• Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care: A Statewide Analysis

      Balucani, Clotilde; Carhuapoma, J Ricardo; Canner, Joseph K; Faigle, Roland; Johnson, Brenda; Aycock, Anna; Phipps, Michael S; Schrier, Chad; Yarbrough, Karen; Toral, Linda; et al. (Lippincott Williams and Wilkins, 2021-03-11)
      Background and Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, the various emergency measures implemented to contain the spread of the virus and to overcome the volume of affected patients presenting to hospitals may have had unintended consequences. Several studies reported a decrease in the number of stroke admissions. There are no data on the impact of the COVID-19 pandemic on stroke admissions and stroke care in Maryland. Methods: A retrospective analysis of quality improvement data reported by stroke centers in the State of Maryland. The number of admissions for stroke, overall and by stroke subtype, between March 1 and September 30, 2020 (pandemic) were compared with the same time period in 2019 (prepandemic). Median last known well to hospital arrival time, the number of intravenous thrombolysis and thrombectomy were also compared. Results: During the initial 7 months of the pandemic, there were 6529 total admissions for stroke and transient ischemic attack, monthly mean 938 (95% CI, 837.1-1038.9) versus prepandemic 8003, monthly mean 1156.3 (CI, 1121.3-1191.2), P<0.001. A significant decrease was observed in intravenous thrombolysis treatments, pandemic 617, monthly mean 88.1 (80.7-95.6) versus prepandemic 805, monthly mean 115 (CI, 104.3-125.6), P<0.001; there was no significant decrease for thrombectomies. The pandemic decreased the probability of admissions for stroke and transient ischemic attack by 19%, for acute ischemic stroke by 20%, for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage, pandemic 199, monthly mean 28.4 (CI, 22.5-34.3) versus prepandemic 217, monthly mean 31 (CI, 23.9-38.1), respectively, P=0.507. Conclusions: Our findings suggest that the COVID-19 pandemic adversely affected the acute care of unrelated cerebrovascular emergencies.
    • Personal protective equipment in the siege of respiratory viral pandemics: strides made and next steps

      Eke, U.A.; Eke, A.C. (Taylor and Francis Ltd., 2020-12-24)
      Introduction: In December 2019, SARS-CoV-2 originated from China, and spread rapidly to several countries, bringing a frightening scarcity of personal protective equipment (PPE). The CDC recommends N95 or higher-level particulate filtering respirators as part of the PPE while caring for patients with COVID-19, with facemasks as an alternative; and cloth face-coverings in public where social distancing of at least 6 ft. is not feasible. With new evidence about the efficacy of facemasks, knowledge gaps remain. Areas covered: This reviews the history of respiratory viral pandemics and PPE use, exploring the influenza pandemics of the 20th and 21st century, and prior coronavirus pandemics. A literature search of PubMed and google was done between March 22nd to May 2nd, and on September 28, 2020. The evidence for PPE is described, to delineate their efficacy and 'best safe' practices. Solutions to ameliorate pandemic preparedness to meet surge-capacity to efficiently combat future pandemics, should they arise, are discussed. Expert opinion: PPE, when used appropriately in addition to other infection control measures, is effective protection during respiratory viral pandemics. The current evidence suggests that wearing facemasks in the community is protective, especially if used consistently and correctly with other infection control measures such as hand hygiene. Copyright 2020 Informa UK Limited, trading as Taylor & Francis Group.