Following the announcement that the UK will remain on lockdown for the foreseeable future, NeuroNews speaks to Shahram Derakhshani about the impact of COVID-19 on stroke care in the country’s capital. “Society appears to be in shock,” he says, as he speculates that people are “ignoring their [stroke] symptoms to ease pressure on the National Health System [NHS]”.
Can you tell us about the current situation with COVID-19 in London?
Like everywhere else in the world at present we are facing an unprecedented crisis with disruption to almost all normal services. The intensive care units across London have expanded massively and we are also creating new makeshift hospitals such as the NHS Nightingale hospital set at the Excel exhibition centre, which is trying to alleviate some of the pressures facing the intensive care unit (ICU) services of NHS hospitals.
Have the criteria for an urgent neurosurgery case become stricter?
In the current climate where NHS England and the UK in general are facing mounting pressure due to the pandemic, many other services have either been suspended or are running with limited resources. We now have patients that are not able to have treatment for cancer and similar significant conditions. Our neurological services have been restricted to immediate life- and limb-threatening emergencies only, with all elective, non-urgent work postponed for the time being.
Is the city managing to provide stroke care as coronavirus cases rise?
As priority shifts to caring for COVID-19 patients, many other services have had to be reduced. One factor impacting other services has been the re-deployment of medical and nursing staff from specialties other than respiratory and intensive care medicine to the COVID-19 front line. The stroke service has definitely been affected but continues to be supported with a skeleton team.
Another factor affecting stroke care is the late presentation of patients to hospital. Society appears to be in shock, ignoring their symptoms to help ease pressure on the NHS; the late presentation of these patients to interventional neuroradiology centres ultimately has a detrimental impact on outcome. We have been experiencing late admission in both ischaemic and haemorrhagic subarachnoid stroke groups since the beginning of the pandemic.
Has there been any restructuring of your faculty given the circumstances?
Yes. As consultants, we make decisions based on our knowledge and experience. In this crisis situation where most patients and many resources are diverted towards COVID-19 management, we in interventional neuroradiology have to justify any action we take regarding any patient. We have a much lower capacity of intensive care beds available for patients who are undergoing other life-threatening pathologies, including neurological conditions. It is a difficult situation where you sometimes have to make decisions that would not otherwise happen on a normal day.
How are you preparing residents for getting called into the ICU?
A comprehensive plan has been formulated to train trainees, particularly those from other specialties, to prepare for intensive care medicine in order to cope with the COVID-19 crisis in London.
This has already been achieved in anaesthesia for example, where all anaesthesia residents have been merged into the intensive care resident rota. Again, this certainly will have a significant impact on the work of other specialties including neurosurgical and stroke services.
What positives do you see arising from the pandemic, in terms of lessons learnt?
As with any other crisis there are numerous lessons to be learnt. An example of a positive impact is that we have seen a lot of healthcare professionals come together to address a unique challenge as a team; all have put their combined efforts and knowledge together in order to overcome the current problem.
We have seen the speed of change in the NHS increase drastically. Issues that were not resolvable over months are now being dealt with within a day or two. The speed of function has increased significantly.
After the crisis, there will be more appreciation of medical staff and their exemplary dedication worldwide. As a society, there will be open discussions about the reasons we got caught unprepared by this crisis. There will be a significant change in the understanding and management of health care systems, including the NHS.