AUTHOR=Venketasubramanian Narayanaswamy 

TITLE=Stroke Care Services in Singapore During COVID-19 Pandemic—A National Perspective

JOURNAL=Frontiers in Neurology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00780

DOI=10.3389/fneur.2020.00780

ISSN=1664-2295

ABSTRACT=Stroke is a significant cause of admission to our acute care hospitals. With the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases(NCID). Otherwise, on arrival at the emergency room, all cases with fever or respiratory symptoms [possible COVID-19 patients(PCPs)] are evaluated separately, staff wearing full personal protection equipment(PPE). Triage is not delayed. PCPs needing hyperacute therapies are sent to a separate scanner; otherwise, imaging is deferred to the latter part of the day. PCPs are managed in isolation rooms, and sent to the acute stroke unit(ASU) if 2 consecutive COVID-19 swabs are negative. Investigations and rehabilitation are done within the room. ASU rounds are attended by essential members, communications by electronic means. Multidisciplinary team rounds have ceased, discussions via electronic platforms. Patient transfer and staff movement are minimized. All hospital staff wear face-masks, infection control is strictly enforced. Visitors are not allowed; staff call to update families daily. Rehabilitation is provided as before; mild strokes may be sent home with advice. Out-patient rehabilitation centres are closed. Patients return for out-patient visits only if needed; medications are sent to their home, nurses make essential home visits. Stroke support and rehabilitation activities have started on-line. Continuing medical education activities are mainly by webinars. Stroke research has been severely hampered. Overall, evidence-based stroke care is delivered in a re-organised manner, with a clear eye on infection control.