Raffaele Ornello, MD

The scientific community has largely investigated the association between COVID-19 and thrombosis, pointing out that COVID-19 may cause large blood clots all over the body. However, this information from science contrasts with clinical practice. Indeed, several reports worldwide have shown that stroke-related hospitalizations declined during the COVID-19 pandemic. Why did the pandemic lead to a decline in stroke-related hospital admissions? It is unlikely that COVID-19 has led to a real decline in stroke incidence, as the infection is associated with a high thrombotic risk. It is more likely that patients’ fear of being admitted to the hospital, coupled with the disruption in emergency care services due to the pandemic emergency, has had a major role in reducing stroke-related admissions.

The ongoing medical emergency has taught us some lessons. The first lesson is to remember that stroke is a medical emergency that needs immediate attention regardless of infectious disease. People from the general population should be educated to seek urgent attention despite the outbreak of other diseases. A second lesson is for the organization of stroke professionals. In territories where stroke patients could be urgently screened for COVID-19 and treated in “clean” wards, the activity and quality of stroke care could be preserved. Establishing and following clear rules led to an effective management of stroke even where the pandemic had large outbreaks. The reorganization of stroke care led to changes in care models; more patients were centralized to centers dedicated to acute stroke care, as demonstrated by the stable number or even increase in endovascular treatments during the pandemic, paralleled by a decline in the use of intravenous thrombolysis, as compared with past years.

If the general population loses its attention to stroke, and if stroke healthcare workers are not able to reorganize when other emergencies occur, stroke care will lose its efficacy. Efforts should be taken to maintain high standards of stroke care by promoting awareness and an efficient organization, to avoid a pandemic of stroke-related disability after the current infectious outbreak.