PMC:7417201 / 15326-20017
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7417201","sourcedb":"PMC","sourceid":"7417201","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7417201","text":"Discussion\nThe results of this study show that, due to the restrictive medical measures for COVID-19 emergency, the number of stress SPECT-MPI procedures was significantly reduced during the pandemic compared with the corresponding months of the previous 3 years (i.e., 2017, 2018, and 2019). However, the proportion of abnormal stress SPECT-MPI was not different between the two study periods. This finding suggests that a significant number of patients, who would have performed MPI test with abnormal results, have been missed during the COVID-19 pandemic. Given the mean number of 139 abnormal stress SPECT-MPI detected at our institution in the previous 3 years during the time range corresponding to the COVID-19 pandemic, and given the 44 abnormal tests observed during COVID-19 outbreak, it can be hypothesized that there is a 68% of abnormal test missed.\nPiccolo et al. [8] recently investigated the association between the outbreak of COVID-19 and primary PCI rates due to ACS in the Campania region. They found evidence that the outbreak of COVID-19 was associated with a decline by 32% in the number of PCI due to ACS. Data presented by Piccolo and co-workers [7] refer to the same region from which the patients belonging to this department come from. Even more concern may rise looking at reduced admissions for acute myocardial infarction during the COVID-19 pandemic not only in Campania region but also across Italy, with a parallel increase in fatality and complication rates [18].\nOur data also show that while patients with abnormal stress SPECT-MPI findings during the previous years 2017–2019 were older with higher proportion of diabetes and hypertension compared with those with normal imaging results, during pandemic COVID-19 outbreak, there was no difference between patients with normal and abnormal tests as regards to these clinical risk factors. This finding is not surprising given the high concern for vulnerability to COVID-19 in frail patients such as elderly subjects with hypertension and diabetes [19, 20]. Hence, it is reasonable that regarding frail population, the anxiety to become exposed to COVID-19 contagion while performing medical controls and diagnostic procedures has dominated the will to monitor CAD development on both sides of therapeutic alliance, from patient side through media communication and from health system side who was focused on relocation resources on COVID-19 pandemic management.\nThe lesson we learned from this global experience may be useful to improve nuclear medicine laboratories’ daily activities. Such implementation should have been put into practice as standard protocol rather than only during potential new emergencies. This is the only way to assure high-quality healthcare performances in terms of numbers and therapeutic strategies regardless specific contingencies without sacrificing medical assistance in favor of emergency needs. Protection of healthcare personnel, with personal protective equipment use and strict hand and laboratory hygiene, should be always recommended. To minimize contact, all information regarding the performing test, clinical history data, and consent to undertake the test should be provided prior to the patients’ on-site arrival. On the other hand, patient’s compliance should be always assured with a brief and safe interview before test. Regarding the choice of imaging protocol during the pandemic, this aspect should take into account only the diagnostic and prognostic evidences provided by literature as regards to the maximum benefit of patients from the type of test performed preferring 1-day-pharmacological stress-first SPECT-MPI protocols to optimize not only radioactive dose exposure but also the time of patient staying in hospital facilities. Patient selection for SPECT-MPI should be based on clinical judgment on expected benefit to guide management, on the urgency of the test, and in discussion with the referring clinician.\nThere are numerous physical and social scars from the pandemic COVID-19 emergency that humanity is called to manage. Among those directly linked to COVID-19 disease, human beings need to be aware and fully prepared to deal with those less evident when all the lights were on SARS-COV2 virus. There is a concrete risk to have gone back to the pre-primary prevention era, when diagnosis and treatments were reached too late. Thus, there is an urgent need to restore mutual trust in all hospital facilities as places of care rather than virus spread centers to avoid a further, long-term and no less dangerous effect of COVID-19 outbreak on non-COVID-19 patients saved from the virus storm but not from the darkness of 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