A survey of nine major hospitals earlier this month showed the number of severe heart attacks being treated in U.S hospitals had dropped by nearly 40% since the novel coronavirus took hold in March, leaving cardiologists worried about a second wave of deaths caused indirectly by Covid-19: patients so afraid to enter hospitals that they are dying at home or waiting so long to seek care that they’re going to suffer massive damage to their hearts or brains. Some call it “a virus of fear.”

“The whole community is discussing this, asking where are all of our patients?” said Martha Gulati, chief of cardiology at the University of Arizona. “There’s nothing we’ve done overnight that has cured heart disease.”

The same is true for appendicitis and stroke. Clinicians say patients with these life-threatening conditions have also stopped seeking treatment in large numbers. “My worry is some of these people are dying at home because they’re too scared to go to the hospital,” Gulati said.

Others are coming in so late, she added, that some are presenting with massively damaged hearts, including heart muscles that have ruptured.