To the Editor: The COVID-19 pandemic has imposed unprecedented challenges on health-care systems to protect providers while maintaining sufficient resources to handle emergent conditions. Endovascular thrombectomy for stroke is a timesensitive life-saving procedure that involves highly-specialized units of neuroendovascular-trained interventionalists, nurses, and technologists. In this group, minimizing the exposure of providers to COVID-19 maintains emergency operations. We studied the impact of the COVID-19 pandemic on the functional capacity of neuroendovascular units in 35 centers globally,1 including regions with high (>2000 cases/1 million) or low COVID-19 prevalence (<2000 cases/1 million) between 3/1/2020 and 5/10/2020. Among 592 providers, we surveyed 113 interventionalists, 251 nurses, and 228 technologists. Elective neuroendovascular interventions were cancelled across all sites within a median of 14 d (interquartile range: 10-21) from the first case reported in the region. This delay was similar between sites of high or low COVID-19 prevalence (P > .1). Mitigation strategies to limit staff exposure included reducing the number of staff in physical proximity by dividing the teams into mutually exclusive groups, assuming all patients were COVID19 positive until proven otherwise, and using COVID-19 testing as resources permit.2-4 Despite these measures, 38% of providers were required to self-quarantine due to COVID-19 exposure or confirmed or suspected infection. This percentage was similar between high and low prevalence sites (39% vs 37%, P > .1), but with significant variability within the same prevalence class (σ = 40%). Due to the presence of mutually exclusive teams, high rates of self-quarantine did not force centers into diversion except for one site (<1 wk). The self-quarantine rate was higher in nurses (50%) and technologists (40%) compared to interventionalists (6%, P < .05). Higher relative exposure of nurses and technologists is expected given their more prolonged and more frequent physical interaction with patients. Among providers who self-quarantined, only 12% tested positive for COVID-19 using polymerase chain reaction-based testing, and were limited to high prevalence regions. A higher proportion of quarantined interventionalists tested positive for COVID-19 (28%) compared to nurses (13%) and technologists (8%) in high prevalence sites (P< .05). NoCOVID-19 infection was documented in providers in low prevalence regions during the study. We observed a strong positive correlation between the number of quarantined providers and those testing positive for COVID-19 (R2 = 0.56, P < .01), suggesting that quarantine efforts were implemented appropriately. In contrast, the correlation was weak between the prevalence of COVID-19 infection in the community and the number of providers positive for COVID-19 (R2 = 0.15) suggests that the implemented mitigation strategies have successfully prevented the outbreak from compromising the services provided by highly specialized units.

中文翻译：

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信件：对高度专业化神经介入部门 COVID-19 大流行和劳动力枯竭的国际调查——来自中风血栓切除术和动脉瘤登记处以及血管内神经外科研究小组的见解

致编辑：COVID-19 大流行给医疗保健系统带来了前所未有的挑战，以保护提供者，同时保持足够的资源来处理紧急情况。卒中血管内血栓切除术是一项时间敏感的挽救生命的手术，涉及神经血管内训练的介入医师、护士和技术人员的高度专业化单位。在该组中，最大限度地减少提供者接触 COVID-19 以维持紧急操作。我们在全球 35 个中心研究了 COVID-19 大流行对神经血管内单位功能能力的影响，包括 COVID-19 流行率高（>2000 例/100 万）或低（<2000 例/100 万）的地区。 3/1/2020 和 5/10/2020。在 592 名提供者中，我们调查了 113 名介入医师、251 名护士和 228 名技术人员。在该地区报告的第一例病例的中位时间为 14 天（四分位距：10-21）内，所有地点的选择性神经血管内介入治疗均被取消。这种延迟在 COVID-19 流行率高或低的站点之间是相似的（P > .1）。限制员工接触的缓解策略包括通过将团队划分为相互排斥的组来减少物理上接近的员工数量，假设所有患者在被证实之前均为 COVID19 阳性，并在资源允许的情况下使用 COVID-19 测试。 2-4 尽管采取了这些措施, 38% 的提供者因接触 COVID-19 或确诊或疑似感染而被要求进行自我隔离。该百分比在高流行和低流行站点之间相似（39% 对 37%，P > .1），但在同一流行类别中存在显着差异（σ = 40%）。由于存在相互排斥的团队，除了一个站点（<1 周）之外，高自我隔离率并没有迫使中心转移。与介入医师 (6%, P < .05) 相比，护士 (50%) 和技术人员 (40%) 的自我隔离率更高。鉴于护士和技术人员与患者的身体接触时间更长、更频繁，预计他们的相对接触会更高。在自我隔离的提供者中，只有 12% 的人使用基于聚合酶链反应的测试对 COVID-19 进行了阳性检测，并且仅限于高流行地区。在高流行地区，与护士 (13%) 和技术人员 (8%) 相比，被隔离的介入医生 (28%) 检测出 COVID-19 呈阳性的比例更高 (P < .05)。在研究期间，在低流行地区的提供者中没有记录到 COVID-19 感染。我们观察到被隔离的提供者数量与 COVID-19 检测呈阳性的提供者之间存在很强的正相关性（R2 = 0.56，P < .01），表明隔离工作得到了适当的实施。相比之下，社区中 COVID-19 感染的流行率与 COVID-19 呈阳性的提供者数量（R2 = 0.15）之间的相关性较弱，这表明实施的缓解策略已成功防止疫情爆发影响提供的服务高度专业化的单位。