Deborah R. Shatzkes
This paper is not about imaging in stroke, nor is it about stroke physiology or even the incidence of stroke in COVID-19. This paper, born from the observations of a group of suddenly less busy neuroradiologists at a large Manhattan hospital, reports the decrease in the monthly incidence of stroke code imaging during matched periods of 2019 and 2020, including New York City’s first COVID-19 wave of 2020. Basically, as we sat in our new home offices, reading only inpatient and emergency department studies, chatting about our experiences, we wondered where all the strokes had gone. As a dedicated head and neck imager, I had even more time on my hands than most, since the cancer and elective ENT-related studies that form the basis of my practice nearly disappeared. As such, I was chosen to shepherd the first brain imaging paper I have first-authored in over 2 decades through to publication in AJNR.
It seemed counterintuitive. Certainly, everyone understood that elective imaging had to stop. There was no way that preoperative studies in degenerative spine disease, chronic sinusitis, and even benign brain tumors like meningioma could continue in the nightmare that was NYC in March and April of 2020. We watched (remotely) as hospital unit after unit was converted into COVID-19 wards, and quickly understood that while we saw the occasional neuroimaging study, this was not primarily a central nervous system disease (and only later did the extent of the neurologic sequelae become apparent). Still, we expected that acute disease, including stroke, would continue at prepandemic rates. Yet at a hospital where 6–8 stroke codes per day was not unusual, we were seeing far fewer. We decided to quantify our observations and, because we suspected that all but the sickest patients might be staying home, assess positivity rates as well.