Understanding the effects of COVID-19 on health care and systems
Authors: Grégoire Mercier, Caroline Arquizan, François Roubille
Journal: The Lancet Public Health (2020)

In The Lancet Public Health, Jules Mesnier and colleagues1Mesnier J Cottin Y Coste P et al.Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry study.Lancet Public Health. 2020; 5: 536-542Summary Full Text Full Text PDF Scopus (143) Google Scholar used data from a French multicentre registry and observed a decrease in hospital admissions for acute myocardial infarctions following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Such findings are of high interest to clinicians and policy makers who are willing to improve the resilience of health systems and hospitals during pandemics or similar acute shocks, including extreme climatic events. Possible explanations for this decrease in acute myocardial infarctions are numerous and remain conjectural. Other studies2De Rosa S Spaccarotella C Basso C et al.Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era.Eur Heart J. 2020; 41: 2083-2088Crossref PubMed Scopus (642) Google Scholar, 3Garcia S Albaghdadi MS Meraj PM et al.Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.J Am Coll Cardiol. 2020; 75: 2871-2872Crossref PubMed Scopus (858) Google Scholar, 4Solomon MD McNulty EJ Rana JS et al.The Covid-19 pandemic and the incidence of acute myocardial infarction.N Engl J Med. 2020; 383: 691-693Crossref PubMed Scopus (489) Google Scholar, 5Huet F Prieur C Schurtz G et al.One train may hide another: acute cardiovascular diseases could be neglected because of the COVID-19 pandemic.Arch Cardiovasc Dis. 2020; 113: 303-307Crossref PubMed Scopus (56) Google Scholar have found similar results, but the underlying reasons remain unclear and are sometimes contradictory. To address these challenges, we must better understand the real limits and weaknesses of our health systems. To disentangle this complex array of interrelated causal factors, we suggest the following methodological approaches. First, the timeframe of studies should be extended to the months following the end of the lockdown, to assess whether the decrease in hospitalisations persists over time. Additionally, comparison with the same months of previous years would account for the seasonality of acute myocardial infarction admissions. Second, detailed data describing in-hospital management, such as time from hospital admission to primary percutaneous coronary intervention, could help us understand the organisational impact of both COVID-19 and the lockdown. Third, the COVID-19 pandemic has been shown to increase pre-existing gender-based,2De Rosa S Spaccarotella C Basso C et al.Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era.Eur Heart J. 2020; 41: 2083-2088Crossref PubMed Scopus (642) Google Scholar geographic, and socioeconomic disparities in access to health care.6Abrams EM Szefler SJ COVID-19 and the impact of social determinants of health.Lancet Respir Med. 2020; 8: 659-661Summary Full Text Full Text PDF PubMed Scopus (420) Google Scholar It is crucial to systematically document the place of residence and socioeconomic status of patients with COVID-19. Finally, extending the analysis to admissions for other acute vascular diseases, such as stroke,7Sharma M Lioutas VA Madsen T et al.Decline in stroke alerts and hospitalisations during the COVID-19 pandemic.Stroke Vasc Neurol. 2020; (published online Aug 27.)https://doi.org/10.1136/svn-2020-000441Crossref PubMed Scopus (56) Google Scholar would bring additional valuable insights into the respective roles of generic versus disease-specific factors, and into the role of local organisations and the importance of clinical features at admission. Such work is underway and we hope it provides useful explanations with wide pragmatic translations. FR reports grants, personal fees, and non-financial support from Air Liquide, grants and personal fees from Abbott, Novartis, and Astra Zeneca, and personal fees from Vifor, Servier, Abiomed, Zoll, Medtronic, Resmed, LVL, Eole, Pfizer, Novonordisk, and Mylan, outside the submitted work. GM and CA declare no competing interests. Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: a registry studyA marked decrease in hospital admissions was observed following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Health authorities should be aware of these findings, in order to adapt their message if the COVID-19 pandemic persists or recurs, or in case of future major epidemics. Full-Text PDF Open Access