Author: Dr Inna Lutsenko, for the ESO Young Stroke Physicians and Researchers Committee, twitter: @inna_lutsenko
Affiliations: Specialist, Neurologist, Center for Distance Learning and Advanced Training, Kyrgyz State Medical Academy after I.K.Akhunbaev
Based on cross-sectional, web based survey which ESO initiated in March 2020, for the quality of stroke care during the COVID-19 pandemic times, we also designed a similar survey for paramedics and physicians in Kyrgyzstan. 101 specialists (60 physicians and 41 paramedic) took part in our survey from 6th regions and 9 hospitals of Kyrgyzstan between April,28 till May, 5th.
We created two different surveys for the emergency center in Bishkek (capital of Kyrgyzstan) with one focusing on the logistics of stroke pathway and the other regarding the therapeutic approaches for patients with suspected or proven coronavirus infection and stroke. Here we highlight some interesting findings.
We found an interesting discrepancy between the emergency services and admitting hospitals in their answers to the question: “How has the routine flow of patients to hospitalization changed since the beginning of the pandemic?” 45% respondents from the emergency center mentioned that there were no changes in the amount of calls from stroke patients while only 23% of physicians at hospitals saw no decreased admissions. The reason was that some patients with an acute stroke, assessed by paramedics, refused to be hospitalized due to the fear “to be infected in the hospitals”.
Another interesting response we received was about the question: “In which case will you conduct a coronavirus detection test for a stroke patient?” Respondents indicated they would test in stroke patients who also presented with “classic” COVID-19 symptoms including dry cough,dyspnoe, and high fever plus proven contact with a confirmed case of coronavirus infection. Physicians did not bring much attention to gastrointestinal symptoms, headache or muscular pain as potential manifestations of COVID-19. This can be due to a series of training on COVID-19 infection which respondents received where pulmonary symptoms of COVID-19 were emphasized and so were the contact history.
During the pandemic, 26% of stroke hospitals were rearranged for the admission of patients with COVID-19 and the number of stroke beds was reduced. Due to that, for 30% of patients with TIA, mostly in remote regions, the treatment was prescribed to be received at home. 59% of stroke physicians linked the reduced hospital admission of stroke patients with the fact that before the pandemic some patients came to stroke centers by private car or taxi and during the pandemic the movement of cars was very limited due to the curfew measure.
Finally, 70% of physicians commented on unchanged workload during the pandemic and 15% cared for patients who suffered from both a stroke and COVID-19.
On June, 8, 2020, there are 2032 confirmed cases of COVID-19 in Kyrgyzstan, of which 1445 recovered and 23 died . As a result of the survey, physicians from15 hospitals also initiated a video campaign: “With stroke do not stay at home!”. We concluded that more trainings are necessary for stroke physicians to identify atypical COVID-19 symptoms as well as early neurological signs of COVID-19. We are providing the full translation of ESO webinars and messages for stroke physicians and paramedics in Kyrgyz and Russian language for further consideration.
- Delivering high quality stroke care during the COVID-19 pandemic: lessons from colleagues across Europe. ESO Blog. https://eso-stroke.org/delivering-high-quality-stroke-care-during-the-covid-19-pandemic-lessons-from-colleagues-across-europe/
- COVID-19 statistics in Kyrgyzstan. https://24.kg/obschestvo/150634_koronavirus_vkyirgyizstane_chislo_bolnyih_ikarta_rasprostraneniya_zabolevaniya/
- With stroke do not stay at home! – Video-message for population of Kyrgyzstan.