EHS-COVID (486) World Stroke Day 29 October (3)

1 December, 2021

A few weeks ago I posted on HIFA a press release from WHO about stroke in SE Asia [ ] and I added this question at the bottom of my message:

"In the context of our WHO-supported discussion on Essential health services during COVID, can anyone share experience on the availability of quality health services for people with stroke? I suspect many people will have had delayed or absent care, and that a negative outome (death or permanent disability) will have been increased."

Our HIFA literature search expert John Eyers has kindly run a search for us, and we found just one paper relating to stroke care during COVID-19. Citation, abstract and a comment from me below.

CITATION: Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Henrique Diegoli, Pedro S.C. Magalhães, Sheila C.O. Martins, Carla H.C. Moro, Paulo H.C. França, Juliana Safanelli, Vivian Nagel, Vanessa G. Venancio, Rafaela B. Liberato, Alexandre L. Longo

Originally published 12 Jun 2020 Stroke. 2020;51:2315–2321


Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil.

Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019.

Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 (P=0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage.

Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

COMMENT: The authors hypothesize that patients with stroke are 'not seeking hospital care... Patients may be reluctant to seek hospital care for fear of becoming infected...' There are other reasons, such as 'some people may be confused about stay-at-home orders meant to slow the spread of COVID-19'. However, from my perspective of reading HIFA messages, this fear of becoming infected as the result of atttending a health facility appears to be a massive issue for patients with stroke and other non-communicable diseases. It seems likely that this will inevitably result in poor health outcomes from those diseases, over and above any risk of nosocomial infection. I would be interesterd to hear observations and thoughts from others.

Neil Pakenham-Walsh, HIFA Coordinator,