#15,468Within the first few months of COVID-19's arrival it became apparent that the SARS-CoV-2 virus was producing a high morbidity - low mortality pandemic; several times deadlier than than seasonal flu, but not as lethal as would be expected from MERS-CoV, SARS, or avian H5N1, H5N6, or H7N9.
Hospitalized patients often required weeks of medical care before being discharged, and a significant number of `recovered' patients continue to battle lingering - and sometimes permanent - health issues.
We've seen ample evidence that the SARS-CoV-2 virus provokes far more than just a respiratory disease (see Nature Med. Review: Extrapulmonary manifestations of COVID-19), and reports of cardiac, renal, pulmonary, and neurological impacts are increasingly common.
In early July, Dr. Anthony Fauci expressed concerns that many COVID patients are suffering from a post-viral syndrome - similar to ME/CFS - which has disabled and traumatized well over a million Americans over the past 3 decades (see NIH About CFS/ME).
The long-term public health legacy of this pandemic is uncertain, but over the past few months we've seen cardiologists and neurologists weigh in on the potential for seeing huge increases in COVID-19 related heart failure and neurological diseases, some that may not become fully apparent for years.
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
Emily A. Troyer, Jordan N. Kohn, and Suzi Hong
Although a causal link to the 1918 H1N1 pandemic virus has not been established, many researchers believe these neurological epidemics of the 1920s were caused by either a viral infection or the body's immune response to an infection (see Nature Comms: Revisiting The Influenza-Parkinson's Link).
While there are relatively simple medical tests to detect diminished cardiac, lung, or renal function, the same can not be said for pre-clinical Parkinsonism (a group specific neurological disorders, which includes Parkinson's Disease).
It may take years before we can fully appreciate COVID's ultimate impact on neurological health.
All of which brings us to a Review Article, published yesterday in the Journal of Parkinson's Disease, that looks at the parallels between COVID-19 and epidemics of the past, and the potential for seeing a new wave of neurological disorders.
This is a lengthy, and quite detailed review. I've only posted the link and a brief excerpt from the abstract, you'll want to follow the link to read it in its entirety. I've also included a link, and some excerpts, from a press release.
Authors: Beauchamp, Leah C.a; b | Finkelstein, David I.a | Bush, Ashley I.a; c | Evans, Andrew H.d | Barnham, Kevin J.a; b; c; *
Correspondence: [*] Correspondence to: Kevin J. Barnham, PhD, Florey Institute of Neuroscience and Mental Health, Parkville, Australia. E-mail: email@example.com.
Keywords: Parkinson’s disease, parkinsonism, COVID-19, SARS-CoV-2
Journal: Journal of Parkinson's Disease, vol. Pre-press, no. Pre-press, pp. 1-11, 2020
Accepted 27 August 2020 | Published: 22 September 2020
Since the initial reports of COVID-19 in December 2019, the world has been gripped by the disastrous acute respiratory disease caused by the SARS-CoV-2 virus. There are an ever-increasing number of reports of neurological symptoms in patients, from severe (encephalitis), to mild (hyposmia), suggesting the potential for neurotropism of SARS-CoV-2.
This Perspective investigates the hypothesis that the reliance on self-reporting of hyposmia has resulted in an underestimation of neurological symptoms in COVID-19 patients. While the acute effect of the virus on the nervous system function is vastly overshadowed by the respiratory effects, we propose that it will be important to monitor convalescent individuals for potential long-term implications that may include neurodegenerative sequelae such as viral-associated parkinsonism.
As it is possible to identify premorbid harbingers of Parkinson’s disease, we propose long-term screening of SARS-CoV-2 cases post-recovery for these expressions of neurodegenerative disease.
An accurate understanding of the incidence of neurological complications in COVID-19 requires long-term monitoring for sequelae after remission and a strategized health policy to ensure healthcare systems all over the world are prepared for a third wave of the virus in the form of parkinsonism.
Something to seriously consider when deciding how rigorously to follow social distancing and other NPI recommendations this fall and winter.