Abstract
With the rapid pace and scale of the emerging coronavirus 2019 (COVID-19) pandemic, a growing body of evidence has shown a strong association of COVID-19 with pre- and post- neurological complications. This has necessitated the need to incorporate targeted neurological care for this subgroup of patients which warrants further reorganization of services, healthcare workforce, and ongoing management of chronic neurological cases. The social distancing and the shutdown imposed by several nations in the midst of COVID-19 have severely impacted the ongoing care, access and support of patients with chronic neurological conditions such as Multiple Sclerosis, Epilepsy, Neuromuscular Disorders, Migraine, Dementia, and Parkinson disease. There is a pressing need for governing bodies including national and international professional associations, health ministries and health institutions to harmonize policies, guidelines, and recommendations relating to the management of chronic neurological conditions. These harmonized guidelines should ensure patient continuity across the spectrum of hospital and community care including the well-being, safety, and mental health of the patients, their care partners and the health professionals involved. This article provides an in-depth analysis of the impact of COVID-19 on chronic neurological conditions and specific recommendations to minimize the potential harm to those at high risk.
Highlights
Coronavirus 2019 (COVID-19), officially severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV2) [1], was declared by the World Health Organization (WHO) to have reached pandemic status on the 11th March 2020 [2]
Studies investigating the neurovirological manifestations of COVID-19 are being conducted increasingly, as growing evidence demonstrates the ability of the virus to cross the blood-brain barrier and due to involvement of angiotensinconverting enzyme 2 (ACE2) receptor [77]
The physical and emotional burnout among physicians is a major long-term concern, and symptoms of burnout such as loss of empathy should be recognized [87]. Another important consideration in the COVID-19 pandemic is the impact of adjustment disorder, acute stress disorder and post-traumatic stress disorder (PTSD) symptoms on clinicians, providers and those working in direct contact with patients
Summary
Coronavirus 2019 (COVID-19), officially severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV2) [1], was declared by the World Health Organization (WHO) to have reached pandemic status on the 11th March 2020 [2]. A triage and management protocol for chronic neurological patients presenting to the emergency in the COVID-19 period is proposed (Figure 1). A Korean study reported a prevalence of acute anosmia or ageusia in 15.3 and 15.7% in the early stage of COVID-19 and in patients with asymptomatic-to-mild disease severity, respectively [11]. Reliance on telemedicine for outpatient consultations, separation of COVID and nonCOVID patients in emergency departments (ED) and working across subspecialties are being applied [14]. Such patients and those with vascular comorbidities need to be supported so that issues such as discontinuing previous medications out of fear, canceled outpatient appointments, and general anxiety can be managed. We will critically examine the impact of COVID-19 on various neurological conditions and provide strategies and recommendations to improve patient management and reduce negative impact during the current pandemic
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