2  DISCUSSION
This case highlights the issues that have been raised before by others regarding the coronavirus, stay‐at‐home regulations, and demand for emergency care for non‐COVID conditions. A recent article published in the Washington Post, 1  has reported that physicians in the United States, Spain, and the UK have all noticed a serious decline in the number of patients coming to the ER not only for typical problems like appendicitis, bowel obstructions, gall bladder problems but also for the more critical heart attacks and strokes. Metzler reports a 40% decline in the number of admissions for STEMI and non‐STEMI in Austria during the COVID‐19 pandemic. 2  In a soon to be published report by Garcia, 3  number of cardiac catheterization laboratory activations for STEMI have been reduced by almost 40% in nine high‐volume centers in the United States.
The reasons for this decline are many and include fear for catching a deadly virus in the hospital, the instruction to strictly stay in‐house, consideration of many heart‐related symptoms of shortness of breath and chest discomfort by patients to be related to respiratory infections and best dealt with at home and so forth.
This patient's pain started 2 days earlier, but he did not seek attention until later. From the conversation with him and his wife, they were concerned about the risk of catching the deadly COVID‐19 in the hospital. The patient was not a smoker or a known diabetic and did not have any family history of coronary artery disease. A heart attack was not on their mind but respiratory infection and fear of COVID‐19 was the first and foremost concern of theirs. It was not until his chest pain had persisted for 2 days that he finally came to ER. Had he come when the pain had started, this patient would likely have had an uneventful recovery after treatment of the right coronary artery occlusion per the ACC guidelines. His avoidance of an ER visit in a timely fashion because of the fear of COVID‐19 led to the catastrophic complication of STEMI that surgeons rarely see today because of successful results of timely percutaneous revascularization.
Whatever the reason for this patient's or that of others to delay seeking medical attention during this pandemic, the concern remains that this delay will lead to increased morbidity and mortality in the coming weeks and months. There most certainly are many others like this patient, who have suffered or will suffer a catastrophic complication due to delay in treatment. Metzler et al 2  posits that if 40% of people are not seeking care for acute coronary syndromes, and assuming 40% of those untreated people suffer a significant complication or death, the effect of COVID‐19 pandemic on non‐COVID related health of our population may be even more devastating than COVID‐19 itself. And this case just highlights the fact that this assumption may not be too far from the truth.