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Do We Have to Choose Between Stroke or COVID-19 Patients? | Healthiest Communities

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Across the United States, 911 calls during the past few weeks in some counties have dropped by 35% and 20% in others. As a physician who performs stroke procedures, I have also anecdotally seen a 50% drop in the number of stroke patients coming to our Chicago hospital for emergency treatment.

Fewer treated stroke patients may be yet another disturbing consequence of the COVID-19 pandemic. Perhaps people suffering symptoms of a stroke are too scared to go to the hospital for fear of COVID-19 exposure. Perhaps they avoid hospitals now because they do not want to be a burden to their local health care system.

But patients with strokes still very much need to come to the hospital. That is the only way they can receive an emergency procedure, thrombectomy, involving X-ray guidance of catheters and devices within arteries to restore blood flow to the brain within minutes.

Photos: Hospitals Fighting Coronavirus

NEW YORK, NY - MARCH 24: Doctors test hospital staff with flu-like symptoms for coronavirus (COVID-19) in set-up tents to triage possible COVID-19 patients outside before they enter the main Emergency department area at St. Barnabas hospital in the Bronx on March 24, 2020 in New York City. New York City has about a third of the nation’s confirmed coronavirus cases, making it the center of the outbreak in the United States. (Photo by Misha Friedman/Getty Images)

Thrombectomy is a well-proven treatment for stroke with three simultaneous studies published five years ago in the New England Journal of Medicine. Thrombectomy is designed for the type of stroke with a large vessel occlusion, which leaves 75% of patients dead or permanently disabled.

Combining these studies show that more than half of the patients treated with stroke thrombectomy become independent again. The sooner thrombectomy is performed, the higher the chance of success.

However, the necessary and unrelenting emphasis on COVID-19 preparedness at the hospital may interfere with the delivery of this powerful therapy to a disease with equal if not greater morbidity.

As the leading cause of adult disability in the U.S., stroke affects 800,000 people in the country each year, with up to 46% having a large vessel occlusion. If half the number of stroke patients do not have their blood flow restored quickly, hundreds of thousands of more stroke patients may end up dead, in nursing homes or hospice, often hidden from public view.

Most of my older patients regard stroke as worse than death itself.

Stroke is the most disabling and time-sensitive disease in all of medicine. I perform thrombectomies to treat stroke patients and understand treatment needs to be done early while the brain is still viable. If done too late, all you do is restore blood flow to the permanently injured brain.

During a stroke, the brain is essentially holding its breath.

However, our urban, academic comprehensive stroke center in the nation’s third-largest city has been redesigned and repurposed to prepare for an upcoming surge of COVID-19 patients.

Staffing, beds and hospital resources from a variety of services, including neurology and neurosurgery, are now focused on COVID-19 care. Our hospital has actively sought out opportunities to showcase how much preparation has been made to care for COVID-19 patients both locally and nationally.

Perhaps hospitals also need to clearly communicate that they are still the only place to go to take care of important non-COVID-19 medical emergencies such as heart attacks, trauma and stroke.

Italian physicians, who are further along in the pandemic than the U.S., provide some relevant insight. Because the U.S. medical system overemphasizes hospital-based care, the virus can exploit this and exacerbate the disease ramifications at many levels. They suggest decentralized care, separating out patients with and without the COVID-19 infection.

Providing COVID-19 care outside hospitals already known to provide specialized life-saving treatments such as trauma, heart attacks and stroke may be a better way to organize emergency care in this climate.

Chicago’s McCormick Place convention center recently opened up its first 500 beds to specifically care for COVID-19 patients, effectively decreasing the burden on specialized tertiary care hospitals.

The Javits Center in New York City is now the country’s largest hospital with 2,500 beds and U.S. military medical personnel ready to help COVID-19 patients.

Hospitals that provide specialized, tertiary care for medical emergencies can then have the resources needed to effectively treat emergencies such as stroke. To avoid dependency or death, patients with stroke still need to seek treatment at hospitals that can provide these specialized treatments quickly.

By decentralizing COVID-19 care, our tertiary care hospitals will not only be able to maintain the resources needed to treat all medical emergencies including stroke, but also be viewed by the public as a safe place to go for emergency treatment.

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