. 2022 Mar;29(3):724-731.

doi: 10.1111/ene.15209. Epub 2022 Jan 4.

Association of the COVID-19 outbreak with acute stroke care in Switzerland

Gian Marco De Marchis^{1

2}, Patrick R Wright², Patrik Michel³, Davide Strambo³, Emmanuel Carrera⁴, Elisabeth Dirren⁴, Andreas R Luft^{5

6}, Susanne Wegener⁵, Carlo W Cereda⁷, Georg Kägi^{8

9}, Jochen Vehoff⁸, Henrik Gensicke^{1

2}, Philippe Lyrer^{1

2}, Krassen Nedeltchev¹⁰, Timo Khales¹⁰, Manuel Bolognese¹¹, Stephan Salmen¹², Rolf Sturzenegger¹³, Christophe Bonvin¹⁴, Christian Berger¹⁵, Ludwig Schelosky¹⁶, Marie-Luise Mono¹⁷, Biljana Rodic¹⁸, Andrea von Reding¹⁸, Guido Schwegler¹⁹, Alexander A Tarnutzer²⁰, Friedrich Medlin²¹, Andrea M Humm²¹, Nils Peters²², Morin Beyeler⁹, Lilian Kriemler^{1

2}, David Bervini²³, Javier Fandino²⁴, Lars G Hemkens^{2

25

26}, Pasquale Mordasini²⁷, Marcel Arnold⁹, Urs Fischer^{1

2

9}, Leo H Bonati^{1

2}; Swiss Stroke Registry Investigators

Affiliations

¹ Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.
² Department of Clinical Research, University of Basel, Basel, Switzerland.
³ Department of Neurology, Lausanne University Hospital-Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
⁴ Department of Neurology, University Hospital Geneva, Geneva, Switzerland.
⁵ Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁶ Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.
⁷ Department of Neurology and Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland.
⁸ Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
⁹ Department of Neurology and Stroke Center, University Hospital Bern-Inselspital, Bern, Switzerland.
¹⁰ Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
¹¹ Stroke Center, Kantonspital Lucerne, Luzern, Switzerland.
¹² Stroke Unit, Spitalzentrum Biel, Biel, Switzerland.
¹³ Stroke Unit, Cantonal Hospital Graubünden, Chur, Switzerland.
¹⁴ Department of Neurology, Hôpital du Valais, Sion, Switzerland.
¹⁵ Stroke Unit, Cantonal Hospital Grabs, Grabs, Switzerland.
¹⁶ Stroke Unit, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland.
¹⁷ Stroke Unit, Stadtspital Waid and Triemli, Zurich, Switzerland.
¹⁸ Stroke Unit, Cantonal Hospital Winterthur, Winterthur, Switzerland.
¹⁹ Stroke Unit, Spital Limmattal, Schlieren, Switzerland.
²⁰ Stroke Unit, Cantonal Hospital Baden, Baden, Switzerland.
²¹ Stroke Unit, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
²² Department of Neurology and Stroke Center, Hirslanden Clinic Zurich, Zurich, Switzerland.
²³ Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
²⁴ Department of Neurosurgery, Hirslanden Clinic Aarau and Zurich, Zurich, Switzerland.
²⁵ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.
²⁶ Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
²⁷ Department of Neuroradiology, University Hospital Bern, Bern, Switzerland.

PMID: 34894018
PMCID: PMC9305499
DOI: 10.1111/ene.15209

Association of the COVID-19 outbreak with acute stroke care in Switzerland

Gian Marco De Marchis et al. Eur J Neurol. 2022 Mar.

. 2022 Mar;29(3):724-731.

doi: 10.1111/ene.15209. Epub 2022 Jan 4.

Authors

Affiliations

¹ Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.
² Department of Clinical Research, University of Basel, Basel, Switzerland.
³ Department of Neurology, Lausanne University Hospital-Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
⁴ Department of Neurology, University Hospital Geneva, Geneva, Switzerland.
⁵ Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁶ Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.
⁷ Department of Neurology and Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland.
⁸ Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
⁹ Department of Neurology and Stroke Center, University Hospital Bern-Inselspital, Bern, Switzerland.
¹⁰ Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
¹¹ Stroke Center, Kantonspital Lucerne, Luzern, Switzerland.
¹² Stroke Unit, Spitalzentrum Biel, Biel, Switzerland.
¹³ Stroke Unit, Cantonal Hospital Graubünden, Chur, Switzerland.
¹⁴ Department of Neurology, Hôpital du Valais, Sion, Switzerland.
¹⁵ Stroke Unit, Cantonal Hospital Grabs, Grabs, Switzerland.
¹⁶ Stroke Unit, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland.
¹⁷ Stroke Unit, Stadtspital Waid and Triemli, Zurich, Switzerland.
¹⁸ Stroke Unit, Cantonal Hospital Winterthur, Winterthur, Switzerland.
¹⁹ Stroke Unit, Spital Limmattal, Schlieren, Switzerland.
²⁰ Stroke Unit, Cantonal Hospital Baden, Baden, Switzerland.
²¹ Stroke Unit, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
²² Department of Neurology and Stroke Center, Hirslanden Clinic Zurich, Zurich, Switzerland.
²³ Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
²⁴ Department of Neurosurgery, Hirslanden Clinic Aarau and Zurich, Zurich, Switzerland.
²⁵ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.
²⁶ Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
²⁷ Department of Neuroradiology, University Hospital Bern, Bern, Switzerland.

PMID: 34894018
PMCID: PMC9305499
DOI: 10.1111/ene.15209

Abstract

Background and purpose: In Switzerland, the COVID-19 incidence during the first pandemic wave was high. Our aim was to assess the association of the outbreak with acute stroke care in Switzerland in spring 2020.

Methods: This was a retrospective analysis based on the Swiss Stroke Registry, which includes consecutive patients with acute cerebrovascular events admitted to Swiss Stroke Units and Stroke Centers. A linear model was fitted to the weekly admission from 2018 and 2019 and was used to quantify deviations from the expected weekly admissions from 13 March to 26 April 2020 (the "lockdown period"). Characteristics and 3-month outcome of patients admitted during the lockdown period were compared with patients admitted during the same calendar period of 2018 and 2019.

Results: In all, 28,310 patients admitted between 1 January 2018 and 26 April 2020 were included. Of these, 4491 (15.9%) were admitted in the periods March 13-April 26 of the years 2018-2020. During the lockdown in 2020, the weekly admissions dropped by up to 22% compared to rates expected from 2018 and 2019. During three consecutive weeks, weekly admissions fell below the 5% quantile (likelihood 0.38%). The proportion of intracerebral hemorrhage amongst all registered admissions increased from 7.1% to 9.3% (p = 0.006), and numerically less severe strokes were observed (median National Institutes of Health Stroke Scale from 3 to 2, p = 0.07).

Conclusions: Admissions and clinical severity of acute cerebrovascular events decreased substantially during the lockdown in Switzerland. Delivery and quality of acute stroke care were maintained.

Keywords: COVID-19; epidemiology; stroke.

PubMed Disclaimer

Conflict of interest statement

GMDM has been receiving support from the Swiss National Science Foundation (No. 32003B_200573, No. PBBEP3_139388); Spezialprogramm Nachwuchsförderung Klinische Forschung, University of Basel; Science Funds (Wissenschaftspool) of the University Hospital Basel; Swiss Heart Foundation; Bangerter‐Rhyner‐Stiftung; Swisslife Jubiläumsstiftung for Medical Research; Swiss Neurological Society; Fondazione Dr Ettore Balli; De Quervain research grant; Thermo Fisher GmbH; travel honoraria by Bayer and BMS/Pfizer; speaker honoraria by Bayer and Medtronic. He is a member of the Steering Committee of PACIFIC Stroke (NCT04304508). Industry payments are made to the research fund of the University Hospital Basel. PM reports receipt of research support from Siemens, Cerenovus, iSchmaview, Medtronic, Stryker, the Swiss Heart Foundation and the Swiss National Foundation, receipt of consultant fees paid to the institution from Medtronic, Cerenovus, Phenox and Microvention during the conduct of the study, unrelated to the submitted work. FM has been receiving support from the Swiss Heart Foundation. All other authors report no disclosures related to the present paper.

Figures

**FIGURE 1**
Weekly admissions registered in the Swiss Stroke Registry from 1 January 2018 to 8 June 2020 (top). The linear regression is based on the data from 2018–2019. Week 53 has been removed for all years. Fractions compared to the expected number of arrivals (bottom)

**FIGURE 2**
(a) High COVID‐19 incidence regions (>700 COVID‐19 cases/100,000 inhabitants; all regions located in the Italian and French speaking parts of Switzerland). (b) Average COVID‐19 incidence regions. Weekly arrivals registered in the Swiss Stroke Registry from 1 January 2018 to 8 June 2020 (top). The linear regression is based on the data from 2018–2019. Week 53 has been removed for all years. Fractions compared to the expected number of arrivals (bottom)

See this image and copyright information in PMC

References

1. Epidemiologische Zwischenbilanz zum neuen . Coronavirus in der Schweiz und im Fürstentum Liechtenstein. Accessed July 22, 2021. https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche‐epidemien‐pa...
1. Katsanos AH, Palaiodimou L, Zand R, et al. The impact of SARS‐CoV‐2 on stroke epidemiology and care: a meta‐analysis. Ann Neurol. 2021;89:380‐388. - PMC - PubMed
1. Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID‐19 pandemic at a comprehensive stroke center. J Stroke Cerebrovasc Dis. 2020;29:104953. - PMC - PubMed
1. Siegler JE, Cardona P, Arenillas JF, et al. Cerebrovascular events and outcomes in hospitalized patients with COVID‐19: the SVIN COVID‐19 Multinational Registry. Int J Stroke. 2021;16:(4):437–447. - PMC - PubMed
1. Montaner J, Barragan‐Prieto A, Perez‐Sanchez S, et al. Break in the stroke chain of survival due to COVID‐19. Stroke. 2020;51:2307‐2314. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

Schweizerische Herzstiftung

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Association of the COVID-19 outbreak with acute stroke care in Switzerland

Affiliations

Association of the COVID-19 outbreak with acute stroke care in Switzerland

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous