The new normal stroke victims face during the COVID-19 pandemic

The era of the COVID-19 pandemic has had a dire effect on the economy, education system, and society. It has also created a complicated healthcare landscape for patients who have suffered a stroke or who suffer a stroke during the pandemic. 

We sat down with Nadav Bitton, MD (pictured below), Chief Resident in Soroka Medical School’s neurology department, who has collaborated with the BrainQ team for our recent research. Dr. Bitton also happens to be serving his residency during the COVID-19 pandemic, working with stroke victims in the hospital, overseeing their treatment from check-in in the ER at the onset of the stroke to release, and creating a dynamic plan for their rehabilitation needs. We recognized that the insights Dr. Bitton gained from his experiences might be useful for stroke victims and their families around the world. 

According to Dr. Bitton, before the pandemic hit when a patient would enter the ER presenting with a stroke they would perform the standard examination to determine what tests were required, they would be admitted, and following discharge, they would attend an outpatient clinic about three months later to assess their rehabilitation progress.

However, in the face of the COVID-19 pandemic, the patient pathway in a hospital for stroke victims looks very different.

The effects COVID-19 has on the patient pathway for stroke victims

“Nowadays this process has diverged significantly,” explained Dr. Bitton. “If you’re a young person showing signs of a stroke but are strong and healthy, so contracting COVID-19 wouldn’t necessarily threaten your life, then you would probably be admitted to the hospital. On the other side of the spectrum, I’ll admit the patients who require immediate life-saving medical care and may not survive if they were to go home. 

But then there is the gray area of the patients who are fragile and had a small stroke,” continued Dr. Bitton. “So the question arises as to what to do. You have to make a tough choice.”

Doctors must weigh the risk of infection compared to the benefits of rehabilitation when considering whether to send the patient home earlier than usual. Because of the scarce numbers of available neurologists around the world, often the main reason for a stroke victim to go to the hospital is to get that physical therapy exercise referral so they can begin rehabilitation.

“It’s a trade-off, high risk vs low risk. Would admitting these patients to the hospital cause them more harm by putting them at risk for contracting the virus?” Dr. Bitton questioned. “Often the family members make the call for these patients.” 

In pre-covid days, around 13 million people worldwide suffered from a stroke, according to the World Health Organization. The most common type being ischemic stroke, accounting for 87% of all stroke patients. Defined as a leading cause of disability by the CDC, strokes are caused by a buildup of plaque in a brain artery, restricting blood flow. The deprivation of such blood to the cells can lead to their damage or even death. 

A stroke occurs when blood flow to specific areas of the brain is interrupted. There are two main types of stroke: hemorrhagic and ischemic attack. The brain is considered to be the most complex structure, not just within the human body, but on the entire planet. After all, the brain is paramount across our day-to-day functions, including our thoughts, feelings and movement. 

While the statistics are not yet final, there is significant evidence that points to an increasing prevalence in stroke cases following COVID-19, especially in younger individuals.  Furthermore, there is growing evidence that patients who suffer from neurological disorders, such as a stroke, are at greater risk for developing serious complications if they were to contract COVID-19. Additionally, for people who suffer a stroke during the COVID-19 pandemic, their route to recovery is greatly inhibited by a growing prevalence of misdiagnosis, longer wait times in the hospital or simply delaying a hospital visit.

Medical professionals are seeing a huge reduction in patients who would normally return for outpatient checkups around three months following a stroke. Now, a select few are following up on Zoom, but it’s not ideal and we haven’t fully adapted to the world of Telemedicine yet. 

Moreover, with the growing prevalence of stroke, the social and economic burden related to the disease is likely to increase in the coming years. This will require us to adapt quickly to the new situation by making the shift to alternative treatment options.

Advice for stroke patients during the COVID-19 pandemic

Dr. Bitton offered useful insights on good practices patients can adopt during the pandemic:

1. If you’re experiencing a stroke go as fast as possible to a neurologist (in a medical facility) for treatment, don’t ask questions, just go. COVID-19 should not change this rule.
2. Designate one person to visit you or your loved one who has had a stroke. The more people you interact with, the more exposed the stroke victim becomes to people who can potentially infect them with the COVID-19 virus.
3. Due to the pandemic it may not be possible to go into the clinic for consistent physical therapy (PT), so if you plan on doing PT with a therapist who makes house calls it’s best to ensure that they are taking the proper measures to avoid cross-contaminating their patients. This includes decreasing the number of patients they see, properly sanitizing their equipment, and taking necessary social-distancing precautions.

The new normal

Based on his ongoing experience during the pandemic, Dr. Bitton shared his thoughts on how to adapt to the new normal. “It’s possible we won’t have a vaccine until at least a year or so, and maybe even after the vaccine is invented we’re going to learn to discharge patients faster, we’re going to need to rehabilitate patients in a hospital setting much more efficiently, and we’re going to work with solutions that allow for remote therapy like Telemedicine-based PT.”

“Telemedicine is on the rise, the pandemic made these technologies more accessible and accelerated their development,” he said. “Developments that would have happened in 10-15 years are going to happen at a faster pace. Neurologists are now seeing patients remotely, especially stroke patients who have had severe side effects and require consistent follow-ups. Medical services for other severe neurodisorders such as Parkinson’s and Alzheimer’s are being moved to telecommunication as well.”

The future of the patient-doctor relationship 

According to Dr. Bitton, the future of patient-doctor relationship will be rocky as we learn to adapt to remote communication. “From the human perspective it’s hard, a lot of neurology is about the neurological examination and working hands-on with the patients, which is challenging because this can’t be done on the phone.” Dr. Bitton explained. 

“From the economic perspective, though, this is a positive shift. People have more access to neurologists and will be able to receive immediate output, and neurologists can see more patients daily.”

“Although we are living in uncertain and foreign times, the healthcare system, home-care physicians, and patients can and should adapt to the new reality.”