May 20, 2020: Dr. Ugo Paolucci was named the Stroke Director of New York Presbyterian-Lawrence Hospital in July of last year, about eight months before the coronavirus pandemic started in New York, with one of the first known cases at NYP-Lawrence Hospital.
Dr. Paolucci specializes in vascular neurology, acute stroke management, and acute cerebrovascular emergencies, training that has been invaluable during the COVID-19 outbreak.
Before the COVID-19 outbreak, Dr. Paolucci's medical practice consisted of treating patients experiencing neurological issues of all kinds. But, since the outbreak, 90% of the patients he sees have COVID-19 and are experiencing neurological problems.
He works five days a week, up to 10 hours per day at NYP-Lawrence Hosptial, and shares calls in the evenings and weekends. He and his colleague, Dr. Igor Zilberman, rotate schedules along with other neurologists to provide the 100% coverage needed.
As Dr. Paolucci explains, COVID-19 is a new disease, and doctors have been developing a better understanding of it over the past couple of months but still have much to learn. One thing they now know is that patients with COVID-19 tend to "clot more," which can put them at risk of ischemic stroke as well as pulmonary embolism. As a result, some patients with no known risk factors for stroke are having strokes.
He explains that, at this time, it's not possible to be 100% sure that the strokes that they are seeing in COVID-19 patients are a result of COVID-19 because 10 to 20 percent of typical stroke patients may have no specific cause or underlying condition at presentation. But the additional clotting that is suspected to accompany COVID-19 may be the "tipping point" for some patients that results in a stroke. Doctors won't know for sure until they have more long term data and analysis.
One of the challenges now is how to treat COVID-19 patients. Should they all be given blood thinners that slow down clotting? What are the best protocols? This is what doctors are looking at, and there are also several studies underway.
Another issue that Dr. Paolucci and his colleagues see is that some COVID-19 patients are experiencing cognitive problems after leaving the ICU and going home. These patients will continue to come back for follow up appointments to see how they are doing and whether these problems improve or continue to linger.
Dr. Paolucci said that during the peak of COVID-19, approximately 10% of the patients they saw were non-COVID-19 patients. He suspects that patients who would typically seek treatment were not comfortable coming into an emergency room because they were worried about the risks of COVID-19. This is concerning because it's likely that some people went untreated during this time.
Thankfully, the number of COVID-19 patients is how decreasing, and the more traditional patients are coming back to see their doctors. But this too is a challenge. Because of social distancing guidelines, doctors' offices can no longer operate at full capacity with patients in waiting rooms to see their doctor. As a result, some doctors are using a combination of telemedicine and in-office visits to see patients in a timely manner.
Dr. Paolucci is optimistic about COVID-19 treatments because the search and testing of potential treatments is moving at "a highly accelerated rate." He says that this unprecedented research activity to find potential treatments will likely include "a multi-faceted approach."
That being said, Dr. Paolucci says that right now, the most important thing the general public can do is follow established guidelines to "prevent infection through social distancing and wearing masks when this is not possible."
He also says that as difficult as this time has been, it has been "rewarding to help out" and heartening to now see "more patients leaving the ICU and eventually the hospital." "We have a better understanding of how to treat patients now," he says, "and this is very good news."
Finally, May 2020 is Stroke Awareness Month. The four key signs of a stroke are weakness on one side, lack of sensation, facial droop, and speech impairment. If you or a loved one is experiencing these symptoms, please call 911 or consult a doctor.
Pictured: Dr. Paolucci
Photos courtesy NYP-Lawrence Hospital