Israel Neurological Society: COVID 19 and Stroke: Challenges and Changes

06 May 2020

Report from webinar in Israel led by Prof Michael Brainin and Prof Natan Bornstein in response to the COVID19 Pandemic

On April 26, 2020 at 8:30 p.m. I had the pleasure to hold a webinar on COVID-19 and stroke with my friend Prof. Michael Brainin, the President of the WSO.

The webinar was conducted as an open discussion with initial statements by both invited speakers followed by questions and comments from the audience. Prof. Natan Bornstein hosted the event on behalf of the Israel Society of Neurology and described the impact of COVID-19 on stroke care in Israel where a significant decrease in stroke admissions by about 40% and to some extent a decline in recanalization procedures was noted. It was also observed that many patients arrived too late to the ER to receive appropriate treatment. The MOH messages that were issued, asking patients not to come to the hospitals acted as a double-edged sword. And as the numbers of COVID-19 patients begun to rise many people with medical emergencies including stroke were afraid to come to the hospitals.

Another important discussion point was the impact of the above-mentioned phenomenon on the long-term consequences and its effect on secondary stroke prevention.

After the introduction by Prof. Bornstein, Prof. Brainin was introduced as the President of the World Stroke Organisation (WSO) and asked to give a comprehensive overview on the global perspective and to explain how the WSO reacts to this and takes action on the global pandemic. In a survey conducted by the WSO already in March, reports were received from more than 20 countries around the world which included all continents (www.world-stroke-org). It was confirmed that many acute stroke patients do not seek medical care early enough to enable thrombolysis or thrombectomy or even prefer to stay at home. The effects on worsened outcomes and increased mortality due to stroke itself is still being evaluated. Many other acute patients with mild symptoms are missing the evaluation, assessment and secondary preventions measures. These effects are currently being evaluated in a more detailed survey by the WSO. Rehabilitation following stroke has come almost to a standstill. Telemedicine rehabilitation is being increasingly offered instead and preliminary reports show that it is taken up well by patients, spouses and community workers.

Some questions referred to medical issues such as the pathophysiology of COVID19 triggered damage to cerebral vessels or the heart and whether anticoagulation would be effective if given in a prophylactic dose range. The issue of increased risk of stroke in COVID 19 infected patients is still under investigation and whether young adults or children have an increased risk of mortality or bad outcomes.

Following the introduction, a lively discussion was held, answering questions from the audience that actively participated in the discussion.

It was an enjoyable experience and fun to have this successful webinar with 72 participants from around the world.

Prof. Natan Bornstein,

Tel Aviv, Israel

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