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New York

Covid-19: NY issues do-not-resuscitate rule for cardiac patients

In New York state, emergency-services no longer to revive patients without a pulse because of an overload of Coronavirus patients. And globally, mortality rates are spiking.

Published: April 22, 2020, 7:52 am

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    Paramedics had previously tried for at least 20 minutes to revive cardiac arrest patients, but now it has become “necessary during the COVID-19 response to protect the health and safety of EMS providers by limiting their exposure, conserve resources, and ensure optimal use of equipment to save the greatest number of lives,’’ according to the state Health Department.

    “They’re not giving people a second chance to live anymore,’’ said the head of the city union for uniformed emergency responders and paramedics. “Our job is to bring patients back to life. This guideline takes that away from us,” Oren Barzilay said.

    Earlier this month, the Regional Emergency Services Council of New York, which oversees the city’s ambulance service, declared that cardiac-arrest patients who could not be revived at the scene, should no longer be taken to hospital.

    According to a New York Times analysis of mortality data from 11 countries, at least 25 000 more deaths have occurred over the last month than normal, adding to the official Covid-19 numbers.

    The totals include deaths from both the virus and other causes. Most countries count as Covid-19 deaths only those that occur in hospitals.

    “Whatever number is reported on a given day is going to be a gross underestimate,” a demographer at the Max Planck Institute for Demographic Research in Germany noted.

    Since the beginning of the pandemic in Italy, victims of heart attacks have increased and life-saving procedures have decreased by 40 percent, data from the study of the Monzino Cardiology Center in Milan shows.

    Thus the mortality rate from acute heart attack has almost tripled. Monzino believes the 40 percent decrease in life-saving cardiology procedures is due to the distrust of patients towards hospitals.

    “Patients arrive in hospital in ever more serious conditions,” explained Giancarlo Merenzi, head of the Intensive Care Unit of Cardiology. “They often already with arrhythmic or functional complications, which make the therapies that have proven to be life-saving much less effective.”

    The reason, according to the source, is very clear and it is the same that is found in all the countries most affected by the new coronavirus pandemic: “The virus, which does not seem to have a primary role in the heart attack, pushes people to postpone the access to the hospital out of fear of contagion. Unfortunately, however, this delay is harmful, and often fatal, because it prevents timely treatment and in heart attacks the time factor is crucial.”

    The authors cite the results of a recent study that analyzed the activity of 81 Spanish ICUs, comparing it with that of the same period in 2019. Due to a significant drop in hospitalizations for heart attacks, the consequent 40 percent reduction has been noted “in primary coronary angioplasty procedures” according to AdnKronos.

    A similar situation was also reported in studies arriving from elsewhere in the United States. To the already alarming figures are also added those that indicate an increase in deaths caused by cardiac arrest.

    In Europe, around 20 to 30 percent more people dying than normal. In Paris, the death rate has almost doubled while deaths across the Atlantic have quadrupled in New York City.

    Cities and countries that were slow to acknowledge the crisis have been especially hard-hit. Turkey’s capital Istanbul, for example, recorded about 2 100 more deaths than expected from mid-March to mid-April — about twice the official number of Covid-19 deaths reported for the whole country in that period.

    Meanwhile, new data shows that the United Kingdom will soon become the second worst-hit country in Europe, after Italy, for the number Covid-19 fatalities.

    On Tuesday, the UK Office for National Statistics (ONS) revealed that the Coronavirus-related death toll was over 40 percent higher than daily figures, Reuters reported.

    The ONS reportedly registered 13 121 death cases in England and Wales by 10 April, while the government reported 9 288 deaths in hospitals. The ONS included deaths registered in both hospitals and care homes, where the toll has doubled in less than a month.

    UK Corona deaths in hospitals stood at 17 337, but the real number could be more than 23 000, making the UK the second-worst nation hit in Europe after Italy.

    Matt Hancock, the UK Health Secretary, dismissed the 40 percent gap however saying it was “not an accurate representation of those figures”.

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