What is COVID-19?
"Human Coronaviruses are common throughout the world. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans.
On 7 January 2020, ‘Severe Acute Respiratory Syndrome Coronavirus 2’ (SARS-CoV-2) was confirmed as the causative agent of ‘Coronavirus Disease 2019’ or COVID-19" (https://sacoronavirus.co.za/information-about-the-virus-2/).
Who is most vulnerable?
Anyone who has been in contact with a confirmed case of COVID-19 is at risk, however, healthcare practitioners, the elderly and individuals with co-morbidities, such as heart disease (including high blood pressure), chronic respiratory diseases, cancer patients, endocrine diseases (such as diabetes), have been found to be at a higher risk of severe illness and mortality associated with COVID-19.
Stroke and COVID-19
According to the World Stroke Organisation (WSO), of which the Helderberg Stroke Support Group is a member, stroke patients are facing an increasing number of difficulties during this unprecedented time. Around the world a decline in acute stroke admissions and treatment has been observed (Brainin & Markus, 2020). This is concerning, as the prevalence of strokes has not declined, but rather, doctors are postulating that patients are fearful of hospitals and of admission to a hospital during the pandemic, and are just staying at home when their symptoms are milder. Limitations on visitors may also be a concern for patients, who fear being alone in hospital. According to a recent study done by Brainin & Markus (2020), the stroke units themselves are also at danger of being moved, or reduced in capacity, as hospitals prepare for COVID-19 patients and must make more space and free up beds/wards. Further, medical staff who are exposed, or infected by COVID-19, must quarantine themselves and so numbers in hospital staff/personnel decrease and redeployed staff do not necessarily have the expertise in stroke management.
It has also been noted that outpatients (for rehabilitation therapy) are not readily being seen in rehab centres/therapy departments as much as before, as some hospitals are limiting outpatient bookings, which has a big impact on stroke recovery long term; rehabilitation is vital for stroke recovery. Lastly, patients are being discharged from hospital to home/step down facilities quicker to free up beds. All this has an impact on the level of care that stroke patients receive. In South Africa we are still in the process of learning what impact COVID-19 is going to have on our stroke patients.
The WSO further mentions that the risk of stroke due to COVID-19 is becoming recognised and that COVID-19 may actually increase ischemic stroke risk because of the hypercoagulable state and effects on the cardiovascular system associated with a severe form of the viral infection. There has been an increased incidence of stroke noted in younger, otherwise healthy adults, worldwide. Further research is being done here.
It should be noted that stroke is, and will remain, a medical emergency. If you suspect yourself or someone you know to be having a stroke, or a Transient Ischaemic Attack (TIA), you should call your doctor, or go to the nearest emergency unit and seek help, or call an ambulance. Stroke does not wait for COVID-19 and time matters.
Reference: Markus, H. and Brainin, M. (2020). ‘COVID-19 and stroke—A global World Stroke Organization perspective’. International Journal of Stroke, Vol. 15(4), pp 361–364
World Stroke Organization (2020). ‘Stroke Care and the COVID-19 Pandemic’. Available from: https://www.world-stroke.org/news-and-blog/news/stroke-care-and-the-covid19-pandemic. Accessed on 01 June 2020.
How are we supporting our stroke survivors?
Our groups have had to close since lockdown began, as our stroke survivors are at high risk for complications of COVID-19. Most of our venues are public venues and are also not open to the public with the current lockdown regulations. Our philosophy is "we are not meeting now, so that when we do meet again no one will be missing". We are encouraging our members to stay safe, and stay at home.
We are, however, still operational during this time- we are busy assisting our stroke survivors and persons with disabilities in the community by:
Distributing food and relief parcels (including food, toiletries, candles etc.). Our assistants deliver each food parcel to our stroke survivors' homes individually so that we can ensure that the right people are getting them
Designing and distributing home based exercise programmes
Phoning all our members to check in
Providing our stroke survivors with masks
Providing assistive devices
Following up with new stroke patients and supporting them as needed
Providing "contactless" learning platforms to continue our stroke training with the home-based carers