The effects of COVID-19 pandemic have overwhelmed health care systems globally, both in developed and developing countries. Medical facilities are struggling to overcome the pandemic and at the same time to provide care for patients with other emergency medical conditions. The unprecedented situation with the large number patients and limited resources has resulted in reduced presentation of other patients to hospitals during the crisis. Reports indicated a decline in the number of patients with acute ST-elevation myocardial infarction (STEMI) presenting to hospitals. In Spain, the rate of primary percutaneous coronary intervention (pPCI) declined by 40% (1), and in the United States pPCI was reduced by 38% (2). One of the possible reasons for that is the idea of contracting the infection from hospitals is currently prevalent among people, so patients are avoiding calling emergency services despite major events. Another reason, but likely to a lesser extent, is increasing use of fibrinolytic therapy for STEMI patients, especially those suspected of COVID-19 infection (3).

In Iraq, the COVID-19 pandemic is less prevalent in comparison with other affected countries such as China, Iran, Italy, Spain, and others. At the peak of the pandemic, the authorities decided to limit medical resources for emergency conditions and defer elective cases for later appointments across the country.

The data from two tertiary cardiac centers in the south of Iraq showed a 20% reduction in the rate of pPCI procedures performed during March-April 2020 in comparison with the proceeding months. Possible explanations are patient anxiety towards admission to hospitals, the total lockdown of the cities causing difficult access to hospitals, adoption of pharmacotherapy to treat STEMI patients in hospitals with no catheterization laboratories, and to a lesser extent the possibility of reduced STEMI incidence during the pandemic.

The most important point here how well patients understand the current situation. We need to educate patients with STEMI and other acute events that hospitals are safe and that they have to call for help immediately to save their lives. It is our responsibility as medical professionals to keep an eye on all aspects of our field to minimize losses as much as possible.