Background and Purpose: Shelter-in-place (SIP) orders implemented to mitigate severe acute respiratory syndrome coronavirus 2 spread may inadvertently discourage patient care-seeking behavior for critical conditions like acute ischemic stroke. We aimed to compare temporal trends in volume of acute stroke alerts, patient characteristics, telestroke care, and short-term outcomes pre- and post-SIP orders. Methods: We conducted a cohort study in 21 stroke centers of an integrated healthcare system serving 4.4+ million members across Northern California. We included adult patients who presented with suspected acute stroke and were evaluated by telestroke between January 1, 2019, and May 9, 2020. SIP orders announced the week of March 15, 2020, created pre (January 1, 2019, to March 14, 2020) and post (March 15, 2020, to May 9, 2020) cohort for comparison. Main outcomes were stroke alert volumes and inpatient mortality for stroke. Results: Stroke alert weekly volume post-SIP (mean, 98 [95% CI, 92–104]) decreased significantly compared with pre-SIP (mean, 132 [95% CI, 130–136]; P <0.001). Stroke discharges also dropped, in concordance with acute stroke alerts decrease. In total, 9120 patients were included: 8337 in pre- and 783 in post-SIP cohorts. There were no differences in patient demographics. Compared with pre-SIP, post-SIP patients had higher National Institutes of Health Stroke Scale scores ( P =0.003), lower comorbidity score ( P <0.001), and arrived more often by ambulance ( P <0.001). Post-SIP, more patients had large vessel occlusions ( P =0.03), and there were fewer stroke mimics ( P =0.001). Discharge outcomes were similar for post-SIP and pre-SIP cohorts. Conclusions: In this cohort study, regional stroke alert and ischemic stroke discharge volumes decreased significantly in the early COVID-19 pandemic. Compared with pre-SIP, the post-SIP population showed no significant demographic differences but had lower comorbidity scores, more severe strokes, and more large vessel occlusions. The inpatient mortality was similar in both cohorts. Further studies are needed to understand the causes and implications of care avoidance to patients and healthcare systems.

Early during the COVID-19 pandemic, marked declines in patients presenting with acute cardiovascular conditions were observed, 1,2 whereas mortality attributed to cardiovascular causes increased. 3 This raised concerns that patient reluctance to seek emergency care contributed to preventable complications and excess deaths, and public health campaigns sought to reassure patients that hospitals were safe and to encourage seeking care when needed. As COVID-19 resurged in late 2020, rates of infections, hospitalizations, and deaths exceeded those of previous surges. Many countries reimplemented lockdowns, and recent UK data indicate that presentations for emergent cardiovascular conditions again declined. 4 We evaluated changes in rates of acute myocardial infarction (AMI) hospitalizations and suspected ischemic stroke as measures of patient willingness to seek emergency care during the most recent COVID-19 surges in the US.Methods | We examined data from Kaiser Permanente Northern California (KPNC), a large, integrated health care delivery system with 21 medical centers and 255 clinics, providing comprehensive care for more than 4.5 million persons throughout Northern California. Its membership is highly representative of the local and statewide population regarding age, sex, race and ethnicity, and socioeconomic status. 5 We examined weekly incidence rates for adult members hospitalized for AMI or suspected acute ischemic stroke (ie, "stroke alerts") who presented to KPNC facilities from January 22, 2019, to January 18, 2021. Acute MI was identified with a combination of discharge diagnosis codes and positive values of serum cardiac troponin I. 1 Stroke alerts are tracked through a comprehensive stroke program at 21 Joint Commission stroke-certified KPNC facilities that includes immediate consultation by neurologists for evaluation and treatment for all suspected ischemic strokes. 2,6 We excluded patients younger than 18 years, with unknown sex, or with lack of active health plan membership in each weekly cohort.Weekly incidence rates of events per 100 000 personweeks and 95% CIs for AMI and stroke alerts during COVID-19 periods (

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.

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IMPORTANCEGreater difficulty in controlling blood pressure (BP) and adverse lifestyle practices such as higher salt intake or less physical activity may account for some of the differences between BP control rates in Black vs White adults, thereby exposing Black adults to a higher risk of vascular events. OBJECTIVE To determine whether a lifestyle coaching intervention or an enhanced pharmacotherapy protocol is more effective than usual care in improving BP control rates in Black adults treated within an integrated health care delivery system.