Chronic Neurology in COVID-19 Era: Clinical Considerations and Recommendations From the REPROGRAM Consortium

Abstract

With the rapid pace and scale of the emerging coronavirus 2019 (COVID-19) pandemic, a growing body of evidence has shown a strong association of COVID-19 with pre- and post- neurological complications. This has necessitated the need to incorporate targeted neurological care for this subgroup of patients which warrants further reorganization of services, healthcare workforce, and ongoing management of chronic neurological cases. The social distancing and the shutdown imposed by several nations in the midst of COVID-19 have severely impacted the ongoing care, access and support of patients with chronic neurological conditions such as Multiple Sclerosis, Epilepsy, Neuromuscular Disorders, Migraine, Dementia, and Parkinson disease. There is a pressing need for governing bodies including national and international professional associations, health ministries and health institutions to harmonize policies, guidelines, and recommendations relating to the management of chronic neurological conditions. These harmonized guidelines should ensure patient continuity across the spectrum of hospital and community care including the well-being, safety, and mental health of the patients, their care partners and the health professionals involved. This article provides an in-depth analysis of the impact of COVID-19 on chronic neurological conditions and specific recommendations to minimize the potential harm to those at high risk.

Keywords: chronic neurological disease; coronavirus disease 2019 (COVID-19); guidelines; healthcare services; neurodegenerative disorders; pandemics; protocols; recommendations.

Figure 1

Proposed flow chart outlining the triage and management decisions for patients with chronic neurological conditions in the COVID-19. This flow chart applies to chronic patients who need to make a regular appointment, such as for scheduled check-ups or prescription refills, or for acute emergency presentations due to possible COVID-19 cases or acute neurological symptoms. In both situations, an initial telephone conversation should screen patients to assess the possibility of a COVID-19 infection. This will involve asking about fever, cough, sore throat, fatigue, shortness of breath, anosmia, and potential COVID-19 contact. For those patients without COVID-19 symptoms or who are at low risk and don't require presentation to hospital, telehealth consultation with their neurologist or primary physician can be undertaken. Where this is not possible, physical consultation may be required. If there is suspicion that the patient may have COVID-19 and they are considered at higher risk to their health, they should present to the hospital and receive point-of-entry triage and swabbing for COVID-19 infection. PPE should be worn by both staff and patients. Patients should be assumed to be COVID-19 positive until proven otherwise and be taken to a designated COVID-19 neurology ward. Close relatives and attendees of the patient should also practice social isolation whilst awaiting test results. For patients who require acute neurological care and are not suspected of having a COVID-19 infection, they should receive point-of-entry triage, PPE should be supplied to patients and staff and they should be admitted to a non-COVID-19 neurology ward if necessary. Triage assessment will involve stratification by mild, moderate, severe, and critical risk, according to Table 1.