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From SARS to COVID-19: A Neurologist Now on the Front Lines in France

Elena Moro, MD, PhD, professor of neurology at the faculty of medicine of the Grenoble Alpes University in Grenoble, France, had arrived in Canada in October  2002 from Italy. Since she was new to the staff at Toronto Western Hospital of the University Health Network (UHN), she did not attend the AAN Annual Meeting that was held in Honolulu in 2003 when SARS struck Toronto. Many neurologists had gone to Hawaii and those that remained attended a neurology business meeting where they were exposed to an infected colleague.  The remaining neurologists were therefore quarantined, except for Drs. Moro and her colleague, Cheryl Jaigobin, MD, who were deemed not exposed.  After two weeks neurologists who had been in Hawaii returned to relieve them, and the quarantined personnel were able to return to work.

At the UHN—which is comprised of four hospitals—she and Dr. Jaigobin cared for all the neurological inpatients and those coming to the emergency room. Their temperatures were checked every day coming into work, and they had to wear gloves and a heavy mask all day (as well as occasional googles and heavy surgical clothes). Patients already admitted to neurology wards could not be discharged and they had to stay in-house for 40 days.

"Dr. Jaigobin was always very energetic and positive, and that was what sustained me," Dr. Moro said. "Without her, I would have not been able to fulfill my duties," she added.  Her presence was especially important when one of the neurologists working outside the hospital became affected by SARS and had to be admitted to ICU, she added.

Currently, in Grenoble, France, Dr. Moro said the COVID-19 pandemic has just started. "To date, we have less than 20 cases admitted at the infectious disease ward and two in intensive care, but there are many more patients affected and admitted in other regions of France."

The neurologists at the Centre Hospitalier Universitaire de Grenoble have discharged most patients to make beds available to COVID-19 patients and to spare personnel so that they can be ready to take the place of the ones who will become sick; all out-patient consultations have been cancelled, including botulinum toxin injections. Only patients who need to be urgently evaluated are scheduled so that they will be quickly seen without getting in contact with other patients in the waiting areas.

The neurologists have created a process to get stroke patients directly to MRI, thrombolysis and/or thrombectomy, without going through the emergency department (in order to avoid contact with COVID patients). Special phone lines for family doctors and neurologists working outside the hospital have been set to limit admission as much as possible. Teleconsultations have been implemented. "We are adapting our way to work every day as the situation evolves," said Dr. Moro.

"Looking back at the SARS time in Toronto, I think that I did not fully realize that the situation was so dangerous, including for me," Dr. Moro reflected. "I believe that Canadian authorities and Canadian hospitals managed the situation extremely well, putting everybody coming from outside Canada immediately into quarantine, and heavily protecting the hospital staff," she said.

"Paradoxically, this lesson has been forgotten and these strict measures have not been applied in Europe and in many countries worldwide. We are trying to do our best now, but we have lost too much time and it does not work very well," she observed.

A key lesson from SARS has been the importance of our colleagues' support and help, including that of the AAN and its COVID-19 neurology resource center, which was very useful, Dr. Moro said. "We are not alone fighting this battle; we have our colleagues, teams, friends, and family who are standing beside us, encouraging and assisting us," she explained. "Here, all my colleagues have been very enthusiastic in collaborating and applying the directives from the head of the division and from the head of the hospital."

"People from my movement disorders team are ready to help and be engaged; chocolates and croissants are also given to staff, and I receive so many messages full of support, empathy, and love every day from colleagues around the world."

"All this is very moving and helps to keep our hope that everything will end soon and make us even stronger as human beings and physicians," she concluded.