Fear of contagion: One of the most devious enemies to fight during COVID-19 pandemic

An impressive reduction in Emergency Department patient attendance was observed during COVID-19 pandemic coupled with an increase in the burden of patients with respiratory failure compared with the same period in 2019. These data are in line with the reduction in hospital admissions rate for acute coronary syndrome observed during COVID-19 outbreak, probably due to the patients' fear of being infected during hospital stay. All these factors may have contributed to the out-of-hospital cardiac arrest (OHCA) occurrence increase observed during the same period. The OHCAs rate increase can recognize two great sets of causes: The infection-related and the pandemic-related ones. If the first recognize different underling mechanisms that can be dealt with more and more effectively as evidence accumulates, we must remember also the latter: The fear of in-hospital contagion and the willingness not to further burden the health system, which can prevent some citizens from the activation of the EMS even in case of symptoms suspected for time-dependent diseases, resulting in at-home deterioration until the OHCA occurrence. Information campaigns during pandemic must focus also on the importance of EMS early activation in case of real need to prevent COVID-19 from being a disease that kills at home.