Abstract 1122‐000139: Impact of COVID‐19 on Acute Ischemic Stroke Treatment in Latin America
Authors: Gudavalli Tanusri 
Published: December 2021

Introduction
: Acute ischemic stroke is one of the leading causes of death and disability in the lower and middle income countries (LMIC). The emergence of COVID‐19 has negatively impacted medical care, specifically AIS treatment, in many parts of the world. In this study, we investigated AIS treatment barriers in high COVID‐19 incidence regions in Latin America.

Methods
: In our study, we organized the 21 Latin American regions based on the number of COVID‐19 cases from the highest to the lowest. In August 2020, Brazil had the highest number of COVID‐19 cases which was 2,736,298 while Belize had the lowest number of COVID‐19 cases which was 57. Taking the top 5 countries with the highest COVID‐19 cases (Brazil, Peru, Chile, Colombia, and Argentina), we compiled a list of neurologists, neurosurgeons, and neurointerventionalists involved in stroke care. We then sent 100 of these clinicians a survey to understand the effects of the pandemic on stroke treatment in their hospitals. Following the survey, we requested the doctors to set up an interview to delve deeper into the barriers to access to AIS treatment. Out of the 100 clinicians contacted, 16 filled out the survey and 14 doctors set up an interview with us.

Results
: Using the survey results and the interview data, the top‐5 barriers mentioned were transportation, disease awareness, rehabilitation, shortages in staff, and fear among the public about contracting COVID‐19 at the hospital. About 62% of the doctors indicated that people are scared of coming to the hospital due to the high COVID‐19 cases. Furthermore, 60% of the doctors mentioned that there has been a lack of staff at hospitals which causes a reduction in the number of treatment procedures performed, especially mechanical thrombectomies. Moreover, 50% of the doctors said that the main barrier was transportation delay, which results in time lost before treatment. About 50% of the doctors also mentioned that most of the population does not know what AIS is or its symptoms, resulting in fewer patients seeking appropriate care. Finally, 50% of the doctors said that there has been no sufficient rehabilitation. Many rehab units/hospitals have been converted into COVID‐19 hospitals due to the large number of COVID‐19 patients. Therefore, after a patient has received stroke treatment, they have not been able to recover back to their original healthy status. These barriers have overall decreased AIS treatments in hospitals and have negatively impacted patients who have experienced AIS.

Conclusions
: Overall, the emergence of COVID‐19 has negatively impacted AIS treatment in regions in Latin America with the highest COVID‐19 cases. Hospitals faced several barriers during the pandemic making it difficult for staff to adjust to those specific circumstances. Based on recommendations that doctors have provided us, we are currently working with doctors in Peru to launch an app that tackles the transportation, educational, and rehabilitation barriers. This app will allow patients to connect with doctors online and perform rehabilitation exercises at the comfort of their home while also being able to learn more about stroke.