Elena Zapata-Arriaza, MD

Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions. Stroke. 2020.

Since the first COVID-19 case was reported in December 2019 in Wuhan, China, the magnitude of this global pandemic, unimaginable at first, has invaded our daily routine and our professional work, displacing any other pathology to a secondary level. As of Saturday, May 9, 2020 at 1:36 p.m., the global number of infected is 3.94 million people and 275,000 deaths, with a spatial dispersion that increasingly affects more countries. Given its ease of transmission (drops when coughing, speaking, direct contact), we are facing a highly contagious virus capable of saturating the health systems, preventing proper management of time-dependent pathologies such as ischemic stroke. Zhao J et al. aimed to demonstrate COVID-19 impact on stroke care. For this purpose, the authors collected data from the Big Data Observatory Platform for Stroke of China (BOSC), formed by 280 hospitals across China. In addition, they designed a survey to investigate major changes in stroke care during the COVID-19 outbreak.

After performing a retrospective and simple descriptive study, the authors found a drop of 26.7% and 25.3% (p<0.001), respectively, in thrombolysis and thrombectomy cases, in February 2020 as compared to February 2019. In 2020, hospital admissions related to stroke dropped by nearly 40%, due to the reduction in stroke care capacity in the majority of hospitals. In stroke care centers, the majority of them stopped completely or partially their efforts in stroke education for the public, with no difference in the patterns of changes between COVID-19 and non-COVID-19 designated hospitals. Among potential causes of observed changes, the authors found that patients or patients’ families not coming to the hospital was likely the most important factor affecting reduced hospital admission rate, and reduced thrombolysis and thrombectomy cases. Deficiencies in stroke awareness, lack of adequate transportation methods, and the COVID-19 screening process were considered as important factors with a direct impact on stroke care and door-to-needle and door-to-groin times. Finally, the authors offer recommendations to improve stroke care in affected countries.

Stroke care has suffered negative impact around the world since the COVID-19 pandemic started. Fundamentally, the data most frequently reported by the scientific community show worsening in the times of access to treatment, with a drop in patients admitted for strokes, or with strokes highly evolved over time due to their late finding, preventing the possibility of offering reperfusion therapies, without increasing the bleeding risk. The findings reported by the authors reflect, on the one hand, the population’s fear of contagion and, on the other, the impact of the social distancing measures imposed as a strategy to stop the pandemic, without forgetting the changes in hospital circuits, prioritizing the COVID-19 patient on the other pathologies.

The fear of contagion has caused patients with symptoms of stroke or TIA to avoid going to the hospital, delaying or even nullifying the possibilities of acute treatment or adequate secondary prevention in these patients. However, not only fear has limited access to acute stroke rescue treatment; social isolation has had a negative impact on the reaction time. When the patient finally activates the emergency systems, it has found a lacking of resources and long COVID-19 screenings that have further reduced access to treatment with demonstrated efficacy and safety in stroke. For all these reasons, those patients who may have received a reperfusion treatment can be considered lucky. At this point of the pandemic, we need simple strategies with high clinical impact in order to offer correct COVID-19 management, maintaining quality and safety guarantees in stroke patients.