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ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 17-20

Did the fear of contagion deter patients from reporting serious conditions during the COVID-19 pandemic lockdown? A report from South India


1 Department of General Medicine, Father Muller's Medical College, Mangalore, Karnataka, India, India
2 Department of General Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
3 Department of General Medicine, KSHegde Medical Academy, Mangalore, Karnataka, India
4 Department of Physiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission02-Nov-2020
Date of Acceptance24-May-2021
Date of Web Publication03-Sep-2021

Correspondence Address:
Dr. B Ganaraja
Department of Physiology, Kasturba Medical College, Mangaluru (A constituent of Manipal Academy of Higher Education), Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_48_20

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  Abstract 


Context: Severe acute respiratory syndrome coronavirus-19 has had a devastating effect on the common man's life. Aim: To study whether the fear of contracting covid19 infection deter the patients from seeking medical help? Setting and Design: Retrospective study from hospital data were obtained from the medical record departments of four major hospitals. Materials and methods: Number of admissions for eight serious illnesses in the month of April in 2020 compared to 3 preceding years. Statistical analysis: The data were analyzed by applying multiple measures ANOVA and descriptive statistics. Results: There was a significant decrease in the number of admissions in each of the eight listed illnesses during April 2020 compared to the same period in the previous 3 years. There was no significant change in the number of deaths reported in the district during this period, as suggested by the government data. Conclusion: From the observed results, it is evident that there was a marked decline in the hospitalization for serious illnesses during the lockdown period in south India. This result is in agreement with the data from similar studies, published from hospitals worldwide.

Keywords: Acute coronary syndrome, acute kidney injury, COVID-19 pandemic, gastroenteritis, sepsis


How to cite this article:
Prasanth Y M, Kumar P P, Rao S M, Ganaraja B. Did the fear of contagion deter patients from reporting serious conditions during the COVID-19 pandemic lockdown? A report from South India. Muller J Med Sci Res 2021;12:17-20

How to cite this URL:
Prasanth Y M, Kumar P P, Rao S M, Ganaraja B. Did the fear of contagion deter patients from reporting serious conditions during the COVID-19 pandemic lockdown? A report from South India. Muller J Med Sci Res [serial online] 2021 [cited 2021 Nov 30];12:17-20. Available from: https://www.mjmsr.net/text.asp?2021/12/1/17/325482




  Introduction Top


A novel coronavirus, subsequently named severe acute respiratory syndrome coronavirus 2, was detected in China in late 2019. It has spread across the globe, leading to the COVID-19 pandemic.[1] The novel coronavirus pandemic has led to several containment measures all over the world. India has seen a total lockdown beginning in March and extending to May. A similar lockdown was also implemented in many other countries around the world. During this period, there was a significant disruption in the routine functioning of the population. Businesses and offices were shut down, and every individual was affected in some or other way. Health care was no exception. There are several reports of widespread changes in the pattern of hospital visits by patients.

Reports from Milan hospital claimed a reduction of 37% in the admissions of non-COVID patients in 2020 and after the first report of COVID.[2] They suggested that the fear of the infection may be the main reason for this decline. An Israeli study reported a 27%–32% decline in nontrauma surgical patients during the pandemic period in early 2020, while hospitalization for diverticular disease decreased by 84%.[3] A multicenter study in Italy during the height of the COVID-19 outbreak noted a 48.4% reduction in acute myocardial infarction. However, it was associated with a higher rate of major complications at 18.8% (10.4% in 2019) and a higher case fatality rate at 13.7% (4.1% in 2019).[4] A study at Monaco compared admission for cardiovascular emergencies during March 2019 and March 2020 and found a reduction by 21% in 2020.[5] De Filippo et al. studied acute coronary syndrome admissions at 15 hospitals in northern Italy during the COVID-19 outbreak with social containment measures. They reported a 28.17% reduction in admissions in 2020.[6]

Reports comparable to this also have been published from surgical departments across the spectrum from France. Urology admissions where they report a decline by 55% of cases in surgical urology in the year 2020 compared to the data from a similar period in 2019. The number of kidney transplants declined by 92%. Oncology activity was reportedly decreased by 34% and oncology emergencies by 44%.[7]

Delayed reporting of cancer and consequences of this, due to lockdown and COVID-19 pandemic, caused delayed diagnosis and could lead to increased years of life lost, as reported from England, UK.[8]

Kazi et al. at Harvard, Boston, Massachusetts, USA, noted a reduction in admissions for acute myocardial infarction and stroke by 48.3% and 43.24%, respectively, as compared to the same time in 2019.[9] Solomon et al. examined the data from Kaiser Permanente, Northern California comprising 21 medical centers and 255 clinics and observed a 32.83% drop in admissions for acute MI during the COVID-19 pandemic in March–April 2020 compared to the same period last year.[10] Bhatt et al. studied hospital admissions for acute cardiovascular emergencies across 15 centers in the United States of America; they also observed a 43.4% reduction in admissions in 2020.[11] Even surgical specialties noted a drop in emergency surgeries. O Cano-Valderrama studied the data for emergency surgeries in three Spanish hospitals during march 2020 and used the same period in 2019 as control. There was a 65.4% drop in the surgeries in 2020 comparatively.[12]

However, medical emergencies cannot be postponed. So far, few Indian hospitals reported hospital admissions statistics during the early stages of lockdown to contain the pandemic. In this report, we present the hospital admission data for the period of lockdown ensuing the COVID-19 pandemic, particularly for specific serious medical problems, which generally need in-patient treatment.


  Materials and Methods Top


This is a multicenter, retrospective, observational study. The study period was the month of April, of 3 consecutive years, 2017–2020. Data were acquired from the medical records department (MRD) of four major medical college tertiary care hospitals in a major city of South India, which are attached to Medical colleges, Mangaluru, India. Father Muller Medical College Hospital, Kasturba Medical College Hospital, Mangalore, K S Hegde Medical College Hospital, and Yenepoya Medical college Hospital were included in the study. These four prominent medical college hospitals cater to more than one million residents from Dakshina Kannada and neighboring districts. The inpatient data were accessed from the medical records section for April, for 4 consecutive years 2017–2020. Data were collected for the following critical illnesses as per the ICD-10 codes: chronic obstructive pulmonary disease (COPD) exacerbation, acute asthma, acute coronary syndromes, acute gastroenteritis, acute appendicitis, acute cholecystitis, sepsis, and acute kidney injury. All age groups were included. The hospital admission data for a particular disease were included. The average admission for the 3 years from 2017 to 2019 was calculated. It was compared with the admission for 2020. The change has been mentioned in percentage. The data were analyzed using one-way ANOVA – multiple measures, and P < 0.05 was accepted as significant.

The permission to gather data from the MRD was obtained from each institution's head. Ethical clearance was taken before the study was carried out. Since MRD data were harvested without the patient details, informed consent was waived. (principal investigator institution: FMIEC/CCM/188/2020; dated: 10.06.2020). Ethical clearance was obtained from each participant institution.


  Results Top


Hospital admissions

In the present study, number of patients admitted during the coronavirus disease-2019 lockdown as compared to the same period in the previous years at Mangaluru - consolidated figures of all four hospitals considered a significant decrease was observed in the admissions for each condition in all the hospitals ([Table 1], ANOVA P < 0.001). Disease-wise descriptive statistics revealed a 78.77% reduction in admission in COPD exacerbation. There was an 82.73% reduction in bronchial asthma exacerbation. Cardiovascular emergencies also saw a decrease by 52% during the pandemic. Gastrointestinal emergency admissions such as acute gastroenteritis, acute appendicitis, and acute cholecystitis and showed 87.39%, 91.97%, 67.55% reduction, respectively. Admissions for sepsis were reduced by 56.41%. Acute kidney injury admissions were also reduced by 60.64%.
Table 1: Hospitalization for critical diseases

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Mortality statistics

We collected the monthly mortality statistics from January to June of last year compared to the same period in 2020 [Table 2]. There was no discernible difference inhospital mortality or the home deaths up to February (until the pandemic started), but following this, the number of deaths showed a decline.
Table 2: Mangaluru city corporation mortality statistics

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  Discussion Top


Several studies from across the globe had actively analyzed the effect of restrictions imposed to contain COVID-19 spread in their respective countries regarding individual diseases. We decided to extend the scope of study and looked at various emergency medical conditions that would otherwise warrant hospitalized care prevalent in this region of south India. We observed an unnaturally low report of the diseases, which was intriguing. The reasons attributed to this could be multiple.

[Table 3] below throws light into the extent of change observed in various countries. However, most of them focused on a single type of disease but reported a significant decline in hospitalization. Unlike these, our study took into consideration all major diseases prevalent in the region.
Table 3: A comparison of studies showing a reduction in admissions during the coronavirus disease-2019 pandemic

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Factors that caused this kind of variation could only be speculated at this juncture. However, several pointers are apparent. Probably, short-term lifestyle changes such as reduced exertion and lower stress levels could have contributed to reducing cardiovascular events. At the same time, low levels of pollution could have reduced respiratory emergencies. Dependence on home-cooked food may be the reason for reduced gastrointestinal cases. However, Enrico Baldi et al. found increased out of hospital cardiac arrests in Italy compared to the same period in the years 2019 and 2020, and there was a 52% increase in OHCAs in 2020.[13]

The rapidity of the spread of the pandemic and the influence of visual media and social media created an untold extent of influence on the public. Fear of contracting the coronavirus at hospitals may be the prime factor that led to the observed reduction in hospital admissions. Lack of access to public transport facilities might have also been responsible for the delay in seeking care. This movement restriction has resulted in fewer people accessing health-care facilities for their medical issues and relying more upon online or telephonic consultations.[14] A drop in income could have been a factor for the uninsured patients, as they hesitate to burden family members for unforeseen expenses. Lack of primary care physicians' availability to guide and refer patients due to the closing down of several clinics may have contributed. This study will be continued to find the various reasons for the observed changes by considering the inputs from doctors, other health-care workers; patients and caretakers; and the common public.

Lack of public awareness on means to access health care and a general breakdown of the health-care system needs to be looked into. Therefore, this study highlights the need to augment the delivery of health-care needs of people and educate the importance of timely intervention in many cases so that precious lives could be saved.


  Conclusion Top


From this study, it is evident that there was marked decline in the hospitalization for serious illness during the lock-down period in India as well as in other countries. This suggested a need for sensitization of people regarding the importance of timely intervention for saving precious life, even during pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zhu Na, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Eng J Med 2020;382:727-33.  Back to cited text no. 1
    
2.
Franchini S, Spessot M, Landoni G, Piani C, Cappelletti C, Mariani F, et al. Stranger Months: How SARS-CoV-2, fear of contagion, and lockdown measures impacted attendance and clinical activity during february and march 2020 at an urban emergency department in Milan. Disaster Med Public Health Prep. 2020;1-10. doi: 10.1017/dmp.2020.265.  Back to cited text no. 2
    
3.
Anteby R, Zager Y, Barash Y, Nadler R, Cordoba M, Klang E, et al. The impact of the coronavirus disease 2019 outbreak on the attendance of patients with surgical complaints at a tertiary hospital emergency department. J Laparoendosc Adv Surg Tech A 2020;30:1001-7.  Back to cited text no. 3
    
4.
De Rosa S, Spaccarotella C, Basso C, Calabrò MP, Curcio A, Filardi PP, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J 2020;41:2083-8.  Back to cited text no. 4
    
5.
Enache B, Claessens YE, Boulay F, Dor V, Eker A, Civaia F, et al. Reduction in cardiovascular emergency admissions in Monaco during the COVID-19 pandemic. Clin Res Cardiol 2020;109:1577-8.  Back to cited text no. 5
    
6.
De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, et al. Reduced rate of hospital admissions for ACS during Covid-19 outbreak in northern Italy. N Engl J Med 2020;383:88-9.  Back to cited text no. 6
    
7.
Pinar U, Anract J, Duquesne I, Dariane C, Chartier-Kastler E, Cussenot O, et al. Impact of the COVID-19 pandemic on surgical activity within academic urological departments in Paris. Prog Urol 2020;30:439-47.  Back to cited text no. 7
    
8.
Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study. Lancet Oncol 2020;21:1023-34.  Back to cited text no. 8
    
9.
Kazi DS, Wadhera RK, Shen C, Ho KK, Patell R, Selim MH, et al. Decline in emergent and urgent care during the COVID-19 pandemic. BMJ Yale, MedRxiv - Preprint 2020; May 18. https://doi.org/10.1101/2020.05.140.20096602.  Back to cited text no. 9
    
10.
Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung SH, et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med 2020;383:691-3.  Back to cited text no. 10
    
11.
Bhatt AS, Moscone A, McElrath EE, Varshney AS, Claggett BL, Bhatt DL, et al. Fewer hospitalizations for acute cardiovascular conditions during the COVID-19 pandemic. J Am Coll Cardiol 2020;76:280-8.  Back to cited text no. 11
    
12.
Cano-Valderrama O, Morales X, Ferrigni CJ, Martín-Antona E, Turrado V, García A, et al. Reduction in emergency surgery activity during COVID-19 pandemic in three Spanish hospitals. Br J Surg 2020;107:e239.  Back to cited text no. 12
    
13.
Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, et al. COVID-19 kills at home: The close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. Eur Heart J 2020;41:3045-54.  Back to cited text no. 13
    
14.
Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc 2020;27:1132-5.  Back to cited text no. 14
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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