Neurological Care and the COVID-19 Pandemic - E-Book

Ahmad Riad Ramadan, Gamaleldin Osman

• Publisher: Elsevier
• Year: 2021
• ISBN:
  9780323826921
• Topic: Medicine
• Subtopic: Neurology

Offering a comprehensive review of the neuropathology of SARS-CoV-2, Neurological Care and the COVID-19 Pandemicprovides up-to-date coverage of the wide array of the pathogen's neurological symptoms and complications. Drs.Ahmad Riad Ramadan andGamaledinOsmandiscussthe neuropathology of SARS-CoV-2, its neurological manifestations, and the impact the pandemic has had on the care of patients with pre-existing neurological conditions. The authors also offer an overview of emerging treatments and vaccines, as well as ways healthcare systems have reorganized in order to respond to the pandemic.

• Offers a thorough discussion of the impact the virus has had on the care of patients with neurological ailments, accompanied by recommendations on how to care for these patients.
  
  

• Covers the impact of COVID-19 on patients with cerebrovascular diseases, seizures, demyelinating diseases, neuromuscular disorders, movement disorders, headache disorders, cognitive disorders, and neuro-oncological disorders.
  
  

• Includes a detailed case study of how one healthcare system hit hard by COVID-19 successfully transformed itself to respond to the challenges imposed by the pandemic.
  
  

• Consolidates today's available information on this timely topic into a single, convenient resource.
  
  

Chapter 1: Fears and Hopes

Ahmad Riad Ramadan^a; Gamaleldin Osman^{b,c a} Neurologist, Stroke and Neurocritical Care, Henry Ford Neuroscience Institute, Henry Ford Hospital, Detroit, MI, United States
^b Mayo Clinic Comprehensive Epilepsy Center, Neurology Department, Rochester, MN, United States
^c Epilepsy fellow at Mayo Clinic Hospital, Assistant Professor of Neurology, Mayo School of Medicine, Rochester, MN, United States

Abstract

COVID-19 has been on every human’s mind and lips for the past year, as it has undeniably transformed health care and social living, and disturbed the economy on a planetary scale. This novel disease, the product of a relative of SARS-CoV, saw the light in Wuhan, China and, with fulgurant speed, reached all continents in a matter of weeks. “Unprecedented” is a word that saw a revival with COVID-19. The 21st-century virus has brought death, unemployment, and social isolation to an extent unparalleled by any other pandemic. It has crippled health-care systems worldwide, overwhelming all tiers of hospital resources, from personnel to equipment, therapies, and beds. Yet despite the mayhem, a formidable international mobilization of researchers, pharmaceutical companies, policy makers, health officials, and health-care workers has been tirelessly working to contain the spread and eradicate the virus. New vaccines, some with novel, never-marketed-before mechanisms yield the promise of better days ahead and are paving the way to a new era in vaccine development.

This book is intended for the probing creature within us, curious to learn how SARS-CoV-2 extends its damaging effects to the nervous system. Produced by a team of experts in the fields of neurology, infectious diseases, and pharmacology, this work details the neurological symptomatology and pathophysiology of COVID-19, and explains how the pandemic has impacted the care of patients with neurological conditions. Much remains to be learned about the acute manifestations and long-term ramifications of the coronavirus on the nervous system, and therefore this manual should be considered as an initial framework for future iterations.

Keywords

Epidemiology; Timeline; Zoonosis; Transmissibility; Social policies; Social distancing; Confinement; Economy; Testing; Vaccines

A Novel Virus Sees the Day

China awoke on December 31, 2019 to the first public message from the Wuhan Municipal Health Commission alerting its residents of a cluster of 27 cases of viral pneumonia of unknown etiology that had emerged in Wuhan, capital of the Hubei province and home to over 11 million people.¹ The news reached the US Centers for Disease Control and Prevention (CDC) later that day. Four days later, the genomic sequence of the new respiratory virus was established by the Chinese National Institute of Viral Disease Control and Prevention (NIVDC), which isolated the pathogen from patients in Wuhan and named it novel coronavirus, or 2019-nCoV. The sequence was posted on the NIH genetic sequence database, GenBank, on January 13, 2020.² On that day, the first case outside of China was confirmed in Thailand, and a week later the United States in turn reported its first case.^{3, 4} On February 11, the International Committee on Taxonomy of Viruses (ICTV) rebaptized the virus SARS-CoV-2 due to the similarity of its genetic sequence with the virus responsible for the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. That same day, the World Health Organization (WHO) named the disease produced by SARS-CoV-2, COVID-19, an acronym which stands for Coronavirus Disease 2019.⁵ By mid-February 2020, the global death toll had surpassed the one thousand mark, exceeding the fatalities caused by the SARS and Middle East Respiratory Syndrome (MERS) epidemics (774 and 866 lives, respectively; Fig. 1.1).⁶ The WHO eventually declared the outbreak a global pandemic on March 11, 2020, 6 weeks after its designation of “public health emergency of international concern.”⁷

Fig. 1.1 Comparison of pandemics’ death tolls throughout history. (Modified from LePan N. Visualizing the History of Pandemics. Visual Capitalist. https://www.visualcapitalist.com/history-of-pandemics-deadliest/; 2021 Accessed March 5, 2021.)

Origins and Zoonotic Transmission of SARS-CoV-2

Coronaviruses belong to the Coronaviridae family of single-stranded RNA viruses. They owe their name to their characteristic appearance under electron microscopy: a viral envelope with petal-like spike projections, akin to the solar corona. Coronaviruses are divided into four main genera based on their genomic characteristics: Alphacoronavirus, Betacoronavirus, Gammacoronavirus, and Deltacoronavirus. The first two genera are known to infect mammals (including humans), while the last two predominantly infect birds along with pigs. There are currently seven known human coronaviruses that have been recognized since the 1960s. Three of them, MERS-CoV, SARS-CoV, and the novel SARS-CoV-2, are beta-coronaviruses and are credited with large outbreaks and the ability to produce severe respiratory and extrapulmonary symptoms. The other four, HCoV-NL63 and HCoV-229E of the Alphacoronavirus genus, and HCoV-OC43 and HCoVHKU1 of the Betacoronavirus genus, however, usually only cause a mild upper respiratory tract illness.

Phylogenetic genomic analyses of isolated SARS-CoV-2 virions confirm the zoonotic nature of viral transmission to humans. These analyses have revealed a high degree of similarity with the genomes of horseshoe bat coronaviruses, making bats of the Rhinolophus genus the most likely primary reservoir for the novel coronavirus. Specifically, SARS-CoV-2 shares 96.2% of its genomic identity with the BatCoV-RaTG13 strain,^{8, 9} and 87%–88% with the bat-SL-CoVZC45 and bat-SL-CoVZXC21 strains.¹⁰ There is less similarity with the genome of SARS-CoV (79%) and even less with that of MERS-CoV (50%).¹⁰ Interestingly, while the whole genome of SARS-CoV-2 is closest to that of bat coronaviruses, the receptor-binding domain (RBD) of the spike protein responsible for the docking of the virion particle to the angiotensin-converting enzyme 2 (ACE2) receptor on human cells (Chapter 2) is closest to that of a SARS-like coronavirus isolated from dead Malayan pangolins smuggled into the Guangdong province of China.^{9, 11} One of the posited putative mechanisms for the origin...