How did COVID 19 preventive measurements impact cardiovascular emergencies rates?

BACKGROUND: During the COVID19 pandemic, Tunisia adopted a preventive health policy, consisting of containment, self-quarantine, and social distancing to reduce viral contamination. Many health care workers noticed a decrease in urgent admissions in different medical wards and intensive care units. In this work, we aimed to evaluate the impact of COVID19 preventive measurements on the number of patients’ admissions in a Tunisian intensive cardiac care unit. METHODS: We collected the number of admissions in the ICCU of Charles Nicolle's Hospital of Tunis for acute myocardial infarction and acute heart failure during February, March, and April of the years 2018, 2019, and 2020 and compared the number of admissions between those periods. In Tunisia, containment has already started on March, 22nd. We also compared the mean number of admissions per day between the pre-containment period (40 days before) and the containment period (40 days after), and the mean number of admissions per week during the 6 weeks after March, 22nd. RESULTS: During the three months, the overall number of admissions declined respectively from 103, 100 in 2018, 2019 to 75 in 2020 showing a 25% drop in overall admissions. The mean number of admissions dropped significantly from1 ± 0.93 patient/day (pre-containment period) to 0.6 ± 0.81 patient/day during the containment period (Wilcoxon-Mann-Whitney test; P = 0,024). The mean number of admissions per week during the 6 weeks after March, 22nd dropped respectively from 7.66 ± 1.75 and 7.66 ± 3.2 in 2018 and 2019 to 4.16 ± 3.25 patients per week in 2020. (Kruskal–Wallis test, P = 0.13) (Fig. 1). CONCLUSION: Many reasons could explain this slight drop in ICU admissions during containment such as the lack of public transport, the business of our emergency hotlines with the COVID 19 calls, and even patient's fear of being infected by the virus in hospitals. This can lead to an increase in sudden cardiac deaths, heart failures due to this lack of medical care.