Association of the COVID‐19 Outbreak with Acute Stroke Care in Switzerland

Background: In Switzerland, the COVID-19 incidence during the first pandemic wave was high. We aimed to assess the association of the outbreak with acute stroke care in Switzerland in spring 2020.

Methods: Retrospective analysis based on the Swiss Stroke Registry, which includes consecutive patients with acute cerebrovascular events admitted to Swiss Stroke Units and Centers. We fitted a linear model to the weekly admission from 2018 and 2019 and used it to quantify deviations from the expected weekly admissions during from March, 13 to April 26, 2020 (the "lockdown period"). We compared characteristics and 3-month outcome of patients admitted during the lockdown period versus patients admitted during the same calendar period of 2018-2019.

Results: We included 28'310 patients admitted between 1 January 2018 and 26 April 2020. Of these, 4'491 (15.9%) were admitted in the epochs March 13-April 26 of the years 2018 to 2020. During the lockdown in 2020, the weekly admissions dropped by up to 22% compared to rates expected from 2018 and 2019. During three consecutive weeks, weekly admissions fell below the 5% quantile (likelihood 0.38%). The proportion of intracerebral hemorrhage (ICH) among all registered admissions increased from 7.1% to 9.3% (P=0.006), and numerically less severe strokes were observed (median NIHSS from 3 to 2, P=0.07).

Conclusions: Admissions and clinical severity of acute cerebrovascular events decreased substantially during the lockdown in Switzerland. Delivery and quality of acute stroke care were maintained.