To the Editor:
The COVID-19 pandemic has imposed unprecedented challenges on health-care systems to protect providers while maintaining sufficient resources to handle emergent conditions. Endovascular thrombectomy for stroke is a time-sensitive life-saving procedure that involves highly-specialized units of neuroendovascular-trained interventionalists, nurses, and technologists. In this group, minimizing the exposure of providers to COVID-19 maintains emergency operations. We studied the impact of the COVID-19 pandemic on the functional capacity of neuroendovascular units in 35 centers globally,1 including regions with high (>2000 cases/1 million) or low COVID-19 prevalence (<2000 cases/1 million) between 3/1/2020 and 5/10/2020. Among 592 providers, we surveyed 113 interventionalists, 251 nurses, and 228 technologists.
Elective neuroendovascular interventions were cancelled across all sites within a median of 14 d (interquartile range: 10-21) from the first case reported in the region. This delay was similar between sites of high or low COVID-19 prevalence (P > .1). Mitigation strategies to limit staff exposure included reducing the number of staff in physical proximity by dividing the teams into mutually exclusive groups, assuming all patients were COVID-19 positive until proven otherwise, and using COVID-19 testing as resources permit.2-4 Despite these measures, 38% of providers were required to self-quarantine due to COVID-19 exposure or confirmed or suspected infection. This percentage was similar between high and low prevalence sites (39% vs 37%, P > .1), but with significant variability within the same prevalence class (σ = 40%). Due to the presence of mutually exclusive teams, high rates of self-quarantine did not force centers into diversion except for one site (<1 wk). The self-quarantine rate was higher in nurses (50%) and technologists (40%) compared to interventionalists (6%, P < .05). Higher relative exposure of nurses and technologists is expected given their more prolonged and more frequent physical interaction with patients. Among providers who self-quarantined, only 12% tested positive for COVID-19 using polymerase chain reaction-based testing, and were limited to high prevalence regions. A higher proportion of quarantined interventionalists tested positive for COVID-19 (28%) compared to nurses (13%) and technologists (8%) in high prevalence sites (P < .05). No COVID-19 infection was documented in providers in low prevalence regions during the study. We observed a strong positive correlation between the number of quarantined providers and those testing positive for COVID-19 (R2 = 0.56, P < .01), suggesting that quarantine efforts were implemented appropriately. In contrast, the correlation was weak between the prevalence of COVID-19 infection in the community and the number of providers positive for COVID-19 (R2 = 0.15) suggests that the implemented mitigation strategies have successfully prevented the outbreak from compromising the services provided by highly specialized units.
Funding
This study did not receive any funding or financial support.
Disclosures
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Contributor Information
Ali Alawieh, Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia.
Sami Al Kasab, Department of Neurosurgery Medical University of South Carolina Charleston, South Carolina; Department of Neurology Medical University of South Carolina Charleston, South Carolina.
Eyad Almallouhi, Department of Neurology Medical University of South Carolina Charleston, South Carolina.
Michael R Levitt, Department of Neurosurgery University of Washington Seattle, Washington.
Pascal M Jabbour, Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia, Pennsylvania.
Ahmad Sweid, Department of Neurosurgery Thomas Jefferson University Hospitals Philadelphia, Pennsylvania.
Robert M Starke, Department of Neurosurgery University of Miami Health System Miami, Florida.
Vasu Saini, Department of Neurosurgery University of Miami Health System Miami, Florida.
Kyle M Fargen, Department of Neurosurgery Wake Forest School of Medicine Winston Salem, North Carolina.
Stacey Q Wolfe, Department of Neurosurgery Wake Forest School of Medicine Winston Salem, North Carolina.
Adam S Arthur, Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis, Tennessee.
Nitin Goyal, Department of Neurosurgery Semmes-Murphey Neurologic and Spine Clinic University of Tennessee Health Science Center Memphis, Tennessee; Department of Neurology University of Tennessee Health Science Center Memphis, Tennessee.
Isabel Fragata, Neuroradiology Department Hospital São José Centro Hospitalar Lisboa Central Lisboa, Portugal.
Ilko Maier, Department of Neurology University Medical Center Göttingen Göttingen, Germany.
Charles Matouk, Department of Neurosurgery Yale University/Yale-New Haven Hospital New Haven, Connecticut.
Brian M Howard, Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia.
Jonathan A Grossberg, Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia.
Michael Cawley, Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia.
Peter Kan, Department of Neurosurgery Baylor School of Medicine Houston, Texas.
Muhammad Hafeez, Department of Neurosurgery Baylor School of Medicine Houston, Texas.
Justin Singer, Division of Neurosurgery Spectrum Health Grand Rapids, Michigan.
R Webster Crowley, Department of Neurosurgery Rush University Chicago, Illinois.
Krishna C Joshi, Department of Neurosurgery Rush University Chicago, Illinois.
Waleed Brinjikji, Department of Radiology Mayo Clinic Rochester, Minnesota.
Luis E Savastano, Department of Radiology Mayo Clinic Rochester, Minnesota.
Christopher S Ogilvy, Department of Neurosurgery Beth Israel Deaconess Hospital Boston, Massachusetts.
Santiago Gomez-Paz, Department of Neurosurgery Beth Israel Deaconess Hospital Boston, Massachusetts.
Elad Levy, Department of Neurosurgery University at Buffalo Buffalo, New York.
Muhammad Waqas, Department of Neurosurgery University at Buffalo Buffalo, New York.
Maxim Mokin, Department of Neurosurgery University of South Florida Tampa, Florida.
Erol Veznedaroglu, Global Neurosciences Institute Pennington, New Jersey.
Mandy Binning, Global Neurosciences Institute Pennington, New Jersey.
Justin Mascitelli, Department of Neurosurgery University of Texas Health Science Center at San Antonio San Antonio, Texas.
Albert J Yoo, Texas Stroke Institute Dallas-Fort Worth, Texas.
Jazba Soomro, Texas Stroke Institute Dallas-Fort Worth, Texas.
Richard W Williamson, Department of Neurosurgery Allegheny Health Network Pittsburgh, Pennsylvania.
Reda M Chalhoub, Department of Neurosurgery Medical University of South Carolina Charleston, South Carolina.
Andrew Grande, Department of Neurosurgery University of Minnesota Minneapolis, Minnesota.
Roberto Crosa, Department of Neurosurgery Centro Endovascular Neurologico Medica Uruguaya Montevideo, Uruguay.
Sharon Webb, Department of Neurosurgery Bon Secours Greenville, South Carolina.
Marios Psychogios, Department of Radiology University of Basel Basel, Switzerland.
Andrew F Ducruet, Department of Neurosurgery Barrow Neurological Institute Phoenix, Arizona.
Felipe C Albuquerque, Department of Neurosurgery Barrow Neurological Institute Phoenix, Arizona.
Neil Majmundar, Department of Neurosurgery Barrow Neurological Institute Phoenix, Arizona.
Raymond Turner, PRISMA Heath – Upstate Greenville, South Carolina.
Walter Casagrande, Department of Cerebrovascular and Endovascular Neurosurgery Hospital Juan Fernandez Buenos Aires, Argentina.
Fawaz Al-Mufti, Department of Neurosurgery and Radiology Westchester Medical Center New York, New York.
Reade De Leacy, Department of Neurosurgery Mount Sinai Health System New York, New York.
J Mocco, Department of Neurosurgery Mount Sinai Health System New York, New York.
Richard D Fessler, Department of Surgery Ascension St. John Hospital Detroit, Michigan.
Toshiya Osanai, Faculty of Medicine Hokkaido University Hokkaido, Japan.
Shakeel A Chowdhry, Department of Neurosurgery NorthShore University Health System Evanston, Illinois.
Min Park, Department of Neurosurgery University of Virginia Charlottesville, Virginia.
Clemens M Schirmer, Department of Neurosurgery and Neuroscience Institute Geisinger Health System Wilkes-Barre, Pennsylvania; Research Institute of Neurointervention Paracelsus Medical University Salzburg, Austria.
Andrew Ringer, Department of Neurosurgery Mayfield Brain & Spine Cincinnati, Ohio.
Alejandro M Spiotta, Department of Neurosurgery Medical University of South Carolina Charleston, South Carolina.
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