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The neurological impact of COVID-19

Presented by
Dr Anthony Fauci (National Institute of Allergy and Infectious Diseases, USA) & Dr Walter Koroshetz (National Institute of Neurological Disorders and Stroke, USA)
AAN 2021
In a special hot-topics session at the AAN 2021 meeting, top experts Dr Anthony Fauci and Dr Walter Koroshetz provided an update on the neurological implications of COVID-19. Dr Fauci is director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to the US President; Dr Koroshetz is director of the National Institute of Neurological Disorders and Stroke.

The wide variation in response to COVID-19 infection is one of the most puzzling and unprecedented aspects of this disease, according to Dr Fauci [1]. He could only guess at possible explanations, such as underlying pre-existing immunity, or the density of ACE2 receptors in the nasopharynx and the lungs. He called this “one of the most exciting areas of research”. Dr Fauci also stressed that the pandemic has highlighted “very disturbing health disparities” in the US. People of colour have a higher rate of infection, but they also suffer more severe consequences as a result of having more comorbidities. The Biden administration has taken measures to improve access of minorities to vaccination.

Can vaccinated people still transmit the virus? Due to the relatively low levels of virus in the nasopharynx of vaccinated people, Dr Fauci deemed this unlikely. He said a study on college campuses will assess this question. If the answer is negative, people who are vaccinated will not have to worry about wearing a mask. Asked about advances in treatment, Dr Fauci said that monoclonal antibodies and convalescent plasma are most valuable in an early stage of the infection. He added that dexamethasone is a “life saver”, effectively decreasing 28-day mortality. However, Dr Fauci thinks the future belongs to targeted antiviral therapy, to be administered when symptoms emerge, to prevent hospitalisation.

Dr Koroshetz addressed safety issues of COVID-19 vaccines [1]: “The question of vaccines and different neurological conditions has been studied over the years. We don't have any real concerns about the COVID-19 vaccine being any different.” He observed that COVID-19 does not appear neurotropic, even though it infiltrates nasal mucosa. Whether the virus invades the brain is controversial. What it certainly can do, is affect vital systems that support the brain, which for example may result in encephalopathy, delirium, acute necrotising encephalitis, and transverse myelitis.

Also in want of more research is the chronic fatigue syndrome after infection, officially known as 'post-acute sequelae of SARS-CoV-2’ (PASC). Possible symptoms include fatigue, memory and attention problems, dysautonomia, postural orthostatic tachycardia, sleep disorder, and pain syndromes. Dr Koroshetz observed that the percentage of COVID-19 patients who develop PASC may be below 10%, but that this is still a huge number of people.

  1. Hot topics: Neuro-COVID plenary session. COVID-19 Keynote Address. AAN 2021 Virtual Congress, 17-22 April.

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