To analyze impact of COVID-19 Pandemic on acute stroke care.

We collected stroke data from TriNetX network research platform. We analyzed number of ischemic stroke patients greater than 18 years, intravenous tissue plasminogen activator (IV tPA) administration and mechanical thrombectomy (MT) in Study group (SG) from 20 January 2020 to 16 May 2020 and compared them with two control groups (CGs): control group 1 (CG1) from 20 January 2019 to 16 May 2019 and control group 2 (CG2) from 25 September 2019 to 19 January 2020. We used Bonferroni’s method to correct for multiple comparisons and alpha of 0.01 was considered significant.

There was 43% decrease in number of stroke patients in SG compared to CG1 and 25.5% decrease compared to CG2. In the SG, there was drop in number of IV tPA administrations 51% and 35%, and MT by 39% and 27% compared to CG1 and CG2 respectively. Likelihood of stroke patients receiving IV tPA was higher in both CGs compared to the SG (X²=8.95, p=0.002 for CG1, and X²=6.59, p=0.010 for CG2). There was no significant difference in MT between groups. There were 287 (0.8%) stroke patients with diagnosis of COVID-19 in SG. When COVID-19 positive patients were compared to COVID-19 negative patients, younger patients were significantly overrepresented in COVID-19 positive group (X²=8.75, p=0.003).

There was substantial drop in number of stroke patients seeking medical help in the SG, suggesting that people with strokes were not presenting to hospitals during study period, likely due to concerns contracting SARS-CoV2 in hospital. Younger patients were overrepresented in COVID-19 strokes suggesting possible increased risk of strokes due to hypercoagulable state with COVID-19.