Need to strike balance between Covid and non-Covid care: Dr PN Sylaja

There is a need to strike a proper balance between Covid-19 and non-Covid-19 care so that patients afflicted with a thoroughly disabling and life-threatening disease such as stroke gets prompt medical attention.

“Stroke is a major disease where treatment is time-sensitive,” says Dr PN Sylaja, Professor of Neurology, and In-Charge of the Comprehensive Stroke Care Programme at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram.

Sylaja is also Global Co-Chair, South Asia, of MT 2020 (Mission Thrombectomy) and National Co-Chair, India. MT 2020 is a global campaign by the Society of Vascular Interventional Neurology that aims to accelerate worldwide access to rapid emergency mechanical thrombectomy (MT) for acute ischemic stroke.

Time is of essence

“Following a stroke, so many neurons die with each passing minute. If you want to treat a patient with a blood clot in the brain, you have at best four and a half hours for giving the clot lysing drug. But almost 30 per cent of the ischemic stroke patients have big clots in one of the main blood vessels that requires removal of clot by thrombectomy devices,” she said.

This is why time is the essence of any medical response to stroke patients. In the early part of the Covid-19 pandemic , the vital importance of managing non-communicable diseases was neglected, though neurologists had been articulating caution against it from time to time.

Separate strategy needed

But later, most of the developed countries realised that they need to focus also on non-Covid-19 diseases requiring urgent treatment. “Every major hospital should have a separate strategy by which stroke patients are received while complying with all Covid-19 protocols and managing them on time,” Sylaja says.

A survey on major hospitals in India and a report published in one of the major journals in June-July last year stated that admissions of stroke patients had reduced. Administration of the thrombolytic drug too was reduced by 60 per cent while MT (mechanical thrombectomy) procedures had trickled down to almost nil.

Better realisation now

This has changed significantly since, observes Sailaja. “There is a better realisation that we need to concentrate on stroke as well even as we fight the pandemic. In case of Covid-19, the message is ‘Stay home, keep safe’ but in case of a stroke, it is ‘please don’t stay at home.”

When a patient develops a stroke in the major blood vessels, that will produce damage to a big area of the brain since supply of blood to a large area is blocked. “If the patient has a large vessel occlusion (LVO) and if you are not able to open up the blood vessel and restore the blood supply, he/she is likely to be significantly disabled for life,” Sylaja said. But currently, there are lot of barriers to performing mechanical thrombectomy in India.

Ayushman Bharat coverage

The maximum thrombectomy procedures performed in India per year is 2,000 to 2,500 where we are supposed to do more than 20,000 to 40,000. Cost is one of the major ones curbing this number. Treatment with a clot lysing medicine costs ₹30,000-to-₹40,000. But an MT costs ₹2.5-3 lakh. Also, there are only about 200 centres in India where stroke thrombectomy can be done and most of these are in private hospitals.

Unfortunately, Ayushman Bharat does not cover mechanical thrombectomy procedures, though intravenous thrombolytic drug is available free in few of the states, Sylaja said. “We have made a request to the government to include lifesaving procedures like thrombolysis and mechanical thrombectomy in the government schemes.”

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