COVID-19 indirectly hits stroke patients, as hospital discharges in Romania see a dramatic decrease during the pandemic

Background and aims: SARS-CoV-2 has reshaped the healthcare delivery pathways around the world. The high burden on secondary and tertiary care capacity and several mobility restrictions have forced restriction or deference of treatment for most patient groups, to a mostly unexplored extent. Driven by the hypothesis that underfunded health systems such as Romania have become disproportionately weak due to these changes, and based on reports of patient access barriers, we examined the number of neurology ward discharges national level before and during the pandemic. Methods: Monthly reimbursement data from the Romanian Diagnoses Related Groups (RO-DRG) was used to identify monthly discharge totals from acute neurology wards and stroke groups (B3111-B3114), from private and public hospitals in contract with the Romanian National Health Insurance House. We report crude cases, as well as proportional differences between 2019 and 2020. Results: Neurological ward discharges dropped as much as 65% in 2020 compared to the previous year, during the country-wide lockdown (Figure 1). A nearly similar trend has been observed for stroke, which in theory is prioritized due to the high burden and importance of acute care for overall patient outcomes (Figure 2). In total, Romania discharged 71,612 fewer patients on acute neurology wards in 2020 vs. 2019, of which 56% were stroke patients. Conclusion: The decrease in discharges for acute care neurology wards in Romania during the COVID-19 pandemic is worryingly high. Romanian stroke patients continue to be denied access to essential acute care and neurorehabilitation, even after the country's full lockdown has been lifted. (Figure Presented).