Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care

Abstract

Background and Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the various emergency measures implemented to contain the spread of the virus and to overcome the volume of affected patients presenting to hospitals may have had unintended consequences. Several studies reported a decrease in the number of stroke admissions. There are no data on the impact of the COVID-19 pandemic on stroke admissions and stroke care in Maryland. Methods: A retrospective analysis of quality improvement data reported by stroke centers in the State of Maryland. The number of admissions for stroke, overall and by stroke subtype, between March 1 and September 30, 2020 (pandemic) were compared with the same time period in 2019 (prepandemic). Median last known well to hospital arrival time, the number of intravenous thrombolysis and thrombectomy were also compared. Results: During the initial 7 months of the pandemic, there were 6529 total admissions for stroke and transient ischemic attack, monthly mean 938 (95% CI, 837.1–1038.9) versus prepandemic 8003, monthly mean 1156.3 (CI, 1121.3–1191.2), P <0.001. A significant decrease was observed in intravenous thrombolysis treatments, pandemic 617, monthly mean 88.1 (80.7–95.6) versus prepandemic 805, monthly mean 115 (CI, 104.3–125.6), P <0.001; there was no significant decrease for thrombectomies. The pandemic decreased the probability of admissions for stroke and transient ischemic attack by 19%, for acute ischemic stroke by 20%, for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage, pandemic 199, monthly mean 28.4 (CI, 22.5–34.3) versus prepandemic 217, monthly mean 31 (CI, 23.9–38.1), respectively, P =0.507. Conclusions: Our findings suggest that the COVID-19 pandemic adversely affected the acute care of unrelated cerebrovascular emergencies.

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

“…This may be related to possible delayed hospital arrival and an overall decrease in the absolute number of patients with mild and moderate stroke seeking medical care. 21,29,30,46,54,55,59,60,62,70 However, the likelihood of being treated with IVT did not differ between two periods in comprehensive stroke centers and that of being treated with EVT increased during the pandemic, which might be due to adequate changes made in workflow of acute stroke care in comprehensive stroke centers. 71 Higher likelihood of being treated with EVT might also have been caused by higher likelihood of large vessel occlusions due to prothrombotic state driven by COVID-19 virus, as reported by multiple studies.…”

“…8, Twenty-four studies met criteria for 'good' quality and 13 met criteria for 'fair' quality (Supplemetary Tables 2-4). Most studies compared the pandemic period (ranging from January to June 2020) to a similar period in the preceding year (range January to June 2019) [28][29][30][31]33,35,39,[41][42][43]45,46,[48][49][50]52,[54][55][56][57][58]60 or the months preceding the pandemic (range September 2019 to December 2019). 8,32,34,[36][37][38]40,44,47,51,53,59,[61][62][63]…”

“…The onset-to-door time was reported in 14/37 studies. 29,30,44,46,48,49,52,54,55,[57][58][59]61,63 There was no difference in mean onset-to-door time during pandemic when compared to pre-pandemic period (standardized mean difference=-0.2; 95% CI, -0.8 to 0.3).…”

The Collateral Damage of the Pandemic on Non-COVID Related Pneumothorax Patients: A Retrospective Cohort Study

“…Several studies have reported that delays in surgery among cancer patients impacted their long-term survival, and the proportion of advanced stages of malignancies increased during the pandemic [4]. On the other hand, as the pandemic continues over a long period, there were rising concerns for non-COVID-19 patients requiring urgent care, such as acute coronary syndrome, stroke, or appendicitis [5][6][7][8]. During the national lockdown in Italy, COVID-19 changed the quality of emergent surgical care with poorer prognosis and higher mortality rates [9].…”

Response to the Letter regarding article, “Vertebral artery dissecting aneurysm rupture under severe COVID-19”

“…The relationships between SARS-CoV-2 and the dissecting aneurysm that we described in our paper are only hypothetical [2] , as Dr. Finsterer pointed out [1] . There is a report that the number of hospitalizations for acute stroke patients, especially for ischemic stroke ones, declined, resulting in that the number of hospitalizations for aneurysmal SAH patients increased relatively under the COVID-19 pandemic compared with the pre-pandemic period, although the exact reasons are unknown [3] . Dissecting aneurysms differ from saccular aneurysms, and are most common in the East Asian population, particularly in males, and in the vertebrobasilar artery, accounting for only 3−5% of aneurysmal SAH cases in the general population [4] .…”