INCIDENCE OF STROKE DURING THE SARS-COV-2 PANDEMIC IN NEW ZEALAND;FINDINGS FROM ARCOS V, 2020

ABSTRACT

Objectives: The Auckland Regional Community Stroke Studies (ARCOS) are population-based studies conducted in Auckland, New Zealand in adults (<15 yrs). In 2020, the SARS-CoV-2 pandemic disrupted the health system and potentially affected the presentation and care of stroke patients. We aimed to utilise this opportunity to study the impact of the pandemic on stroke incidence, and hospitalisation during this extended phase of the ARCOS V study. Methods: Between 1st March and 31st August 2020, stroke cases were identified through multiple case ascertainment methods, including public hospitals and emergency departments;CT/MRI records;hospital discharge registers;private hospitals, rest homes, and community health services. During this time, the Auckland (population 1,257,690) was in various phases of lockdown, including Level 4 during which everything except essential services was shut down. Completion of case ascertainment from the death registry is currently underway, hence preliminary findings are presented. Results: Of the 1198 registered stroke cases, 50.8% were women, 29.4% were aged between 15-64 years 84.1% were first-ever strokes. The age standardised attack rate of stroke in the 6-month period was 72 [95% CI 72 to 80] per 100,000 and the incidence of first ever stroke was 64 [95% CI 60 to 68] per 100,000. The majority (81%) presented to hospital via ambulance, and 96.1% received brain imaging within 24 hours of admission. While the majority sought attention within minutes or hours of symptom onset, 22% delayed seeking attention by a day or more. Conclusions: Robust and well-established online data collection protocols allowed the continuation of the ARCOS V study during the peak of the SARS-CoV-2 pandemic. The number of people presenting to hospital with stroke was close to expected levels. However, a significant number of people delayed seeking medical attention. Learnings from this study will be important to plan for stroke services during future pandemics.