Neurologists should expect major disruption to treatment pathways for patients with stroke and other neurological disorders as the COVID-19 ‘tsunami’ swamps hospital services, according to clinicians from a region of Italy hit hardest by the pandemic.
Doctors at the Reggio Emilia Hospital Neurology Unit have provided an online presentation on the impact the COVID-19 pandemic in their unit and their experience treating COVID-19 patients with neurological conditions.
Dr Marialuisa Zedde describes how the huge burden of viral pneumonia came to prevent access of neurology patients not just ICU beds but also other services such as the CT suite for neuroimaging for stroke, leading to delays in diagnosis.
And she notes that the restrictions imposed on local society and services such as social distancing, fear of infection risk in hospital and lack of transport led to delays in recognition of stroke symptoms and in ‘drip and ship’ transfer of patients to stroke units.
“Our experience is that patients with TIA or mild stroke don’t go to hospital or seek medical attention. As a consequence we are seeing a general reduction in admissions for stroke and a significant delay in arrival to the hospital, and this makes some patients ineligible for acute treatment,” she says.
Similarly the huge burden of work in CT diagnostics and the transport staff as well as the risk of COVID-19 transmission means that neurologists are being asked to be very selective in sending patients “because at this moment the system cannot afford futile transportations,” she adds.
The closure of outpatient clinics and dedication of hospitals to treating COVID-19 patients meant that some neurologists have been reassigned to work in general internal medicine roles or in COVID-19 treatment clinics, says Dr Zedde.
In her region, neurologists have been reorganised into teams in which some operate a new hub and spoke model of IVT and EVT services. But she says a key lesson for other countries is the need for separate treatment pathways for patients who are COVID-19 positive with neurological illness, and also those who develop neurological co-morbidities while being treated in hospitals for COVID-19.
Other Italian neurologists provide examples of cases they have treated where neurological symptoms such as seizures and cognitive impairment were either misdiagnosed or overlooked in patients with COVID-19 infection.
The presentation is produced by the European Academy of Neurology (EAN) can be accessed here.