The COVID-19 declared pandemic by the World Health Organization (WHO) in March 2020 challenges healthcare systems and societies worldwide. 1,2 Many health professionals have questioned whether the public anxiety around COVID-19 discourages some patients from contacting the healthcare system. After the pandemic lockdown in the UK, there was a 25% fall in emergency room attendances the first week. 3 If this fall continues, it may be asked whether a substantial proportion of the population are missing treatment opportunities with potentially long-term harm as a consequence. Rapid admission to hospital following stroke is vital in ensuring patients have timely access to treatments such as thrombolysis and endovascular treatment. 4 The effect of acute stroke treatment is highly time dependent with late admission being an independent predictor of worse outcome. 5-8 It is therefore feared that a large number of stroke patients are at increased risk of dependency or death if they do not seek emergency help. During the pandemic, there have been many anecdotal reports that the number of stroke patients seen in the emergency

Background There was a significant decrease in stroke admissions during the first phase of the COVID-19 pandemic. There are concerns that stroke patients have not sought medical attention and in the months after the lockdown suffer recurrent severe strokes. The aims of this study were to investigate how stroke admission rates and distributions of severity varied before, during and after the lockdown in a representative Norwegian hospital population. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke from January to September 2020 were identified by hospital chart review. Results We observed a transient decrease in weekly stroke admissions during lockdown from an average of 21.4 (SD 4.7) before to 15.0 (SD 4.2) during and 17.2 (SD 3.3) after (p < 0.011). The proportion of mild ischemic and haemorrhagic strokes was also lower during lockdown with 66% before, 57% during and 68% after (p = 0.011). Conclusion The period of COVID-19 lockdown was associated with a temporary reduction in total admissions of strokes. In particular, there were fewer with TIA and mild stroke. Given the need to prevent the worsening of symptoms and risk of recurrence, it is necessary to emphasise the importance to seek medical care even in states of emergency.

In March 2020, the coronavirus disease of 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO), causing restructured healthcare systems worldwide. 1 During the pandemic, reports emerged describing a considerable drop in the number of stroke patients seen at local, regional, and national levels. 2-9 However, most of these studies are reporting overall number of stroke admissions and/or procedures. Independently of these, by then unknown, decreasing stroke numbers, most healthcare