Stroke Treatment in Covid Times

The Covid pandemic has been raging the world over since beginning of 2020. There is no immediate end in sight. And even when a vaccine is found, it is quite possible that this ‘ black swan’ event will fundamentally alter how humanity progresses further.

The disease being highly infectious, it is quite understandable that visits to Hospitals have declined for other diseases. People feel that they will expose themselves to greater risk by visiting a place already frequented by patients and hence, if possible, try to avoid.

While for some time there was an overload on the public health systems world over the fear is still much prevalent. Particularly since infection numbers at many places – and more relevant, in India , are still showing an upward trend.

For instance, Sewri Hospital in Mumbai has seen a drop in OPD visits of TB patients.  Even in Emergency departments, attendance has fallen by more than 50 %, as reported in this news article pertaining to Irish Hospitals.  

This is a dangerous route to follow. And simply not an option when stroke strokes. Unfortunately, some symptoms of stroke can be misleading , or may pass away after some time. Thereby putting the patients under a delusion that they  can avoid, or at least delay a hospital visit for some time.

Such an action can be fatal or can cripple one for life !

Hospitals world over, including India are well aware of these fears . At the same time, clear protocols have been developed and are continuously being improved upon so as to minimize the risk of Covid while emergency patients are brought in and treated , including stroke patients.

Such fears and steps taken to overcome those have been discussed at different foras , one such was aired at CNBC Awaaz and is as under ;

The India Stroke Association has taken note of these fears and its various members are working on allaying them by developing different strategies for stroke patients management and treatment. Such steps can minimize the risk of Covid, not only for the patients and their families but also for the medical personnel treating them.

To that intent, a Consensus statement – suggested recommendations for acute stroke management during the COVID-19 pandemic: Expert group on behalf of the Indian Stroke Association has been released.

As stated therein, various steps are being taken to reduce / eliminate the risk of Covid infection. Salient points of this statement include :

  • Patients with an acute stroke need optimum management and prioritization even during a pandemic.
  • Robust screening of individual patients for COVID-19 should be performed at the level of triage in every hospital using a standard detailed checklist.
  • All COVID-19 suspect stroke cases should be managed in designated COVID-19 health facilities.
  • However, in circumstances where the primary contact hospital is not a designated COVID-19 center, and it is not possible to refer the patient on time to the COVID-19 designated hospital, and considering that stroke management is time-sensitive, the primary contact hospital may consider managing the patient, provided all laid down guidelines as per MoHFW, Govt of India, are in place and the patient is notified. The patient should then be shifted to the designated COVID-19 hospital as soon as possible for admission with prenotification and appropriate transfer method. (see details in the document)
  • COVID-19 positive stroke patient should be managed in designated health facilities for COVID-19.
  • Report of laboratory testing for COVID-19 suspect patients should be available on priority to guide the management.
  • Standard acute stroke treatment guidelines will apply to the management of patients. Individualized decisions will need to be taken for patients with a serious COVID-19 illness.
  • Hospitals may consider designating a separate CT machine for acute imaging of a COVID-19 suspect or positive patients in the designated areas and appropriately sanitize the area after use as per standard protocols. Standard imaging protocols will apply. Optimize/minimize the use of MRI during this pandemic to reduce exposure to the staff and system.
  • Individualised decisions regarding thrombolysis and endovascular stroke treatment may need to be taken in patients seriously ill due to COVID-19.
  • The non-COVID-19 suspect or negative patients should be provided care in the designated stroke unit or inpatient unit.
  • COVID-19 suspect or active patients have to be provided care in designated hospital areas only (till test reports of final COVID-19 status are available for suspected patients). Limitations of care may arise, but standard guidelines should follow for monitoring and advice. It may be prudent to educate the health care workers in COVID-19 demarcated area about stroke. Checklists and stroke protocols could be made available for these areas to follow and discuss with the stroke team.
  • Telemedicine could be used for consultations between designated areas and specialty areas within or outside the hospital.
  • Discharge of stable COVID-19 negative patients should be planned early to minimize exposure and also reduce the burden on the health system. Discharge of COVID positive patients should follow standard guidelines.
  • Telemedicine consultation should be considered for follow-up visits.
In short, a stroke is an EMERGENCY and the patient HAS to be shifted immediately to an appropriate medical facility when stroke symptoms occur. Steps are being taken to minimize the risk of Covid infections in such facilities, and such fears should NOT hold back the stroke affected or the caregivers.

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Thank you VERY MUCH !

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