key: cord-0958791-i4txync6 authors: Hasan, A T M Hasibul; Das, Subir Chandra; Islam, Muhammad Sougatul; Mansur, Mohaimen; Shawon, Md Shajedur Rahman; Hassan, Rashedul; Hoque Chowdhury, Mohammad Shah Jahirul; Mondal, Md Badrul Alam; Mohammad, Quazi Deen title: Impact of COVID-19 on Hospital Admission of Acute Stroke patients in Bangladesh date: 2020-09-28 journal: bioRxiv DOI: 10.1101/2020.09.28.316448 sha: d5748d448f5b4e8b32e946fc64a8ef789d2cffdd doc_id: 958791 cord_uid: i4txync6 Background With the proposed pathophysiologic mechanism of neurologic injury by SARS COV-2 the frequency of stroke and henceforth the related hospital admissions were expected to rise. In this paper we investigate this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic. Methods We conducted a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. We considered all the admitted cases from the 1st January to the 30th June, 2020. We used Poisson regressions to determine whether statistically significant changes in admission counts can be found before and after 25 March since when there is a surge in COVID-19 infections. Results A total of 1394 stroke patients got admitted during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger with a male-female ratio of 1.06:1. From January to March, 2020 the mean rate of admission was 302.3 cases per month which dropped to 162.3 cases per month from April to June with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done whereas in the last three months there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT- PCR for SARS Cov-2 positive based on nasal swab testing. Conclusion Our study revealed more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. It is still elusive whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement and stay-home measures. Neurologic dysfunction is reported in up to one-third of the cases of COVID-19 1 . The frequency 82 of stroke has been reported to range from 2.8% to 5.4% among confirmed and hospitalized 83 COVID-19 patients 1, 2 . Reported COVID-19-related hemorrhagic strokes are far less common 84 than ischemic strokes 3-6 . While the pathogenesis of COVID-19-related hemorrhagic strokes is 85 still elusive, hypercoagulable state, vasculitis and cardiomyopathy had been proposed as 86 potential pathogenic mechanisms for ischemic stroke in COVID-19 patients 7,8 . Some researchers 87 had stated that the viral affinity to ACE-2 receptor present in endothelium might be responsible 88 for the rupture of intracranial vessel wall 9 . COVID-19-related stroke patients were more likely to 89 be older, hypertensive, and had a higher D-dimer level 10 . Qin C et all 11 reported that COVID-19 90 related stroke patients had more comorbidity, lower platelet counts and leukocyte counts, and the 91 patients had higher levels of D-dimers, cardiac troponin I, NT pro-brain natriuretic peptide, and 92 interleukin-6. Considering the pandemic nature of the spread of COVID-19 together with the proposed 94 pathogenic mechanism of stroke in its patient, the acute stroke cases were expected to have a 95 sharp rise at hospitals. But in recent months neurologists from different parts of the world have April. As of 15 June, the attack rate (AR) in Bangladesh is 532.1 per million 13 . For the last 100 several weeks the case detection rate has been more than 20% and the total number of cases has 101 exceeded the two hundred and seventy-five thousand mark on 16 August 2020 14 . As a 5 102 consequence, a large number of stroke cases were also expected to get admitted to hospitals since 103 the onset of the infection. In this study, we assess whether the volume of actual admissions during the pandemic match 105 suspected rise in stroke cases by conducting a trend analysis of stroke admission at the 100-bed the need for the informed consent was also waived by the ERC due to the retrospective nature of 144 the study. This study did not include any intervention or did not impose any harm to anybody. The issues of privacy and confidentiality of patient information were strictly maintained 146 throughout the study. Table 1 shows that half of the patients were older than 60 years, whereas only 171 2.6% were 30 years old or younger with a male to female ratio of 1.06:1. reperfusion treatment. This downward trend is captured in Figure 3 . 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