Lessons from Severe Acute Respiratory Syndrome Coronavirus 2003 Pandemic as Evidence to Advocate for Stroke Public Education During the Current Coronavirus Disease 2019 Pandemic

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) outbreak is affecting hospital admissions of stroke patients. This, in turn, will reduce the use of proven stroke treatments, which will result in poorer stroke outcomes. We examined local stroke admissions before, during, and after the 2003 outbreak of the severe acute respiratory syndrome (SARS) (these periods being defined in both the Singapore and worldwide contexts), to extrapolate stroke admission patterns in Singapore during the current COVID-19 crisis.

Materials and methods: National inpatient admission data from the Ministry of Health (MOH), Singapore, and death data from the Registry of Births and Deaths (RBD), Singapore, were analysed. Trends of local stroke admissions and stroke-related mortality pre-SARS, during SARS, and post-SARS periods, both in the Singapore and worldwide contexts, were analysed using time series plot in monthly time units. Differences between periods were presented as percentage change between: (1) SARS and pre-SARS periods, and (2) post-SARS and SARS periods and compared using two-sample t-tests.

Results: There was a 19% decline in stroke admissions into all local hospitals during the Singapore SARS period (P = 0.002) and a 13% reduction during the worldwide SARS period (P = 0.006). Stroke admissions increased by 18% after the Singapore SARS period was over (P = 0.003) and rose by a further 8% when the worldwide SARS period ended (P = 0.046). Stroke-related mortality remained stable throughout.

Conclusions: During the SARS pandemic, there was a reduction in the number of stroke admissions, and this was apparent during both the local SARS and worldwide SARS outbreak periods. We should take appropriate steps through public education to minimise the expected reduced stroke admissions during the COVID-19 pandemic, inferred from the findings during the SARS pandemic.