates of untreated heart attacks.	Researchers in Austria estimated that in March 110 citizens died from untreated heart attacks, compared with 86 who died of Covid-19. They based their calculations on a precipitous decline in patients going to hospitals, the expected number of heart attacks in Austria, and the mortality rates of untreated heart attacks.
“I am very very worried that we are creating a problem that will have long-term consequences for the health of the community,” said Dr. Richard A. Chazal, medical director of the Heart and Vascular Institute at Lee Health in Fort Myers, Fla., and a past president of the American College of Cardiology.	“I am very very worried that we are creating a problem that will have long-term consequences for the health of the community,” said Dr. Richard A. Chazal, medical director of the Heart and Vascular Institute at Lee Health in Fort Myers, Fla., and a past president of the American College of Cardiology.
Could it be that there actually are fewer medical emergencies now? Dr. Fuster speculated that perhaps people are healthier because they are eating better, exercising more and under less stress now that so many are working from home. And, of course, the air is cleaner in urban areas.	Could it be that there actually are fewer medical emergencies now? Dr. Fuster speculated that perhaps people are healthier because they are eating better, exercising more and under less stress now that so many are working from home. And, of course, the air is cleaner in urban areas.
~~Updated June ~~24,~~ 2020~~	Updated June 30, 2020
	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.	Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.	A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.	The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.	The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Other experts doubt that better health habits could have such dramatic and immediate effects. Far from eating better, Dr. Nissen said, many patients tell him they are overeating comfort food. There is no evidence that people are exercising more, and people are hardly under less stress.	Other experts doubt that better health habits could have such dramatic and immediate effects. Far from eating better, Dr. Nissen said, many patients tell him they are overeating comfort food. There is no evidence that people are exercising more, and people are hardly under less stress.
“They are scared to death,” Dr. Nissen said.	“They are scared to death,” Dr. Nissen said.
And, he said, even if some people changed their habits, studies have failed to find any immediate effects of short-term lifestyle changes on heart attack rates.	And, he said, even if some people changed their habits, studies have failed to find any immediate effects of short-term lifestyle changes on heart attack rates.
At the moment, it is nearly impossible to know who is not showing up in emergency rooms, and why, said Dr. Harlan Krumholz, a cardiologist at Yale University. “You can’t find the dog that doesn’t bark,” he said.	At the moment, it is nearly impossible to know who is not showing up in emergency rooms, and why, said Dr. Harlan Krumholz, a cardiologist at Yale University. “You can’t find the dog that doesn’t bark,” he said.