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Comment by nostromo | Hacker News Reader

Heart attacks are similarly down 40-60%.

https://www.nytimes.com/2020/04/06/well/live/coronavirus-doc...

And cancer diagnoses are down by half.

Of course, no, they aren’t down, it’s just that people that absolutely should be going to the hospital aren’t and they’re endangering their lives trying to avoid COVID-19.

Could something similar be at play here?

I laughed out loud when they suggested that this is a “low stress” time to be pregnant. All indicators show the opposite.

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Difference is you can't "hold in" a pre-term birth b/c you're afraid of covid.

Half of premature babies are delivered via c-section and many more are induced, usually because there is some risk to the mother or baby at holding the baby to term.

I find it doubtful that the people researching this phenomenon didn't think of that, don't you?

Such as inducement for preeclampsia, which in prior years accounted for ~15% of premature births in the U.S.: https://www.marchofdimes.org/complications/preeclampsia.aspx

Like with coronary and cardiovascular diseases, I imagine long-term impacts won't be known for several years.

c-sections are money makers, we left our hospital in Boston when we found they had a 50% c-section rate, ha

That's straight-up cyberpunk horror territory. What the actual fuck

Could many of those C-sections be at the request of the mother? I know quite a few professional women who have scheduled C-sections (or just induced births) so they can "manage" the delivery better. Seems crazy to me, but not my body, child, or career.

That also seems horrifying & cyperpunk to me but I doubt a significant chunk of women choose it, let alone independently.

In India, it's something of a fashion and women choose it because its convenient, etc.

India is cheating

Based on time-of-day data, it seems the scheduling is more likely to convenience the doctors.

Unless there's a medical need it's not ethical to give a c-section as it creates greater risk of complication (including and especially death), more long-term effects, worse effects on the child, and just so happens to make the hospital more money. Of course if there is a medical need then they should be done, but it's not like tonsilectomy.

It could be a ward that specializes in handling risky pregnancies, so a desired result.

The pressure to schedule an induction up to a week or so early is also very strong. The sales pitch is "we can schedule at a convenient time for you and ensure that you'll have a bed". Implying that you're being super irresponsible by letting nature decide when the baby's ready. It all just feels like the OB/GYN is worried about their schedule more than the baby's or mother's well-being.

And c-sections are definitely subtly encouraged even if there's not a real need.

But you can 'hold in' cancer?

It's not about cancer deaths, it's cancer diagnoses. Don't go to the hospital/doctor => no diagnosis

Oh if that's what the commentor I replied to meant, I misunderstood completely. :thumbs-up:

I think the surprising truth is that women may, inconsciously or to some extent, influence the time of birth.

If you look at the distribution of birth per calendar days there are unusual spikes and distributions on special days such as valentines day and i'm not sure this could explain by people deciding to have specifically more sex 9 month before considering the "supposed" randomness of the day of birth aound the 9 month mark..

http://thedailyviz.com/2016/09/17/how-common-is-your-birthda...

I could be wrong but I thought that was explained by c section scheduling. Doctors love nothing more than a tight schedule and birth is anything but that.

Had a child due around Christmas in our family, and I think both you and parent are both correct. The mother really didn't want to miss Christmas and the doctor offered to schedule an early induction. They didn't offer to induce on Christmas Day, eve or the day after. The baby came a couple days after Christmas.

That would be kinda sad though

Yeah I was thinking the same.. This is not a low stress time. I've not been so stressed (and depressed) for a long time.

There's lots of evidence from fitness tracker companies that most people (who use fitness trackers at least) are indeed less stressed.

But fitness devices are notoriously bad at tracking stress :) I have stress measurement on both my Galaxy watch active and my phone (S8), and neither reading has any correlation with how stressed I am.

Basically when I've been working out it always thinks I'm stressed because my heartrate is still high, and when I'm all stressed in work it shows the lowest possible :S

I think it's just not possible to measure something as complex as stress using so few metrics. Same with sleep tracking. When I had a sleep study done I was wired up like a borg :D Checked the sleep tracking on my watch later with the graphs I received and it didn't match at all.

They're good at showing raw stats like footsteps, location and heartrate (and tracking them over time for laps/pace etc) but that's about it. But I don't trust their derived measurements at all. If the other trackers work like my watch, they'll think you're super relaxed if you haven't been working out.

Anecdotally, I can say the opposite. The algorithms seem to work on me to a reasonable extent.

Not arguing your broader point, but heart rate variability is a better tracker of stress than heart rate itself, if you want to track it yourself.

Not many heavily pregnant people will be out doing strenuous exercise!

There isn't much point wearing your fitness tracker if you never leave the house.

I think what you're saying has merit.

No data from me, only a personal anecdote.

I avoided the ER during a severe illness comprising intense bloating, severe pain, and constant vomiting for about five days roughly a month ago.

I ended up in the hospital for about eight days and was discharged just over a week ago. Turns out I'd suffered a severe acute necrotizing pancreatitis attack and just "battled through" with gatorade, water (when I could keep fluids down) and sleep. I even worked from home in between falling over on the couch!

I just really didn't want to visit the hospital. Figured it was a bad stomach bug or bad take out.

No—it turns out I was lucky to avoid the ICU and am going to be dealing with it for the next 6-12 months, if not permanently. I lost about 30 lbs in a couple of weeks because I couldn't really eat.

Even now I'm doing what I can to prevent a premature return to the hospital outside of appointments. The intake procedure is slower and requires more attention than normal from people suffering and in pain.

It's quite stressful. And this is in Canada where I didn't have to worry about a single hospital bill after multiple CT scans, ultrasounds, XRays, medications, regular blood work and blood cultures, and a semi-private hospital bed.

Outside of the stress of health issues, the worst thing I've had to endure is my employer asking me to have an insurance form filled out by my attending doctor in case I have to be re-admitted. It's difficult organizing having forms filled out when most appointments are held over the phone presently.

I can't imagine the burden of trying to navigate grants and massive bills on top of it all.

Yes, reluctance of going to the hospital is definitely the biggest factor for rapid changes in hospital-treated, non emergency health trends.

So what's the advertising campaign going to look like to get people to start going again? "Get that hernia repaired" just doesn't sound that catchy.

It short-sighted to look at those reductions in heart attacks and cancer and claim that they are all the result of people not going to the hospital, I'm sure for some percentage is true but there are dozens more factors likely involved: Less going out means less exposure to smog/contamination, less car accidents, less commute-caused stress, less physical confrontations with coworkers and strangers (eg thieves), more homemade food over street food, less bar fights, less weekend nightlife (eg parties) means less likelihood to get a cold (and pneumonia et al), as well as less promiscuity, you get the point, and I'm sure I'm missing a lot more possible factors on this list.

I'm sure there's some truth in all those other factors but I'm not sure how much any of them have to do with heart attack rate, much less cancer.

People are absolutely putting off going to the doctor or hospital for symptoms and problems that they can at least convince themselves are "nothing" or which will get better on their own.

I did it myself in May for a probable pinched nerve. (I did talk to a doctor friend of mine admittedly and she didn't think it was something that needed urgent medical attention and it has largely subsided on its own for now.) But it was definitely at the point where I would normally have gone to see my doctor.

Suicides were down in Japan due to less stress without the pressures of work. Something like that could also affect heart attack rates, though no idea if it would be significant. Record numbers of people have quit smoking as well, though I don't know if that would affect heart attack risk that fast.

So you're saying people are just pushing through heart attacks then going about their business?

I was a bit taken aback at first, too, but then I realised heart attack symptoms fall on a continuous scale, and sometimes people don't even know they had a cardiovascular event. Smaller ones that mainly cause a lot of discomfort but then go away might be ignored now when they shouldn't be. Pure speculation, of course.

That’s exactly what the NYTimes piece I linked to postulates:

“The most concerning possible explanation is that people stay home and suffer rather than risk coming to the hospital and getting infected with coronavirus. This theory suggests that Covid-19 has instilled fear of face-to-face medical care. As a result, many people with urgent health problems may be opting to remain at home rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened. Doctors from Hong Kong reported an increase in patients coming to the hospital late in the course of their heart attack, when treatment is less likely to be lifesaving.”

It is in fact very possible to do this, a fact I found surprising. In Asimov’s biography he described having gone about his affairs for at least several weeks after a major heart attack. He thought it was indigestion I think.

This is, of course, a very bad thing for the health outcome of a patient, and it is far preferable that they get early treatment. But it is certainly quite possible to live after a heart attack.

It’s in fact a common enough phenomenon that Harvard writes articles about it: https://www.health.harvard.edu/heart-attack/when-heart-attac...

That would explain some of the excess mortality from the covid situation. Besides the induced poverty, this is one mechanism whereby the lock down could have longer lasting damage than the virus.

We can’t judge this yet though, as we don’t have a 10 year lens to look back on what is going on. If there is no vaccine developed, then it is more likely true (since the lockdown just delays the inevitable).

> Of course, no, they aren’t down, it’s just that people that absolutely should be going to the hospital aren’t and they’re endangering their lives trying to avoid COVID-19.

Do we have any clear data for this link of causality? Isn't it just one guess among many as to why?

It is unlikely single factor explains the entirety of the changes in these metrics and I actually doubt healthcare usage reluctance will turn out to be the primary factor.

Here in Spain it's almost impossible to see a doctor if you're not dropping dead.

If I try to book an appointment with my GP it tells me I can't, they only do over the phone consultancies unless it's an emergency.

So at least here it's not even reluctance but rather the lack of possibility to see a doctor.

Those differences are so wild!

Here in Germany it was easy for my partner to get an appointment at her GP. She also asked and that particular GP didn’t see a single COVID case. Not every German city is like that, certainly, but that shows what a difference in the lived experience different reaction times, measures and luck played.

>I laughed out loud when they suggested that this is a “low stress” time to be pregnant. All indicators show the opposite.

For most people it isn't, but for some people it is. If you are financially secure, then staying at home with no obligations could very well be relaxing.

I thoroughly enjoyed the lockdown until about a month ago, when I started getting tired of it. I spent every day out in the woods reading.

Psychologically not, but staying home is physically way less stressful which possibly makes the difference.

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