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

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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.

Glossary

COVID-19=: coronavirus 2019;
GETA=: general endotracheal anesthesia;
ICU=: intensive care unit;
PPE=: personal protective equipment

Footnotes

Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
NPub.org/COVID19

Received April 8, 2020.
Accepted in final form April 29, 2020.

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Letters: Rapid online correspondence

Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Enrique Leira, MD, MS, University of Iowa

Andrew N. Russman, DO, Cleveland Clinic Foundation

Bradford B. Worrall, MD, University of Virginia
Submitted July 28, 2020
Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Enrique Leira, MD, MS, University of Iowa

Andrew N. Russman, DO, Cleveland Clinic Foundation

Bradford B. Worrall, MD, University of Virginia
Submitted July 24, 2020
Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Vaitsa Giannouli, PhD, Institute of Neurobiology, Bulgarian Academy of Sciences

Nikolaos Syrmos, PhD, School of Medicine, Aristotle University of Thessaloniki
Submitted July 23, 2020
Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Khichar Shubhakaran, Senior Professor and Head of Department of Neurology, Dr. S.N. Medical College (Jodhpur, India)
Submitted July 21, 2020
Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Enrique Leira, Neurlogist, University of Iowa

Andrew N. Russman, DO, Cleveland Clinic Foundation

Bradford B. Worrall, MD, University of Virginia
Submitted June 10, 2020
Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Marcele Schettini, Neurologist, Hospital das Clínicas, University of São Paulo, Brazil

Adalberto Studart, Neurologist, Hospital das Clínicas, University of São Paulo, Brazil

Adriana Bastos Conforto, Neurologist - PhD, Hospital das Clínicas, University of São Paulo, Brazil
Submitted June 01, 2020
Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Enrique Leira, MD, MS, University of Iowa

Andrew N. Russman, DO, Cleveland Clinic Foundation

Mitchell S.V. Elkind, MD, MS, MPhil, Columbia University

Bradford B. Worrall, MD, University of Virginia
Submitted May 19, 2020
Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
Calixto Machado, Neurologist, AAN Corresponding Fellow, Insttitute of Neurology and Neurosurgery (Havana, Cuba)
Submitted May 10, 2020

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