Abstract 1122‐000062: Impact of COVID‐19 on Stroke Care in the United States and Potential Solutions
Authors: Mhatre Sanika S 
Published: December 2021

Introduction
: The emergence of the COVID‐19 pandemic has negatively impacted medical care across the United States, especially so for rural communities. In this qualitative study, we investigated the barriers to the access of adequate treatment of ischemic stroke that have risen due to COVID‐19 in urban and rural regions of the United States of America.

Methods
: Using CDC data, we identified 16 regions, consisting of half urban and half rural regions, that had the highest stroke mortality rate and the highest incidence of COVID‐19 cases in the country. We compiled a list of neurointerventionalists practicing in these regions and designed a survey that was emailed to each neurointerventionalist. The survey investigated how stroke treatment in their hospital has been affected by the COVID‐19 pandemic; it additionally contained a request for a virtual interview to allow neurointerventionalists to discuss in greater detail the barriers to stroke treatment they are facing. Neurointerventionalists from hospitals across four urban regions and three rural regions filled out the survey and were then interviewed by Zoom or phone.

Results
: The survey and the interviews highlighted a number of barriers: hospitals in both urban and rural regions faced an unavailability of ICU beds during COVID surges. As COVID‐19 patients continued to occupy ICU beds, thrombectomy‐capable hospitals could not accept transfer stroke patients. These patients had to be diverted to other thrombectomy‐capable hospitals with vacant ICU beds, resulting in time lost before treatment. Stroke transfer posed more of a challenge in rural regions (as compared to urban communities) due to fewer rural‐area hospitals performing thrombectomy. Secondly, both urban and rural regions saw stroke patients delay their arrival to the hospital. In urban regions, stroke patients delayed their arrival by up to a week in some cases. Patients with milder stroke symptoms did not show up to the hospital for treatment at all, hoping the stroke would subside on its own. This pattern has been attributed to patients’ fear of contracting COVID‐19. In comparison, rural hospitals faced a smaller average delay of up to a few days, as many patients did not see the virus as a threat. The delay was attributed to some patients’ fear of the virus, fear of the procedure, or longstanding physician mistrust. Lastly, rural regions encountered an understaffing of nurses; a likely factor is the incidence of layoffs early in the pandemic, which lessened the time spent at a stroke patient’s bedside and impacted stroke outcome.

Conclusions
: Urban regions were quicker to adapt to the pandemic than rural regions. They had a greater number of available staff and vacant ICU beds to be able to treat patients with minimal interference. Urban regions could still consider having nearby hospitals communicate with each other so that they can share the burden of care and prevent a single hospital from becoming overwhelmed. Rural regions could especially focus on hiring travel nurses in cases of understaffing, increasing the number of thrombectomy performing centers, and pushing the education of stroke.