Brain; COVID; Heart
Are stroke sufferers silent victims of COVID-19?
April 22, 2020
Every 40 seconds in the United States, someone has a stroke, according to the CDC. The statistic is nearly identical for heart attacks. But in recent weeks, emergency departments across the U.S. have been eerily devoid of patients experiencing either condition.
And COVID-19 is the likely culprit. The Washington Post and The New York Times have reported on this common theme: Fear of contracting COVID-19 is believed to be keeping people away from hospitals, even in emergency situations.
But there's a grimmer layer to the story. For patients isolated from loved ones, it's possible and perhaps likely that some stroke symptoms are going unnoticed.
UT Southwestern data show that during the week of March 1, 14 patients presented with ischemic strokes, which are caused by a blocked blood vessel in or around the brain. The week of April 5, there was just one.
My colleague Kennith Layton, M.D., a neuroradiologist at a nearby hospital in Dallas, noted similar findings. From January to March 2020, Dr. Layton reports a 30% decrease in patients presenting with ischemic stroke symptoms. During this same timeframe, he reports a threefold increase in patients who present too late to intervene.
For all the benefits of "stay home and save lives," nonstop coronavirus coverage has led to a tragic miscommunication. Fear appears to have increased the volume of people who assume stroke symptoms will go away without lasting damage. This has led to more patients arriving at the ER too late to intervene.
Unfortunately, without emergency medical care, strokes can devastate the brain and body. Even during the pandemic, your life depends on getting timely and appropriate intervention. Approximately 2 million nerve cells die each minute during an ischemic stroke.
Each year, nearly 140,000 people in the U.S. die of strokes – that’s 1 in every 20 deaths in our country. Those who survive risk long-term physical and cognitive impairment that can substantially decrease quality of life.
Do not allow fear of COVID-19 stop you from seeking emergency care. The Peter O’Donnell Jr. Brain Institute at UT Southwestern is one of only two Advanced Comprehensive Stroke Centers in North Texas certified by The Joint Commission and the American Heart Association. We are fully equipped to treat stroke patients during the COVID-19 pandemic, with advanced protocols in place to mitigate exposure and reduce risks.
BE FAST to identify stroke symptoms
If you experience any of these symptoms or notice them in a loved one, call 911 and get to the ER right away:
- Balance issues
- Eye problems, such as blurry vision
- Facial drooping on one side
- Arm weakness
- Speech difficulties, such as slurred words
- Time to call medical help
In the ambulance, emergency responders will test you for COVID-19. When you arrive at the ER, we will get your results right away. Based on the rapid test and screening questions, we will triage your loved one to the proper ward to start treatment and minimize virus exposure.
You can help speed up this process by gathering information about their respiratory health, including COVID-19 symptoms and potential risk of exposure from colleagues or loved ones.
Related reading: What women need to know about heart attack symptoms
Patients and visitors at UT Southwestern are protected by the most advanced pandemic ER protocols. Several of my colleagues and I are members of national cardiovascular and neurosurgical associations. We are involved firsthand in creating emergency care COVID-19 protocols , which we immediately implement in our clinics.
ER protocols to reduce patient, visitor COVID-19 exposure
All patient and visitor touch points at UT Southwestern are constantly evaluated and refined for safety, from ER admittance through triage and discharge. After more than a month of these safety measures, our team is adept at implementing our risk-reduction protocols, which include:
Revised screening questions: All patients and caregivers are screened for COVID-19 symptoms prior to admission. Along with a temperature check, we also ask about potential exposure, including local travel such as to the grocery store or loved ones' homes. Patients who may have been exposed and are exhibiting stroke symptoms or extreme distress will be triaged to a secluded area of the hospital and prepped for emergency care.
Triage to specific wards: We are a large center with multiple floors, buildings, and campuses. As such, we've taken precautions to properly isolate patients as they are admitted. Emergency responders can screen the patient in the ambulance, and within minutes, we can determine whether the patient has COVID-19. Then we can quickly route the patient to the appropriate facility for prompt stroke treatment.
Admission intubation: In some hospitals, stroke patients are not given a breathing tube until they get into the intensive care unit. But here, we are intubating patients who need it upon admission to reduce the spread of COVID-19 from their respiratory droplets to patients or staff throughout the hospital.
Deep and wide provider staffing: As an academic medical center, we have ample staff to care for all stroke patients. We've split our neurology, cardiology, and nursing teams among shifts and centers to minimize COVID-19 exposure without sacrificing access and quality of care. For example, a stroke patient will have one dedicated nurse to remain in the room with the patient for several hours at a time rather than returning hourly on typical rounds.
These measures have been invaluable in protecting our patients, visitors, and staff from COVID-19 exposure. When paired with timely action the moment you notice symptoms, you or your loved one will have far better chances for positive respiratory and cardiovascular outcomes.
Related reading: COVID-19 patient and visitor information
When it comes to stroke, 'Time is Brain'
Babu Welch, M.D., talks about stroke, aneurysms, and the importance of identifying symptoms quickly so the neurology team at UT Southwestern can help minimize any damage to the brain and body.
Recognize symptoms – even during physical isolation
Observance of stroke symptoms often comes from others – not the patient themselves. While physical isolation reduces opportunities to candidly spot symptoms, communication technology provides low-key and high-tech options to connect with loved ones in a more straightforward way.
Tips to observe symptoms in isolated loved ones
In person, in a sense
During the pandemic, you've likely seen news and social media stories of kids "touching hands" with older loved ones through glass doors or windows. These sweet moments give you time to observe your loved one's physical and mental state.
If you can visit like this with a loved one, stop by to chat. Listen for slurred speech and deficient conversational skills. Do they seem disoriented or confused?
Watch their movements as well. Are their eyes tracking properly? Can they smile? Can they lift both their arms away from their body? If they can't, they may be experiencing stroke symptoms.
Facetime or video chat
Today, many older patients are tech savvy. They're used to using social media, text, and video chats to connect with family regularly – a skill that has come in handy during the pandemic. UT Southwestern has moved 100% to telehealth for psychology and psychiatric care, as well as the majority of our neurology consultations.
Video calls give you another opportunity to observe speech and physical cues. If you don't notice symptoms, ask how they've been feeling the last couple weeks. Patients who experience stroke symptoms might underreport or ignore symptoms so as not to alarm loved ones.
Call on the phone
You can get much of the same information by phone that you would in person. If your loved one lives with someone else, you could ask to speak with that person, too. Ask whether they've noticed any changes in behavior, function, or cognition in recent days.
If you suspect a loved one is having a stroke or had one recently, call 911 – even if the patient is nervous about going to the hospital. They might be upset with you, but quick action can help them avoid long-term impairment. The consequences of waiting – potential disability, decreased quality of life, or death – vastly outweigh the minimal risk of COVID-19 exposure at the hospital.
A few closing thoughts
Though pandemic-related circumstances feel overwhelming at times, we can still control many aspects of stress management and improving our general health. Consider these tips as we ride out the pandemic together:
Continue taking your medication. Ample literature shows that aspirin, a nonsteroidal anti-inflammatory drug (NSAID), can help reduce the risk of heart attacks and ischemic strokes. However, some reports have associated adverse COVID-19 outcomes with long-term NSAID use. To date, there is no body of data to suggest patients who take NSAIDs should stop taking their medication.
For concerns like this, we recommend taking a "definitely – maybe" approach: Definitely ask your doctor if maybe you are at risk. COVID-19 is a novel virus, so we can't make blanket recommendations based on correlations.
Look at regional data. It's alarming to see the number of cases in metro areas around the U.S. Here in the Metroplex, we are fortunate to have a lower population that is less densely packed than hard-hit areas like New York.
Hospitals in North Texas are seeing a few dozen cases a month compared to hundreds in other regions. Providers from hospitals around the state are sharing data and recommendations to get the big picture and provide the best outcomes for our patients.
Work to maintain good general health. Processed food can be comforting in times of high stress. But long-term reliance on processed food increases cardiovascular risks. Additionally, stress and isolation related to the pandemic can lead to lethargy and increased substance use – both of which negatively impact our physical and mental health.
During COVID-19 and beyond, strive to stay active and eat a healthier diet. Healthy life choices impact our physical and emotional health over the long term.
Related reading: Quarantine cuisine: Easy meals to support a healthy immune system
Ask your provider about virtual visits: Virtual visits extend specialty care to patients at home or in community clinics through mobile device technology. All UT Southwestern stroke, psychology, and many neurosurgery consultations today are conducted via telemedicine (virtual visits), such as our telestroke program.
Telestroke reduces required non-emergency hospital visits, saving patients' time and travel costs – and alleviating fears of COVID-19 exposure. I am optimistic that we will continue to use virtual visits long after the pandemic. We are actively developing relationships with community neurosurgeons and clinics to allow our consultants to come to you remotely.
To say COVID-19 has greatly impacted the world of medicine is an understatement. However, amidst the rampant change, two truths hold steadfast. Heart attack and stroke symptoms should always be treated as medical emergencies. And the virus will not impede our ability to provide our patients with fast, effective emergency care.