Observational study on chest pain during the Covid-19 pandemic: changes and characteristics of visits to a Norwegian emergency department during the lockdown

Abstract

The Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) emerged in Wuhan, China in December 2019, and spread rapidly worldwide causing the Coronavirus Disease 2019 (Covid-19) pandemic [1]. Italy was the first country in Europe to be severely stricken by the disease, and the health care services struggled to keep up with the rapid surge of cases due to limited capacity of intensive care units [2]. Similar scenarios were expected in other European countries the following weeks.

The first case of Covid-19 in Norway was reported on February 21st, 2020. By March 12th, reported cases in Norway counted 621. In some cases, it was no longer possible to determine the source of infection. Comprehensive measures were implemented by the Norwegian Institute of Public Health (NIPH) the same day, March 12th, in an effort to contain the situation [3]. From April 20th, the preventive measures in Norway were gradually lifted as the number of new cases decreased. The incidence of Covid-19 remained low over the summer, followed by a steady increase in the number of new cases throughout August.

As Covid-19 spread across the world, a growing number of reports were published on a substantial decline in the numbers of emergency department (ED) visits [4, 5]. An initial report from the ED at St. Olav’s University Hospital presented findings consistent with this trend, depicting a general reduction in all patient groups, with no specific symptom, condition or acuity level standing out [6].

The general decline in ED visits has also been found to include patients presenting with chest pain and possible acute coronary syndrome (ACS) in several international studies [7,8,9]. This trend was worrisome as this patient population is prone to severe complications, such as acute myocardial infarction, heart failure, arrhythmia, and death, if there are delays in treatment. An increase in such events has been reported since the beginning of the Covid-19 pandemic [10]. Moreover, a substantial decline in the rate of hospitalization among patients with ACS has also been reported [4], and the number of cardiac arrests outside of hospitals has increased in some countries during this period [11].

The trend of a general decline in ED visits as reported internationally was confirmed in an initial report from the ED at St. Olav’s University Hospital by Bjørnsen et al. [6]. Although the report provided an overview of the situation during an early phase, it is not known how the Covid-19 pandemic and the following national lockdown affected the chest pain population specifically in this early phase and throughout the following months. Thus, the present study sought to provide insight into how the chest pain population in the ED of a Norwegian University Hospital responded to the Covid-19 pandemic and the following national lockdown.