The Baffling Case of Ischemic Stroke Disappearance from the Casualty Department in the COVID-19 Era

Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading worldwide, and the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic on March 11, 2020 [1]. The outbreak has hit Europe and, as of March 27, 2020, Italy has the second largest number of confirmed cases, that is, a total of 86,498 cases according to the Istituto Superiore di Sanità and 9,134 deaths [2]. This health emergency issue has plunged the Italian health system into an unprecedented state of emergency, and many hospitals are now dedicated exclusively to COVID-19 assistance. We work at the Guglielmo da Saliceto Hospital in Piacenza, a city in northern Italy near Milan. Despite being a relatively small city, Piacenza and its province (about 280,000 inhabitants) are one of the epicenters of the Italian epidemic, listing 2,276 cases at the time of writing. This health emergency has revolutionized the hospital organization, and everything has changed for practicing clinicians in just a few weeks. For example, neurologists also contribute to the management and care of COVID-19 patients or have been “converted back” to operating as emergency physicians, as numerous colleagues have been infected. The question is: what can we say about the remaining non-COVID-19 pathologies? Let us take the ischemic stroke as an example: it seems to have almost disappeared from the Casualty Department! Over the past 5 years (2015–2019), the city of Piacenza has recorded an annual average of 612 new cases of ischemic stroke, with a monthly average of 51 cases, and 21% of them are large vessel occlusion (LVO). We investigated the monthly variance of ischemic stroke using the ANOVA test. Surprisingly, between February 21, 2020 (first SARS-CoV-2 patient recorded in Italy – in Codogno, a nearby city), and March 25, 2020, there were only 6 admissions from the Casualty Department for ischemic stroke (2 transient ischemic attacks, 1 cardioembolic LVO, and 3 lacunar stroke).