Decline and Recurrence of Stroke Consultations during the COVID-19 Pandemic Lockdown Parallels Population Activity Levels

Abstract

<b><i>Background:</i></b> The COVID-19 pandemic lockdown (CPL) lead to a significant decrease in emergency admissions worldwide. We performed a timely analysis of ischemic stroke (IS) and related consultations using the telestroke TEMPiS “working diagnosis” database prior (PL), within (WL), and after easing (EL) of CPL. <b><i>Methods:</i></b> Twelve hospitals were selected and data analyzed regarding IS (including intravenous thrombolysis [intravenous recombinant tissue plasminogen; IV rtPA] and endovascular thrombectomy [EVT]) and related events from February 1 to June 15 during 2017–2020. In addition, we aimed to correlate events to various mobile phone mobility data. <b><i>Results:</i></b> Following the significant reduction of IS, IV rtPA, and EVT cases during WL compared to PL in 2020 longitudinally (<i>p</i> values <0.048), we observed increasing numbers of consultations, IS, recommendations for EVT, and IV rtPA with the network in EL over WL not reaching PL levels yet. Absolute numbers of all consultations paralleled best to mobility data of public transportation over walking and driving mobility. <b><i>Conclusions:</i></b> While the decrease in emergency admissions including stroke during CPL can only be in part attributed by patients not seeking medical attention, stroke awareness in the pandemic, and direct COVID-19 triggered stroke remains of high importance. The number of consultations in TEMPiS during the lockdown parallels best with mobility of public transportation. As a consequence, exposure to common viruses, well-known triggers for acute cerebrovascular events and other diseases, are reduced and may add to the decline in stroke consultations. Further studies comparing national responses toward the course of the COVID-19 pandemic and stroke incidences are needed.

Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020

“…However, data of all remaining telemedical networks showed a reciprocal increase of telemedical consultations after relaxation of COVID-19 measures, leading us to the assumption that a substantial bias is unlikely. Sixth, data of the TEMPiS network were already published [20,21].…”

“…Single-center observations from the United States and Germany report a significant decline in teleconsultations during the peak phase of the COVID-19 pandemic in March and April 2020 [18][19][20][21].…”

COVID-19 and Stroke: A Neurological Perspective

“…They performed the analysis prior to, within, and after easing of lockdown. They concluded that the decrease in emergency admissions for stroke during the pandemic was largely attributed to patients not seeking medical attention and a lack of stroke awareness (36). There are further reports showing a similar trend of time-dependent declines in hospitalization for stroke during the pandemic and nationwide lockdowns (37)(38)(39)(40)(41)(42)(43)(44)(45)(46).…”

“…Patients with AIS continued to receive acute recanalization treatment (35). Schlachetzki et al analyzed data related to ischemic stroke from 12 hospitals; intravenous (IV) thrombolytic treatment, endovascular treatments (EVT), and related consultations using the telestroke (stroke telemedicine) TEMPiS "working diagnosis" were analyzed (36). They performed the analysis prior to, within, and after easing of lockdown.…”

World Brain Day 2021: Global campaign to stop multiple sclerosis

“…[1][2][3][4] The burden of these illnesses impacts mostly low-to middle-income countries, where larger percentage of the world's population also continue to suffer the consequences of the ongoing pandemic. [5][6][7] In this context, the World Federation of Neurology (WFN) World Brain Day (WBD) campaign is of particular importance. Since the inception of the WBD campaign in 2014, this global advocacy initiative has been very successful.…”