Amid COVID-19, let’s not forget about strokes

Legislation needed to provide quality care

AS OUR NATION mourns the immense loss of life from COVID-19 and the socioeconomic disruption it has caused, the people of our Commonwealth should be proud of what they have accomplished in minimizing the impact of the coronavirus. Like every state throughout the nation, Massachusetts has been working diligently to respond to COVID-19 — changing the way we live and think about public health.

We must not lose sight of another health problem equally as deadly. This year, nearly 800,000 people in the United States will have a stroke, and 140,000 of them will die. The COVID-19 pandemic is likely to amplify the magnitude of this problem, with potential delays in calls for help and strain on triage and transport systems.

Time is brain. Every minute of delay before a patient receives stroke care means an extra week of recovery. Stroke patients who arrive at the hospital quickly have the best chance to survive and regain their independence. That is why it is critical for anyone experiencing symptoms of a stroke, including loss of speech, face, arm, or leg weakness, to dial 9-1-1 immediately to get the care that could save their lives and prevent disability.

At the same time, first responders need to have the ability to triage and transport these patients to the facilities best-equipped to treat them. The most severe strokes may require procedures to remove the blood clot causing the stroke, restore blood supply to the brain, and save threatened tissue.  Fortunately, Massachusetts is on the right path toward improving outcomes for stroke patients and their families.

Pending legislation, H4640, would ensure that patients experiencing the most severe cases of stroke are triaged by ambulance crews and transported to hospitals capable of performing such a procedure at any time of the day or night. These facilities, known as Level 1 Stroke Centers, are staffed with highly trained neurointerventional care teams: doctors, nurses and technologists. These teams offer a minimally-invasive, life-saving procedure called mechanical thrombectomy. The procedure is accomplished by accessing blood vessels (in the leg or the wrist) and navigating to the clot causing the stroke. Devices are deployed that engage the clot to extract it. This ultimately reopens blocked arteries in the brain.

During the pandemic, facilities across Massachusetts offering this life-saving procedure have met regularly online to coordinate our responses and ensure we maintain access to treatment for patients suffering from stroke. This exemplifies the commitment of our state, a longstanding leader in the field of stroke, to stroke care.

The individual costs of not maintaining access, and failing to improve our stroke triage and transport protocols, are devastating – with potential lifelong disability or death for patients. The societal costs are also tremendous. Stroke costs the United States about $34 billion annually, including health services and missed days of work. Massachusetts’ stroke costs are projected to have increased from $1.5 billion 10 years ago to $2.5 billion today. With effective treatment leading to better patient outcomes, the societal cost of stroke is reduced. Clot removal treatment for the most severe form of stroke is statistically one of the most effective therapies in the history of medicine.

As we continue adapting to the new realities of living in a world with coronavirus, we must avoid complacency about equally life-threatening emergencies like strokes and heart attacks. Highly effective, high-quality, research-driven treatments for these conditions exist. Emergent access for patients suffering from these conditions is key to successful outcomes. Among the many lessons policymakers need to take from the current pandemic is that systematic approaches to care offer the greatest societal benefit. Improving emergency transportation and interfacility protocols, starting with stroke, will ensure patients get to facilities equipped to treat them without delay.

Meet the Author

Thabele Leslie-Mazwi

Director of endovascular stroke services, Massachusetts General Hospital
Meet the Author

Thanh Nguyen

Director of neuroendovascular service, Boston Medical Center
Health care workers in Massachusetts are taking every precaution to protect patients and staff from COVID-19 exposure, from first contact in the field, to the emergency room, to stroke nit, and to rehabilitation. Fear of COVID-19 should not deter patients with stroke symptoms. Avoiding or delaying treatment for this terrible illness will lead to more tragic losses for our families and our nation.

Dr. Thabele (Bay) Leslie-Mazwi is the director of endovascular trokesServices at Massachusetts General Hospital and Dr. Thanh Nguyen is director of the neuroendovascularsService at Boston Medical Center. They are both members of the Society of NeuroInterventional Surgery, supporting its Get Ahead of Stroke campaign to improve systems of care for stroke patients. For more detailed information, click here, here, or here.