The Impact of COVID-19 on Nuclear Medicine Operations Including Cardiovascular Manifestations in the USA

Abstract

The pandemic of coronavirus 2019 disease (COVID-19) not only directly causes high morbidity and mortality of the disease, but also indirectly affects patients with pre-existing medical conditions, particularly cardiovascular diseases, with delayed or deferred outpatient care and procedure including nuclear medicine studies because of concerns about exposure to the virus. In this article, the impact of COVID-19 on hospital operation and nuclear medicine practice in the United States along with recommendations and guidance from major academic organizations are presented. Safe operation of specific nuclear medicine scans, such as lung scintigraphy and nuclear cardiac imaging, are reviewed in the context of balancing benefits to patients against the risk of exacerbating the spread of the virus. Thoughtful reintroduction of nuclear medicine services are discussed based on ethical considerations that maximize benefits to those who are likely to benefit most, taking into consideration baseline health inequities, and ensuring that all decisions reflect best available evidence with transparent communication. Finally, potential correlation between decreased volume of nuclear cardiac studies performed during the pandemic and corresponding increased deaths from ischemic and hypertensive cardiac disease is discussed.

Figure 1

International impact of COVID-19 on the diagnosis of heart disease (Top panel) bar graph demonstrating reduction in procedure numbers for all stress studies in 758 facilities in 99 countries, who performed at least 1 modality of stress imaging. Individual modalities are also displayed showing reduction in each in March 2020, compared with March 2019, and a further reduction to April 2020. (Bottom panel) The world maps further illustrate these reductions for individual countries for stress electrocardiography (ECG), echocardiography (Echo), nuclear (combined single-photon emission computed tomography [SPECT] and positron emission tomography [PET]) imaging, and cardiac magnetic resonance (CMR) imaging between March 2019 and April 2020. Gray shading indicates data not available from the country or territory. (Reproduced from Einstein AJ, et al. J Am Coll Cardiol 2021:77;173-185 with permission).

Figure 2

Monthly case volume trend for general nuclear medicine studies (A), nuclear cardiac studies (B) and oncologic PET/CT (C) from January 2019 to April 2021 in the authors’ institution.