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Lost in the COVID-19 Pandemic: Stroke Awareness Month and Treatment

May 19, 2020
Published in: COVID-19, Stroke

Stroke assessment being performed in the Emergency Room

Each May, healthcare organizations observe Stroke Awareness Month to remind communities about stroke signs and symptoms, and how to prevent and treat stroke. It's an important message every year because although stroke remains a leading cause of death and disability, it is preventable and treatable.

In 2020, the message takes on an increased concern. In a study published online in May as a Letter to the Editor in the New England Journal of Medicine, researcher Akash Kansagra, MD, notes that the number of people seeking stroke treatment has dropped 39% compared to pre-COIVD-19 pandemic levels.

Amy Markham, MSN, RN, SCRN and Quality Coordinator for Neurology, Sepsis and Emergency Medicine

Augusta Health has experienced similar decreases in people seeking stroke treatment in the Emergency Department.

"In March of 2019, we had 46 Stroke Alerts in our Emergency Department. In March of 2020, we had only 22 Stroke Alerts in our ED," says Amy Markham, MSN, RN, SCRN and Quality Coordinator for Neurology, Sepsis and Emergency Medicine at Augusta Health. "In April, the numbers were even a greater concern: 43 Stroke Alerts in 2019 and only 14 Stroke Alerts in 2020." It is unlikely that there were fewer strokes in the area. It is likely that those experiencing a stroke are avoiding to seek treatment in the Emergency Department because they are concerned about exposure to COVID-19.

"While COVID-19 is a concern, the fact is that heart disease is the leading cause of death in our area and stroke is the leading cause of disability. Unfortunately, these emergencies (among others) have not gotten the message about a pandemic and continue to afflict patients. Many of these emergencies are dependent on rapid treatment to ensure the best results and therefore it is critical that everyone understand that if you are having signs or symptoms of a heart attack, stroke, or other emergency that you call 911 and go to the Emergency Room," says Adam Rochman, MD, Medical Director of the Emergency Department and member of Augusta Health's interdisciplinary Stroke Team. "You need to be examined and treated as quickly as possible."

What is a Stroke?

A stroke is also called a brain attack. Most strokes occur when blood flow through an artery in the brain is blocked. Stroke also occurs when an artery in the brain ruptures. Both cause brain cells to die, and result in permanent damage to the part of the brain that is impacted.

Strokes can happen at any time to anyone.

Some risk factors can not be controlled:

  • Age—Although strokes can occur at any age, the chance of stroke increases as you age.
  • Race—African Americans, Hispanics and Asian/Pacific Islanders have a higher risk of stroke than other races.
  • Gender—More women have stroke than men. In fact, more women die from stroke than breast cancer every year.
  • Family History—Risk of stroke increases if a family member has had a stroke.

There are also risk factors that can and should be managed:

  • High blood pressure
  • Atrial fibrillation (A-fib)
  • High Cholesterol
  • Smoking
  • Diabetes
  • Poor Circulation
  • Lack of Physical Activity
  • Obesity

Controlling these risk factors should be regularly discussed with a Primary Care Provider (PCP).

Signs and Symptoms of a Stroke

The signs and symptoms of a stroke are often reduced to acronyms such as BE FAST—which stands for Balance, Eyes, Face, Arms, Speech and Time:

Source: DukeHealth

However, there is a wider range of symptoms that are all could indicate a stroke. Sudden onset of any of these symptoms is cause for concern and a reason to seek care as quickly as possible.

Source: strokeawareness.com

Uzo Ugochukwu, MD, Augusta Health neurologist from the Stroke Team urges anyone experiencing any of these symptoms to seek immediate care at the Emergency Department. "When it comes to stroke, time is brain," she says. "The treatment options to reduce the risk of permanent damage to the brain are very time sensitive. We are here 24/7 to give our patients the best chance of recovery from a stroke, and Augusta Health is taking all necessary precautions in this pandemic crisis."

Dr. Rochman agrees. "One of the very concerning trends we are experiencing in the Augusta Health Emergency Department is what we call 'late presentation'. It means someone has delayed the decision to come to the ED, so they are arriving later than they should to have the best chance of recovery. We've seen this with patients who are having strokes," he adds.

Safety in the Emergency Department

"We've redesigned both the physical Emergency Department and our processes to greatly reduce the risk of exposure to COVID-19," explains Dr. Rochman. "Physically, we've created a separate negative-pressure COVID unit to care for patients with respiratory conditions. Patients being evaluated and treated for other conditions are in a completely separate area of the ED. We've also eliminated any air recycling in the entire Emergency Department. Fresh air is brought in from the outside and then blown out to the exterior."

Patients are screened at triage, and if there are any respiratory concerns, the patient is 'direct bedded' to a negative pressure room. The waiting room has been eliminated. Staff is also screened at the start of each shift, including temperature checks, and each must pass the screening in order to work his or her shift.

Dr. Rochman also adds that the ED has adopted universal masking of both patient and provider to contain spread of droplets, and staff is wearing eye protection. The ED has partnered with local Emergency Medical Services (EMS) agencies to ensure safe transport of patients to the hospital and safe transfer from ambulance into the ED. Thorough protocols for cleaning and disinfecting all rooms, surfaces, and equipment have been reinforced and standardized.

Renzo Figari, MD

Visitors are restricted: one visitor is allowed for non-respiratory patients and no visitors are allowed in the COVID/Respiratory section. To ease the stress on patients and families caused by the policy, patient-family liaisons have been established to keep everyone connected during treatment and possible admission.

Another Augusta Health neurologist and Stroke Team Medical Director, Renzo Figari, MD, adds, "Having a stroke is a very dangerous situation. We have good treatments, but they are effective when begun during the first several hours after the stroke starts. The Augusta Health Stroke Team is always ready with the appropriate protective equipment to keep both patient and caregiver safe. We are prepared to treat you and help you recover—do not have a fear of coming to the hospital."

"We've learned a lot about the best practices for containing the spread of COVID-19 while continuing to treat non-COVID-19 patients," says Dr. Rochman. "So honestly, I can say that right now, your risk of death or harm from delaying coming to the ED for treatment of a stroke or other emergency condition is greater than your risk of contracting COVID-19 in the ED. Please, pay attention to what your symptoms are telling you and seek care as early as possible."