Dr Kevin McVaney was attending a daily operational briefing last April when a lieutenant told him there had been “a lot of cardiac arrests last night.”
Another lieutenant intervened and said he had seen a large number of cardiac arrests the night before.
McVaney, the medical director of Paramedics in Denver, Colo., Was worried. He looked at this week’s numbers and found that cardiac arrests were double their normal rate.
He told Al Jazeera he remembered thinking, “Is something really important going on or just a coincidence?” COVID-19 cases were on the rise and within a month they would peak.
This pattern was repeated in the United States, Europe and elsewhere: an increase in cardiac arrests and then an increase in reported COVID cases.
A new study, released this month, collected data in 50 US cities as well as major cities in the UK, France, Italy, New Zealand and Australia. The study showed that the increase in cardiac arrests outside the hospital was linked to the rise in COVID cases.
The study was based on data provided by the Metropolitan EMS Medical Directors Global Alliance, a monitoring network of emergency medical services (EMS) personnel who voluntarily share data.
Dr Paul Pepe is the global coordinator of the alliance and also co-author of the study.
He told Al Jazeera that normally a 10% increase in cardiac arrests would be of concern. But last spring in the United States, two-thirds of U.S. cities in the study recorded increases of between 20 and 50 percent. In particularly affected cities, the rate doubled. New York’s rates rose an average of 250% in April, and in just one day, April 6, the rate of cardiac arrests in New York City was 10 times that of the previous year.
Scientists have noticed that COVID cases and cardiac arrests are increasing at a similar rate. Then, as cases plummeted over the summer, the number of cardiac arrests also declined. In cities relatively spared from COVID in the spring, the rate of cardiac arrests remained normal. But, in the summer, as the epicenters shifted, these cities saw their COVID rates rise, as did their cardiac arrest rates.
A more precise death toll?
There is no way to definitively prove the link since almost none of those who have had cardiac arrest have been tested for COVID. But since this trend has been observed city after city, country after country, the study concludes that the link is highly likely.
Doctors in Lombardy, Italy, were among the few who tested those who had suffered cardiac arrest for COVID, even after their death. They looked at the data and concluded that while some were caused by indirect effects of the pandemic such as fear of going to hospital, the vast majority of those excessive cardiac arrests were likely caused by COVID itself.
Pepe explained that just as some people develop a cough or fever, or lose their sense of taste and smell, others can suffer from cardiac arrest.
“This is one of the myriad of chimerical presentations,” he said.
Since many of those who had cardiac arrests were not counted among COVID deaths, the data could potentially help calculate a more accurate death toll.
Across the United States, for example, the number of cardiac arrests in April rose 59% from previous years. As a result, that could add 4,307 people to the COVID death toll in the United States for April alone. The authors of the new study estimate that the number of deaths from COVID could increase by 10 to 15% worldwide if excess cardiac arrests are included.
“It shows how much the death rate from COVID-19 really is underestimated,” said Dr Aileen Marty, an expert in response to the epidemic. “It is important to put the risk of the virus into perspective.”
Early warning for COVID
Just as McVaney, who also co-authored the new study, noticed an increase in cardiac arrests in Denver before COVID cases began to increase, scientists found that cardiac arrest flares were often noticeable before the outbreaks. cases of COVID.
This may be due to the delay of certain symptoms or test results. Sometimes cardiac arrests increased just days before COVID cases. In other cases, it happened a week or more before.
Early warning could give EMS time to prepare. Responding to cardiac arrests takes a lot of time, resources, and can be traumatic for medical staff.
“When planning a strategy for the healthcare system,” said Dr Simone Savastano, cardiologist at the Fondazione IRCCS Policlinico San Matteo in Pavia, Italy, “you have to take into account a possible increase in cardiac arrests outside the hospital. hospital to strengthen the emergency system. “
Using real-time EMS data can also have wider benefits. A spike in cardiac arrests could provide an early warning for the virus itself. If an unusual increase in cardiac arrests indicates an imminent increase in COVID cases, cities and EMSs could respond accordingly.
“It might only give us a few days’ notice, but maybe it would save lives if we shut down earlier or tell people we are being hit hard,” Pepe said.
EMS data could provide useful real-time information and some scientists believe it could be a tool for spotting clusters and waves, as well as tracking how vaccine deployments are affecting people. It may even be part of a strategy to spot future pandemics.
“It is very important to follow the situation day by day, looking for signals, looking for a nominal increase in cardiac arrests,” said Savastano. He hopes the Lombardy cardiac arrest register, to which his hospital provides data, will be used to spot impending waves. “In the near future, we will have enough power to be predictive.”
