Author: Dr Maja Bozinovska Smiceska, Neurologist and President of the Macedonian association for a fight against stroke “Stroke”- North Macedonia
Situation in Republic of North Macedonia with regards to the cost of COVID pandemic is similar to many other countries. Our country is managing to flatten the curve, but the mortality rate is still very high. New healthcare problem that appears is a danger of mismanaging many other conditions in different clinical fields, that will lead to additional dramatic, serious and long lasting consequences for many other diseases, especially stroke.
Beyond the fact that people with cerebrovascular diseases have been found to be particularly prone to developing complications and death when suffering from COVID-19 infection, the pandemic also has a much higher impact on stroke care, with significant influence on stroke-related health services, which can lead to worse outcome of patients who have had a stroke comparing to pre-pandemic time.
Even FAST treatment (thrombolytic therapy) is under threat from the burden imposed by management orientated towards potentially contaminated patients, and these measures result in a prolonged needle-to-door time, and in the worst-case scenario, patients do not get the treatment. Furthermore, there is delay in admission to the hospital or a delay in referral, or an error by the patients themselves who prefer not to enter the hospital at all.
Last but not least, regular periodic medical check-ups or consultations and activities related to the rehabilitation of these patients have been reduced, due to the redirection of the resources for emergency management of COVID-19, but also due to patients’ personal fear, especially of those who are already familiar with the fact that they are more susceptible to severe infections. This can lead to increased physical as well as psychological consequences.
This situation is even worse in developing countries like ours, where resources are already scarce.
That is why our organisation is striving to be active and working to emphasize the need for healthcare services for acute stroke to be maintained consistently even in these difficult times, and for patients themselves and their family physicians to continue to strive to provide hospital referral for acute stroke.
Macedonian association for a fight against stroke “Stroke” has been involved in several missions over the past three months to improve statistics on the disease. Online activities were continuously organised, led by a team of doctors and nurses, through which the public was informed about the problems of stroke patients and at the same time practical advice was offered regarding the early recognition of the signs of stroke, the need for prompt response and referral to an appropriate center, the need for early screening for the risk in those who have had a transient ischemic attack or a small stroke, and also support for chronic stroke problems management as stiffness, pain, depression, dementia, etc. Through the ZOOM platform, we have reached more than 200 people who are directly or indirectly related to stroke. The association also made an effort not to leave aside even the most sensitive categories of our population, and in several actions distributed food aid and other basic products to the socially disadvantaged stroke victims.