Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Henrique Diegoli, MD; Pedro S.C. Magalhães, MD; Sheila C.O. Martins, PhD; Carla H.C. Moro, MD; Paulo H.C. França, PhD; Juliana Safanelli, RN, MSc; Vivian Nagel, RN, PhD; Vanessa G. Venancio, RN; Rafaela B. Liberato, MSc; Alexandre L. Longo, MD


Stroke. 2020;51(8):2315-2321. 

In This Article

Abstract and Introduction


Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil.

Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019.

Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 (P=0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage.

Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.


Stroke is one of the leading causes of mortality and morbidity in Brazil and worldwide. Much of the burden caused by stroke can be reduced by the adoption of acute and subacute treatments.[1] Acute-care treatments, such as intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), require that the healthcare system is highly organized in stroke care, enabling patients to receive life-saving procedures in the briefest time from stroke onset. The subacute management requires a multidisciplinary team, usually working in a stroke unit to perform care, such as dysphagia screening, adequate venous thromboembolism prophylaxis, early rehabilitation, and cause investigation.

From late 2019 to early 2020, coronavirus disease 2019 (COVID-19) started to disrupt the healthcare systems of many nations. From the beginning of the pandemic, it has been a major concern for doctors and public authorities that resources needed to treat other conditions such as stroke are diverted for COVID-19.[2] Also, patients may be unwilling to go to a hospital for stroke treatment due to fear of becoming contaminated with the disease. There is also concern that COVID-19 increases stroke risk, which may worsen the burden of stroke.[3]

Using a population-based stroke registry, we developed a study to investigate the impact of the COVID-19 pandemic in stroke care in Joinville, Brazil. Our hypothesis was as follows:

  • Hospital admissions for stroke were reduced after the onset of the COVID-19 pandemic.

  • The reduction occurred only in transient ischemic attacks (TIA) and mild cases.

  • There was a change in the time between stroke onset and hospital admissions.

  • The number of patients receiving reperfusion therapies (IVT and MT) has decreased.