Impact of COVID-2019 on stroke services in China: survey from the Chinese Stroke Association

Abstract

BackgroundThe COVID-19 pandemic and physical distancing guidelines have compelled stroke practices worldwide to reshape their delivery of care significantly. We aimed to illustrate how the stroke services were interrupted during the pandemic in China.MethodsA 61-item questionnaire designed on Wenjuanxing Form was completed by doctors or nurses who were involved in treating patients with stroke from 1 February to 31 March 2020.ResultsA total of 415 respondents completed the online survey after informed consent was obtained. Of the respondents, 37.8%, 35.2% and 27.0% were from mild, moderate and severe epidemic areas, respectively. Overall, the proportion of severe impact (reduction >50%) on the admission of transient ischaemic stroke, acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH) was 45.0%, 32.0% and 27.5%, respectively. Those numbers were 36.9%, 27.9% and 22.3%; 36.5%, 22.1% and 22.6%; and 66.4%, 47.5% and 41.1% in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For AIS, thrombolysis was moderate (20%–50% reduction) or severely impacted (>50%), as reported by 54.4% of the respondents, while thrombectomy was 39.3%. These were 44.4%, 26.3%; 44.2%, 39.4%; and 78.2%, 56.5%, in mild, moderate and severe epidemic areas, respectively (all p<0.0001). For patients with acute ICH, 39.8% reported the impact was severe or moderate for those eligible for surgery who had surgery. Those numbers were 27.4%, 39.0% and 58.1% in mild, moderate and severe epidemic areas, respectively. For staff resources, about 20% (overall) to 55% (severe epidemic) of the respondents reported moderate or severe impact on the on-duty doctors and nurses.ConclusionWe found a significant reduction of admission for all types of patients with stroke during the pandemic. Patients were less likely to receive appropriate care, for example, thrombolysis/thrombectomy, after being admitted to the hospital. Stroke service in severe COVID-19 epidemic areas, for example, Wuhan, was much more severely impacted compared with other regions in China.

Stroke Care in the First Affiliated Hospital of Chengdu Medical College during the COVID-19 Outbreak

“…However, we did not observe a significant change of ICH admissions in our hospital, this could be partly explained by that ICH is normally a more severe type of stroke so that patients have to seek medical help rather than stay at home. In addition, the sample size for ICH is small in our report, which might be another reason to explain why our result differs from a prior study [17]. In addition, COVID-19 pandemic also impacted in-hospital stroke care; our results and the prior study [10] both observed a significant longer DNT in patients treated with IVT.…”

“…For stroke admission during the COVID-19 pandemic, our findings are consistent with that from a big data analysis of 280 hospitals across China [ 6 ] and a multicenter study in Germany [ 7 ]. In prehospital setting, the admission of minor stroke has experienced the biggest drop, followed by AIS, and ICH had the smallest drop [ 6 , 17 ]. This might be due to the fact that patients with minor stroke remained at home due to the fear of getting an infection if going to the hospital [ 6 , 18 ].…”

Patient Characteristics and Outcomes Associated with Decline in Stroke Volumes During the Early COVID-19 Pandemic

“…These findings are comparable to those from other parts of the country 1 , 2 and world. 9 , 10 , 11 , 12 This analysis also included more recent data, which demonstrated recovery of stroke volumes from March 27 – June 23, 2020, though at a more gradual rate of 0.15 strokes/day.…”

Attitudes toward COVID-19 vaccines in Chinese college students

“…Due to the risk of contagion of the COVID-19, face-to-face interviews were not adopted. Following previous studies [22][23][24][25], an online questionnaire was designed using the WeChat-based QuestionnaireStar application and subsequently a Quick Response code (QR code) was then generated. The QR code linked to the assessment tools was supported in several WeChat groups by influential academic staff including University Presidents, Faculty Deans and Department heads, who forwarded the QR code to students in their universities to encourage students to participate in this survey.…”