Is the fear of disease worse than the disease itself?

COVID-19 is the first major pandemic the modern world has faced since the Spanish influenza pandemic of 1918 and has had a profound impact on all aspects of society.1 Governments worldwide have established emergency plans to help tackle and reduce the rapid spread of the infection, with social isolation being implemented by most to varying degrees. Healthcare systems are facing unprecedented challenges and real-time restructuring and, as expected, this has resulted in an excess mortality worldwide.1 The first fatality with COVID-19 in the UK was reported on 2 March 2020, with subsequent nationwide lockdown on 23 March 2020. Public health concerns have focused on the increases in mortality directly attributable to COVID-19 and the indirect consequences of the pandemic on the healthcare system’s ability to manage non-COVID-19 related life-threatening illnesses due to diversion of established healthcare resources and capacity. This is a complex situation and there is also some overlap in direct and indirect causes of mortality. For example, as with other viral and respiratory illnesses, there is the potential for COVID-19 to trigger other fatal events that may not have otherwise happened. For example, it is well described that there is a 44% increase in myocardial infarction in the weeks after respiratory tract infections.2 There is also the concern that patients themselves may be reluctant to seek attention because of concerns regarding contracting COVID-19 in the hospital or burdening an overstretched healthcare system that is trying to cope with seriously ill patients with COVID-19. In the current issue of Heart , Wu and colleagues have assessed the impact of COVID-19 on both the population incidence and location of acute cardiovascular mortality that sheds light on some of these …