The coronavirus pandemic has claimed many more victims than the Covid-19 patients alone. A study published this week in the newspaper “The Lancet Public Health” indeed shows that during confinement in the Paris region, not only has the number of cardiac arrests increased but the survival of these patients admitted to hospital has also significantly decreased .
According to the Inserm researchers who carried out the study, 521 cardiac arrests were recorded between March 16 and April 26 in Paris, in the Hauts-de-Seine, in Seine-Saint-Denis and in the Val de Marne. During the peak of the epidemic (the weeks of March 23 and 30), the frequency of these stops rose to 26.64 per million inhabitants, i.e. exactly double that recorded in the previous seven years (13, 42 per million inhabitants).
On arrival at the hospital, only 12.8% of these patients were alive, compared to 22.8% at the same period in previous years. This rate returned to normal towards the end of the study period.
Several hypotheses
How to explain these bad figures? Only a third of the excess death observed is directly associated with Covid-19, according to the researchers. Although the profile of the patients has not changed (two thirds of men, a little less than 69 years on average), the context of these arrests was different during this period: more than 90% occurred home (compared to 76.8% usually) and therefore often before fewer witnesses.
The latter, most often the family, did less cardiac massage. However, the latter increases the chances of survival by 8, according to previous studies by the authors. Rescuers also took longer to arrive during confinement, despite the empty roads.
The researchers also put forward the hypothesis of less accessible care during this period. “There was a breakdown in the medical follow-up of the patients, because they were unable to consult, because they feared to interfere, resulting in a delay in the call, or fear, for some, of being contaminated in the hospital, “explains Professor Eloi Marijon of the Cardiovascular Research Center of Paris (Inserm / University of Paris) who conducted the study with his colleague Nicole Karam, in collaboration with Daniel Jost (Brigade of firefighters of Paris).
He thus evokes the less regular monitoring of cardiac patients, and even, “perhaps also in a small number of cases” of possible deleterious effects of drugs taken by patients to treat Covid-19 disease. “There were probably difficulties in reaching the emergency services on 15 (Samu) and 18 (firefighters) with longer waiting times,” he adds.
Lessons to be learned
This study highlights the excess mortality caused by the pandemic, emphasizes its authors. The results “allow us to better understand the consequences of this crisis, the lessons to be learned, also to better react in the event of a second wave,” says Nicole Karam. She considers it “necessary to find a balance” between taking charge of the epidemic and monitoring other patients.
An increase in the incidence of cardiac arrests has been observed elsewhere, in New York, in California, and in Italy, in particular in Lombardy, which was faced with an overwhelming overload of health care, therefore in a different context of the Paris region, underlines the researcher.
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