Collateral damage of a global pandemic: implications of COVID-19 for Australians with cardiovascular disease.

The coronavirus disease 2019 (COVID‐19) pandemic is a crisis of unprecedented proportions with immeasurable health, societal and economic implications. The rapid inter‐continental spread of COVID‐19 led to the declaration of a global pandemic merely 3 months following its discovery. In Australia, the institution of social mitigation practices has been largely successful, with some of the lowest rates of infection and death recorded across the world. However, the toll of the COVID‐19 pandemic is not limited to those infected with the virus.

To contain the transmission and conserve personal protective equipment (PPE), up to 80% of elective cardiovascular procedures have been postponed or cancelled. The collateral damage resulting from the diminished resources available to those with non‐COVID‐19 illness is slowly emerging, with case reports of under‐utilisation of hospital resources resulting in significant morbidity and mortality.

Over the past six decades, The National Heart Foundation has pioneered efforts to increase cardiovascular symptom awareness and early presentation of acute coronary syndromes (ACS). The establishment of systems designed to minimise the time from symptom onset to revascularisation is pivotal to improving long‐term cardiac outcomes. In light of the current climate, government mandates and societally adopted agoraphobia, there is a risk that the effects of such campaigns may be lost. From a patient's standpoint, rigorous public health warnings that are undoubtedly critical to curb the spread of COVID‐19 may lead to unintended delays in seeking help. A recent study from our institution investigated both trends in ACS presentations and the time to seeking medical attention. This demonstrated a fourfold increase in symptom‐to‐door time that translated to a 6‐h delay to hospital presentation (Fig. 1). Moreover, approximately one in two patients presented over 12 h following symptom onset. This is of significant concern due to the consequences posed by the delayed treatment of acute myocardial infarction.

Figure 1

Symptom‐to‐door time in the COVID era. Median symptom‐to‐door time (h) for the COVID‐19 era compared with the same time period in previous years at a single Australian institution. P‐value for trend is <0.001. COVID‐19 era defined as 16 March to 15 April 2020. Reproduced from Toner et al.,5 with permission.

From a healthcare delivery perspective, obtaining detailed travel and contact history, patient testing prior to transfer and extensive donning of PPE can further prolong time to reperfusion. The effect of under‐utilisation of healthcare during acute cardiac events, reduced preventative and early detection services and the potential for future barriers to treatment due to financial hardship on patient prognosis is unknown. Only in hindsight will the real burden of this collateral damage be truly appreciated.

As the curve flattens, there is a growing possibility that more deaths will result in Australia from preventable illness other than COVID‐19. Every effort must be undertaken by the medical community to minimise this collateral damage. The latent effects caused by the enforced allocation of resources away from prevention and early detection of non‐COVID‐19 disease will be unveiled in time. As such, forethought must be given to the establishment of hospital systems to meet the growing needs of patients who have been overshadowed by the threat of this pandemic.