Preserving stroke care during the COVID-19 pandemic
The COVID-19 pandemic, with reported cases in more than 200 countries, is a worldwide crisis challenging all aspects of health care systems around the globe. Managing the pandemic has required some drastic changes and allocation of resources. This is affecting the delivery of care for health conditions that can be unrelated to COVID-19. Experts in various fields across health care are working to adjust to the changes to ensure they provide the best care during this time while also protecting themselves and their colleagues.
Dr. Larry Goldstein, chair of the University of Kentucky Department of Neurology, coauthored an article titled, "Preserving Stroke Care During the COVID-19 Pandemic," which was recently published in Neurology, the primary journal of the American Academy of Neurology. In the article, Goldstein and others explore how the changes can affect the delivery of stroke care while providing some recommendations for this unprecedented time. In the article the authors write, "There is no previous model to guide our approach to the ferocious COVID-19 pandemic, which has brought the world to a standstill. Still, we hope that these recommendations prove useful to the neurological community in this time of considerable uncertainty."
Goldstein and the other authors were guided by three principles while making the recommendations and they acknowledge these will occasionally conflict as new processes of care during crisis are adopted. The three guiding principles are: ensuring the best care for those with COVID-19; providing excellent care and advocacy for patients with cerebrovascular disease and their families; and advocating for the safety of health care personnel.
While keeping those principles in mind, the article looks at potential issues in stroke care during the pandemic. Topics addressed include patient demand and provider supply. The authors writing, "The stroke community must prepare for the possibility of a shortage of neurologists practicing stroke medicine, as well as residents and fellows, either due to illness or because of redeployment to other medical duties."
Other potential issues regarding stroke care include hospital bed capacity, requirements for limiting health care worker's direct exposure to patients, testing restrictions and discharge planning. In regard to discharge planning, the authors explain how the pandemic could impact a patient's move to rehabilitation and skilled nursing facilities.
The authors also explained various ethical considerations for stroke care during the pandemic writing, "Neither persons under investigation for COVID-19 infection nor those known to be infected should be disqualified from receiving usual stroke care that is modified to incorporate the new standards for PPE." Another ethical consideration discussed is the potential negative impact on a patient and their family because of visitation restrictions. The authors believe that communication skills are "paramount in this crisis."