The ANA Q&A: The Global Impact of COVID-19

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"I hope that more young neurologists and neuroscientists will consider an academic career in global neurology, which is so important at the current time, and join the fight against neurological manifestations of various viral outbreaks." 

~Igor Koralnik, MD, Archibald Church Professor of Neurology, Feinberg School of Medicine, Northwestern University, Chief of the Division of Neuro-Infectious Diseases & Global Neurology at Northwestern Memorial Hospital

In response to the ever-evolving COVID-19 pandemic, this month’s ANA Q&A focuses on the neurological impact of the virus. We spoke with ANA member Igor Koralnik, MD, who has been involved in informing the public about the risks of COVID-19 and how to mitigate them since the beginning of the pandemic. Dr. Koralnik is the Archibald Church Professor of Neurology, Feinberg School of Medicine, Northwestern University, as well as Chief of the Division of Neuro-Infectious Diseases & Global Neurology at Northwestern Memorial Hospital in Chicago. He is the outgoing President of the International Society of Neuro Virology and has published more than 160 peer-reviewed articles, reviews and book chapters on the topics of Neuroinfectious diseases, Neurovirology and Neuroimmunology.

Dr. Koralnik’s laboratory has developed a novel assay for virus detection and discovery called “ViroFind”. This is a Next Gen sequencing-based platform for detection of >500 viruses known to infect humans or cause zoonoses: the entire Virome. His laboratory is now characterizing the Virome in brain, CSF and blood samples from patients with a variety of degenerative and auto-immune diseases including, Alzheimer’s, Amyotrophic lateral Sclerosis , Parkinson’s, Multiple System Atrophy, Progressive Supranuclear Palsy, and Multiple Sclerosis.

When he was at Harvard Medical School, Dr. Koralnik and colleagues initiated in 2010 a Global Neurology research program at the University Teaching Hospital in Lusaka, Zambia, a country severely affected by the AIDS epidemic. Over the years, this program has grown tremendously and become a multi institutional consortium, the Zambia Institute for Neurological Care, Research and Education (ZINCARE). Members of the consortium participate to teach the first class of adult and pediatric Zambian Neurology residents, who will graduate in 2020.

What does the public need to understand about the neurological impact of COVID-19 that it likely doesn’t?

Based on a report from 214 hospitalized adults in Wuhan, China, we already know that 36% of COVID-19 patients will have neurological manifestation. That number goes up to 45% of those who have severe disease. So, we understand already that SARS-CoV-2, which is the novel Coronavirus, affects the nervous system and causes various complications including anosmia, ageusia, dizziness, headache, alteration of consciousness, encephalopathy, strokes, and muscle damage. Whether those complications will be only temporary or cause long-term sequelae remains to be determined; we’ll find out when we start seeing those patients who survived COVID-19 coming to our clinics.

You were recently interviewed on a special COVID-19 episode of ANA Investigates. Who do you think will benefit most from listening to this episode and why?

This episode was designed for neurologists who are members of the ANA, but since it’s been downloaded more than 1,600 times during its first week, it appears that it has been of interest not only to neurologists, but also to intensive care unit physicians and nurses caring for those patients. People have started to notice that patients with COVID-19 have very intense delirium, they are difficult to ventilate, and they probably have an encephalopathy that either is related directly to the virus or is some sort of parainfectious manifestation associated with inflammation caused by the immune response to the virus. I think it’s very important to share information about our experience with those patients from various geographic locations. Obviously some physicians and neurologists in the world, like in Europe or in China, have seen patients for many more weeks than we have in the United States. It is very important that everybody shares information about their understanding of those manifestations and how to better treat them at the time where there is a shortage of various medications and equipment to take care of those patients.

What might we learn from the COVID-19 virus that could help us tackle other viruses?

That’s a very interesting and important question. As you know, the most puzzling aspect of this disease is that about 80% of people who are infected by the virus have no or minor symptoms, especially children and young adults. Whereas people after the age of 70 or 80 have a very high mortality rate. Yet, some young adults still develop severe lung disease that may be fatal. And we don’t understand exactly what this is about. It seems that SARS-CoV-2 dysregulates the immune system in some people, leading to a hyperactive immune response and what is called a cytokine storm, which may cause part of the lung symptomatology. And if we understand how the immune system reacts or fails to react to this virus, that can help us also understand how the immune system works fighting against other viruses.

In addition, there are many other viruses affecting the nervous system causing meningitis or encephalitis, for which we have no treatment or vaccine. So, I personally and probably all neurologists hope that what we learn about COVID-19 will also help us devise better treatment and vaccines for other viruses affecting the nervous system even though it is not currently a priority for pharmaceutical companies to do so. But there’s a very big need for those therapies and vaccines in the world.

Can you share any words of wisdom for neurologists who may not have a background in neuroinfectious disease and are trying to grasp the global impact of COVID-19?

Coronavirus are common–some of them are agents of the common cold—and there have been other outbreaks of Coronavirus in the past. In 2003, the Severe Acute Respiratory Syndrome (SARS), which was caused by what we now call SARS-CoV-1, caused about 8,000 cases in the world, and that outbreak had a 10% rate of fatalities. In 2012, there was another outbreak called the Middle East Respiratory Syndrome or MERS. There were about 2,500 cases in the world with 35% fatalities. All coronavirus outbreaks seemed to have originated in bats and affected various intermediate animals before getting into humans. That means that unfortunately there will be other virus outbreaks, either of Coronavirus types or other types like we’ve had recently such as the Zika virus and Ebola. So, I really hope this current pandemic will help us to be better prepared to detect, track, and mitigate future virus outbreaks in the world.

Is there anything else you’d like to add?

I think everybody understands now how we’re all connected and that what happens halfway across the world can affect them and everyone else. And it really highlights the importance of global health. I hope that more young neurologists and neuroscientists will consider an academic career in global neurology, which is so important at the current time, and join the fight against neurological manifestations of various viral outbreaks. I’m especially worried about how COVID-19 will affect countries that are in resource-limited settings, in sub-Saharan Africa, for example. There have been much less cases of COVID-19 there compared to the United States, China or Europe, and I hope that mitigation strategies are in effect and will help prevent the spread of the pandemic in those areas.

These are indeed crazy times, but we’re all in it together and we’ll get through this together. In the meantime, we should embrace technology and use all the web platforms that bring us together to recover a sense of normalcy in our lives.  That will allow us to flip the narrative on the pandemic and transform social distancing into what I like to call “distancing socially”. I’m looking forward to continuing to interact with my friends and colleagues this way for the time being, and hopefully in person at upcoming ANA meetings.