Where Are All the Stroke Patients?

A surprising thing happened in the early months of the coronavirus pandemic: Emergency rooms went quiet.

As they began preparing for virus patients to come in, physicians began to wonder. Where are all the heart attack patients? Where are all the stroke patients? Many worried they were at home dying, too afraid of the virus to come in for care.

Evidence is now emerging that this is likely what was happening.

“We went maybe two to three weeks — the latter part of March [2020], first part of April — where we didn’t give one TPA,” Dr. Heidi Schwarz, a neurologist at The University of Rochester, told us.

Rochester’s chief medical officer, Dr. Michael Apostolako, told the New York Times in May that ER visits had dropped by 50 percent. Patients with strokes who were coming in were coming in too late for treatment.

Dr. Elaine Jones, a neurologist who sees patients in ERs across the country through SOC Telemed, said in May that there was about a 40 percent drop in ER volume, “and our volume mirrored that. No one was really sure what was happening. It doesn’t make sense that people weren’t having strokes, but they also didn’t seem to pop up later with worse strokes, so it was a little strange.”

The U.S. Centers for Disease Control and Prevention (CDC) published a report in June finding that, in the 10 weeks following the declaration of the COVID-19 national emergency, ER visits for stroke declined 20 percent compared with the previous 10 weeks.

A recent analysis of federal death data by the Washington Post suggests it is likely that these missing patients stayed home and, without proper care, died. The Post looked through death data by cause from 2014 to early 2020 for “five hard-hit states” and New York City. They found 75,000 more deaths from heart disease and other medical conditions than would have been expected during normal, non-COVID, times.

Heart disease accounted for most of the “excess deaths.” Other conditions such as diabetes, Alzheimer’s disease, and stroke also contributed. In New York City alone, 170 excess deaths were attributed to stroke and cerebrovascular disease.

These are still early days in terms of analyzing data from those initial months of the pandemic. More data is being generated every day as infections once again ramp up. But The Post’s insights are consistent with the fears already expressed by many physicians.

Special thanks to the following neurologists for their insights on this issue:

• Heidi Schwarz, MD, Professor of Clinical Neurology, University of Rochester Medical center, Rochester, NY. She specialises in headache medicine.
• Elaine Jones, MD, a neurologist for SOC Telemed, providing specialist care in ER’s across the country.

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