Worrying stroke trend in S.C. during coronavirus pandemic

April 15, 2020
This image from the American Stroke Association shows blood flow blocked in the brain.
This illustration from the American Stroke Association shows blood flow blocked in the brain.

Fewer South Carolinians are being treated for strokes during the coronavirus pandemic. Doctors at MUSC Health fear that’s not because fewer people are suffering strokes but because people are afraid that getting help will expose them to the virus.

How significant is the decrease? The number of acute stroke calls to MUSC Health’s Telestroke Program has dropped by 50%. Telestroke uses technology to connect patients in communities without stroke experts to specialists at MUSC Health. 

Christine Holmstedt, D.O., serves as a professor of neurology at the Medical University of South Carolina and medical director of the MUSC Health Comprehensive Stroke and Teleneuroscience Programs. “We used to do 17 to 20 telestroke calls a day. Call volume dropped to 12 in March and now it’s fewer than nine calls a day. That’s a big and concerning reduction.”

There are also fewer stroke patients showing up in person at MUSC Health.

The decrease is a global phenomenon, Holmstedt said. “We’ve seen drops elsewhere. In China, there was a 50% reduction. Similar reductions have been documented in the UK and other regions of the U.S.”

She thinks there are a couple of factors. “We’d normally see a lot of small strokes, transient ischemic attacks or stroke like events over telestroke and at MUSC. These patients typically come in the Emergency Department for acute stroke care knowing that was the right thing to do. But now, we’re not seeing those patients.”

They may be trying to wait out the pandemic, Holmstedt said. Calls are still coming in, but they’re mainly for people with severe symptoms.

The imbalance is a problem, said Chirantan Banerjee, M.D., a neurologist and assistant professor at MUSC. All stroke patients need immediate care

“Even patients who are having minor strokes or transient ischemic attacks, not coming in runs the risk that they’ll worsen in the next three to five days. About one-third of them will end up with a deficit that will affect their daily lifestyle. Even though, on the face, it may seem like symptoms are minor, they lead to long-term effects in terms of the patients’ functional status,” Banerjee said.

He encouraged people to watch for signs of a stroke, which are summed up in the acronym BE FAST.

B-Balance loss.

E-Eyesight changes.

F-Facial drooping.

A-Arm or leg weakness.

S-Speech difficulty

T-Time to call 911.

Holmstedt said it’s important to keep in mind that a stroke is a medical emergency. “We need to intervene quickly, so those patients need to call 911. They need to get to an emergency department to be evaluated. They also need to know we’re doing everything in our power to keep all patients safe from COVID exposure and keep our providers and nurses safe.”

MUSC Health has developed protocols for taking care of people with and without COVID-19. Banerjee said its Comprehensive Stroke Center, the first in the state to earn Joint Commission Comprehensive Stroke Center certification, is well-prepared for what lies ahead. “Luckily, we haven’t reached a point here in Charleston where we are overwhelmed. We still have plenty of resources to take care of stroke patients.”

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