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Some Coronavirus Patients Show Signs of Brain Ailments Some Coronavirus Patients Show Signs of Brain Ailments
(1 day later)
Neurologists around the world say that a small subset of patients with Covid-19 are developing serious impairments of the brain.Neurologists around the world say that a small subset of patients with Covid-19 are developing serious impairments of the brain.
Although fever, cough and difficulty breathing are the typical hallmarks of infection with the new coronavirus, some patients exhibit altered mental status, or encephalopathy, a catchall term for brain disease or dysfunction that can have many underlying causes, as well as other serious conditions. These neurological syndromes join other unusual symptoms, such as diminished sense of smell and taste as well as heart ailments.Although fever, cough and difficulty breathing are the typical hallmarks of infection with the new coronavirus, some patients exhibit altered mental status, or encephalopathy, a catchall term for brain disease or dysfunction that can have many underlying causes, as well as other serious conditions. These neurological syndromes join other unusual symptoms, such as diminished sense of smell and taste as well as heart ailments.
In early March, a 74-year-old man came to the emergency room in Boca Raton, Fla., with a cough and a fever, but an X-ray ruled out pneumonia and he was sent home. The next day, when his fever spiked, family members brought him back. He was short of breath, and could not tell doctors his name or explain what was wrong — he had lost the ability to speak.In early March, a 74-year-old man came to the emergency room in Boca Raton, Fla., with a cough and a fever, but an X-ray ruled out pneumonia and he was sent home. The next day, when his fever spiked, family members brought him back. He was short of breath, and could not tell doctors his name or explain what was wrong — he had lost the ability to speak.
The patient, who had chronic lung disease and Parkinson’s, was flailing his arms and legs in jerky movements, and appeared to be having a seizure. Doctors suspected he had Covid-19, and were eventually proven right when he was finally tested.The patient, who had chronic lung disease and Parkinson’s, was flailing his arms and legs in jerky movements, and appeared to be having a seizure. Doctors suspected he had Covid-19, and were eventually proven right when he was finally tested.
On Tuesday, doctors in Detroit reported another disturbing case involving a female airline worker in her late 50s with Covid-19. She was confused, and complained of a headache; she could tell the physicians her name but little else, and became less responsive over time. Brain scans showed abnormal swelling and inflammation in several regions, with smaller areas where some cells had died.On Tuesday, doctors in Detroit reported another disturbing case involving a female airline worker in her late 50s with Covid-19. She was confused, and complained of a headache; she could tell the physicians her name but little else, and became less responsive over time. Brain scans showed abnormal swelling and inflammation in several regions, with smaller areas where some cells had died.
Physicians diagnosed a dangerous condition called acute necrotizing encephalopathy, a rare complication of influenza and other viral infections.Physicians diagnosed a dangerous condition called acute necrotizing encephalopathy, a rare complication of influenza and other viral infections.
“The pattern of involvement, and the way that it rapidly progressed over days, is consistent with viral inflammation of the brain,” Dr. Elissa Fory, a neurologist with Henry Ford Health System, said through an email. “This may indicate the virus can invade the brain directly in rare circumstances.” The patient is in critical condition.“The pattern of involvement, and the way that it rapidly progressed over days, is consistent with viral inflammation of the brain,” Dr. Elissa Fory, a neurologist with Henry Ford Health System, said through an email. “This may indicate the virus can invade the brain directly in rare circumstances.” The patient is in critical condition.
These domestic reports follow similar observations by doctors in Italy and other parts of the world, of Covid-19 patients having strokes, seizures, encephalitis-like symptoms and blood clots, as well as tingling or numbness in the extremities, called acroparesthesia. In some cases, patients were delirious even before developing fever or respiratory illness, according to Dr. Alessandro Padovani, whose hospital at University of Brescia in Italy opened a separate NeuroCovid unit to care for patients with neurological conditions.These domestic reports follow similar observations by doctors in Italy and other parts of the world, of Covid-19 patients having strokes, seizures, encephalitis-like symptoms and blood clots, as well as tingling or numbness in the extremities, called acroparesthesia. In some cases, patients were delirious even before developing fever or respiratory illness, according to Dr. Alessandro Padovani, whose hospital at University of Brescia in Italy opened a separate NeuroCovid unit to care for patients with neurological conditions.
The patients who come in with encephalopathy are confused and lethargic and may appear dazed, exhibiting strange behavior or staring off into space. They may be having seizures that require immediate medical care, and experts are warning health care providers who treat such patients to recognize that they may have Covid-19 and to take precautions to protect themselves from infection.The patients who come in with encephalopathy are confused and lethargic and may appear dazed, exhibiting strange behavior or staring off into space. They may be having seizures that require immediate medical care, and experts are warning health care providers who treat such patients to recognize that they may have Covid-19 and to take precautions to protect themselves from infection.
Much is still unknown about the neurological symptoms, but efforts are underway to study the phenomena, said Dr. Sherry H-Y. Chou, a neurologist at the University of Pittsburgh School of Medicine, who is leading a team of investigators for the Neurocritical Care Society.Much is still unknown about the neurological symptoms, but efforts are underway to study the phenomena, said Dr. Sherry H-Y. Chou, a neurologist at the University of Pittsburgh School of Medicine, who is leading a team of investigators for the Neurocritical Care Society.
“We absolutely need to have an information finding mission, otherwise we’re flying blind,” Dr. Chou said. “There’s no ventilator for the brain. If the lungs are broken we can put the patient on a ventilator and hope for recovery. We don’t have that luxury with the brain.”“We absolutely need to have an information finding mission, otherwise we’re flying blind,” Dr. Chou said. “There’s no ventilator for the brain. If the lungs are broken we can put the patient on a ventilator and hope for recovery. We don’t have that luxury with the brain.”
Experts have emphasized that most Covid-19 patients appear to be normal neurologically.Experts have emphasized that most Covid-19 patients appear to be normal neurologically.
“Most people are showing up awake and alert, and neurologically appear to be normal,” said Dr. Robert Stevens, a neurologist at the Johns Hopkins School of Medicine in Baltimore who is tracking neurological observations.“Most people are showing up awake and alert, and neurologically appear to be normal,” said Dr. Robert Stevens, a neurologist at the Johns Hopkins School of Medicine in Baltimore who is tracking neurological observations.
Neurological specialists also say that it is too early to make definitive statements or identify the specific mechanisms by which the new coronavirus is affecting the neurological system.Neurological specialists also say that it is too early to make definitive statements or identify the specific mechanisms by which the new coronavirus is affecting the neurological system.
In one recent paper, Chinese scientists noted that there was some evidence that other coronaviruses were not confined to the respiratory tract and invaded the central nervous system, and the authors speculated that this may potentially play a role in acute respiratory failure in Covid-19.In one recent paper, Chinese scientists noted that there was some evidence that other coronaviruses were not confined to the respiratory tract and invaded the central nervous system, and the authors speculated that this may potentially play a role in acute respiratory failure in Covid-19.
Dr. Stevens emphasized that all mechanistic explanations at this point are hypotheses because so little is known: “It could be as simple as low levels of oxygen in the bloodstream,” resulting from respiratory failure, along with an increase in carbon dioxide, which “can have significant impact on the function of the brain, and lead to states of confusion and lethargy,” he said.Dr. Stevens emphasized that all mechanistic explanations at this point are hypotheses because so little is known: “It could be as simple as low levels of oxygen in the bloodstream,” resulting from respiratory failure, along with an increase in carbon dioxide, which “can have significant impact on the function of the brain, and lead to states of confusion and lethargy,” he said.
“We are still in the early days of this, and we don’t really know for sure.”“We are still in the early days of this, and we don’t really know for sure.”
Neurologists in Wuhan, China, where the outbreak started, were among the first to report the symptoms in a preliminary paper published online in February.Neurologists in Wuhan, China, where the outbreak started, were among the first to report the symptoms in a preliminary paper published online in February.
Since that report, specialists observed similar symptoms in Germany, France, Austria, Italy and Holland as well as the United States, including among patients under 60, Dr. Stevens said.Since that report, specialists observed similar symptoms in Germany, France, Austria, Italy and Holland as well as the United States, including among patients under 60, Dr. Stevens said.
Some doctors have reported cases of patients who were brought in for treatment because of their altered mental state, and who ultimately tested positive for Covid-19, although they had none of the classic symptoms like fever or cough.Some doctors have reported cases of patients who were brought in for treatment because of their altered mental state, and who ultimately tested positive for Covid-19, although they had none of the classic symptoms like fever or cough.
Four elderly patients who came into Danbury Hospital in Connecticut with encephalopathy ultimately tested positive for Covid-19, although they had no other symptoms, said Dr. Paul Nee, an infectious disease specialist at the hospital. Two of the four went on to develop low grade fevers and needed oxygen briefly, but two did not, he said.Four elderly patients who came into Danbury Hospital in Connecticut with encephalopathy ultimately tested positive for Covid-19, although they had no other symptoms, said Dr. Paul Nee, an infectious disease specialist at the hospital. Two of the four went on to develop low grade fevers and needed oxygen briefly, but two did not, he said.
While it is not unusual for elderly people to experience confusion when they develop other infections, “the striking thing is we have not seen any real respiratory illness in these patients,” Dr. Nee said. They have continued to test positive and cannot be discharged, even though they are not really ill, he said.While it is not unusual for elderly people to experience confusion when they develop other infections, “the striking thing is we have not seen any real respiratory illness in these patients,” Dr. Nee said. They have continued to test positive and cannot be discharged, even though they are not really ill, he said.
Updated June 5, 2020Updated June 5, 2020
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
But earlier reports had indicated that severely ill individuals with more typical symptoms were more likely to exhibit the rare neurological conditions, which ranged from dizziness and headaches to impaired consciousness, stroke and musculoskeletal injury. The Chinese study in February said that about 15 percent of those patients with severe illness experienced a change in mental status, compared with 2.4 percent of those who did not have severe illness, according to that study.But earlier reports had indicated that severely ill individuals with more typical symptoms were more likely to exhibit the rare neurological conditions, which ranged from dizziness and headaches to impaired consciousness, stroke and musculoskeletal injury. The Chinese study in February said that about 15 percent of those patients with severe illness experienced a change in mental status, compared with 2.4 percent of those who did not have severe illness, according to that study.
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Another study, published in the British Medical Journal in late March, found that of 113 patients from Wuhan who died of Covid-19, 22 percent had experienced disorders of consciousness, ranging from somnolence to deep coma, compared with only 1 percent of another group of patients who recovered from the illness.Another study, published in the British Medical Journal in late March, found that of 113 patients from Wuhan who died of Covid-19, 22 percent had experienced disorders of consciousness, ranging from somnolence to deep coma, compared with only 1 percent of another group of patients who recovered from the illness.
For potential Covid-19 patients and the people caring for them, the Centers for Disease Control and Prevention includes “new confusion or inability to rouse” among the warning signs that should prompt a decision to seek immediate medical care.For potential Covid-19 patients and the people caring for them, the Centers for Disease Control and Prevention includes “new confusion or inability to rouse” among the warning signs that should prompt a decision to seek immediate medical care.
Patients who have encephalopathy and seem confused or incoherent are prone to having seizures, and should receive treatment as soon as possible, said Dr. Jennifer Frontera, a neurologist at N.Y.U. Langone Health who is working with Dr. Chou. She added that seizures can manifest in more subtle ways than the dramatic presentations often depicted in movies and television shows.Patients who have encephalopathy and seem confused or incoherent are prone to having seizures, and should receive treatment as soon as possible, said Dr. Jennifer Frontera, a neurologist at N.Y.U. Langone Health who is working with Dr. Chou. She added that seizures can manifest in more subtle ways than the dramatic presentations often depicted in movies and television shows.
“Seizures are not always big things where people fall down and are shaking on the ground,” Dr. Frontera said. “Some could be just veering off, not paying attention, making repetitive non-purposeful movements, or just mental status changes where people are just not themselves.”“Seizures are not always big things where people fall down and are shaking on the ground,” Dr. Frontera said. “Some could be just veering off, not paying attention, making repetitive non-purposeful movements, or just mental status changes where people are just not themselves.”
But even if seizures are not observed, people who are sick should be aware of other potential mental symptoms.But even if seizures are not observed, people who are sick should be aware of other potential mental symptoms.
“You don’t feel your best when you have a fever, but you should be able to interact normally,” Dr. Frontera said. “You should be able to answer questions and converse in a normal fashion.”“You don’t feel your best when you have a fever, but you should be able to interact normally,” Dr. Frontera said. “You should be able to answer questions and converse in a normal fashion.”
She added: “I don’t want everyone calling 911 because they’re overly concerned. We just don’t have the capacity. But if someone is really out of it, they probably need medical attention.”She added: “I don’t want everyone calling 911 because they’re overly concerned. We just don’t have the capacity. But if someone is really out of it, they probably need medical attention.”