Affiliation: Department of Neurology, SUNY Upstate Medical University, Syracuse, NY

As COVID-19 continues to fester across the world and place strains on global healthcare systems and health resources, the degree of its impact on the delivery of stroke care remains unknown.

Nogueira et al., in collaboration with 187 comprehensive stroke centers spanning 6 continents and 40 countries, collected data on hospitalizations for stroke, intracranial hemorrhage and mechanical thrombectomies during the initial period of the COVID-19 pandemic period (March 1st to May 31st 2020, in addition to 3 months immediately preceding this period) and the same 3 month period from the prior year, in an effort to assess the burden of the pandemic on stroke care.

The results of this cross-sectional retrospective study show significant declines in all stroke hospitalizations of -19.2% (95%CI -19.7 to -18.7), ICH -11.5% (95%CI -12.6 to -10.6) and mechanical thrombectomy of -12.7% (95%CI -13.6 to -11.8) from the immediate 3 months prior to the initial pandemic period. The declines were somewhat less compared to the same 12-month period from the prior year, but still statistically significant. Moreover, the declines were somewhat more apparent at high volume COVID-19 hospitals than at mid and especially low COVID-19 volume hospitals. In addition, the authors report an overall stroke rate of 1.45% in COVID-19 hospitalizations which was similar to previous pooled data sets, and an incidence of 3.9% for SARS-CoV-2 infection across stroke admissions from centers with documented COVID-19 hospitalizations.

The data presented is to date, the largest sample of concomitant COVID-19 and stroke diagnoses and begins to paint the likely grim picture of the impact of COVID-19 on stroke care. As the authors note, while there is possibility for reduced disease burden in the setting of presumed improved medication compliance during lockdown, and reduced volumes of perioperative strokes from fewer elective procedures, social distancing measures may have also prevented timely detection and reporting of stroke symptoms. In addition, previous studies have already noted a decline in admissions for milder stroke symptoms, which again suggests patient fears of COVID-19 may have prevented them from seeking timely care. A further possibility is that during this pandemic period, increased vigilance regarding spread of the infection on the part of healthcare providers, may have led to fewer points of contact with hospitalized COVID-19 patients and possibly fewer assessments, thus lowering the rate of detection of stroke symptoms, especially milder symptoms, in hospitalized COVID-19 patients.

Overall, the findings of this study suggest that we as a society should continue our advocacy for stroke care with renewed urgency, especially for increasing stroke awareness both in the community and among healthcare workers who continue to face systemic strains from the ongoing pandemic.

Reference:

Nogueira R, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, Qiu Z, Farhoudi M, Siegler JE, Yaghi S, Raz E, Sakai N, Ohara N, Piotin M, Mechtouff L, Eker O, Chalumeau V, Kleinig T, Liu JM, Pop R, Winters HS, Shang X, Rodriguez Vasquez A, Blasco J, Arenillas JF, Martinez-Galdamez M, Brehm A, Psychogios M, Lylyk P, Haussen DC, Al-Bayati A, Mohammaden MH, Fonseca L, Silva MLS, Montalverne FJ, Lima FO, Renieri L, Mangiafico S, Fischer U, Gralla J, Frei D, Chugh C, Mehta BP, Nagel S, Mà Hlenbruch M, Ortega S, Farooqui M, Hassan AE, Taylor A, Lapergue B, Consoli A, Campbell B, Sharma M, Walker M, van Horn N, Fiehler J, Nguyen HT, Nguyen QT, Watanabe D, Zhang H, Le HV, Nguyen VQ, Shah R, Devlin T, Khandelwal P, Linfante I, Izzath W, Lavados P, Olavarrà A VV, Sampaio Silva G, Verena de Carvalho Sousa A, Kirmani J, Bendszus M, Amano T, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Morris JG, Griffin E, Thornton J, Lavoie P, Matouk C, Hill MD, Demchuk AM, Killer M, Nahab F, Altschul D, Perez de la Ossa N, Kikano R, Boisseau W, Walker G, Cordina S, Puri AS, Kuhn A, Gandhi D, Nguyen T. EXPRESS: Global Impact of the COVID-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes. Int J Stroke. 2021 Jan 18:1747493021991652. doi: 10.1177/1747493021991652. Epub ahead of print. PMID: 33459583.