What your doctor reads on Medscape.com:
APRIL 8, 2020 – Neurologists across the country are reporting a decline within the variety of stroke patients requiring emergency care through the COVID-19 pandemic, suggesting that some patients could also be selecting to remain home relatively than risk exposure to the coronavirus in a hospital emergency room.
Stroke specialists in New Orleans, Chicago, Seattle and elsewhere said Medical news from Medscape They are seeing a steep decline within the variety of acute strokes of their facilities – and not only the milder ones. Doctors are sharing similar reports on Twitter and using social media to lift awareness of the issue.
Gabriel Vidal, MD, a vascular and interventional neurologist at Ochsner Medical Center in New Orleans, Louisiana, said there are “definitely” fewer stroke and transient ischemic attack (TIA) patients in search of treatment at his facility and others throughout the New Orleans area hard hit by COVID-19.
“Even in Louisiana, we have a very large telestroke network with 53 hospitals, and the number of consultations has dropped dramatically,” Vidal added.
In Chicago, the variety of emergency calls for patients with suspected stroke has dropped by about 30%, said Dr. Shyam Prabhakaran, professor and chief of neurology on the University of Chicago Biological Sciences in Illinois. Medical news from Medscape.
“It appears that patients with mild strokes and TIAs are more likely to stay home and seek alternative treatment options rather than coming to the emergency department,” Prabhakaran said. “However, those with severe strokes may be less affected and still come to the emergency department.”
“Spread the message”
That may not tell the complete story in Seattle, Washington, where a stroke specialist at Harborview Medical Center reported a decline in patient numbers across the spectrum of stroke severity.
Some patients with milder strokes now not come to Harborview for a comprehensive evaluation and workup, but that's only “a partial explanation,” says David Tirschwell, MD, medical director of comprehensive stroke care on the University of Washington (UW) Medicine Stroke Center at Harborview and professor of neurology on the UW.
“The number of thrombectomies has also decreased,” he added. “It is difficult to have exact numbers in real time, but it is probably safe to say that the number of admissions has decreased by at least 50%.”
As a stroke referral center, his facility is seeing fewer local cases and referrals from outside hospitals. “I think both sources of stroke patient admissions have declined,” Tirschwell said.
Neurologists, institutions and medical groups are recognizing the severity of forgoing needed treatment for acute stroke and are using social media to potentially save lives. “In our @FLStrokeReg, fewer patients are coming to our hospitals with #stroke symptoms. We need to spread the word that our teams are working hard to provide safe treatment when needed during #COVID19,” tweeted Ralph Sacco, MD, chief medical officer and professor of neurology on the University of Miami Miller School of Medicine in South Florida, shared this tweet:
Although Florida Stroke Registry data will not be publicly available, anecdotal evidence suggests that stroke admissions have declined in lots of hospitals, Sacco said. Medical news from Medscape.
Moreover, it shouldn’t be only a phenomenon within the United States. “This has also been reported in other countries affected by COVID-19,” he said.
China is a main example. There, many stroke centers have shown limited performance, “due to fear of cross-infection in the hospital and the lack of experienced stroke experts,” write Dr. Jing Zhao and colleagues in a editorial published online on 31 March in stroke.
Preliminary data showed that “thrombectomies in Shanghai fell by 50% in the first month after the Spring Festival compared with the same period in 2019,” write the editorialists from Kings College London and the University of Pennsylvania in Philadelphia.
“Although controlling COVID-19 is very important, at the same time, stroke treatment must not be neglected,” they add.
“In China alone, more than 9,000 people suffer from strokes every day. It cannot be right that the treatment of one potentially curable disease is neglected at the expense of another.”
Fear factor?
The the reason why individuals who have suffered a stroke avoid emergency care are currently unclear. “Honestly, I'm not sure anyone really understands why,” Tirschwell said.
Until survey or other data can be found, many experts imagine that fear of COVID-19 is more vital than other medical concerns, reminiscent of emergency treatment for strokes.
“We believe this may indicate that patients are afraid to come to medical facilities with stroke-like symptoms in light of the COVID-19 pandemic,” said Sacco, who can even be the longer term editor-in-chief of stroke.
The BBC spread the news within the UK via social media with a tweet to “Despite Corona, dial 999 in the event of a stroke emergency.”
The World Stroke Campaign also uses Twitter to lift awareness of the necessity for urgent stroke care when needed:
“Don't let worries about COVID19 stop you from seeking emergency treatment for a stroke. If you notice the signs of a stroke, act FAST. Get emergency medical help,” the group urged in a tweet.
Do not hesitate
The American Heart Association (AHA) has also addressed this worrying trend.
“People with serious symptoms should not ignore them,” explains Dr. Sarah Perlman, associate professor of emergency medicine on the University of Colorado School of Medicine in Denver, in an article on the AHA. website.
Perlman added that some individuals who show signs of a stroke or heart disease could also be hesitant to hunt medical look after fear of putting additional strain on an overburdened health care system and staff, but she flatly dismissed those concerns.
“If you notice any signs of a heart attack or stroke, call 911,” she said. “In an emergency, we are of course here for you and can and would like to take care of you.”