Researchers at Virginia Commonwealth University in Richmond analyzed national weekly death data from January to mid-April of this year and compared it with data from the past six years. In a study published July 1, 2020, in the Journal of the American Medical Association the team tallied the sharp rise in deaths due to heart disease and stroke during the height of the COVID-19 pandemic in the United States. They found that in March through mid-April, when New York City was experiencing the height of its COVID-19 cases thus far, death rates from heart disease in the city rose by almost 400 percent. Deaths due to stroke increased by more than 350 percent in the city. In states that had experienced the most COVID-19 deaths by the end of April — Massachusetts, Michigan, New Jersey, New York, and Pennsylvania — heart disease deaths nearly doubled, while stroke deaths increased 35 percent. “The number of deaths due to COVID-19 that we hear about is an underestimate of the number of Americans dying of the pandemic,” says Steven Woolf, MD, MPH, the director emeritus at Virginia Commonwealth University’s Center on Society and Health and a professor of family medicine and population health at VCU School of Medicine, who led the research. He estimates that the novel coronavirus itself accounts for only two-thirds of pandemic-related deaths, while a number of other factors are fueling a spike in deaths due to heart disease, stroke, and chronic diseases, including Alzheimer’s disease and diabetes. Dr. Woolf says that although researchers typically do not get such health data until at least one year after an event, and therefore the exact results are likely to change, it is still clear that pandemic deaths that are not a direct result of the novel coronavirus are rising. “Just how much it has increased is something that we’ll refine as we go on over the next couple of years,” he says. RELATED: The New Normal, What We Know About the Coronavirus So Far And How We Got Here
Doctors Advise Against Skipping Preventive Care
Woolf’s team pointed to excess stress, either directly related to the fear of contracting COVID-19 or to the economic ripple effect of the pandemic, as a potential factor that could be contributing to the rise in heart disease and stroke deaths. According to the Mayo Clinic, stress hormones damage arteries and cause high blood pressure, both risk factors that can trigger a cardiovascular event. According to Woolf, it’s also possible that some heart-related deaths may have been a result of COVID-19 at the beginning of the pandemic when all the symptoms were not fully understood and testing was less available. “Early on in the pandemic, COVID-19 was still believed to be only a respiratory disease, but we now know that it causes other issues outside the respiratory system, such as clotting,” explains Woolf. “That means that some deaths that were called heart disease or stroke may have actually occurred in people with COVID-19 complications.” But Woolf says a third key factor is the one that concerned the researchers most. “People who don’t have COVID-19 are dying because they are not seeking care in medical emergencies or have chronic diseases that are spiraling out of control because of lack of medical care,” he says. In April, emergency department doctors sounded the alarm that fewer people were visiting the hospital or calling an ambulance if they were experiencing early symptoms of a heart attack or stroke. Many were not going to the doctor for routine or preventive care out of fear of getting COVID-19. “We are concerned that other chronic diseases aren’t getting as much attention, not because doctors don’t want to pay them attention, but because individuals are still reluctant to come to the emergency room if they have signs or symptoms that they would have normally come to the emergency room for,” says Ann Woolley, MD, an infectious disease specialist at Brigham and Women’s Hospital in Boston, who notes that because COVID-19 patients are quarantined in the hospital, patients seeking help for other health emergencies aren’t increasing their risk of exposure to the virus by going to the hospital. According to Woolley, doctors should continue to encourage their patients to seek preventive care, including screenings such as colonoscopies and mammograms, which cannot be done via telehealth. “If patients are not following through with preventive care, we will see a spike in deaths due to these chronic diseases that could have been caught earlier,” she says. Woolf hopes such statistics from early in the pandemic serve as both a warning and a learning tool for medical professionals in states that are now being inundated with COVID-19 patients. “If we don’t learn from what happened early on, we will keep seeing these spikes in non-coronavirus deaths,” he says.
