Overcoming Fears to Save Lives
Authors: Sarah M. Perman
Journal: Circulation (2020)

he world continues to be entrenched in the coronavirus disease 2019 (CO-VID-19) pandemic, which has significantly affected our daily interpersonal interactions, including community response to public emergencies that require bystander cardiopulmonary resuscitation (bCPR).For healthcare workers on the front line of COVID-19 care, our reality is a spectrum of disease that ranges from the mildly symptomatic patient to the critically ill, hypoxic, crashing patient.The public reality is stay-at-home orders or newly implemented safer-at-home plans, job losses, and coping with the illness and death of family and friends.These events predominate daily routines in this new normal, as does a profound sense of fear: fear for the community and for healthcare providers.As a cardiac arrest outcomes researcher, I fear how this viral pandemic will threaten our altruistic societal approach to helping individuals with cardiac arrest.bCPR is an essential physical maneuver proven to impart better survival and neurological recovery for individuals with cardiac arrest.CPR requires bystanders to come into close proximity with another individual, sometimes even a stranger, at a time when the message is to socially distance and fears about severe acute respiratory syndrome coronavirus 2 transmission predominate.Our generation has faced similar fears before in the community and among healthcare providers.In 1981, the US Centers for Disease Control and Prevention advised the public about a new infectious disease, initially causing pneumonia in homosexual men.This marked the beginning of the HIV pandemic, now a historical memory for many, but at the time the events shocked society and produced overwhelming fear.Misconceptions about disease transmission were prevalent, and discrimination against people living with HIV became pervasive.Exaggerated fears that touching someone with HIV might result in transmission of disease became ostracizing, and unsubstantiated fears of acquiring the disease by way of casual contact or touch became as endemic as the disease.We are all presently experiencing a similar fear, with pervasive underpinnings anchored on avoidance and anxiety.Similar to HIV, COVID-19 is heavily affecting disenfranchised communities (eg, those with low socioeconomic status, racial/ethnic minorities, those undomiciled, and others) that are already prone to poor access to health care, lower rates of bCPR, and delayed response from emergency medical services. 1,2Confounding preexisting disparities in rates of bCPR with the fear of an infectious virus that is aerosolized during CPR could have devastating results.Early findings reported from 4 Italian provinces heavily affected by COVID-19 were reported in the New England Journal of Medicine. 3Compared with the previous year, Baldi et al 3 reported that the incidence of out-of-hospital cardiac arrest increased by 58%.This is in stark contrast to the provision of bCPR, which decreased by 15.6% in a region that had previously reported a bCPR rate of 47%.If we translate similar findings to the United States, where rates of bCPR are variable and neighborhoods with lower socioeconomic status observe considerably less, we