Stroke is the second most common cause of death and the most common cause of disability in the world. Hong Kong recorded its first Coronavirus Disease 2019 (COVID-19) case on January 23, 2020 and is currently in its containment phase without sustained community spread. Non-emergency services throughout hospitals in Hong Kong have been adjusted to cope with the outbreak, while emergency services such as acute stroke treatment have been maintained as much as possible. However, it is uncertain whether COVID-19 has influenced public behaviour in seeking medical attention for stroke and whether stroke services have been affected.
Researchers at The Stroke Research and Prevention Group (HKU Stroke), LKS Faculty of Medicine of The University of Hong Kong (HKUMed) analysed 73 patients who presented to the Accident and Emergency (A&E) Services of Queen Mary Hospital with symptoms of a stroke during the first two months of COVID-19 locally (January 23, 2020 – March 24, 2020), and compared these with 89 patients during a similar period in 2019 (January 23, 2019 – March 24, 2019). They found that, despite similar clinical characteristics between the two groups, patients who presented during the COVID-19 pandemic sought medical attention via the A&E on average 60 minutes later, compared with patients in 2019 (154 vs 95 minutes). Importantly, during the period, only 55% of patients with stroke were presented to hospitals within the therapeutic time window for thrombolysis treatment (4.5 hours from symptom onset), which was ~20% lower compared with the preceding year (55% vs 72%). Furthermore, much fewer patients with a mini-stroke or transient ischaemic attack (TIA) were presented to hospitals during COVID-19 (4% vs 16%). Reassuringly, during COVID-19, it appeared that in-hospital stroke services at Queen Mary Hospital, flagship teaching hospital of HKUMed, were nevertheless not affected and timings of in-patient stroke pathways, such as those from hospital admission to giving treatment, remained similar during and before COVID-19.
Dr Gary Lau Kui-kai, Director of HKU Stroke who was in charge of the study commented, “Delays in seeking care or not seeking care in stroke patients could be detrimental to stroke outcome. Time is brain and for every minute that stroke is not treated, it has been estimated that up to 1.9 million brain neurons will be lost. Earlier treatment for stroke is associated with better outcome and any delays in seeking care would seriously jeopardise the patient’s eligibility for treatment. For example, intravenous thrombolysis, an effective ‘clot-busting’ medication for patients with blockages within the arteries causing the stroke (ischaemic stroke) can traditionally only be provided if the patient presents to hospital within 4.5 hours of their symptom onset. Our results unfortunately show that, during COVID-19, as patients with stroke are presenting to hospital later, far fewer patients will be eligible for thrombolysis.”