Decline in acute coronary syndrome hospitalisation rates during COVID-19 lockdown in private hospitals in South Africa

Abstract

Cardiovascular presentation of acute coronary syndrome (ACS) patients with severe acute respiratory disease coronavirus- 2 (SARS-CoV-2), referred to as “COVID-19”, can be complex with varying presentations of ST-elevation myocardial infarction (STEMI), stress cardiomyopathy, non-ischaemic cardiomyopathy, coronary spasm or non-specific myocardial injury. Concern has been expressed worldwide regarding the failure of patients with emergent ACS to access healthcare during the SARS-coronavirus disease 19 (COVID-19) pandemic, which was declared to be a pandemic by the World Health Organization (WHO) on 14 March 2020. The first COVID-19 case was diagnosed in South Africa on 5 March 2020. On 15 March 2020, the South African President, Cyril Ramaphosa, declared a national state of disaster in terms of the Disaster Management Act, 2002, and coronavirus alert level 5 lockdown regulations were applied to reduce the transmission of the virus from 27 March. Alert level 4 lockdown regulations were then made applicable from 1 May 2020. A marked decrease in the volume of patients presenting with ACS was observed during lockdown in April 2020 by one of the three major private hospital groups in South Africa.