Telemedicine in the delivery of stroke care during the COVID-19 pandemic*

*DISCLAIMER: Data relating to COVID-19 herein are current as of article submission date of April 8, 2020.

Unprecedented times

In January 2020, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) was identified as the pathogen underlying a surge of pneumonia cases in Wuhan, China. Coronavirus disease 2019 (COVID-19) has since spread exponentially to pandemic status, dramatically altering daily life on a global scale. As of April 3rd, more than half of the world’s population (over 3.9 billion people) had been placed under some level of ‘lockdown’ measures by their governments in order to mitigate contagion.1 These measures – essential in flattening the curve and preventing staggering projected numbers of COVID-19-related death – have had considerable negative off-target consequences that have raised concern amongst some regarding whether these measures might end up causing more harm than COVID-19 itself.2 Although such questions have arisen most often in reference to the financial crisis and ensuing human impact that has resulted from bringing the global economy to a grinding halt, similar questions have been posed by healthcare professionals regarding requisite sacrifices in the quality of healthcare delivery for non-COVID-19-related diseases that have uncourteously persisted onwards without hiatus during this pandemic. In order to circumvent such healthcare challenges imposed by physical distancing measures, many physicians and healthcare systems have turned to telemedicine. For instance, Arya, a Canadian electronic health record system that provides a virtual platform with integrated video telemedicine, has reported a 500% increase in their website traffic and have doubled their user base in the last two weeks of March alone (R. Vandegriend, S. Gharbi, R. Sztramko, personal communication, April 6, 2020).3 In view of this rapid paradigm shift in healthcare delivery, this article aims to review the evidence that supports the use of telemedicine in the management of neurological patients (teleneurology), with particular focus on stroke care. Current evidence supporting the use of teleneurology in other disease states was recently thoroughly reviewed by the Telemedicine Work Group of the American Academy of Neurology and will not be covered here.4