Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions

Enrique C Leira; Andrew N Russman; José Biller; Devin L Brown; Cheryl D Bushnell; Valeria Caso; Angel Chamorro; Claire J Creutzfeldt; Salvador Cruz-Flores; Mitchell S V Elkind; Pierre Fayad; Michael T Froehler; Larry B Goldstein; Nicole R Gonzales; Brian Kaskie; Pooja Khatri; Sarah Livesay; David S Liebeskind; Jennifer J Majersik; Asma M Moheet; Jose G Romano; Nerses Sanossian; Lauren H Sansing; Brian Silver; Alexis N Simpkins; Wade Smith; David L Tirschwell; David Z Wang; Dileep R Yavagal; Bradford B Worrall

doi:10.1212/WNL.0000000000009713

Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions

Neurology. 2020 Jul 21;95(3):124-133. doi: 10.1212/WNL.0000000000009713. Epub 2020 May 8.

Authors

Enrique C Leira¹, Andrew N Russman², José Biller², Devin L Brown², Cheryl D Bushnell², Valeria Caso², Angel Chamorro², Claire J Creutzfeldt², Salvador Cruz-Flores², Mitchell S V Elkind², Pierre Fayad², Michael T Froehler², Larry B Goldstein², Nicole R Gonzales², Brian Kaskie², Pooja Khatri², Sarah Livesay², David S Liebeskind², Jennifer J Majersik², Asma M Moheet², Jose G Romano², Nerses Sanossian², Lauren H Sansing², Brian Silver², Alexis N Simpkins², Wade Smith², David L Tirschwell², David Z Wang², Dileep R Yavagal², Bradford B Worrall²

Affiliations

¹ From the Departments of Neurology, Neurosurgery & Epidemiology (E.C.L.), University of Iowa, Iowa City, IA; Cerebrovascular Center (A.N.R.), Cleveland Clinic, OH; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (D.L.B.), University of Michigan, Ann Arbor, MI; Department of Neurology (C.D.B.), Wake Forest School of Medicine, Winston-Salem, NC; Stroke Unit (V.C.), University of Perugia, Italy; Department of Neurology (A.C.), Hospital Clinic, Barcelona, Spain; Department of Neurology (C.J.C., D.L.T.), University of Washington, Seattle, WA; Department of Neurology (S.C.-F.), Texas Tech University, El Paso, TX; Departments of Neurology & Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurological Sciences (P.F.), University of Nebraska, Omaha, NE; Department of Neurology & Neurosurgery (M.T.F.), Vanderbilt University, Nashville, TN; Department of Neurology (L.B.G.), University of Kentucky, Lexington, KY; Department of Neurology (N.R.G.), McGovern Medical School at UTHealth, Houston, TX; Department of Health Management and Policy (B.K.), University of Iowa, Iowa City, IA; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Adult Health & Gerontology Nursing (S.L.), Rush University, Chicago, IL; Department of Neurology (D.S.L.), UCLA; Department of Neurology (J.J.M.), University of Utah, Salt Lake City, UT; Neurocritical Care, OhioHealth Riverside Methodist Hospital (A.M.M.), Columbus, OH; Department of Neurology (J.G.R.), University of Miami, FL; Department of Neurology (N.S.), University Southern California, Los Angeles, CA; Department of Neurology (L.H.S.), Yale School of Medicine, New Haven, CT; Department of Neurology (B.S.), University of Massachusetts, Worcester, MA; Department of Neurology (A.N.S.), University of Florida, Gainesville, FL; Department of Neurology (W.S.), UCSF; Department of Neurology (D.Z.W.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology & Neurosurgery (D.R.Y.), University of Miami, FL; and Department of Neurology (B.B.W.), University of Virginia, Charlottesville, VA. enrique-leira@uiowa.edu.
² From the Departments of Neurology, Neurosurgery & Epidemiology (E.C.L.), University of Iowa, Iowa City, IA; Cerebrovascular Center (A.N.R.), Cleveland Clinic, OH; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (D.L.B.), University of Michigan, Ann Arbor, MI; Department of Neurology (C.D.B.), Wake Forest School of Medicine, Winston-Salem, NC; Stroke Unit (V.C.), University of Perugia, Italy; Department of Neurology (A.C.), Hospital Clinic, Barcelona, Spain; Department of Neurology (C.J.C., D.L.T.), University of Washington, Seattle, WA; Department of Neurology (S.C.-F.), Texas Tech University, El Paso, TX; Departments of Neurology & Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurological Sciences (P.F.), University of Nebraska, Omaha, NE; Department of Neurology & Neurosurgery (M.T.F.), Vanderbilt University, Nashville, TN; Department of Neurology (L.B.G.), University of Kentucky, Lexington, KY; Department of Neurology (N.R.G.), McGovern Medical School at UTHealth, Houston, TX; Department of Health Management and Policy (B.K.), University of Iowa, Iowa City, IA; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Adult Health & Gerontology Nursing (S.L.), Rush University, Chicago, IL; Department of Neurology (D.S.L.), UCLA; Department of Neurology (J.J.M.), University of Utah, Salt Lake City, UT; Neurocritical Care, OhioHealth Riverside Methodist Hospital (A.M.M.), Columbus, OH; Department of Neurology (J.G.R.), University of Miami, FL; Department of Neurology (N.S.), University Southern California, Los Angeles, CA; Department of Neurology (L.H.S.), Yale School of Medicine, New Haven, CT; Department of Neurology (B.S.), University of Massachusetts, Worcester, MA; Department of Neurology (A.N.S.), University of Florida, Gainesville, FL; Department of Neurology (W.S.), UCSF; Department of Neurology (D.Z.W.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology & Neurosurgery (D.R.Y.), University of Miami, FL; and Department of Neurology (B.B.W.), University of Virginia, Charlottesville, VA.

Abstract

The coronavirus 2019 (COVID-19) pandemic requires drastic changes in allocation of resources, which can affect the delivery of stroke care, and many providers are seeking guidance. As caregivers, we are guided by 3 distinct principles that will occasionally conflict during the pandemic: (1) we must ensure the best care for those stricken with COVID-19, (2) we must provide excellent care and advocacy for patients with cerebrovascular disease and their families, and (3) we must advocate for the safety of health care personnel managing patients with stroke, with particular attention to those most vulnerable, including trainees. This descriptive review by a diverse group of experts in stroke care aims to provide advice by specifically addressing the potential impact of this pandemic on (1) the quality of the stroke care delivered, (2) ethical considerations in stroke care, (3) safety and logistic issues for providers of patients with stroke, and (4) stroke research. Our recommendations on these issues represent our best opinions given the available information, but are subject to revision as the situation related to the COVID-19 pandemic continues to evolve. We expect that ongoing emergent research will offer additional insights that will provide evidence that could prompt the modification or removal of some of these recommendations.

Publication types

Review

MeSH terms

Betacoronavirus
Biomedical Research
COVID-19
Coronavirus Infections / epidemiology*
Delivery of Health Care*
Ethics, Medical
Health Care Rationing / ethics
Health Resources
Health Services Accessibility
Health Services Needs and Demand*
Hospital Bed Capacity
Humans
Intensive Care Units
Neurology
Pandemics
Pneumonia, Viral / epidemiology*
Quality of Health Care*
SARS-CoV-2
Stroke / therapy*
Telemedicine

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States