The Neurology and Neuropsychiatry of COVID-19

Evidence on the neurological and neuropsychiatric manifestations and complications of COVID-19 infections is emerging and this is likely to accelerate as the pandemic develops and clinical syndromes are detected, characterized and their mechanisms investigated. This published research database is listed by topic in order of date of publication. 

To date and of interest to the AE community, conditions COVID-19 has triggered are: Guillain-Barré Syndrome (GBS), Encephalopathy, Encephalitis, Meningoencephalitis, Psychiatric, Epilepsy, ADEM and acute myelitis. 

 

COVID-19 NEUROLOGY RESOURCE CENTER

Neurology Colleagues:  You can count on the American Acadamy of Neurology (AAN) to provide you with expert guidance on the care of neurology patients affected by COVID-19, as well as timely news on how this pandemic is affecting the field of neurology overall. Please visit this page often for continuous updates.

LATEST COVID-19 ARTICLES, VIDEOS, AND PODCASTS

Stay healthy. Stay strong.

 

SARS-CoV-2 Infection Rate 16% in Asymptomatic Pregnant Women at Delivery

 

In all, researchers screened 158 patients with a planned delivery, and 155 agreed to undergo COVID-19 testing. Of the 155 women tested, 24 (16%) tested positive for SARS CoV-2 infection. Among 146 support persons who had a negative interview screen and underwent SARS-CoV-2 testing, 14 (10%) tested positive for SARS-CoV-2 infection.

Test results were substantially concordant among patient and support person pairs. “Among patients who tested positive for COVID-19 infection and had a support person present, 11 of 19 (58%) support persons also tested positive for COVID-19 infection,” the authors reported. “Among patients who tested negative for COVID-19 infection and had a support person present, only 3 of 127 (2.4%) support persons tested positive for COVID-19 infection.”

 

 

Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report

Anti N-Methyl-D aspartate (NMDA) receptor (anti-NMDAR) encephalitis is one of the most common types of autoimmune encephalitis with its clinical presentation characterized by simultaneous presentation of neurological and psychiatric symptoms, the latter miming schizophrenia and psychotic spectrum disorders or substance induced psychosis. The importance of this case study is due to the probability that COVID-19 leads to neurological damage, an indirect pathway involving the immune system. Interleukin (IL)-6, an important member of the cytokine storm, is positively correlated with the severity of Coronavirus symptoms. Additional experiments have confirmed that primary glial cells cultured in vitro secrete a large amount of inflammatory factors including IL-6, IL-12, IL-15 and TNF-alpha after being infected with SARS-CoV-2. This data suggests that the activation of immune cells in the brain may cause inflammation and brain damage.

 

COVID-19 patients having known psychiatric disorders should be monitored closely for neurologic manifestations including headache, dizziness, and symptoms, changes in mental status, meningeal signs, dyskinesias. Patients with severe infection may be at greater risk for developing neurological sequelae and increased mortality. Furthermore, SARS-CoV-2 infection should be considered as a differential diagnosis in psychiatric patients with presentation of sudden onset symptoms including respiratory distress and other Covid-19 related symptoms to avoid wrong or delayed diagnosis

Psychosis spike linked to effect of coronavirus

Dozens of patients across Scotland have been treated for psychosis in recent weeks, as evidence mounts that the coronavirus pandemic can trigger mental illness.

A UK-wide surveillance programme suggests that some patients infected with Covid-19 suffer “altered mental states” such as psychosis and encephalitis, an inflammation of the brain that can cause seizures and hallucinations.

About 400 cases have been flagged to the project, known as CoroNerve, in the past month. Behind a stroke, psychosis has emerged as the second most common condition linked to the virus, affecting about one in three patients.

COVID-19 Data Dives: Airborne Transmission Increases With Crowding

Reviews two studies and illustrates the value of distancing (ie, avoiding crowding).

Even if the airborne transmission can happen, it doesn’t mean that it is the dominant mode of transmission or the major contributor to dynamics. The evidence we have now is still that close contacts are the most important. I will revisit this as the evidence evolves.

Respiratory virus shedding in exhaled breath and efficacy of face masks

We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis

We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for the treatment of COVID-19.

Neurological Manifestations of COVID-19 and Other Coronavirus Infections: A Systematic Review

Highlights

Neurological manifestations has been reported in SARS-CoV2 infection recently.

SARS-CoV2 could spread to the brain hematogenously or through the cribriform plate.

Neurological symptoms can be due to systemic illness or viral invasion of the CNS.

UK-wide surveillance of neurological and neuropsychiatric complications of COVID-19: The first 153 patients

This is the first nationwide, cross-specialty surveillance study of acute complications of COVID-19 in the nervous system. Alteration in mental status was common, reflecting encephalopathy/encephalitis and primary psychiatric diagnoses, often in young patients.

These data provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy throughout the areas of neurology and neuropsychiatry

Convalescent plasma in Covid-19: Possible mechanisms of action

Highlights:  Coronavirus disease 19 (COVID-19) is an emerging viral threat with major repercussions for public health.

There is not specific treatment for COVID-19.

Convalescent plasma (CP) emerges as the first option of management for hospitalized patients with COVID-19.

Transference of neutralizing antibodies helps to control COVID-19 infection and modulates inflammatory response.

Other plasma components may enhance the antiviral and anti-inflammatory properties of CP. 

Children are falling sick with a rare mystery inflammatory syndrome linked to Coronavirus

The new condition that’s being linked to COVID-19 got an official name this week: pediatric multisystem inflammatory syndrome.

Children and teens with the rare but potentially dangerous complication have been identified in at least seven states and the Washington, D.C., area as well as some parts of Europe. The condition can resemble features of other inflammatory illnesses like the Kawasaki Disease and toxic shock-like syndrome.

Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected,” she said. Dr. John revealed that “the feature that’s been most concerning is that they have problems with their heart function.”

Dr. John added: “In general, families do not need to worry about this. I doubt that this is really new. I think it’s just really newly recognized. I hope what comes of this is that, because we’re seeing more cases, it will not take long before we will be better at recognizing this and treating it.”

Immunomodulation in COVID-19

Here, we expand on the theoretical basis of IL-6 inhibition and propose potential benefits from other immunomodulators that could, in theory, prove more efficacious.

 

As insight is gained into the clinical phenotypes associated with COVID-19, we propose JAK and IL-1 inhibitors as therapeutic targets warranting rapid investigation. Multidisciplinary collaboration with experts in haematology, inflammation, tissue damage, and repair and resolution is paramount.

Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children.

Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged.

Rapid development of an inactivated vaccine candidate for SARS-CoV-2

We developed a pilot-scale production of a purified inactivated SARS-CoV-2 virus vaccine candidate (PiCoVacc), which induced SARS-CoV-2-specific neutralizing antibodies in mice, rats and non-human primates. These antibodies neutralized 10 representative SARS-CoV-2 strains, suggesting a possible broader neutralizing ability against SARS-CoV-2 strains. Three immunizations using two different doses (3 μg or 6 μg per dose) provided partial or complete protection in macaques against SARS-CoV-2 challenge, respectively, without observable antibody-dependent enhancement of infection. These data support clinical development of SARS-CoV-2 vaccines for humans.

FDA Authorizes Emergency Use of Remdesivir for COVID-19

The FDA writes, “Based on evaluation of the emergency use authorization criteria and the scientific evidence available, it was determined that it is reasonable to believe that remdesivir may be effective in treating COVID-19, and that, given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus currently outweigh the known and potential risks of the drug’s use.”

Neurons promote encephalitogenic CD4 + lymphocyte infiltration in experimental autoimmune encephalomyelitis

To our knowledge, we for the first time adopted inhibitory DREADD and a migration assay using embryonic cerebral cortex neurons with CD4+ T cells. This methodology will pave a new way to investigate the pathophysiological role of excitatory neurons in EAE.

'Hypercoagulation,' Antiphospholipid Antibodies Seen in COVID-19

Researchers from China describe three patients admitted to the intensive care unit (ICU) with confirmed SARS-CoV-2 infection, severe COVID-19, and clinically significant coagulopathy, antiphospholipid antibodies, and multiple cerebral infarcts.

“Antiphospholipid antibodies abnormally target phospholipid proteins, and the presence of these antibodies is central to the diagnosis of the antiphospholipid syndrome.

Why Some People Get Sicker Than Others

Personal storytelling of COVID-19 cases. Includes a podcast and overview of clinical trials for therapies. An easy and worthwhile read for the layperson. 

Sudden Loss of Taste and Smell Should Be Part of COVID-19 Screen

In her survey of patients who presented to UC San Diego Health for SARS-CoV-2 testing, Yan and colleagues reported that 68% (40 of 59) of COVID-19-positive patients reported olfactory impairment and 71% (42 of 59) reported taste impairment.

“Based on our study, if you have smell and taste loss, you are more than 10 times more likely to have COVID-19 infection than other causes of infection. The most common first sign of a COVID-19 infection remains fever, but fatigue and loss of smell and taste follow as other very common initial symptoms,” said Yan.

More Evidence Supports COVID-19/Guillain-Barré Link

Five more cases of  Guillain–Barré syndrome (GBS) in association with COVID-19 have been identified, further supporting a link between the virus and neurologic complications, including GBS.

Three of the patients developed a demyelinating form of GBS; the other two had findings generally consistent with an axonal variant. All five patients received intravenous immune globulin treatment.

Hydroxychloroquine for COVID-19: What's the Evidence?

The bottom line is that we don’t need to abandon evidence-based medicine in the face of the pandemic. We need to embrace it more than ever. But in that embrace, we need to realize what we’ve known all along: Evidence-based medicine is not just about randomized trials; it’s about appreciating the strengths and weaknesses of all data, and allowing the data to inch us closer and closer toward truth.

Remdesivir Prevents Disease Progression in Monkeys With COVID-19

Early treatment with the experimental antiviral drug remdesivir significantly reduced clinical disease and damage to the lungs of rhesus macaques infected with SARS-CoV-2, the coronavirus that causes COVID-19, according to National Institutes of Health scientists.

Twelve hours after the initial treatment, the scientists examined all animals and found the six treated animals in significantly better health than the untreated group, a trend that continued during the seven-day study.

The investigators note that the data supports initiating remdesivir treatment in COVID-19 patients as early as possible to achieve maximum treatment effect. “This finding is of great significance for patient management, where a clinical improvement should not be interpreted as a lack of infectiousness,” they write.

Imaging Recommendations Issued for COVID-19 Patients

  • Recommendations: Imaging is indicated for patients with features of moderate to severe COVID-19 regardless of COVID-19 test results.

  • Imaging is indicated for patients with COVID-19 and evidence of worsening respiratory status.

  • When access to CT is limited, chest radiography may be preferred for COVID-19 patients unless features of respiratory worsening warrant using CT.

  • Additional recommendations: Daily chest radiographs are not indicated in stable, intubated patients with COVID-19.

  • CT is indicated in patients with functional impairment, hypoxemia, or both, after COVID-19 recovery.

  • COVID-19 testing is warranted in patients incidentally found to have findings suggestive of COVID-19 on a CT scan.

COVID-19: First Data Confirm Neurologic Symptoms Common

Investigators based in Wuhan, China, analyzed data from more than 200 adult patients with COVID-19 and found that 36.4% had neurologic manifestations. In addition, close to half of those with severe disease had neurologic symptoms, compared to roughly one-third of those with less severe disease.

Nervous system manifestations of COVID-19 were “significantly more common” in severe versus nonsevere infection.

The public and medical personnel alike need to be aware that there may be neurological manifestations of COVID-19 and such symptoms indicate a need for prompt medical attention.

COVID-19: Exercise may protect against deadly complication

Regular exercise may reduce the risk of acute respiratory distress syndrome, a major cause of death in patients with the COVID-19 virus, a top exercise researcher reports. He is urging people to exercise based on his findings, which also suggest a potential treatment approach.

Hydroxychloroquine for COVID-19 Study Did Not Meet 'Expected Standard'

The paper that appears to have triggered the Trump administration’s obsession with hydroxychloroquine as a treatment for infection with the novel coronavirus has received a statement of concern from the society that publishes the journal in which the work appeared.

 Elisabeth Bik took a close look at the IJAA article and detailed a long list of serious problems with the study, including questions about its ethical underpinnings, messy confounding variables, missing patients, rushed and conflicted peer review, and confusing data.

COVID-19:Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism

This paper  explains the action of the virus from a hematological point of view, meaning that the severe hypoxia is because of the desaturation in oxygen of the red blood cells being attacked by the virus and not because of pulmonary inflammation.

A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2

Highlights

Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly.
This is the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance.
The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF.
This case warns the physicians of patients who have CNS symptoms.

Responding to stress experienced by hospital staff working with Covid-19

Drawing on research, best practice guidelines and expert clinical opinions, the COVID Trauma Response Working Group has created rapid guidance for planners putting in place psychological support for staff in the early stages of dealing with the Covid-19 outbreak.

Download Graphic here https://www.kingsfund.org.uk/sites/default/files/2020-04/rapid-guidance-stress-diagram.pdf 

The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection

April 10-2020  In these 214 patients, they report 36.4% had some nervous system-related clinical finding.1 These neurologic manifestations ranged from fairly specific symptoms (eg, loss of sense of smell or taste, myopathy, and stroke) to more nonspecific symptoms (eg, headache, depressed level of consciousness, dizziness, or seizure).1 Whether these more nonspecific symptoms are manifestations of the disease itself or consistent with a systemic inflammatory response in patients who were quite ill will need to be defined in future studies. Importantly, the authors found that patients in their series with some of the more common specific symptoms, including smell or taste impairment and myopathy, tended to have these symptoms early in their clinical course; this appears to be quite distinct from SARS, where manifestations appeared quite late in established disease. 

Coronavirus disease 2019 has now reached pandemic status and is common all over the world; thus, with so many affected patients, we can expect as neurologists to be confronted with these patients commonly in coming months and years.

Many Children With COVID-19 Don't Have Cough or Fever

The characteristic COVID-19 symptoms of cough, fever, and shortness of breath are less common in children than adults, according to the Centers for Disease and Prevention Control.

Among pediatric patients younger than 18 years in the United States, 73% had at least one of the trio of symptoms, compared with 93% of adults aged 18-64, noted Lucy A. McNamara, PhD, and the CDC’s COVID-19 response team, based on a preliminary analysis of the 149,082 cases reported as of April 2.

Neurologic Symptoms and COVID-19: What's Known, What Isn't

Since the Centers for Disease Control and Prevention (CDC) confirmed the first US case of novel coronavirus infection on January 20, much of the clinical focus has naturally centered on the virus’ prodromal symptoms and severe respiratory effects.  

However, US neurologists are now reporting that COVID-19 symptoms may also could include encephalopathy, ataxia, and other neurologic signs. 

Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know

The looming public health crisis for people with rheumatic diseases who will be unable to obtain HCQ is the result of a perfect storm of fear and dissemination of overpromised data. However, there is still time to mitigate the damage. Physicians should educate themselves about the strength of available data regarding HCQ and CQ in treating COVID-19. They should avoid misuse of HCQ and CQ for the prophylaxis of COVID-19, because there are absolutely no data to support this. Public figures should refrain from promoting unproven therapies to the public, and instead provide clear messages around the uncertainties we face in testing and using experimental treatments during the current pandemic, including the risk for serious adverse events. Well-done, randomized clinical trials should be performed urgently to test potential therapies, including HCQ. In the meantime, physicians should remember that first, we must do no harm to the patients with rheumatic disease for whom high-quality evidence shows that HCQ improves health.

Risk Factors for Death From COVID-19 Identified in Wuhan Patients

Nonsurvivors compared with survivors had higher frequencies of respiratory failure (98% vs 36%), sepsis (100%, vs 42%), and secondary infections (50% vs 1%).

The average age of survivors was 52 years compared to 69 for those who died. Liu cited weakening of the immune system and increased inflammation, which damages organs and also promotes viral replication, as explanations for the age effect.

From the time of initial symptoms, median time to discharge from the hospital was 22 days. Average time to death was 18.5 days.

The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro

Highlights: 

Ivermectin is an inhibitor of the COVID-19 causative virus (SARS-CoV-2) in vitro.

A single treatment able to effect ∼5000-fold reduction in virus at 48h in cell culture.

Ivermectin is FDA-approved for parasitic infections, and therefore has a potential for repurposing.

Ivermectin is widely available, due to its inclusion on the WHO model list of essential medicines.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.

Coronavirus survivors' plasma could save lives

This paper: The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study

Two independent research studies have shown the benefit of receiving infusions of blood from COVID-19 survivors.

The teams – both based in China – extracted blood plasma from patients who had recovered from COVID-19, which contained antibodies against the disease. The first study from the National Engineering Technology Research Center for Combined Vaccines in Wuhan   gave plasma to 10 patients who were severely ill with COVID-19. Six days after receiving the infusion, the COVID-19 virus was undetectable in seven of the 10 patients.

 

Hydroxychloroquine: Possible COVID Drug Can Be Toxic to Retinas

Comorbidities Increase Likelihood of Retinal Toxicity

While a detailed patient history may be impossible to obtain if HCQ is used in the treatment of COVID-19, certain comorbidities do place patients at an increased risk for retinal toxicity. HCQ is excreted through renal clearance, so the dosage should be reduced in those with compromised kidney function to minimize the risk for toxicity. The presence of macular disease, such as age-related macular degeneration, has also been demonstrated to be a risk factor for the development of toxic maculopathy. The concurrent use of tamoxifen also increases the risk for retinal toxicity. Tamoxifen itself may deposit in the retina and make the macula more susceptible to the potentially toxic effects of HCQ.

'No Complacency' on COVID-19 After Death of 13-Year-Old-Boy

April-1-2020 

“It is essential that we undertake research to determine why a proportion of deaths occur outside of the groups expected to succumb to infection as it may indicate an underlying genetic susceptibility of how the immune system interacts with the virus.

“Determining if this is the case could help us to learn more about the interaction of the virus with the immune system and subsequently what further treatments may be suitable in patients with severe infection.”

Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms

Autopsies of the COVID-19 patients, detailed neurological investigation, and attempts to isolate SARS-CoV-2 from the endothelium of cerebral microcirculation, cerebrospinal fluid, glial cells, and neuronal tissue can clarify the role played by this novel COVID-19 causing coronavirus in the ongoing mortalities as has been in the recent outbreak.

A dominant cerebral involvement alone with the potential of causing cerebral edema in COVID-19 can take a lead in causing death long before systemic homeostatic dysregulation sets in. 

Also, a staging system based on the severity and organ involvement is needed in COVID-19 in order to rank the patients for aggressive or conventional treatment modalities.

COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurologic Conditions in Patients with the Coronavirus

There are some recent data suggesting that COVID-19 virus also reaches the central nervous system. Neurological symptoms in patients with COVID-19 infection fall into three categories: neurological expressions of the symptoms of the underlying disease (headache, dizziness, disturbances of the state of consciousness, ataxia, epileptic manifestations, and stroke;) symptoms of neuro-peripheral origin (hypo-ageusia, hyposmia, neuralgia;) symptoms of skeletal muscle damage, often associated with liver and kidney damage.” 

Australia's Trialing a TB Vaccine Against COVID-19, And Health Workers Get It First

Australian researchers are fast-tracking large-scale human testing to see if a vaccine used for decades to prevent tuberculosis can protect health workers from COVID-19. 

Similar trials are being conducted in several other countries including the Netherlands, Germany and the United Kingdom.

“This trial will allow the vaccine’s effectiveness against COVID-19 symptoms to be properly tested, and may help save the lives of our heroic frontline healthcare workers,”

Acute disseminated encephalomyelitis after SARS-CoV-2 infection

We report a rare case of an immune-mediated CNS disease that occurs after SARS-CoV-2 infection. Phenotypically, the disease resembled an atypical form of neuromyelitis optica spectrum disorder; however, (1) the hyperacute dynamic of the disease, (2) the presence of multiple, synchronous, enhancing brain lesions, (3) the lack of anti-AQ4 or anti-MOG abs, (4) the absence of longitudinally extended transverse myelitis, and (5) the presence of a viral infection preceding the development of neurologic symptoms do not support this hypothesis, favoring ADEM diagnosis.

Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019 A Review

Published – May 29, 2020

This review serves to summarize available information regarding coronaviruses in the nervous system, identify the potential tissue targets and routes of entry of SARS-CoV-2 into the central nervous system, and describe the range of clinical neurological complications that have been reported thus far in COVID-19 and their potential pathogenesis.

The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported.

The understanding of neurologic disease in patients with COVID-19 is evolving, and clinicians should continue to monitor patients closely for neurological disease. Early detection of neurological deficits may lead to improved clinical outcomes and better treatment algorithms

COVID-19—White matter and globus pallidum lesions Demyelination or small-vessel vasculitis?

Besides demyelination, the associated punctiform lesions might be consistent with ischemic lesions because of small-vessel vasculitis. SARS-CoV-2 infects the host using the angiotensin-converting enzyme 2 receptor that is expressed in several organs, especially in endothelial cells. Recently, Varga et al.7 have showed direct viral infection of the endothelial cell and diffuse endothelial inflammation. This endothelial dysfunction can lead to vasoconstriction and break of the blood-brain barrier with cerebral ischemia and inflammation. Although mechanisms remain obscure, our case shows the importance of the MRI in the exploration of neurologic symptoms in COVID-19. Demyelination or small-vessel CNS vasculitis might be a rare but silent complication of sedated patients with COVID-19.

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

Key Points

Question:  What are the characteristics, clinical presentation, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the US?

Findings  In this case series that included 5700 patients hospitalized with COVID-19 in the New York City area, the most common comorbidities were hypertension, obesity, and diabetes. Among patients who were discharged or died (n = 2634), 14.2% were treated in the intensive care unit, 12.2% received invasive mechanical ventilation, 3.2% were treated with kidney replacement therapy, and 21% died.

Meaning  This study provides characteristics and early outcomes of patients hospitalized with COVID-19 in the New York City area.

Conjunctivitis Can Be Sole Covid-19 Symptom

Acute, non-remitting conjunctivitis may be the only presenting symptom of Covid-19 infections in some instances, according to case reports on five patients in Italy.

Because these patients were treated during the current SARS-CoV-2 pandemic, they also inquired about recent travels and discovered that all five of the patients had recently traveled to Lombardy, a Covid-19 hotspot. None had fever, respiratory symptoms, or other symptoms of Covid-19.

Still, tests performed using naso-pharyngeal swabs were done for all five patients, and all five came back positive for SARS-CoV-2.

MedTech FDA names 28 antibody tests to be taken off the market

The FDA changed its policy May 4, giving test makers with active products 10 days to submit applications for review. The agency said it expects its list of removed products to be updated in the future. 

“Our action today is an important step the agency has taken to ensure that Americans have access to trustworthy tests,” FDA Commissioner Stephen Hahn, M.D.

To date, 12 antibody tests have passed the FDA’s emergency authorization process, while the agency works with the National Institutes of Health and the Centers for Disease Control and Prevention to independently validate certain serology tests.

Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial

The first human trial of COVID-19 vaccine finds it is safe and induces  rapid immune response. Phase 1 human trial of a COVID-19 vaccine called Ad5-nCoV shows that it is safe, well-tolerated, and able to generate an immune response against SARS-CoV-2 in participants. 

The trial demonstrates that a single dose of the new vaccine produces virus-specific antibodies and T cells in 14 days, making it a potential candidate for further investigation. 

Steroid-responsive Encephalitis in Covid-19 Disease

Here we described the case of a 60-year old subject with SARS-CoV-2 infection but only mild respiratory abnormalities who developed an akinetic mutism due to encephalitis. MRI was negative whereas EEG showed generalized theta slowing. CSF analyses during the acute stage were negative for SARS-CoV-2, positive for pleocytosis and hyperproteinorrachia, and showed increased IL-8 and TNF-α concentrations while other infectious or autoimmune disorders were excluded. A progressive clinical improvement along with a reduction of CSF parameters was observed after high-dose steroid treatment, thus arguing for an inflammatory-mediated brain involvement related to Covid-19.

Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic

Interpretation

If infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term.

Trending Clinical Topic: Kawasaki Disease and COVID-19

UK pediatricians have published a working definition of the inflammatory syndrome. No one sign or symptom can be used to identify the children who are affected, and they may or may not test positive for COVID-19. See Image at top of page.

New Focus on Renin-Angiotensin System Role in COVID-19

“As we believe the renin–angiotensin system is being over-activated by the virus, this could also explain why patients with underlying cardiovascular diseases are having worse outcomes and would suggest that taking an ACE inhibitor or ARB would actually be protective.” 

On the influenza study, Oudit said: “The influenza virus may well also activate the renin–angiotensin system. That study suggests that ACE inhibitors and ARBs may be protective here as well.”

Early Safety Indicators of COVID-19 Convalescent Plasma in 5,000 Patients

Background: Convalescent plasma is the only antibody-based therapy currently
available for COVID-19 patients. It has robust historical precedence and sound
biological plausibility. Although promising, convalescent plasma has not yet been shown
to be safe as a treatment for COVID-19.

Conclusion: Given the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive.
These early indicators suggest that transfusion of convalescent plasma is safe in
hospitalized patients with COVID-19.

Coronavirus Disease 2019 (COVID-19) in Children

Signs and symptoms of COVID-19 in children. Common symptoms of COVID-19 in children are cough and fever. It is important to note, however, that these symptoms may not always be present; thus, a high index of suspicion for SARS-CoV-2 infection is required in children. Other symptoms include the following:

  • Shortness of breath
  • Pharyngeal erythema/sore throat
  • Diarrhea
  • Myalgia
  • Fatigue
  • Rhinorrhea
  • Vomiting
  • Nasal congestion
  • Abdominal pain
  • Conjunctivitis
  • Rash

Researchers Have Discovered a Strong Correlation Between Severe Vitamin D Deficiency and COVID-19 Mortality Rates

By analyzing publicly available patient data from around the globe, Backman and his team discovered a strong correlation between vitamin D levels and cytokine storm — a hyperinflammatory condition caused by an overactive immune system — as well as a correlation between vitamin D deficiency and mortality.

Backman is careful to note that people should not take excessive doses of vitamin D, which might come with negative side effects. He said the subject needs much more research to know how vitamin D could be used most effectively to protect against COVID-19 complications.

Neurological Implications of COVID 19 Infections

We strongly encourage the concerted surveillance for such conditions. Additional to the direct neurological complications of COVID‑19 infection, neurological patients are at risk of harm from both structural limitations (such as number of intensive care beds), and a hesitancy to treat with certain necessary medications given risk of nosocomial COVID‑19 infection. We therefore also outline the specific management of patients with neuroinflammatory diseases in the context of the pandemic.

Therapeutic strategies for critically ill patients with COVID-19

In the present article, we have summarized the promising drugs, adjunctive agents, respiratory supportive strategies, as well as circulation management, multiple organ function monitoring and appropriate nutritional strategies for the treatment of COVID-19 in the ICU based on the previous experience of treating other viral infections and infuenza. These treatments are referable before the vaccine and specifc drugs are available for COVID-19.

COVID-19 Panel: Helmet CPAP, Pronation Key Tools for Some Patients

Noninvasive ventilation with helmet continuous positive air pressure (CPAP) deserves to be embraced as an effective strategy in preventing self-induced lung injury, often a key factor in progression from the early milder expression of COVID-19 disease to classic severe acute respiratory Distress Syndrome. 

Compassionate Use of Remdesivir for Patients with Severe Covid-19

CONCLUSIONS: In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy.

'Silent Hypoxemia' and Other Curious Clinical Observations in COVID-19

Podcast and transcript- Gary S. Ferenchick, MD, MS, a professor of medicine at Michigan State University, interviewed his daughter, Hannah R.B. Ferenchick, MD, an emergency and critical care physician working on the frontline in a busy Detroit hospital, about some of the unusual clinical features of patients with suspected or confirmed COVID-19.

A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19

A scientific rationale existed for investigating HCQ in COVID-19. However, other methodological flaws may affect the validity of the findings, even in the current setting, where an efficacious treatment is desperately needed. Thus another explanation is that the baseline viral load, not therapy with HCQ + AZM, affects viral load at day 6.

Despite the study’s substantial limitations, a simplification and probable overinterpretation of these findings was rapidly disseminated by the lay press and amplified on social media, ultimately endorsed by many government and institutional leaders.

A major consequence has been an inadequate supply of HCQ for patients in whom efficacy is established. Hydroxychloroquine is an essential treatment of rheumatoid arthritis and of systemic lupus erythematosus, reducing flares and preventing organ damage in the latter disease. HCQ shortages could place these patients at risk for severe and even life-threatening flares; some may require hospitalization when hospitals are already at capacity. There currently are no data to recommend the use of HCQ as prophylaxis for COVID-19.

Neurologic Features in Severe SARS-CoV-2 Infection

We report the neurologic features in an observational series of 58 of 64 consecutive patients admitted to the hospital because of acute respiratory distress syndrome (ARDS) due to Covid-19.

In this consecutive series of patients, ARDS due to SARS-CoV-2 infection was associated with encephalopathy, prominent agitation and confusion, and corticospinal tract signs. Two of 13 patients who underwent brain MRI had single acute ischemic strokes. Data are lacking to determine which of these features were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.

IDSA: No Recommendations for COVID-19 Treatment for Now, 'Knowledge Gaps' Cited

There is currently insufficient evidence to recommend any particular medication for treatment of COVID-19, an expert panel of the Infectious Diseases Society of America (IDSA) has concluded.

Many pharmacologic therapies are being used or considered for the treatment of patients with COVID-19. Given the rapidly emerging literature on treatment, the IDSA convened the panel to develop interim evidence-based guidelines to support clinicians in making decisions about treatment and management of patients with COVID-19.

This is a “living document” that represents the best understanding to date on the treatment of patients with COVID-19, and it will be updated frequently as new information becomes available

Warning of Higher COVID-19 Problems From Glucocorticoid Use

Adults prescribed glucocorticoid therapy for common conditions, such as asthma and arthritis, as well as individuals with adrenal insufficiency, are at high risk for developing serious complications from COVID-19 due to an inability to mount a normal stress response.

If any doctor or healthcare professional is coming across people who received steroid therapy for the previous 3 months, they need to be regarded as an ‘at risk’ individual in terms of the progression of their illness, with a fairly low threshold for giving them supplemental steroid therapy, which might be life-saving. That’s the plea here.

Cardiology Groups Push Back on Hydroxychloroquine, Azithromycin for COVID-19

The nation’s leading cardiology associations urged caution with hydroxychloroquine and azithromycin for COVID-19 in patients with cardiovascular disease.

“Hydroxychloroquine and azithromycin have been touted for potential prophylaxis or treatment for COVID-19; both drugs are listed as definite causes of torsade de pointes” and increase in the risk of other arrhythmias and sudden death, the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society said in a joint statement April 8 in Circulation.

The statement came amid ongoing promotion by the Trump administration of hydroxychloroquine, in particular, for COVID-19 despite lack of strong data.

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

April 10-2020  Key Points

Question  What are neurologic manifestations of patients with coronavirus disease 2019?

Findings  In a case series of 214 patients with coronavirus disease 2019, neurologic symptoms were seen in 36.4% of patients and were more common in patients with severe infection (45.5%) according to their respiratory status, which included acute cerebrovascular events, impaired consciousness, and muscle injury.

Meaning  Neurologic symptoms manifest in a notable proportion of patients with coronavirus disease 2019.

Nephrologists on Lessons Learned With Kidney Disease in COVID-19

Although lung damage is the main feature of severe COVID-19, it is becoming crystal clear that the kidney is one of the other major organs involved. 

“The mortality we’re seeing with these [dialysis and transplant] patients is because COVID-19 pneumonia/disease can be very aggressive with a severe distress syndrome,” Soler told Medscape Medical News. Discusses Dialysis/Transplant COVID-19 Experience in Spain

COVID-19: Facing Hard Truths on the Front Line

The Royal Society of Medicine (RSM) has launched a series of webinars for members to help support them with the difficult life and death decisions they are going to have to make in the coming months during the height of the COVID-19 pandemic. All health care professionals are having to make decisions during COVID-19 that they never thought they would, and the decision in life and death situations nearly always rests ultimately with the doctor in charge of the case.

The article includes: Ethical guidance published for frontline staff dealing with the pandemic

COVID-19 Linked to Multiple Cardiovascular Presentations

It’s becoming clear that COVID-19 infection can involve the cardiovascular system in many different ways, and this has “evolving” potential implications for treatment, say a team of cardiologists on the frontlines of the COVID-19 battle in New York City.

COVID-19 Daily: More Will Die, First Antibody Test Authorized

A newly available antibody test may help evaluate the SARS-CoV-2 virus in 20 minutes or less. The US Food and Drug Administration has granted Cellex an emergency use authorization to market the first rapid antibody test for
COVID-19.

COVID-19: More Hydroxychloroquine Data From France, More Questions

There was a  Chinese study that did not show a difference in effectiveness between hydroxychloroquine and placebo, but that was, again, conducted in only around 20 patients. This cohort is too small and tells us nothing; it cannot show anything. We must wait for the results of larger trials being conducted in China.

Personally, I really believe in hydroxychloroquine. It would nevertheless be a shame to think we had found the fountain of youth and realize, in 4 weeks, that we have the same number of deaths. That is the problem. I hope that we will soon have solid data so we do not waste time focusing solely on hydroxychloroquine.

Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies

April 7-2020

No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. Numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process.

Coronavirus on Fabric: What You Should Know

April 2-2020

If you suspect you got too close for too long, or someone coughed on you, there’s no harm in changing your clothing and washing it right away, especially if there are hard surfaces like buttons and zippers where the virus might linger. Wash your hands again after you put everything into the machine. Dry everything on high, since the virus dies at temperatures above 133°F. File these steps under “abundance of caution”: They’re not necessary, but if it gives you peace of mind, it may be worth it.

Michigan woman with coronavirus develops rare complication affecting brain

April 1-2020 A 58-year-old woman hospitalized in the Henry Ford Health System who has the new coronavirus developed a rare complication: encephalitis.

It is believed to be the first published case linking COVID-19 and acute necrotizing encephalitis. The rare and serious brain disease can develop in people who have a viral infection, and causes lesions to form in the brain, tissue death and symptoms such as seizures, drowsiness, confusion and coma.

Should We All Be Wearing Masks In Public? Health Experts Revisit The Question

March 31-2020   “Cotton masks constructed in a proper way should provide a reasonable degree of protection from people being able to transmit the virus. ” CDC to issue guidelines

At least 8 strains of the coronavirus are spreading across the globe

Scientists have identified at least eight strains of coronavirus as the bug wreaks havoc spreading across the globe.

More than 2,000 genetic sequences of the virus have been submitted from labs to the open database NextStrain, which shows it mutating on maps in real-time, according to the site.

Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies

No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. Numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process. Gordon et al identified 332 high-confidence SARS-CoV-2 human protein-protein interactions. Among these, they identified 66 human proteins or host factors targeted by 69 existing FDA-approved drugs, drugs in clinical trials, and/or preclinical compounds. As of March 22, 2020, these researchers are in the process of evaluating the potential efficacy of these drugs in live SARS-CoV-2 infection assays.

How long coronavirus survives on surfaces - and what it means for handling money, food and more

The article includes: How can we reduce risk from surfaces and objects? While it’s best to stay home, details tips to enact if you must leave the house.

What Neurologists Can Expect From COVID-19

In rare cases, complications including ADEM (acute disseminated encephalomyelitis)-like demyelination, encephalitis, and brainstem encephalitis were reported. They also saw some peripheral and non–central nervous system stuff, including things that looked like Guillain-Barre syndrome or what they would sometimes call critical illness polyneuropathy.

The data are still limited on whether coronaviruses have a significant neurologic component. There are reports of other coronaviruses entering the brain of patients and experimental animals. Does that mean anything? Right now, we simply don’t know.

You could be spreading the coronavirus without realising you’ve got it

What all this makes clear is that advising only people with a cough or fever and their families to self-isolate won’t prevent the coronavirus from spreading, thanks to its fiendish ability to cause very mild symptoms in people, and to peak in infectiousness before people even realise they are sick.

Read more: https://www.newscientist.com/article/2238473-you-could-be-spreading-the-coronavirus-without-realising-youve-got-it/#ixzz6IHqPt4lV

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

These preliminary findings raise the possibility that convalescent plasma transfusion may be helpful in the treatment of critically ill patients with COVID-19 and ARDS, but this approach requires evaluation in randomized clinical trials.

What we know about the new Covid-19-linked illness in children

A rare, Kawasaki-like disease is striking kids who have coronavirus antibodies.

Doctors in 17 US states are reporting that at least 164 children have fallen sick with a rare inflammatory illness similar to a condition known as Kawasaki disease. Symptoms include fever and inflammation and can affect organs, including the heart. Some of the children have tested positive for Covid-19 or antibodies to the virus, and three have died. 

“As in any infection, it is important for parents to seek care with their pediatrician if their child has high fevers, new rash, significant abdominal pain, persistent vomiting, persistent diarrhea, or any other concerning symptom.”

But she and other doctors underscore that despite the increased incidence of the pediatric syndrome, it is still quite rare, “probably affecting no more than one in 1,000 children exposed to SARS-CoV-2.”

Convalescent plasma in Covid-19: Possible mechanisms of action

Highlights:  Coronavirus disease 19 (COVID-19) is an emerging viral threat with major repercussions for public health.

There is not specific treatment for COVID-19.

Convalescent plasma (CP) emerges as the first option of management for hospitalized patients with COVID-19.

Transference of neutralizing antibodies helps to control COVID-19 infection and modulates inflammatory response.

Other plasma components may enhance the antiviral and anti-inflammatory properties of CP. 

Children are falling sick with a rare mystery inflammatory syndrome linked to Coronavirus

The new condition that’s being linked to COVID-19 got an official name this week: pediatric multisystem inflammatory syndrome.

Children and teens with the rare but potentially dangerous complication have been identified in at least seven states and the Washington, D.C., area as well as some parts of Europe. The condition can resemble features of other inflammatory illnesses like the Kawasaki Disease and toxic shock-like syndrome.

Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected,” she said. Dr. John revealed that “the feature that’s been most concerning is that they have problems with their heart function.”

Dr. John added: “In general, families do not need to worry about this. I doubt that this is really new. I think it’s just really newly recognized. I hope what comes of this is that, because we’re seeing more cases, it will not take long before we will be better at recognizing this and treating it.”

Immunomodulation in COVID-19

Here, we expand on the theoretical basis of IL-6 inhibition and propose potential benefits from other immunomodulators that could, in theory, prove more efficacious.

 

As insight is gained into the clinical phenotypes associated with COVID-19, we propose JAK and IL-1 inhibitors as therapeutic targets warranting rapid investigation. Multidisciplinary collaboration with experts in haematology, inflammation, tissue damage, and repair and resolution is paramount.

Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children.

Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged.

Rapid development of an inactivated vaccine candidate for SARS-CoV-2

We developed a pilot-scale production of a purified inactivated SARS-CoV-2 virus vaccine candidate (PiCoVacc), which induced SARS-CoV-2-specific neutralizing antibodies in mice, rats and non-human primates. These antibodies neutralized 10 representative SARS-CoV-2 strains, suggesting a possible broader neutralizing ability against SARS-CoV-2 strains. Three immunizations using two different doses (3 μg or 6 μg per dose) provided partial or complete protection in macaques against SARS-CoV-2 challenge, respectively, without observable antibody-dependent enhancement of infection. These data support clinical development of SARS-CoV-2 vaccines for humans.

FDA Authorizes Emergency Use of Remdesivir for COVID-19

The FDA writes, “Based on evaluation of the emergency use authorization criteria and the scientific evidence available, it was determined that it is reasonable to believe that remdesivir may be effective in treating COVID-19, and that, given there are no adequate, approved, or available alternative treatments, the known and potential benefits to treat this serious or life-threatening virus currently outweigh the known and potential risks of the drug’s use.”

Neurons promote encephalitogenic CD4 + lymphocyte infiltration in experimental autoimmune encephalomyelitis

To our knowledge, we for the first time adopted inhibitory DREADD and a migration assay using embryonic cerebral cortex neurons with CD4+ T cells. This methodology will pave a new way to investigate the pathophysiological role of excitatory neurons in EAE.

'Hypercoagulation,' Antiphospholipid Antibodies Seen in COVID-19

Researchers from China describe three patients admitted to the intensive care unit (ICU) with confirmed SARS-CoV-2 infection, severe COVID-19, and clinically significant coagulopathy, antiphospholipid antibodies, and multiple cerebral infarcts.

“Antiphospholipid antibodies abnormally target phospholipid proteins, and the presence of these antibodies is central to the diagnosis of the antiphospholipid syndrome.

Why Some People Get Sicker Than Others

Personal storytelling of COVID-19 cases. Includes a podcast and overview of clinical trials for therapies. An easy and worthwhile read for the layperson. 

Sudden Loss of Taste and Smell Should Be Part of COVID-19 Screen

In her survey of patients who presented to UC San Diego Health for SARS-CoV-2 testing, Yan and colleagues reported that 68% (40 of 59) of COVID-19-positive patients reported olfactory impairment and 71% (42 of 59) reported taste impairment.

“Based on our study, if you have smell and taste loss, you are more than 10 times more likely to have COVID-19 infection than other causes of infection. The most common first sign of a COVID-19 infection remains fever, but fatigue and loss of smell and taste follow as other very common initial symptoms,” said Yan.

More Evidence Supports COVID-19/Guillain-Barré Link

Five more cases of  Guillain–Barré syndrome (GBS) in association with COVID-19 have been identified, further supporting a link between the virus and neurologic complications, including GBS.

Three of the patients developed a demyelinating form of GBS; the other two had findings generally consistent with an axonal variant. All five patients received intravenous immune globulin treatment.

Hydroxychloroquine for COVID-19: What's the Evidence?

The bottom line is that we don’t need to abandon evidence-based medicine in the face of the pandemic. We need to embrace it more than ever. But in that embrace, we need to realize what we’ve known all along: Evidence-based medicine is not just about randomized trials; it’s about appreciating the strengths and weaknesses of all data, and allowing the data to inch us closer and closer toward truth.

Remdesivir Prevents Disease Progression in Monkeys With COVID-19

Early treatment with the experimental antiviral drug remdesivir significantly reduced clinical disease and damage to the lungs of rhesus macaques infected with SARS-CoV-2, the coronavirus that causes COVID-19, according to National Institutes of Health scientists.

Twelve hours after the initial treatment, the scientists examined all animals and found the six treated animals in significantly better health than the untreated group, a trend that continued during the seven-day study.

The investigators note that the data supports initiating remdesivir treatment in COVID-19 patients as early as possible to achieve maximum treatment effect. “This finding is of great significance for patient management, where a clinical improvement should not be interpreted as a lack of infectiousness,” they write.

Imaging Recommendations Issued for COVID-19 Patients

  • Recommendations: Imaging is indicated for patients with features of moderate to severe COVID-19 regardless of COVID-19 test results.

  • Imaging is indicated for patients with COVID-19 and evidence of worsening respiratory status.

  • When access to CT is limited, chest radiography may be preferred for COVID-19 patients unless features of respiratory worsening warrant using CT.

  • Additional recommendations: Daily chest radiographs are not indicated in stable, intubated patients with COVID-19.

  • CT is indicated in patients with functional impairment, hypoxemia, or both, after COVID-19 recovery.

  • COVID-19 testing is warranted in patients incidentally found to have findings suggestive of COVID-19 on a CT scan.

COVID-19: First Data Confirm Neurologic Symptoms Common

Investigators based in Wuhan, China, analyzed data from more than 200 adult patients with COVID-19 and found that 36.4% had neurologic manifestations. In addition, close to half of those with severe disease had neurologic symptoms, compared to roughly one-third of those with less severe disease.

Nervous system manifestations of COVID-19 were “significantly more common” in severe versus nonsevere infection.

The public and medical personnel alike need to be aware that there may be neurological manifestations of COVID-19 and such symptoms indicate a need for prompt medical attention.

COVID-19: Exercise may protect against deadly complication

Regular exercise may reduce the risk of acute respiratory distress syndrome, a major cause of death in patients with the COVID-19 virus, a top exercise researcher reports. He is urging people to exercise based on his findings, which also suggest a potential treatment approach.

Hydroxychloroquine for COVID-19 Study Did Not Meet 'Expected Standard'

The paper that appears to have triggered the Trump administration’s obsession with hydroxychloroquine as a treatment for infection with the novel coronavirus has received a statement of concern from the society that publishes the journal in which the work appeared.

 Elisabeth Bik took a close look at the IJAA article and detailed a long list of serious problems with the study, including questions about its ethical underpinnings, messy confounding variables, missing patients, rushed and conflicted peer review, and confusing data.

COVID-19:Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism

This paper  explains the action of the virus from a hematological point of view, meaning that the severe hypoxia is because of the desaturation in oxygen of the red blood cells being attacked by the virus and not because of pulmonary inflammation.

A first Case of Meningitis/Encephalitis associated with SARS-Coronavirus-2

Highlights

Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly.
This is the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance.
The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF.
This case warns the physicians of patients who have CNS symptoms.

Responding to stress experienced by hospital staff working with Covid-19

Drawing on research, best practice guidelines and expert clinical opinions, the COVID Trauma Response Working Group has created rapid guidance for planners putting in place psychological support for staff in the early stages of dealing with the Covid-19 outbreak.

Download Graphic here https://www.kingsfund.org.uk/sites/default/files/2020-04/rapid-guidance-stress-diagram.pdf 

The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection

April 10-2020  In these 214 patients, they report 36.4% had some nervous system-related clinical finding.1 These neurologic manifestations ranged from fairly specific symptoms (eg, loss of sense of smell or taste, myopathy, and stroke) to more nonspecific symptoms (eg, headache, depressed level of consciousness, dizziness, or seizure).1 Whether these more nonspecific symptoms are manifestations of the disease itself or consistent with a systemic inflammatory response in patients who were quite ill will need to be defined in future studies. Importantly, the authors found that patients in their series with some of the more common specific symptoms, including smell or taste impairment and myopathy, tended to have these symptoms early in their clinical course; this appears to be quite distinct from SARS, where manifestations appeared quite late in established disease. 

Coronavirus disease 2019 has now reached pandemic status and is common all over the world; thus, with so many affected patients, we can expect as neurologists to be confronted with these patients commonly in coming months and years.

Many Children With COVID-19 Don't Have Cough or Fever

The characteristic COVID-19 symptoms of cough, fever, and shortness of breath are less common in children than adults, according to the Centers for Disease and Prevention Control.

Among pediatric patients younger than 18 years in the United States, 73% had at least one of the trio of symptoms, compared with 93% of adults aged 18-64, noted Lucy A. McNamara, PhD, and the CDC’s COVID-19 response team, based on a preliminary analysis of the 149,082 cases reported as of April 2.

Neurologic Symptoms and COVID-19: What's Known, What Isn't

Since the Centers for Disease Control and Prevention (CDC) confirmed the first US case of novel coronavirus infection on January 20, much of the clinical focus has naturally centered on the virus’ prodromal symptoms and severe respiratory effects.  

However, US neurologists are now reporting that COVID-19 symptoms may also could include encephalopathy, ataxia, and other neurologic signs. 

Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know

The looming public health crisis for people with rheumatic diseases who will be unable to obtain HCQ is the result of a perfect storm of fear and dissemination of overpromised data. However, there is still time to mitigate the damage. Physicians should educate themselves about the strength of available data regarding HCQ and CQ in treating COVID-19. They should avoid misuse of HCQ and CQ for the prophylaxis of COVID-19, because there are absolutely no data to support this. Public figures should refrain from promoting unproven therapies to the public, and instead provide clear messages around the uncertainties we face in testing and using experimental treatments during the current pandemic, including the risk for serious adverse events. Well-done, randomized clinical trials should be performed urgently to test potential therapies, including HCQ. In the meantime, physicians should remember that first, we must do no harm to the patients with rheumatic disease for whom high-quality evidence shows that HCQ improves health.

Risk Factors for Death From COVID-19 Identified in Wuhan Patients

Nonsurvivors compared with survivors had higher frequencies of respiratory failure (98% vs 36%), sepsis (100%, vs 42%), and secondary infections (50% vs 1%).

The average age of survivors was 52 years compared to 69 for those who died. Liu cited weakening of the immune system and increased inflammation, which damages organs and also promotes viral replication, as explanations for the age effect.

From the time of initial symptoms, median time to discharge from the hospital was 22 days. Average time to death was 18.5 days.

The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro

Highlights: 

Ivermectin is an inhibitor of the COVID-19 causative virus (SARS-CoV-2) in vitro.

A single treatment able to effect ∼5000-fold reduction in virus at 48h in cell culture.

Ivermectin is FDA-approved for parasitic infections, and therefore has a potential for repurposing.

Ivermectin is widely available, due to its inclusion on the WHO model list of essential medicines.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.

Coronavirus survivors' plasma could save lives

This paper: The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study

Two independent research studies have shown the benefit of receiving infusions of blood from COVID-19 survivors.

The teams – both based in China – extracted blood plasma from patients who had recovered from COVID-19, which contained antibodies against the disease. The first study from the National Engineering Technology Research Center for Combined Vaccines in Wuhan   gave plasma to 10 patients who were severely ill with COVID-19. Six days after receiving the infusion, the COVID-19 virus was undetectable in seven of the 10 patients.

 

Hydroxychloroquine: Possible COVID Drug Can Be Toxic to Retinas

Comorbidities Increase Likelihood of Retinal Toxicity

While a detailed patient history may be impossible to obtain if HCQ is used in the treatment of COVID-19, certain comorbidities do place patients at an increased risk for retinal toxicity. HCQ is excreted through renal clearance, so the dosage should be reduced in those with compromised kidney function to minimize the risk for toxicity. The presence of macular disease, such as age-related macular degeneration, has also been demonstrated to be a risk factor for the development of toxic maculopathy. The concurrent use of tamoxifen also increases the risk for retinal toxicity. Tamoxifen itself may deposit in the retina and make the macula more susceptible to the potentially toxic effects of HCQ.

'No Complacency' on COVID-19 After Death of 13-Year-Old-Boy

April-1-2020 

“It is essential that we undertake research to determine why a proportion of deaths occur outside of the groups expected to succumb to infection as it may indicate an underlying genetic susceptibility of how the immune system interacts with the virus.

“Determining if this is the case could help us to learn more about the interaction of the virus with the immune system and subsequently what further treatments may be suitable in patients with severe infection.”

Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms

Autopsies of the COVID-19 patients, detailed neurological investigation, and attempts to isolate SARS-CoV-2 from the endothelium of cerebral microcirculation, cerebrospinal fluid, glial cells, and neuronal tissue can clarify the role played by this novel COVID-19 causing coronavirus in the ongoing mortalities as has been in the recent outbreak.

A dominant cerebral involvement alone with the potential of causing cerebral edema in COVID-19 can take a lead in causing death long before systemic homeostatic dysregulation sets in. 

Also, a staging system based on the severity and organ involvement is needed in COVID-19 in order to rank the patients for aggressive or conventional treatment modalities.

COVID-19: Neurologists in Italy to Colleagues in US: Look for Poorly-Defined Neurologic Conditions in Patients with the Coronavirus

There are some recent data suggesting that COVID-19 virus also reaches the central nervous system. Neurological symptoms in patients with COVID-19 infection fall into three categories: neurological expressions of the symptoms of the underlying disease (headache, dizziness, disturbances of the state of consciousness, ataxia, epileptic manifestations, and stroke;) symptoms of neuro-peripheral origin (hypo-ageusia, hyposmia, neuralgia;) symptoms of skeletal muscle damage, often associated with liver and kidney damage.” 

Australia's Trialing a TB Vaccine Against COVID-19, And Health Workers Get It First

Australian researchers are fast-tracking large-scale human testing to see if a vaccine used for decades to prevent tuberculosis can protect health workers from COVID-19. 

Similar trials are being conducted in several other countries including the Netherlands, Germany and the United Kingdom.

“This trial will allow the vaccine’s effectiveness against COVID-19 symptoms to be properly tested, and may help save the lives of our heroic frontline healthcare workers,”

Trending Clinical Topic: Kawasaki Disease and COVID-19

UK pediatricians have published a working definition of the inflammatory syndrome. No one sign or symptom can be used to identify the children who are affected, and they may or may not test positive for COVID-19. See Image at top of page.

New Focus on Renin-Angiotensin System Role in COVID-19

“As we believe the renin–angiotensin system is being over-activated by the virus, this could also explain why patients with underlying cardiovascular diseases are having worse outcomes and would suggest that taking an ACE inhibitor or ARB would actually be protective.” 

On the influenza study, Oudit said: “The influenza virus may well also activate the renin–angiotensin system. That study suggests that ACE inhibitors and ARBs may be protective here as well.”

Early Safety Indicators of COVID-19 Convalescent Plasma in 5,000 Patients

Background: Convalescent plasma is the only antibody-based therapy currently
available for COVID-19 patients. It has robust historical precedence and sound
biological plausibility. Although promising, convalescent plasma has not yet been shown
to be safe as a treatment for COVID-19.

Conclusion: Given the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive.
These early indicators suggest that transfusion of convalescent plasma is safe in
hospitalized patients with COVID-19.

Coronavirus Disease 2019 (COVID-19) in Children

Signs and symptoms of COVID-19 in children. Common symptoms of COVID-19 in children are cough and fever. It is important to note, however, that these symptoms may not always be present; thus, a high index of suspicion for SARS-CoV-2 infection is required in children. Other symptoms include the following:

  • Shortness of breath
  • Pharyngeal erythema/sore throat
  • Diarrhea
  • Myalgia
  • Fatigue
  • Rhinorrhea
  • Vomiting
  • Nasal congestion
  • Abdominal pain
  • Conjunctivitis
  • Rash

Researchers Have Discovered a Strong Correlation Between Severe Vitamin D Deficiency and COVID-19 Mortality Rates

By analyzing publicly available patient data from around the globe, Backman and his team discovered a strong correlation between vitamin D levels and cytokine storm — a hyperinflammatory condition caused by an overactive immune system — as well as a correlation between vitamin D deficiency and mortality.

Backman is careful to note that people should not take excessive doses of vitamin D, which might come with negative side effects. He said the subject needs much more research to know how vitamin D could be used most effectively to protect against COVID-19 complications.

Neurological Implications of COVID 19 Infections

We strongly encourage the concerted surveillance for such conditions. Additional to the direct neurological complications of COVID‑19 infection, neurological patients are at risk of harm from both structural limitations (such as number of intensive care beds), and a hesitancy to treat with certain necessary medications given risk of nosocomial COVID‑19 infection. We therefore also outline the specific management of patients with neuroinflammatory diseases in the context of the pandemic.

Therapeutic strategies for critically ill patients with COVID-19

In the present article, we have summarized the promising drugs, adjunctive agents, respiratory supportive strategies, as well as circulation management, multiple organ function monitoring and appropriate nutritional strategies for the treatment of COVID-19 in the ICU based on the previous experience of treating other viral infections and infuenza. These treatments are referable before the vaccine and specifc drugs are available for COVID-19.

COVID-19 Panel: Helmet CPAP, Pronation Key Tools for Some Patients

Noninvasive ventilation with helmet continuous positive air pressure (CPAP) deserves to be embraced as an effective strategy in preventing self-induced lung injury, often a key factor in progression from the early milder expression of COVID-19 disease to classic severe acute respiratory Distress Syndrome. 

Compassionate Use of Remdesivir for Patients with Severe Covid-19

CONCLUSIONS: In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy.

'Silent Hypoxemia' and Other Curious Clinical Observations in COVID-19

Podcast and transcript- Gary S. Ferenchick, MD, MS, a professor of medicine at Michigan State University, interviewed his daughter, Hannah R.B. Ferenchick, MD, an emergency and critical care physician working on the frontline in a busy Detroit hospital, about some of the unusual clinical features of patients with suspected or confirmed COVID-19.

A Rush to Judgment? Rapid Reporting and Dissemination of Results and Its Consequences Regarding the Use of Hydroxychloroquine for COVID-19

A scientific rationale existed for investigating HCQ in COVID-19. However, other methodological flaws may affect the validity of the findings, even in the current setting, where an efficacious treatment is desperately needed. Thus another explanation is that the baseline viral load, not therapy with HCQ + AZM, affects viral load at day 6.

Despite the study’s substantial limitations, a simplification and probable overinterpretation of these findings was rapidly disseminated by the lay press and amplified on social media, ultimately endorsed by many government and institutional leaders.

A major consequence has been an inadequate supply of HCQ for patients in whom efficacy is established. Hydroxychloroquine is an essential treatment of rheumatoid arthritis and of systemic lupus erythematosus, reducing flares and preventing organ damage in the latter disease. HCQ shortages could place these patients at risk for severe and even life-threatening flares; some may require hospitalization when hospitals are already at capacity. There currently are no data to recommend the use of HCQ as prophylaxis for COVID-19.

Neurologic Features in Severe SARS-CoV-2 Infection

We report the neurologic features in an observational series of 58 of 64 consecutive patients admitted to the hospital because of acute respiratory distress syndrome (ARDS) due to Covid-19.

In this consecutive series of patients, ARDS due to SARS-CoV-2 infection was associated with encephalopathy, prominent agitation and confusion, and corticospinal tract signs. Two of 13 patients who underwent brain MRI had single acute ischemic strokes. Data are lacking to determine which of these features were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.

IDSA: No Recommendations for COVID-19 Treatment for Now, 'Knowledge Gaps' Cited

There is currently insufficient evidence to recommend any particular medication for treatment of COVID-19, an expert panel of the Infectious Diseases Society of America (IDSA) has concluded.

Many pharmacologic therapies are being used or considered for the treatment of patients with COVID-19. Given the rapidly emerging literature on treatment, the IDSA convened the panel to develop interim evidence-based guidelines to support clinicians in making decisions about treatment and management of patients with COVID-19.

This is a “living document” that represents the best understanding to date on the treatment of patients with COVID-19, and it will be updated frequently as new information becomes available

Warning of Higher COVID-19 Problems From Glucocorticoid Use

Adults prescribed glucocorticoid therapy for common conditions, such as asthma and arthritis, as well as individuals with adrenal insufficiency, are at high risk for developing serious complications from COVID-19 due to an inability to mount a normal stress response.

If any doctor or healthcare professional is coming across people who received steroid therapy for the previous 3 months, they need to be regarded as an ‘at risk’ individual in terms of the progression of their illness, with a fairly low threshold for giving them supplemental steroid therapy, which might be life-saving. That’s the plea here.

Cardiology Groups Push Back on Hydroxychloroquine, Azithromycin for COVID-19

The nation’s leading cardiology associations urged caution with hydroxychloroquine and azithromycin for COVID-19 in patients with cardiovascular disease.

“Hydroxychloroquine and azithromycin have been touted for potential prophylaxis or treatment for COVID-19; both drugs are listed as definite causes of torsade de pointes” and increase in the risk of other arrhythmias and sudden death, the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society said in a joint statement April 8 in Circulation.

The statement came amid ongoing promotion by the Trump administration of hydroxychloroquine, in particular, for COVID-19 despite lack of strong data.

Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

April 10-2020  Key Points

Question  What are neurologic manifestations of patients with coronavirus disease 2019?

Findings  In a case series of 214 patients with coronavirus disease 2019, neurologic symptoms were seen in 36.4% of patients and were more common in patients with severe infection (45.5%) according to their respiratory status, which included acute cerebrovascular events, impaired consciousness, and muscle injury.

Meaning  Neurologic symptoms manifest in a notable proportion of patients with coronavirus disease 2019.

Nephrologists on Lessons Learned With Kidney Disease in COVID-19

Although lung damage is the main feature of severe COVID-19, it is becoming crystal clear that the kidney is one of the other major organs involved. 

“The mortality we’re seeing with these [dialysis and transplant] patients is because COVID-19 pneumonia/disease can be very aggressive with a severe distress syndrome,” Soler told Medscape Medical News. Discusses Dialysis/Transplant COVID-19 Experience in Spain

COVID-19: Facing Hard Truths on the Front Line

The Royal Society of Medicine (RSM) has launched a series of webinars for members to help support them with the difficult life and death decisions they are going to have to make in the coming months during the height of the COVID-19 pandemic. All health care professionals are having to make decisions during COVID-19 that they never thought they would, and the decision in life and death situations nearly always rests ultimately with the doctor in charge of the case.

The article includes: Ethical guidance published for frontline staff dealing with the pandemic

COVID-19 Linked to Multiple Cardiovascular Presentations

It’s becoming clear that COVID-19 infection can involve the cardiovascular system in many different ways, and this has “evolving” potential implications for treatment, say a team of cardiologists on the frontlines of the COVID-19 battle in New York City.

COVID-19 Daily: More Will Die, First Antibody Test Authorized

A newly available antibody test may help evaluate the SARS-CoV-2 virus in 20 minutes or less. The US Food and Drug Administration has granted Cellex an emergency use authorization to market the first rapid antibody test for
COVID-19.

COVID-19: More Hydroxychloroquine Data From France, More Questions

There was a  Chinese study that did not show a difference in effectiveness between hydroxychloroquine and placebo, but that was, again, conducted in only around 20 patients. This cohort is too small and tells us nothing; it cannot show anything. We must wait for the results of larger trials being conducted in China.

Personally, I really believe in hydroxychloroquine. It would nevertheless be a shame to think we had found the fountain of youth and realize, in 4 weeks, that we have the same number of deaths. That is the problem. I hope that we will soon have solid data so we do not waste time focusing solely on hydroxychloroquine.

Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies

April 7-2020

No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. Numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process.

Coronavirus on Fabric: What You Should Know

April 2-2020

If you suspect you got too close for too long, or someone coughed on you, there’s no harm in changing your clothing and washing it right away, especially if there are hard surfaces like buttons and zippers where the virus might linger. Wash your hands again after you put everything into the machine. Dry everything on high, since the virus dies at temperatures above 133°F. File these steps under “abundance of caution”: They’re not necessary, but if it gives you peace of mind, it may be worth it.

Michigan woman with coronavirus develops rare complication affecting brain

April 1-2020 A 58-year-old woman hospitalized in the Henry Ford Health System who has the new coronavirus developed a rare complication: encephalitis.

It is believed to be the first published case linking COVID-19 and acute necrotizing encephalitis. The rare and serious brain disease can develop in people who have a viral infection, and causes lesions to form in the brain, tissue death and symptoms such as seizures, drowsiness, confusion and coma.

Should We All Be Wearing Masks In Public? Health Experts Revisit The Question

March 31-2020   “Cotton masks constructed in a proper way should provide a reasonable degree of protection from people being able to transmit the virus. ” CDC to issue guidelines

At least 8 strains of the coronavirus are spreading across the globe

Scientists have identified at least eight strains of coronavirus as the bug wreaks havoc spreading across the globe.

More than 2,000 genetic sequences of the virus have been submitted from labs to the open database NextStrain, which shows it mutating on maps in real-time, according to the site.

Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies

No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. Numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process. Gordon et al identified 332 high-confidence SARS-CoV-2 human protein-protein interactions. Among these, they identified 66 human proteins or host factors targeted by 69 existing FDA-approved drugs, drugs in clinical trials, and/or preclinical compounds. As of March 22, 2020, these researchers are in the process of evaluating the potential efficacy of these drugs in live SARS-CoV-2 infection assays.

How long coronavirus survives on surfaces - and what it means for handling money, food and more

The article includes: How can we reduce risk from surfaces and objects? While it’s best to stay home, details tips to enact if you must leave the house.

What Neurologists Can Expect From COVID-19

In rare cases, complications including ADEM (acute disseminated encephalomyelitis)-like demyelination, encephalitis, and brainstem encephalitis were reported. They also saw some peripheral and non–central nervous system stuff, including things that looked like Guillain-Barre syndrome or what they would sometimes call critical illness polyneuropathy.

The data are still limited on whether coronaviruses have a significant neurologic component. There are reports of other coronaviruses entering the brain of patients and experimental animals. Does that mean anything? Right now, we simply don’t know.

You could be spreading the coronavirus without realising you’ve got it

What all this makes clear is that advising only people with a cough or fever and their families to self-isolate won’t prevent the coronavirus from spreading, thanks to its fiendish ability to cause very mild symptoms in people, and to peak in infectiousness before people even realise they are sick.

Read more: https://www.newscientist.com/article/2238473-you-could-be-spreading-the-coronavirus-without-realising-youve-got-it/#ixzz6IHqPt4lV

Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma

These preliminary findings raise the possibility that convalescent plasma transfusion may be helpful in the treatment of critically ill patients with COVID-19 and ARDS, but this approach requires evaluation in randomized clinical trials.

Our website is not a substitute for independent professional medical advice. Nothing contained on our website is intended to be used as medical advice. No content is intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice. Although THE INTERNATIONAL AUTOIMMUNE ENCEPHALITIS SOCIETY  provides a great deal of information about AUTOIMMUNE ENCEPHALITIS, all content is provided for informational purposes only. The International Autoimmune Encephalitis Society  cannot provide medical advice.


International Autoimmune Encephalitis Society is a charitable non-profit 501(c)(3) organization founded in 2013 by Tabitha Andrews Orth, Gene Desotell and Anji Hogan-Fesler. Tax ID# 81-3752344. Donations raised directly supports research, patients, families and caregivers impacted by autoimmune encephalitis and to educating healthcare communities around the world. Financial statement will be made available upon request.

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