Advice to the public during the first wave of the Covid-19 pandemic was to avoid going to hospital unless absolutely necessary, motivated by fears that the NHS would become overwhelmed, ultimately putting more lives at risk. Elective surgeries were postponed, visiting of inpatients was greatly restricted and people were encouraged to use telephone or online services to contact GPs and “other essential services”. However, there has been concern expressed over the substantial drop in cases noted for some life-threatening conditions such as heart attack and stroke.
Dr Amir-Homayoun Javadi of the School of Psychology has carried out research into the reduction of stroke admissions since the first Covid-19 lockdown alongside colleagues at University College London (UCL), linked to the public’s anxiety of attending hospital during the pandemic. Dr Javadi and Fern Rodgers (UCL) said:
‘Stroke admissions dropped (on average) by 40% globally during peak periods of the pandemic, however neither Covid-19 nor lockdown measures have the ability to prevent strokes. In fact, there is evidence that Covid-19 can lead to blood coagulation which increases the likelihood of clotting and thus stroke.
‘Staff at University College London Hospital (UCLH) noted a 24.5% reduction in the number of stroke admissions between 1 March and 27 October 2020 compared with the same period last year, and speculated that numbers were down as people avoided coming in for fear of Covid-19; people ‘just coped’ and found their own strategies, and that perhaps some people passed away having not sought help.
‘Heightened anxieties around attending hospital due to the risk of contracting Covid-19 on the premises are understandable. With appropriate separation of Covid-positive and non-Covid patients, and even the set-up of Covid-free hospitals in some regions, these chances can be reduced. It has also been recognised that some people may have been avoiding hospitals so as not to be a ‘burden’ on the NHS, and/or misinterpreting the severity of their symptoms.
‘Seemingly, stroke admissions directly relate to Covid-19 cases in a way which may be reflective of public anxieties. A marked drop in total stroke admissions between January and June 2020 (compared to the previous year) was observed at the Northwick Park HyperAcute Stroke Unit (HASU), with the greatest reductions in admissions mirroring the greatest first peak of confirmed Covid-19 cases nationally. As viral admissions decreased, this mirroring was noticed again, with stroke admissions increasing and trending towards normal levels. We hypothesise that this pattern will be observed again in future ‘waves’ of virus prevalence in the community.
‘Pandemic or no pandemic, stroke poses a very real threat to health, wellbeing and quality-of-life, and if left untreated can be significantly more damaging in both the short and the long term. It is of paramount importance that if individuals suspect they, or someone they are with, may be having a stroke, they do not hesitate in seeking help.
‘Many people may dismiss signs and symptoms of stroke, chalking it up to a ‘funny turn’. People with mild symptoms may have been avoiding hospitals, leading to the false impression of lower incidence of stroke. This could be linked to a lack of awareness about the condition, and dismissal is likely to be exacerbated in the context of the coronavirus pandemic. Even ‘mini strokes’ should not be disregarded, however. They can cause irreparable damage in their own right if not attended to, and they are also often an early sign that a larger stroke is on the horizon; they should not be ignored. There is up to a 21% risk of falling victim to a subsequent stroke within the first year of an initial attack, and time is of the essence in acute stroke care.’
Dr Rudi Coetzer, a ward-attending neuropsychologist and clinical academic from Bangor University, added: ‘The pandemic has made it more complex to safely deliver some aspects of inpatient assessment and rehabilitation to neurological patients, including individuals who have suffered Stroke. Nevertheless, the provision of inpatient rehab has continued to be delivered by therapies, nursing, medical, psychology and other staff working on the frontline. Individuals who have suffered a Stroke, need not fear that they will “put a strain on the hospital”, or try to minimise their symptoms – Stroke care and rehabilitation continues, albeit in a slightly different way.’
Dr Javadi and his research team are conducting further research into individuals’ experiences with strokes since March 2020. A survey can be accessed via this link, for those who would like to share their experiences: http://bit.ly/stroke-survey