Update on regional stroke activation trends during COVID-19 mitigation

Background: The University of Cincinnati Stroke Team provides acute stroke care to the southwest Ohio, northern Kentucky, and southeast Indiana catchment area of ∼2 million people and 30 healthcare facilities We previously published a significant decline in stroke activations and reperfusion treatment (IV thrombolysis and EVT) rates following state announcements of COVID-19 mitigation measures Here, we update these trends after state reopening guidelines Methods: We compared Stroke Team activations and reperfusion treatments logged in a prospectively collected database, comparing the same period in 2020 versus 2019 Kentucky and Ohio announced school and restaurant closures on March 12 and 13, respectively, followed by Indiana A stepwise reopening of our tristate area started on May 1, 2020 We also compared trends in activations and treatment rates before (Weeks 1-10), during (Weeks 11-17), and after (Weeks 18- 26) the lifting of COVID-19 mitigation efforts using the Poisson test, and graphically with segmented regression analysis Results: Compared to 2019, stroke team activations declined by 12% in 2020 (95% CI 7 - 16%;p<0 01) During 2020, an initial decline in stroke activations following COVID-19 mitigation announcements was followed by a 28% increase in activations after reopening (Weeks 18-26: 95% CI 15 - 42%;p<0 01) In contrast, compared to 2019, treatment rates were unchanged (0%, 95% CI -15 - 18%;p=1 00), including specifically IV thrombolysis and thrombectomy rates Similarly, an initial decline in reperfusion treatments was followed by a 24% nonsignificant increase after reopening (95% CI -10 - 71%;p=0 19) in 2020 Conclusion: The initial decline in stroke team activations during COVID-19 mitigation efforts was followed by an increase in activations after reopening Hospital capacity and 911 services remained fully intact, suggesting that the reduction in activations were related to reduced presentation by patients for emergent stroke care (Figure Presented)