key: cord-0775590-baiqcoao
authors: Bersano, Anna; Pantoni, Leonardo
title: The impact of SARS‐Cov‐2 pandemic on stroke care: A warning message
date: 2020-06-11
journal: Eur J Neurol
DOI: 10.1111/ene.14394
sha: 0ea17897ba1f13eac51bad13ec01c4ad5ae8084a
doc_id: 775590
cord_uid: baiqcoao

The recent coronavirus disease (COVID‐19) pandemic intensely impacted the health systems worldwide, which had to deal with the challenge of contemporarily answering to the needs of COVID‐19 patients and managing other life threatening disorders. Several European countries such as Italy, France and Spain, particularly hit by the pandemic, had to deeply reorganize healthcare and to redistribute personnel, resources and beds to deal with the demands of the uncontrolled spreading of the COVID‐19 infection.

reorganize healthcare and to redistribute personnel, resources and beds to deal with the demands of the uncontrolled spreading of the COVID-19 infection (1) . Many stroke services and teams were closed or reallocated and different stroke care pathways were implemented in many countries, according to local health system resources and organization (1) . Overall, these conditions affected the standard stroke care including the delivery of time-dependent treatments and adequate diagnostic work-ups (1, 2) . 

This article is protected by copyright. All rights reserved These two studies, although limited by a short observation time, are among the first to report data on stroke care quality changes in Europe at the time of the COVID-19 pandemic.

Although other observations on stroke care changes have been published, most of them lack of systemic information, due to the difficulty in data collection in this challenging time. A decreased number of acute stroke admissions was registered in many countries despite there is no reason to believe that the overall stroke incidence has been different. This phenomenon is still unexplained.

One possible reason is that many patients with milder stroke remained at home for the fear of infection in the hospital or because symptoms were not clearly recognized because of social isolation and lockdown (2, 3, (5) (6) (7) . In other cases, stroke signs could be misdiagnosed in patients with COVID-19 severe respiratory problems or because protection measures and distancing limited or even prevented neurological consultations. Although these two reports are related to restricted geographical areas of Europe, these observations introduce a warning message on the negative impact that COVID-19 had on quality of pre-hospital and in-hospital stroke care and hint at possible long-term consequences in terms of increased disability burden. Because stroke is the second cause of mortality and the first of disability in Western countries, the best stroke care should be ensured, also in any challenging time, in order to not vanish the excellent results achieved over the last years in improving stroke outcome (5, 8) .

On being a neurologist in Italy at the time of the COVID-19 outbreak Neurology, in press

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Atención al Ictus en Aragón" Ischaemic Stroke in the Time of Coronavirus Disease

Impact of the Covid-19 outbreak on acute stroke pathways -Insights from the Alsace region in France

Stroke care and the COVID19 pandemic words from our President, www.world-stroke.org/news-and-blog/news/stroke-care-and-the-covid19-pandemic

Acute stroke management pathway during Coronavirus-19 pandemic

The Baffling Case of Ischemic Stroke Disappearance from the Casualty Department in the COVID-19 Era

Underutilization of Healthcare for strokes during the COVID-19 outbreak

Accepted Article