Stroke care during the COVID-19 outbreak in Spain: the experience of Spanish stroke units

Abstract

Background and purpose: Spain has been heavily affected by COVID-19. Reallocation of resources for managing the outbreak might have caused a disruption in stroke care. This study analyses the impact on stroke care of reorganising the healthcare system in response to the first COVID-19 outbreak peak in Spain and the strategies adopted by Spanish stroke units to deal with this impact.

Materials and methods: We obtained data from a structured survey sent to the responsible of stroke units across the country. We recorded the number of strokes, stroke code activations, intravenous thrombolysis treatments and mechanical thrombectomies during February and March 2019 and 2020. We also collected information on the impact on workflow metrics and on the availability of specialised neurological care and rehabilitation treatments, the characteristics of stroke care for patients with SARS-CoV-2 infection and the impact on human resources. We compared the activity data between 2019 and 2020 and the information on activity and impact on stroke care between regions classified according to the disease incidence rate.

Results: Fifty-seven (75%) of all stroke units in Spain responded to the survey. There was an overall reduction in admissions for all stroke types during the outbreak's peak and in the number of stroke code activations and intravenous thrombolysis treatments, results that were independent of the COVID-19 incidence rate. Participants reported a delay in workflow metrics and a reduction of admissions to stroke units, outpatient clinics and rehabilitation therapies. Specific pathways and protocols for managing stroke patients with SARS-CoV-2 infection have been established.

Conclusion: The COVID-19 outbreak has jeopardised all phases of stroke care. As a consequence, some patients with stroke did not receive adequate treatment.

Keywords: stroke.

Figure 1

Map of the autonomous communities of Spain. Population density and COVID-19 incidence rate. The circles represent the incidence rate at the peak of the pandemic (per 100 000 inhabitants). Population density is shown beside the name of the community (inhabitants/km²). 1: Andalucía (96). 2: Aragón (28). 3: Principality of Asturias (96). 4: Balearic Islands (230). 5: Canary Islands (289). 6: Cantabria (109). 7: Castilla y León (25). 8: Castilla-La Mancha (26). 9: Cataluña (239). 10: Community of Valencia (215). 11: Extremadura (26). 12: Galicia (91). 13: La Rioja (63). 14: Community of Madrid (830). 15: Murcia region (132). 16: Chartered Community of Navarra (63). 17: Basque Country (305). 18: Autonomous City of Ceuta (7207). 19: Autonomous City of Melilla (4239).