Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands.

INTRODUCTION: We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS: We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS: A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS: During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

HDJ gériatriques et Covid-19 Quelle gestion? Quelles difficultés? Quels enseignements?

Résumé La pandémie Covid-19 a engendré une crise sanitaire inédite. Pour y faire face, les hôpitaux de jour gériatriques ont payé un lourd tribut dans le cadre de la restructuration organisationnelle du milieu hospitalier avec une fermeture quasi instantanée imposée par les tutelles. Une enquête a été menée sous l’égide de l’APHJPA auprès des hôpitaux de jour gériatriques pour tirer les enseignements de la gestion de cette crise et mener une réflexion sur le rôle de ces structures dans un tel contexte. Cinquante hôpitaux de jour répartis sur l’ensemble du territoire national ont répondu. Les professionnels ont d’emblée été redéployés dans les services d’hospitalisation classique, que le bassin de population soit fortement impacté par la Covid-19 ou pas. Certains ont assuré une assistance auprès des EHPAD ou des patients confinés à domicile et de leur entourage. S’ils ont accepté les fermetures lors de la période aiguë de la crise, l’absence de lisibilité sur la réouverture de leur unité, malgré les mesures de précaution envisagées, a été mal vécue, avec souvent le sentiment d’une méconnaissance de leur rôle dans le parcours de soins de la personne âgée par les tutelles et parfois, par leur propre direction. Le confinement et les ruptures de prise en charge ont pu entraîner des « décompensations » notamment chez les patients ayant des pathologies neuro-dégénératives. Situés à l’interface ville-hôpital, les hôpitaux de jour ont un rôle majeur dans la prise en soins des personnes âgées. L’enquête met ainsi en avant une capacité d’adaptation et d’engagement des professionnels pour affirmer la place des hôpitaux de jour dans la prise en charge des pathologies chroniques (diagnostic, suivi et réadaptation) mais aussi leur rôle dans la prévention, le repérage et le suivi des patients fragiles. Summary The COVID-19 pandemic generated an unprecedented health crisis. In the subsequent response, geriatric day hospitals paid a heavy price in the organizational restructuring of the hospital environment, with almost instantaneous closures imposed by the authorities. A survey was conducted under the aegis of the APHJPA among day hospitals to learn the lessons from the management of this crisis and to reflect on the role of these structures in contexts of this nature. 50 day hospitals throughout the country answered. Most of the professionals were immediately redeployed to classic hospitalization services, whether or not the population area was heavily impacted by COVID-19. Some of them provided assistance to nursing homes or patients confined to their homes and their families. Although they accepted the closures during the acute period of the crisis, the lack of clarity about the reopening of their units despite the precautionary measures envisaged was not well received, often with the feeling that the authorities and sometimes the management of their establishments were not well acquainted with their role in the care of the elderly. The lockdown and discontinuation of care led to de-compensations, especially among patients with neurodegenerative pathologies. Situated at the interface between the community and hospital health sectors, day hospitals play a major role in the care of the elderly. This survey highlights the ability of professionals to adapt and commit themselves, demonstrating the relevance of day hospitals in the field of chronic diseases (diagnosis, follow-up, rehabilitation) and also in prevention, identification and follow-up of frail patients.