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Study finds challenges posed by COVID-19 for stroke care in India

Read time: 4 mins
18 Nov 2020
Study finds challenges posed by COVID-19 for stroke care in India

[Image Credits: VSRao from Pixabay and Fusion Medical Animation on Unsplash, edited.]

Stroke, also called ‘brain attack’, happens when blood supply is interrupted to the brain, resulting in the lack of oxygen and nutrients supply to the cells and causing their death quickly. Individuals who have suffered a stroke experience weakness on one side of the body, drooping face, and difficulties in talking and vision. If care is delayed, the damage to the brain could be detrimental. Hence, it is advised that patients get immediate care within 4.5 hours of experiencing a stroke to restore blood flow to the brain.

The condition affects 1.8 million Indians annually, a number that is much higher than what’s seen in other developed countries. As time-bound, comprehensive medical care is crucial for stroke care, India already faces limitations in treatment and rehabilitation.

In 2020, with the pandemic, hospitals have been urged to prioritise treating COVID-19 patients. The nation-wide strict lockdown imposed on March 24th prevailed for a couple of months before restrictions started to ease. As a result, medical care for other infectious and non-infectious diseases, like diabetes, tuberculosis, stroke and cancer, have been severely affected. India’s healthcare system finds itself caught between the pandemic and other widely prevalent diseases. Now, a study, published in the Annals of the New York Academy of Sciences, has found that the lockdown widened the challenges of stroke care in the country.

The study was conducted by a team of stroke neurologists. The researchers conducted a survey to which stroke neurologists from 13 leading medical centres across India participated. The participating centres included Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Kerala, All India Institute of Medical Sciences (AIIMS), New Delhi, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh and Christian Medical College, Ludhiana.

The survey consisted of a questionnaire with eleven questions, seeking the responding neurologists’ observations of stroke care in their hospitals during the lockdown. From these responses, the researchers estimated how many stroke patients visited the hospitals and how their treatment proceeded. They conducted a similar survey in medical centres in the USA and compared their findings between the two countries.

“It was interesting to note that there were similarities and dissimilarities between both countries,” says Dr P N Sylaja, a stroke specialist at SCTIMST and the lead author of the study.

According to the survey, weekly admissions of stroke patients into hospitals dropped sharply in both countries during the lockdown. In Indian hospitals, however, the number of admitted patients went down by 61.2%—two thirds lower than in the USA. Those who reported to hospitals were usually the ones with severe strokes and arrived late, whereas patients with minor symptoms decided to stay home probably due to fear of COVID-19 infection, lack of public transport or financial constraints.

Once discharged from hospitals, patients of stroke need rehabilitation care like speech therapy, physiotherapy, and occupational therapies, to walk and speak clearly again. The study found that the lockdown affected access to rehabilitation care. In addition, patients residing in rural areas found it hard to keep track of their blood pressure, blood sugar, and cholesterol due to limited access to blood testing services. The likelihood of having another stroke, which could be crippling or even fatal, increases in the absence of regular monitoring.

“The introduction of mobile rehabilitation clinics may greatly help patients in need of therapy after discharge,” suggests Dr Aneesh Dhasan, a research associate at SCTIMST, who was not part of this study.

The researchers argue that the absence of emergency medical services, lack of availability of specific protocols for stroke treatment during the pandemic, and lack of awareness among the public posed a challenge to stroke care in India in 2020. They suggest the use of teleconsultation for patients living in rural areas and for those under quarantine. While teleconsultation was being experimented with during the initial days of the pandemic, it has slowly evolved into a standard practice in the hospitals involved in the study, they say.

A successful healthcare model includes infectious and non-infectious diseases during the pandemic to ensure no disease gets neglected. The current study gives us a preview of the limitations of our healthcare system in managing stroke patients during the pandemic and calls for building robust systems that can handle such emergencies. In the context of stroke, the researchers point out that public health systems in both developed and developing nations must improve awareness, and measures for emergency and rehabilitation care of stroke patients.