By Aristeidis H. Katsanos, MD, PhD
Coronavirus disease 2019 (COVID-19) outbreak was declared by the World Health Organization (WHO) on March 11, 2020. Healthcare delivery, including stroke care, has faced unprecedented challenges due to the impact of the COVID-19 pandemic.
International organizations, including the European Stroke Organisation, focused from the very start of the COVID‐19 pandemic on protecting hospital staff and at the same time preserving the quality of patient care. Despite concerns for increased in-hospital delays, the “protected code stroke” measures implemented during the active waves of the COVID-19 pandemic resulted in similar rates and time to reperfusion therapies during the first wave of the pandemic.
The association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and cardiovascular diseases, including stroke, has been an even more puzzling challenge for researchers and healthcare providers. Several studies reported an increased risk of cerebrovascular events in patients infected with SARS-CoV-2, suggesting that a hypercoagulable state induced by the viral infection could be the etiology for cryptogenic strokes in younger individuals. On May 2021, public attention was shifted to a surge of cases of cerebral venous sinus thrombosis (CVST) associated with a thrombosis and thrombocytopenia syndrome induced by viral vector-based vaccines against the SARS-CoV-2. As international regulatory authorities continued to emphasize the overwhelming benefit for vaccination against SARS-CoV-2, swift diagnosis and appropriate treatment initiation for patients with CVST associated with Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) became of paramount importance to improve the dire prognosis associated with this condition.
According to several cohort studies from different parts of the world, patients admitted with stroke during the first wave of the COVID‐19 pandemic had more severe syndromes and a five-time higher risk for in‐hospital mortality compared to the pre-pandemic era. Based on these alarming findings, cohort studies performed during the second wave of the COVID-19 pandemic reported a decrease in stroke severity, in‐hospital strokes, and in‐hospital stroke mortality compared to the first wave of the pandemic.
After two continuous years of struggling to preserve best care practices during these challenging times, stroke teams are left with decreased stamina. Understaffing and extended shifts were the results of prophylactic staff quarantine or COVID-19 illness. Many of the stroke physicians and hospital staff around the globe have been infected with SARS-CoV-2. Unfortunately some have passed away, while others are suffering from the consequences of long-COVID syndrome.
Despite the successes in some of the challenges imposed by the COVID‐19 pandemic, the race is not over. In order to reach the finish line with the least possible casualties, healthcare providers and scientific communities should strive not only to maintain the quality of stroke care, but also address the long-standing unmet needs of stroke team members and patients. The invaluable experience gained from this marathon should be used as the ground to set new standards in stroke care when the pandemic is finally over.
- Markus HS, Brainin M. COVID-19 and stroke-a global world stroke organization perspective. Int J Stroke. 2020;15:361–364.
- Katsanos AH, Palaiodimou L, Zand R, et al. Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Stroke. 2021;52:3651-3660.
- Khosravani H, Rajendram P, Notario L, et al. Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic. Stroke. 2020;51:1891-1985
- Katsanos AH, Palaiodimou L, Zand R, et al. The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis. Ann Neurol. 2021;89:380-388.
- Ferro JM, de Sousa DA, Coutinho JM, Martinelli I. European stroke organization interim expert opinion on cerebral venous thrombosis occurring after SARS-CoV-2 vaccination. Eur Stroke J. 2021;6:CXVI-CXXI.
- Aguiar de Sousa D, van der Worp HB, Caso V, Cordonnier C, Strbian D, Ntaios G, Schellinger PD, Sandset EC; European Stroke Organisation. Maintaining stroke care in Europe during the COVID-19 pandemic: Results from an international survey of stroke professionals and practice recommendations from the European Stroke Organisation. Eur Stroke J. 2020 Sep;5(3):230-236.