Maintaining stroke care during the COVID-19 pandemic in lower- and middle-income countries: World Stroke Organization Position Statement endorsed by American Stroke Association and American Heart Association

Abstract

For more than a year, the SARS-CoV-2 pandemic has had a devastating effect on global health. High-, low-, and middle-income countries are struggling to cope with the spread of newer mutant strains of the virus. Delivery of acute stroke care remains a priority despite the pandemic. In order to maintain the time-dependent processes required to optimize delivery of intravenous thrombolysis and endovascular therapy, most countries have reorganized infrastructure to optimize human resources and critical services. Low-and-middle income countries (LMIC) have strained medical resources at baseline and often face challenges in the delivery of stroke systems of care (SSOC). This position statement aims to produce pragmatic recommendations on methods to preserve the existing SSOC during COVID-19 in LMIC and propose best stroke practices that may be low cost but high impact and commonly shared across the world.

Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan

“…Despite geographic variations, COVID-19 has been associated with a global decline 6) in the volume of overall stroke admissions-from comprehensive stroke centers in highly resourced countries 7,8) to primary stroke centers (PSCs) without endovascular capability in low-or middleincome countries. 9,10) The reasons for such a decline are unclear. There is little information about the worldwide changes in stroke admissions during the pandemic and pre-pandemic periods obtained using an annual survey involving a large population.…”

The World Stroke Academy: A World Stroke Organization global pathway to improve knowledge in stroke care

“…However, these publications are not applicable to everyone as they are primarily based on standard practices in developed countries with established infrastructure and resources. 28 – 30 …”

“…However, these publications are not applicable to everyone as they are primarily based on standard practices in developed countries with established infrastructure and resources. [28][29][30] Stroke care providers in low-resource settings face challenges due to limited access to diagnostic and treatment options, and actionable, high-quality evidence that can be adapted to local settings. 31 In this project, we are developing stroke care checklists with an emphasis on supportive care strategies, validated by international experts and accessible to a global audience.…”

Cerebral small vessel disease: Microbleeds, perforator artery imaging and cliostozol

“…One country which was particularly severely affected early on in the disease was Iran, and Mehrpour describes a case series from that country and the impact it had on stoke admissions. 12 Maintaining stroke services in the face of COVID-19 remains a challenge, particularly for lower- and middle-income countries, and this month we also publish online a World Stroke Organization Position Statement endorsed by American Stroke Association and American Heart Association on maintaining stroke care during the COVID-19 pandemic in lower- and middle-income countries, 13 which will provide useful advice and guidance.…”

“…International Journal of Stroke, 16 (9) remains a challenge, particularly for lower-and middleincome countries, and this month we also publish online a World Stroke Organization Position Statement endorsed by American Stroke Association and American Heart Association on maintaining stroke care during the COVID-19 pandemic in lower-and middle-income countries, 13 which will provide useful advice and guidance.…”