The Impact of Covid-19 Lockdown on Stroke Admissions and Treatments in Campania

Abstract

Objectives The enforcement of complete lockdown with home confinement has been necessary to limit SARS-CoV-2 contagions in Italy, one the most affected countries worldwide. Simultaneously, in several Emergency Departments, a reduction in cardio- and cerebrovascular presentations was noticed. This study analyses the impact of Covid-19 pandemic and lockdown measures on the incidence of stroke, in Campania, the most densely-populated region in Italy. Materials and Methods We retrospectively analyzed data regarding acute stroke patients presenting at 5 Campania stroke hubs, before and after the issue of lockdown in Italy on March 9th, 2020. Results Compared to the pre-lockdown, we observed a significant reduction in the number of acute reperfusion treatments in stroke (P for interact 0.001); however the global number of patients presenting with acute stroke did not significantly differ. The time to reach medical attention was significantly longer in the lockdown phase (230 versus 154 min, P 0.016). For patients who underwent acute reperfusion treatment we also observed significantly longer time-to-imaging (30 versus 40 min, P 0.0005) and a trend to longer time-to-needle (75 versus 90 min P 0.23), but not time-to-groin. Conclusions This study showed the reduction in acute reperfusion treatments for acute ischemic stroke and the slowdown of stroke pathways, during the lockdown phase of Covid-19 pandemic, in Campania, the third-most-populous and the most-densely populated Italian Region. In the next future, the risk for high-grade disability and death, due to delayed or even avoided hospital presentation due to fear of contagion, may be high.

Consequences of COVID-19 pandemic lockdown on emergency and stroke care in a German tertiary stroke center

“…On the other hand, while our IVT rate was stable (23.8% vs 24.3% vs 20.6%), which was in contrast to other observations [13,[17][18][19], but in line with the nationwide German cohort study [8], the rate of large vessel occlusion dropped not significantly along with a significant reduction of our EVT rate and absolute number between 2019 and the spring lockdown of EVT by 58 and 62%, respectively. Our observed reduction of EVT is beyond the 21% decline reported from a registry in France [20] or the 23% decline reported from China [9].…”

Stroke admission rates before, during and after the first phase of the COVID-19 pandemic

“…Many stroke centres have reported that COVID-19 discourages patients from contacting the health care system with an increase in prehospital delay and decrease in stroke admissions as a result [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. We have previously reported a decrease of almost 1/3 in stroke admissions in relation to the lockdown in Norway [6].…”

“…Stroke severity was defined by NIHSS on admission and categorised into mild (NIHSS ≤ 5), moderate (NIHSS [6][7][8][9][10][11][12][13][14] and severe (NIHSS ≥ 15). The proportion of different stroke severities includes both ischemic and haemorrhagic strokes but not TIAs.…”

“…There are contradicting results regarding prehospital delay and the overall number and proportion of ischemic stroke patients receiving intravenous thrombolysis during the lockdown [1,2,5,7,8,[10][11][12][13] and reduced standard of care and delayed stroke care pathways with increased door-to-needle time have also been reported [1,2,5,7,8,[10][11][12][13]. The proportion receiving thrombolysis if they reached our hospital within the time window was similar for all three periods, indicating that the hospital's acute stroke workflow and pathway were not affected to a degree harming patients [10,20]. No changes in length of hospital stay or in-hospital mortality were found in our study.…”

Ischemic Stroke: An Underestimated Complication of COVID-19

“…Similar to stroke alone, treatment for ischemic stroke in COVID-19 patients is individualized and complicated, including thrombolysis [110,111] and thrombectomy [112,113] for acute interventions and antiplatelets and anticoagulants for secondary prevention. It should be noted that many patients with acute ischemic stroke lose the opportunity for acute intervention because of isolation and reluctance to present to the hospital [114,115]. The treatment efficacy for ischemic stroke following COVID-19 needs further evaluation.…”