Shyam Prabhakaran, MD, MS

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Hi there. My name is Shyam Prabhakaran. I'm the chair of neurology at the University of Chicago Medicine. During this corona pandemic, there are many questions and concerns that folks have been asking related to their underlying health conditions, as well as the risk that they may have of getting the virus itself, especially those who have neurologic conditions or have suffered a stroke. I'm here today to try to answer some of those questions.

So as many of you already know-- and there's a lot of literature and reporting on this-- but the novel coronavirus or what's now called COVID-19 is an infectious disease that has now spread throughout the world, including in our own backyards in Chicago. It's a respiratory infection that can range from very mild symptoms for the majority, such as common cold symptoms-- cough and runny nose-- or flu symptoms, like a fever or sore throat. And COVID-19 can also cause severe symptoms, like difficulty breathing and respiratory arrest.

So we've also seen patients experience neurologic symptoms as a result of COVID-19 infection. And those might be symptoms like mild headaches, muscle aches, and then specific symptoms that seem to be relevant to COVID-19, such as loss of smell and taste.

So one of the questions we hear a lot about, of course, is, are you at risk of getting COVID-19 because of your underlying neurologic illness? We do know specific populations of patients with neurologic disease are at higher risk, and those include patients who are on immunotherapy-- so medications that suppress your immune system to, say, treat a condition like MS. That may make you more vulnerable for getting the virus in the first place.

And then there's the group of patients who may have neurologic illness but not on suppressive medications, but may be more vulnerable because of their age and associated neurologic deficits. So those might include patients like stroke patients, Parkinson's disease patients, and dementia patients. So that group of individuals do need to be more aware about the potential exposures to COVID-19 and take precautions when necessary.

So it does seem to be in the data that's been published to date that some patients who have risk factors for stroke and heart disease-- cardiovascular system, so to speak-- as well as prior stroke are at higher risk of the more severe complications of COVID-19, including death. And so that does seem to be a concern that we are, likewise, trying to get the message out that if you have a stroke and you're at risk for stroke from the basis of symptoms or risk factors, you should really be taking extreme caution in this pandemic.

I think what we've been talking about in the general public would apply more strictly to this population. Physical distancing, such that they're not the ones who are coming into contact with others. Certainly, limiting time outside the home to only those activities that are absolutely essential, such as maybe groceries or medications. And even those, one might want to ask family, if possible, to go and get those types of necessities as opposed to going out yourself. And then, of course, the hygiene around handwashing and cleaning around the house applies more strictly to this group of individuals who are older, have risk factors, have had a stroke. We want them to be especially cautious.

And now more recently, there's been emphasis on universal masking. That's been discussed in recent press, that people who are going out should wear fabric-type masks to protect more other people from getting something that they may asymptomatically be carrying. But it's probably recommended for this group in particular.

So a question that often comes up is, should I be taking my stroke medications? And if that's something that I have to get a blood test or other types of checkups, how do I do that? Well, the answer to the question is because there is a risk of having a stroke when you stop medications-- especially medications that are controlling risk factors, like blood pressure or diabetes-- that is essential right now, because we want to prevent you from coming into the hospital with a stroke. And we just mentioned, having a stroke, obviously, would put you at even greater risk, should you contract COVID-19, of having more severe complications from that illness. So we think it's essential that people continue their medications.

Now, when it comes to medications that require blood checks, such as Coumadin or warfarin, we would recommend that you, again, talk to your doctors about the frequency with which you need to have your blood drawn so that you can maintain the level that you need on those medicines to prevent a stroke. Now, they may tell you to do it at a certain frequency, like once a month, or maybe more frequently if needed, if your level isn't where it should be. There are options to do those tests at home. There are home blood monitoring approaches, so you may want to talk to your doctor about that.

So there seems to be several levels of effects. We mentioned earlier that COVID-19 seems to have an effect, in general, of causing some mild neurologic symptoms. And these range from headaches to muscle aches to dizziness. Even some confusion can occur. And then there's more specific ones, like this taste and smell that seems to be even an early sign of infection with the virus.

Then you can have another range of symptoms, and those apply mostly to neurologic patients-- patients who've had a neurologic condition, like stroke or MS. And in those patients, if they get the illness, they may see a temporary worsening of their symptoms. So they may find that their weakness is a little worse when they become infected with the virus. And that's because most viruses and other acute conditions can make the brain a little bit weaker than it was before that condition set on. And so their symptoms will temporarily get worse. They're not permanently going to be worse, but temporarily they may feel that their neurologic symptoms are worse.

It's really important in those instances that the patients and the caregivers for those patients recognize the symptoms, report them to their doctors, and the doctors to determine whether they think the symptoms are just a worsening of their baseline neurologic problems or whether they represent a new problem. And that sometimes requires an assessment, maybe by phone and sometimes in person.

And then the last group, which is probably the more unknown, is whether the disease, the COVID-19, actually has a direct effect on the brain. Does it cause meningitis or encephalitis? Those are infections directly into the brain. Right now we only have some small pieces of data that suggest it's possible, albeit very rare. But it is possible. And again, those who are immunocompromised, those who have risk factors, may be more at risk for that. But for now, we know that those have only rarely been reported.

I think the main message here is to, again, adhere to the guidelines that have been distributed by a lot of different people-- from state, local governments, national. And the message is that physical distancing-- I like to use the word physical distancing, not social distancing. Physical distancing is really important, because we know that this is something that's transmissible by close contact with others, and it's airborne in a limited distance of around six feet.

And that you should obviously be socially engaged. We want, of course, our neurologic patients to be connected to their loved ones, to their friends, their caregivers so that people can check on them and know how they're doing. And of course, we talked about the hygiene that is important-- washing your hands, cleaning and disinfecting your surfaces and things you purchase, as well as masking yourself if you are going to go out for essential activities, like grocery shopping or to the pharmacy.

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