Attendance at Accident and Emergency departments in the UK is widely reported to have decreased precipitously since national lockdown was introduced on March 23, 2020. Anecdotal reports have suggested that heart attacks and strokes have “vanished from hospitals”,1 and that such patients “delay seeking help”.2 ST-segment elevation myocardial infarction (STEMI) and stroke are conditions for which hospital treatment is highly effective.
Daily ambulance callouts for these two conditions are routinely recorded by ambulance crews for the West Midlands Ambulance Service University NHS Foundation Trust, the second largest such service in the UK. We analysed data collected between Jan 10, 2018, and April 19, 2020 (figure ). We tested for the presence of a structural break in the time series of annually differenced weekly admissions (using a linear model with AR [1] errors). There was little evidence for such a break in either the STEMI (year-on-year change in mean callouts associated with lockdown: −9·1, 95% CI: −21·8 to 3·6; p=0·17) or stroke (−21·7, −47·6 to 4·2; p=0·11).
Figure.
Time series of weekly callouts for STEMI and stroke
Upper panels how number of weekly ambulance callouts for STEMI (left) and stroke (right), with mean (solid red line) and two standard deviation (dashed red lines) marked. Bottom panels show the proportionate year-on-year change in weekly ambulance callouts for STEMI (left) and stroke (right). Shaded grey areas indicate weeks 13 to 16 of the year, corresponding to the UK's lockdown period up to April 19, 2020. STEMI=ST-segment elevation myocardial infarction.
These data do not confirm a reduction in ambulance callouts for our two tracer health conditions. Although we cannot exclude such an effect, any effect must be of small magnitude. The COVID-19 pandemic might be associated with negative collateral health effects, but we find no evidence that people are reluctant to call an ambulance when they experience symptoms of stroke or heart attack.
Acknowledgments
We declare no competing interests. We thank Fergus Hamilton (North Bristol NHS Trust), Peter Chilton (University of Birmingham) and Gavin Perkins (University of Warwick) for their contributions to this Correspondence. RL is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands. Views expressed are not necessarily those of the National Health Service, the NIHR, or the Department of Health and Social Care.
References
- 1.Bernstein L, Stead Sellers F. Patients with heart attacks, strokes and even appendicitis vanish from hospitals. April 20, 2020. https://www.washingtonpost.com/health/patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals/2020/04/19/9ca3ef24-7eb4-11ea-9040-68981f488eed_story.html
- 2.Spinney L. Concern as heart attack and stroke patients delay seeking help. April 16, 2020. https://www.theguardian.com/world/2020/apr/16/coronavirus-concern-heart-attack-stroke-patients-delay-seeking-help