There has never been such a spring all over the world as in 2020. Self-isolation and restriction of the movement were accompanied by alarming news of an increase in cases and intractable symptoms of coronavirus infection. All this, as expected, made people more attentive to their health and hygiene issues. We can often hear the opinion that the coronavirus pandemic will change our lives forever.
The pandemic has unsettled even the seemingly most sophisticated medical systems. Most of the reporting countries reported that they had to suspend many routine and ancillary services, focusing on emergency care to save the lives of coronavirus patients. At the beginning of the pandemic, we saw the failure of health systems, even in the most developed countries. The reasons for the disruptions in the health care system, experts say, fit into the classic formula of supply and demand. While the need for inpatient treatment increased sharply during the COVID-19 pandemic, the need for outpatient services decreased: people preferred not to go to doctors unless necessary. In addition, many doctors and paramedics had to urgently change their specialty and take up the fight against COVID-19. Interruptions in the supply of essential equipment and medical supplies also played a significant role in reducing the volume of medical services for the population.
The pandemic of the previously unknown coronavirus caused by SARS COVID-19 and related quarantine measures affect people’s lives worldwide, including in the field of neurology. However, did this affect the course of urgent neurological situations?
Some features of acute neurology due to the COVID-19 pandemic
Neurological diseases during the COVID-19 pandemic have retained their relevance. However, patients were advised, if possible, to refrain from visiting medical facilities for the entire period of the COVID-19 pandemic, carefully assessing the justification of the risk and the potential benefits of the visit. It is advisable to continue the survey begun earlier only in cases of critical need. All patients are advised to continue the previously prescribed therapy and adhere to the once approved course of treatment. Medical consultations were forced to transfer to a telemedicine format; in the complete absence of such an opportunity, the volume of face-to-face visits was reduced to a minimum. The previously prescribed antihypertensive therapy, including ACE inhibitors, is usually continued in the same dose without interruption and “drug holidays”.
Due to limited resources, both financial and human, it was reported that some routine medical interventions had to be abandoned. There are also some urgent nervous conditions in which telemedicine will not help, and acute neurology treatment is needed. These include brain tumors, oncological diseases of the nervous and adjacent tissues, infections of the central nervous system, vascular diseases (stroke, aneurysms, malformations), Parkinson’s disease, etc.
On the recommendation of the European Association of Communities of Neurosurgeons (EANS), when referring patients for neurosurgical examination/treatment, the flow of patients is conventionally divided into:
1. Patients in whom the intervention of a neurosurgeon can be postponed until the conditional improvement of the epidemiological situation (i.e., carpal tunnel syndrome, non-aggressive oligosymptomatic or asymptomatic intracranial neoplasms, degenerative stenosis of the spinal canal, decompression operations on the cranial nerves, deep brain stimulation).
2. Patients who, if possible, can prolong conservative therapy and refer to a neurosurgeon in case of clinical deterioration/suspicion of an unfavorable outcome (i.e., benign neoplasms of the brain with symptoms, initial stage glioma, etc.).
3. Referral to a neurosurgeon regardless of the epidemiological situation (i.e., malignant neoplasms of the central nervous system of any stage, damage to the brachial and other large plexuses, chronic subdural hematoma, progressive myelopathy at the cervical level, congenital malformations).
All operations, whenever possible, are carried out by the most experienced specialists to speed up the process. In addition, all necessary protective equipment is used without fail, and patients with confirmed COVID-19 are operated only in PAPR respirators during the pandemic.
Did the COVID-19 directly affect the work of neurosurgeons and neurologists?
He markedly changed the organization of their work. Providing routine neurosurgical care in a pandemic, they are forced to obey the laws of the pandemic. To take a patient, say, for surgery for a tumor of the spinal cord or brain, he first needs to be tested for the presence of coronavirus and computed tomography of the lungs. And this is not always possible to ensure since there are acute neurology situations where every minute is essential. In addition, the hospital staff themselves are always at risk of infection, as they seek to assist as soon as possible, and the symptoms of patients may not yet appear. As a result, the pandemic still affects the work of neurologists and neurosurgeons.
It is also essential to understand that any infectious condition can lead to exacerbations of chronic diseases and an unpleasant outcome in vascular accidents. But there is evidence that stroke occurs more often against the background of coronavirus than, for example, with the flu. Thrombosis is a severe problem because the affected vessels go to the head and heart and the organs and limbs. In extreme cases, amputation may be required. That is why anticoagulants are used in the treatment of patients with COVID-19 in the pandemic period. Thus, the need for urgent neurological care is also increasing, which can make it challenging to maintain a high level of neurological care in hospitals.
Of course, system-wide planning has changed, including screening protocols, contingency staffing plans, and the expansion of ICU and emergency room capacity.
These kinds of shocks make people look at things differently and look for some methods to deploy healthcare quickly. If it is possible to speak of a positive effect in such a situation, then in this, it can be seen.