Swiss emergency rooms and hospitals are quieter than usual despite an influx of COVID-19 patients, a worrying sign that some doctors say could mean more people are dying at home from other ailments.
Concerned about the trend amid the pandemic, staff at the Cardiocentro hospital in the southern canton of Ticino bordering on hard-hit Italy called its regular patients to check up on them.
One of them had been quietly suffering from a heart vessel problem at home for days and, once he was coaxed to come in, was operated on urgently. Another died before coming into hospital.
"Many patients tell us I waited because I am afraid of coming into contact with a COVID patient," Giovanni Pedrazzini, president of the Swiss cardiology society and co-head of cardiology at the Ticino centre which also accepts COVID-19 patients, told Reuters.
"The risk is that a lot of patients will suffer or die at home when they should go to the emergency room."
The World Health Organization has warned of above-normal deaths unrelated to the coronavirus pandemic as health systems become overwhelmed and issued guidelines to avoid them.
But wealthy Switzerland's hospitals are holding up well despite its more than 22,000 confirmed COVID-19 cases, and most have spare capacity. The Swiss trends hint at the indirect and potentially fatal impact of the pandemic.
Olivier Muller, cardiologist at the Lausanne University Hospital (CHUV), told broadcaster RTS he had seen the number of patients with clogged arteries drop by 35%. "It is a great source of worry for us," he said. "We have early indicators of an excess mortality not linked to COVID-19."
Patients with stroke symptoms have fallen by a fifth, Switzerland's stroke society said.
The concern about hospitals is understandable as people with heart problems are at risk of complications if they catch COVID-19, a highly contagious respiratory disease.
Unlike China which separated COVID-19 care from general hospitals, that has not always been practical in Europe, although Swiss medical workers defend the mixed approach.
The drop of 10-30% in emergency room activity at the CHUV can be partly explained by fewer sporting, driving and drinking accidents, said Professor Pierre-Nicolas Carron, emergency room head. Routine surgeries have also been postponed.
"We've been seeing non-COVID patients come to the hospital very late in the course of their disease," said Thierry Fumeaux, head of the intensive care unit in Nyon and president of the Swiss Intensive Care Medicine Society.
"This is probably one of the adverse impacts of the (coronavirus) containment measures."
Public health officials who urged people not to unnecessarily tax medical resources during the crisis have sought to reassure the public that a visit to the doctor or emergency room, especially for children, should not be put off.
"This is really important: For fear of the coronavirus, people should not avoid calling or using the emergency room," said Daniel Koch, the health ministry's coronavirus czar.
Switzerland has reported 705 deaths from COVID-19 and a total of 22,789 infections. Data on overall causes of death since the coronavirus pandemic began is not yet available.