Excellence guidelines recommend carotid duplex within 7 days of stroke symptoms. 2 Since the UK lockdown, seven acute NHS trusts, which include four regional hyperacute stroke centers, have performed on average (mean 6 standard deviation) 12 6 6 carotid duplex scans where 19% had greater than 50% stenosis. This is compared with the same week in 2019 where 24 6 16 carotid duplex scans were performed with 21% having greater than 50% stenosis. This represents a 50% drop in referral for carotid scans and up to 54% of significant stenosis not identified.Fig, C, demonstrates the decline in interest over time of public search terms for stroke in the health category of Google Trends in the UK. Again, the decline in referrals for carotid duplex, which is a surrogate for the number of patients presenting at rapid access clinics with transient ischemic attacks, may not be due to pandemic administration change or medical abandonment but perhaps due to public cultural avoidance of health care as a result of COVID-19 fear.Our data poses four important questions:
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