Victor J. Del Brutto, MD

Sheth SA, Wu T-C, Sharrief A, Ankrom C, Grotta JC, Fisher, M, et al. Early Lessons From World War COVID: Reinventing Our Stroke Systems of Care. Stroke. 2020.

The past century began with devastating world wars that resulted in immense loss of life and left many countries in ruins and the rest impoverished. These global conflicts not only created negative impacts, but also triggered constructive responses in humanity fueled by the elation for surviving the disaster. The latter resulted in postwar times dominated by the development of society, expansion of economy, and the revolution of technology. This special report published in Stroke draws an analogy between the current global health crisis caused by the COVID-19 pandemic and the damage occasioned by the world wars, and exposes an optimistic point of view regarding the adjustments vascular neurologists have made to take care of stroke patients and how this may influence the way we deliver stroke care in the future.

The authors emphasize the rapid adaptation made by vascular neurologists at the beginning of the pandemic in order to minimize possible COVID-19 exposure to patients and health care personnel, as well as to decrease the burden on hospitals crowded with COVID-19 patients. Undoubtedly, the most relevant of such adaptive changes was the boost of telemedicine. Stroke care via telemedicine is a technique that has been evolving for more than 20 years and has focused mainly on the evaluation of acute ischemic stroke and specialized consultations for rural areas lacking vascular neurologists. During the current pandemic, stroke telemedicine has expanded beyond the acute setting in order to evaluate outpatients via virtual stroke clinics, reduce COVID-19 exposure in the inpatient setting by virtual rounding, facilitate access to physical and speech therapy via telerehabilitation, and even continue biomedical research by remote enrolment into clinical trials. Mobile stroke units (MSU) have also gained relevance during this pandemic as a tool capable of identifying and treating stroke patients in the prehospital setting, thus minimizing ED burden. Although stroke telemedicine seems a pragmatic way of reducing viral exposure during the current pandemic and, overall, a way of expanding specialized stroke care to inaccessible areas, the authors appropriately mentioned that further research is needed in the field to demonstrate non-inferiority against pre-COVID-19 practices.

This manuscript also highlights how the medical community has responded to this global health disaster by streamlining administrative processes for the development and testing of new therapies, as well as by improving collaboration among health care professionals. The current pandemic can leave us timeless lessons on the importance of providing efficient medical services and how to advance science at an accelerated pace. The authors conclude that vascular neurologists have been at the vanguard of implementing novel strategies into medical practice, which have been fundamental in addressing the COVID-19 pandemic, and recognize this crisis as an unprecedented opportunity to modernize medicine for stroke patients across the globe.