key: cord-311588-ocz2rzy7
authors: Gilligan, Jeffrey; Gologorsky, Yakov
title: Collateral Damage During the COVID-19 Pandemic
date: 2020-05-14
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.05.091
sha: 
doc_id: 311588
cord_uid: ocz2rzy7

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At our institution, similarly, we have seen both a huge decline in patients seeking care for neurological and neurosurgical diagnoses, as well as late presentation of life-threatening conditions. For example, a 62 year-old Caucasian female was brought to our emergency room with somnolence. By her husband's report, she developed severe headache 6 days prior to presentation, with associated nausea and vomiting. She refused to seek care at the hospital due specifically to fear of contracting COVID-19. At presentation, she was obtunded, not following commands, and not protecting her airway. She was emergently intubated, and CT/CTA demonstrated subacute subarachnoid hemorrhage most pronounced in the right sylvian fissure, a right carotid terminus aneurysm, and moderate multifocal vasospasm ( Figure 1 ). Her sodium at presentation was 114 mmol/L. Despite endovascular embolization of the aneurysm and aggressive medical care, her exam remains poor. What remains unknown is how many patients with known or unknown pathologies are having progression of a deficit (i.e. worsening vision secondary to a supersellar mass or worsening cervical myelopathy) that would otherwise have brought them to seek urgent medical care.

Fortunately, we are seeing a significant decrease in admissions as the rate of new COVID-19 cases has leveled out. In our own institution, resources and staff are finally being able to assist with non-COVID patient duties. Rather than being able to only perform emergent surgeries, we are starting to schedule urgent and semi-elective cases. Faculty, house-staff, and physician extenders, who had been redeployed to help with the COVID-19 pandemic, are slowly returning to their previous roles. In the next few weeks we will need to create an algorithm to identify patients whose surgeries must be prioritized. Who should be scheduled first: A 68 year-old with cervical spondylotic myelopathy, a 47 year-old with a glioblastoma, or a 36 year-old with an MCA aneurysm? These decisions will be difficult to make, but, yet, must be made in the near future.

Patients with heart attacks, strokes and even appendicitis vanish from hospitals

The untold toll -The pandemic's effects on patients without COVID-19

Quite likely, the greater challenge will be finding the people who are afraid to seek care to begin with. Social distancing has led to isolation and fewer visits by friends and family members. The support network, that is often the catalyst to seek medical care, and also the system that provides for them in times of convalescence, must be reestablished. As the pandemic subsides, we will need to ask our leaders, public health officials, and the media to send a message to patients at risk: please seek help if you're not well or having worsening symptoms.