Abstract
At the time of this writing, the coronavirus disease 2019 pandemic continues to be a global threat, disrupting usual processes, and protocols for delivering health care around the globe. There have been significant regional and national differences in the scope and timing of these disruptions. Many hospitals were forced to temporarily halt elective neurointerventional procedures with the first wave of the pandemic in the spring of 2020, in order to prioritize allocation of resources for acutely ill patients and also to minimize coronavirus disease 2019 transmission risks to non-acute patients, their families, and health care workers. This temporary moratorium on elective neurointerventional procedures is generally credited with helping to “flatten the curve” and direct scarce resources to more acutely ill patients; however, there have been reports of some delaying seeking medical care when it was in fact urgent, and other reports of patients having elective treatment delayed with the result of morbidity and mortality. Many regions have resumed elective neurointerventional procedures, only to now watch coronavirus disease 2019 positivity rates again climbing as winter of 2020 approaches. A new wave is now forecast which may have larger volumes of hospitalized coronavirus disease 2019 patients than the earlier wave(s) and may also coincide with a wave of patients hospitalized with seasonal influenza. This paper discusses relevant and practical elements of cessation and safe resumption of nonemergent neurointerventional services in the setting of a pandemic.
Highlights
Many hospitals were forced to temporarily halt elective neurointerventional procedures with the first wave of the pandemic in the spring of 2020, in order to prioritize allocation of resources for acutely ill patients and to minimize coronavirus disease 2019 transmission risks to non-acute patients, their families, and health care workers. This temporary moratorium on elective neurointerventional procedures is generally credited with helping to “flatten the curve” and direct scarce resources to more acutely ill patients; there have been reports of some delaying seeking medical care when it was urgent, and other reports of patients having elective treatment delayed with the result of morbidity and mortality
Many regions have resumed elective neurointerventional procedures, only to watch coronavirus disease 2019 positivity rates again climbing as winter of 2020 approaches
The coronavirus disease 2019 (COVID-19) virus was identified in the human population in late 2019 and rapidly spread across the globe
Summary
The coronavirus disease 2019 (COVID-19) virus was identified in the human population in late 2019 and rapidly spread across the globe. This document provides guidance during the COVID-19 pandemic, and future pandemics, on the cessation and resumption of elective neurointerventional procedures that allocates scarce resources and minimizes the risk of transmission of infection to patients, families, and health care providers while enabling health care organizations to provide optimal care to all the patients they serve. This pandemic of COVID-19 will at some point pass, there is a clear need to define prioritization of procedures and establishment of safe neurointerventional workflows whenever regional and institutional resources are strained. With the global variation in resources for COVID-19 testing, the type of test required and the appropriate time window of the test relative to the date of the procedure would likely be defined according to local availability.[21,22,23] After a patient is screened or tested, social distancing, and mask wearing are recommended until the time of the procedure
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