SARS-CoV-2 (COVID-19) protection efforts on acute stroke treatment

Introduction: It is unclear how the interventions designed to restrict community and in-hospital exposure to the SARS-CoV-2 virus affected the care for stroke patients seeking acute treatment The objective of the following study was to determine the impact COVID-19 has had on the treatment times for patients evaluated as acute stroke alerts at Baptist Hospital of Miami (BHM) A co-primary objective of the study was to assess the risk of contracting SARS-CoV-2 within 2 weeks from hospital discharge Methods: This retrospective, two phase study was conducted between December 2019 and April 2020 In phase one, we assessed time from symptom onset to hospital arrival, number of strokes with witnessed onset, and in-hospital treatment times pre & post implementation of Covid-19 preventive exposure measures In phase two of the study, a telephone survey was conducted on the post implementation group to assess the risk of patients developing symptoms or testing positive for SARS-CoV-2 from hospital admission up to two weeks post discharge Results: Phase I demonstrated there was a 40% decline in stroke volume, but no significant delay to seek medical attention post implementation of the SARS prevention strategies On average individuals in the pre-group (n=155) waited approximately 260 minutes (SE=24) to seek medical attention vs 203 minutes (SE=27) minutes for the post-group (n=87) However, there was nearly a six-fold increase in the percentage of cases with unknown symptom onset post implementation of COVID-19 safety precautions There was significant delay in administering IV alteplase, increasing from 24 mins (n=16) to 33 mins (n=21) post implementation;delays observed for endovascular treatment were not significant (pre, n=13 mean= 73 mins, post n=12 mean= 82 mins) The volume of patients treated with either IV alteplase and/or endovascular treatment remained similar Phase II of the study is on-going, results will be available for the ISC Discussion: The COVID-19 crisis in our community was associated with a six-fold increase in the percentage of cases with unknown stroke onset time Besides a marked decrease in stroke volume, we did not evidence significant delays to either seek or provide acute stroke care outside a modest increase in door to needle time