To the Editor-The novel coronavirus pandemic accelerated the development of overdue health care solutions in the United States. Proposals have included a new public insurance program, a plan to permanently shore up the national equipment stockpile, and new funding for rural hospitals, among many others. But a glut of interest groups has lobbied aggressively to shape the pandemic response [1, 2].As future practitioners of public health, bioethics, and medicine, we know that one principle is clear: students should lead the charge in this critical moment to enact lasting federal, state, and local policy improvements for all Americans. Ultimately, students are best positioned to advocate for the most important stakeholder: the patient.The best public health practice uses a moment of crisis as an opportunity for long-term change. This is the "triple axel" of public health practice: establishing credibility, explaining a problem, and fighting for a realistic solution [3]. Academics, reporters, and others have established credibility at a moment when messaging from government officials is confused and sometimes contradictory. Experts have also explained the overflowing cornucopia of latent problems in our health care system that COVID-19 brought to the fore: underfunded rural hospitals, treatments that patients cannot afford, and dismantled city and county public health infrastructure [4]. The American public now deserves public policy solutions to support population health-Medicaid and Medicare expansion, surprise billing regulation, and appropriately funded public health agencies.But the third element of the triple axel, fighting for realistic policy solutions, is the most difficult to land. It is here that students and student groups should lend their voices to guide elected leaders' actions. To the public, students are unsullied by negative behaviors that are often a result of training and practicing in our health care system, and they are less likely than other groups to face conflicts of interest [5]. Additionally, in the last decade advocating through social media became increasingly common, and students are using social media platforms to more actively work toward social justice causes [6]. Recently, the American Medical Association formally left a lobbying group prevent-
Introduction: A decline in suspected acute stroke (“code stroke”) presentations in the United States (US) during the first COVID surge has been previously reported. While state emergency declarations may have contributed to the decline and rebound of weekly code stroke activations in our region, the exact temporal relationship of those declarations relative to weekly code stroke volumes is unclear. Methods: We conducted an interrupted time series analysis (ITSA) to identify the impact of the first reported COVID case in North Carolina (NC) and subsequent statewide executive orders (SEOs) on weekly code stroke activation trends across our regional stroke network’s 20 facilities during a 33-week period (December 8, 2019 to July 25, 2020). We included the following time epochs: the first reported COVID case in NC, the NC SEO prohibiting mass gatherings and closing public schools, the stay-at-home NC SEO, and the NC phase 1 and phase 2 reentry orders, which eased restrictions. Results: Utilizing our integrated healthcare network’s code stroke registry, we evaluated 3740 code stroke activations over a 33-week period. We performed two ITSA considering different starting points for the first intervention—one defined as the first COVID case and the other the first SEO. For both models the end of the first-time interval ended with the second SEO. Most of the downward trend in code stroke activation volume was temporally after the first COVID case (p=0.0029), not after the first SEO. After the second SEO, which increased social restrictions, there was a significant increased trend in code stroke activation volume (p=0.0047), while the phase 1 and 2 reopening SEOs were not associated with a significant increase in weekly code stroke activations. Conclusion: Our data indicate that in our region, the decreased trend in code stroke activations preceded the first SEO and started temporally after the first reported COVID case in NC. The overall decrease in code stroke volume was not significantly associated with increasing statewide restrictions and lessening of those restrictions was not significantly associated with a rebounding trend. Restrictive and reentry SEOs do not explain changes in weekly code stroke activation trends our region experienced during its first COVID surge.
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