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CDC Launches Neuro-COVID Unit to Determine Causality and Frequency of Neuro-COVID

Article In Brief

Neurologist James J. Sejvar, MD, discusses what's known to date about COVID-19 and the launch of the CDC's new neuro-COVID-19 unit.

AAN member James J. Sejvar, MD, a neurologist and epidemiologist at the US Centers for Disease Control and Prevention (CDC), has been working on COVID-19 since early January when the first reports of illness were announced in China. Actively monitoring and tracking reports of neurologic illness related to COVID-19, the CDC has recently launched a neuro-COVID unit and placed him in charge. Neurology Today spoke to him in early July to learn about the activities currently underway at his unit and to get an update on what the CDC has learned since the pandemic began.

We last spoke at the end of March.

What do we know now, three months later, about the SARS-CoV-2 virus?

We've learned several things. There appears to have been a minor mutation in the virus that allows it to be more easily spread between people. This makes it somewhat more contagious, but, of note, it does not appear to impact the severity of disease with the virus. There is a great deal of evidence suggesting that not following social distancing and wearing masks can and does lead to increased numbers of cases; this has been very apparent in the United States where jurisdictions that have not emphasized these protective measures have seen a spike in cases.

Have there been advances in antibody tests?

Labs continue to work on serologic (antibody) tests in order to increase the sensitivity and specificity of the assays. There are still some challenges to some of the assays currently available, but various labs throughout the world continue to develop antibody tests.

What have been the epidemiologic trends?

Places that have enforced strict public health measures, including social distancing, mask use, and the avoidance of crowded areas have had very good control over the spread of SARS-CoV-2; this includes the European Union and Asia. On the other hand, places in which these measures have sometimes been curtailed in an effort to lift sheltering regulations, including the United States and Brazil, continue to see significant ongoing spread of the virus. In addition, it continues to appear that minorities in the United States appear to have poorer outcomes.

How close are we to a vaccine?

There are several vaccines that are in Phase II trials, looking at safety. Although there is an international push to develop a vaccine quickly, it will in all likelihood be many months before we see a safe and effective vaccine for SARS-CoV-2, and once identified, it will take time to manufacture enough doses to administer to a large population.

Why did the CDC decide to launch a neuro-COVID team?

There have been increasing reports, in the form of case reports or small case series, associating various neurological conditions and COVID-19. However, these are generally limited due to incomplete information, non-systematized data collection, and questionable information on causality. The CDC has endeavored to take a more systematic approach to these reports, and determine whether there is likely to be a causal association between SARS-CoV-2 and the neurologic illness, and to try to determine whether there are any neurologic conditions that appear to be occurring at a higher-than-expected rate, suggesting a red flag for increased frequency of a particular neurologic illness.

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“There are several vaccines that are in Phase II trials, looking at safety. Although there is an international push to develop a vaccine quickly, it will in all likelihood be many months before we see a safe and effective vaccine for SARS-CoV-2, and once identified, it will take time to manufacture enough doses to administer to a large population.”—DR. JAMES J. SEJVAR

What do you intend to study?

We intend to look at various databases, as well as to conduct a retrospective/prospective case ascertainment, to look for neurologic illnesses of interest, and try to determine causality and frequency of occurrence.

How will you approach those studies and data collection?

We will assess several databases and surveillance platforms which the CDC currently already operates to see if we can determine the epidemiologic and clinical features of neuro-COVID cases. We are also partnering with a number of clinical and academic medical centers to perform a bi-directional retrospective/prospective case investigation in order to more fully characterize the various neurologic illnesses which appear to be associated with COVID-19, and to look at frequency of occurrence of these neurologic illnesses.

Which neurologic symptoms are on your radar for study and why?

There have been a number of neurologic illnesses that have appeared as case reports or as parts of small series, including encephalopathy/encephalitis, Guillain-Barré syndrome (GBS), stroke, myelitis, and others. I think we are mainly interested in stroke, since there appears to be some data suggesting that SARS-CoV-2 can produce or result in strokes in very young individuals (age <50 years). We would like to try to substantiate this further. Another thing that we will be looking for is GBS, since, in rare instances, GBS can be triggered by a vaccine. We would want to have very good background data on the incidence of GBS prior to initiation of a vaccination campaign, so that we can use this to monitor vaccine safety for a SARS-CoV-2 vaccine. Finally, we are interested in encephalitis; it will be important to try to document whether SARS-CoV-2 can be associated with neurotropic disease as this could substantially impact the overall burden of illness with COVID-19.

If neurologists identify one of those symptoms, who can they contact to help with the effort?

If neurologists would like to report an unusual case of neurologic illness possibly in association with COVID-19, they can reach out to CDC-INFO at https://www.cdc.gov/cdc-info/index.html. The CDC-INFO line is staffed 24/7, and can be used by clinicians to report cases, ask questions, or otherwise get additional information from the CDC.

What is the most actionable advice you can give to neurologists in practice today?

We are not out of the woods yet, and it is too early to get complacent. It is still very important to maintain social distancing and mask wearing, as well as frequent hand washing and cough hygiene. Use proper personal protection equipment (PPE) when examining persons with known or suspected COVID-19 to protect yourself and your other patients. Also, when evaluating your patients with acute neurologic illness, consider SARS-CoV-2 in the differential, since we are still unaware of the actual frequency and occurrence of neurologic illness associated with COVID-19.