Treatment for stroke has advanced significantly in recent times, however, the pandemic disrupted healthcare and many people avoided seeking medical help. We speak to Doctor Zafar Hashim, an interventional neuroradiologist at the University Hospital of North Midlands and honorary clinical lecturer at Keele University, about how Covid-19 has affected his work treating stroke patients.
What were you seeing at the start of the pandemic?
When Covid-19 hit us the number of patients coming to hospital dramatically dropped, due to any condition, let alone stroke. Patients just stopped coming in. That did not mean they were not having strokes, but they were coming to hospital much later than they would have normally.
What was the effect of them coming in later?
With stroke we always say time is brain. Time is very important. So, the longer it takes for patients to come to hospital and have treatment, the worse their outcome. That is because the damage to the brain is greater the longer a stroke goes untreated, the options for treatment also narrow. Patients who arrive much later cannot have mechanical thrombectomy – an effective emergency procedure designed to combat stroke that involves the removal of a clot blocking blood vessels using a stent retriever to recover blood flow to a person’s brain.
If the brain is already severely damaged because a stroke has gone untreated for a long time, we cannot even offer thrombolysis treatment – blood thinning medication. This means their outcomes are really bad. They may not survive or will be left with very severe disabilities as a result of the stroke.
What else new have you noticed among stroke patients?
We noticed that the age of the people coming in was younger than we would normally expect.
Was that due to Covid-19?
It is possible that it could be related to covid-19. Multiple centres around the world have reported that covid-19 does make people more prone to having produce blood clots in their blood vessels and that increases the risk of stroke. However, the covid-19 testing was very patchy, so we cannot really say whether it was specifically due to covid-19.
What do you think the lessons are from the pandemic for treating stroke?
This might not be the only pandemic we ever see in our lifetimes. We have to educate the public better that, if anything like this happens, you still have to come to hospital. I think people were scared and were not wanting to seek medical help, because of covid-19, and they have lost out on their treatments. But serious diseases like stroke and cancer will still happen.
Will there be a long-term healthcare impact from the pandemic?
I think, because of all the delays that people have had to their treatment, patients will be coming to hospital in a much worse state than what they would have been if they had had their treatment earlier. The waiting lists have increased a lot for knee replacements and hip replacements, which are not considered urgent operations. However, those are the procedures that people need very soon so that they can lead a productive and active life. Without that, they are at risk of becoming inactive and developing health conditions, such as obesity or diabetes, that will in turn make them more likely to have a stroke.
What would you like to see change?
Our hospitals were not well equipped to deal with covid-19 or any pandemic. Everything that we wanted to do used to take two or three times longer due to delays in the hospital and because of all the precautions we had to take. So, we need to look at our hospitals, how they are designed so that they can cope better in any future pandemic. One example is infection control and improving air circulation to ensure infections like covid-19 cannot easily spread in a hospital.
We have to look at funding too. Realistically speaking, it is very hard to deliver a very good service in normal times, let alone a pandemic situation. The pressures that it places on the people who are working in health are enormous and what covid-19 has highlighted is that staffing is a huge issue.
And what is the picture looking like now?
I think people have realised that you still have to come to hospital and that time is critical in treating stroke. So now we are back to how things were in the number of patients coming and the number of thrombectomies we are doing is actually back to how it was before, which means the outcomes for those patients has improved.
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