Fear of seeking medical attention blamed for rising deaths

Researchers say fear of being exposed to the coronavirus may be scaring people with other ailments away from seeking help.

A recent study showed increasing deaths from causes such as heart disease, stroke and diabetes — while emergency room visits for those conditions are down — a finding that suggests people may be afraid to go to the hospital for care, said Dr. Steven Woolf, professor of family medicine and population health at Virginia Commonwealth University in Richmond, who led the study published in JAMA.

During March and April, when the pandemic began, nationwide data identified 87,000 more deaths than would have been expected during the two-month period, but only two-thirds of the total were attributed to COVID-19, the study found. In 14 states, more than half of the excess deaths were from causes other than COVID-19.

Additionally, the JAMA study found huge increases in “excess deaths” from underlying causes such as diabetes, heart disease and Alzheimer's disease in the five states with the most COVID-19 deaths during that period: Massachusetts, Michigan, New Jersey, New York and Pennsylvania. The biggest jumps were in New York City, which recorded a 398% rise in deaths from heart disease and a 356% increase in diabetes deaths.

The findings were underscored by other studies. Analyzing data from March through May, a study published in JAMA Internal Medicine calculated that 22% of excess deaths were not attributed to COVID-19. The Centers for Disease Control and Prevention said that while data is still being gathered, "upward trends in other causes of death (e.g., suicide, drug overdose, heart disease) may contribute to excess deaths in some jurisdictions."

One explanation could be that COVID-19 did contribute to many of the deaths even though it was not listed on death certificates and people may not have been tested for the virus, Woolf said. He added that “it’s now known that the virus is not just a respiratory problem and causes other physical responses, such as damaging the immune system, blood clotting and arrhythmias.”

“It's possible some of these spikes (in excess deaths) were caused by COVID-19 and the doctors didn't realize it," he said.

Another explanation may be that some people may be avoiding or delaying treatment for medical conditions, as well as mental health or addiction problems. Ten weeks after the pandemic was declared a national emergency on March 13, hospital emergency department visits declined by 23% for heart attacks, 20% for strokes and 10% for uncontrolled high blood sugar in people with diabetes, the CDC reported.

Dr. Mitchell Elkind, professor of neurology and epidemiology at Columbia University in New York, said the results suggest people are afraid of getting the virus, or afraid of adding to the burden on the doctors and the hospital. "They think, 'I don't want to bother anybody, and I'll be OK. Why don't I just stay home and take care of this myself?'”

For serious conditions like heart disease and stroke, delaying treatment may increase the risk of death or lead to a diminished quality of life for survivors, Elkind said, adding that some studies have suggested that during the pandemic some people who do show up for care are sicker, suggesting they waited too long.

"The longer the lack of blood flow to the heart and the brain, the more damage there will be," he said.

Elkind said since the pandemic began the medical community has learned a lot about how to handle the virus and manage the risk of infection by separating people who have it from those who don't.

"There's no question the risk of untreated heart attack or stroke is higher than the risk of COVID-19," he said. "Just like before the pandemic, they should seek help, call 911 or get to the emergency room right away."

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