Neuro-COVID: Medical Experts Calling For Neuro-COVID To be Classified As A Separate Disease As More Neurological Conditions And Complications Are Arising

Neuro-COVID: With the ever growing neurological complications being reported from not only newly infected COVID-19 patients but more so from so called ‘recovered’ COVID-19 patients, numerous medical professionals are calling for the international community to recognize Neuro-COVID as a new disease that needs to be handled differently and also for more healthcare professionals to recognize its existence to deal with patients correctly when they come complaining of symptoms.


 
In certain South-East Asian countries for instance where despite the fallacy that most people think the locals were not affected so badly by the COVID-19 crisis due to claims that the local governments and doctors handled the situation efficiently, the reality is that it had nothing to do with the so called ‘prowess’ of these buffoons rather it was due the fact that these countries were only affected by the milder strains of the SARS-CoV-2 coronavirus coupled with the fact that genetically they were saved from the severe effects of the disease. In many situations, locals who had symptoms were never tested as the local health authorities knew that these infected patients would be able to ‘recover fast’ from the mild symptoms. However many are now complaining of issues of chronic fatigue, ‘mental fogginess’ , delirium etc  but local doctors in these countries are not even recognizing it as a neurological complication arising from the earlierCOVID-19 infection. Stroke cases have also arisen phenomenally over the last few months.
 
Medical experts have now identified three types of Neuro-COVID, and it progresses through 3 stages involving the brain’s respiratory center. (medulla oblongata)

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In early May, medical researchers from the University of Brescia in Italy published a new research in the journal Brain, Behaviour and Immunity detailing about COVID-19 related neurological issues. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199725/
 
The Italian researchers detailed three distinct features of clinical COVID-19 neuroinfection: (1) Cerebral thrombosis with hemorrhagic infarction, (2) demyelinating lesions, and (3) encephalopathy.
Asst ProfessorDr  Marco Maria Fontanella from the University of Brescia and lead researcher told Thailand Medical News, “We defined this condition as Neuro-COVID for the overwhelming CNS involvement in COVID-19.”
 
According to the Italian researchers, Neuro-COVID has three stages which are neuroinvasion, central nervous system (CNS) clearance, and immune response.
 
In the initial phase:  neuroinvasion, the SARS-CoV-2 coronavirus infects the brain via either the olfactory nerve or the bloodstream. The viral load in the cerebrospinal fluid starts to increase until the second phase. Mild or no respiratory symptoms are present.
 
In the second phase:  CNS clearance, the coronavirus starts to go into deeper parts of the brain, such as the brainstem, the respiratory brain center. Respiratory symptoms become more apparent. The viral load in the cerebrospinal fluid begins to decrease. Here is when the nasopharyngeal swab can detect the virus.
 
In the final phase: immune response, the virus has replicated substantially and alarmed the immune system. A cytokine storm may occur, leading to widespread organ damage, including the brain and lungs. The brain respiratory center is further damaged, worsening respiratory symptoms.
 
In this end phase, the coronavirus may be absent in the cerebrospinal fluid, but detectable in the nasopharyngeal swab. The completed phase 2 could explain why the cerebrospinal fluid was tested negative for the virus in some Neuro-COVID cases. Depending on which areas of the brain are damaged, either one of the three clinical types of Neuro-COVID occurs.
 
Researchers in China also support the proposed neuroinfection route by the Italian researchers, which involve either olfactory nerve transport or blood-brain-barrier crossing, or both. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197033/ and https://link.springer.com/article/10.1007/s12640-020-00219-8
 
Numerous other research groups have also linked the brainstem ie brain’s respiratory center to COVID-19. An area of the brainstem called the medulla oblongata harbors the nucleus of the solitary tract that receives and sends nerve signals to the heart and lungs. The pre-Bötzinger complex within the brainstem’s medulla is a cluster of neurons controlling the respiratory rhythm.
 
According to Indian researchers in another study, damage to the pre-Bötzinger complex cause respiratory failure and death. https://pubs.acs.org/doi/10.1021/acschemneuro.0c00217
 
Another research paper published also in the journal Brain, Behavior, and Immunity; and based on previous coronavirus studies in animals states that “it is reasonable to think that SARS-CoV-2 enters the CNS via the olfactory bulb and may reach brainstem causing dysfunction and/or death of infected neurons, especially those located in cardiorespiratory centers in the medulla.”
 
Researchers from the Sultan Moulay Slimane University also indicated that both MERS and SARS deposited in the brainstem when given to mice via the nose. They said, “Accordingly, a part of respiratory failure could be effectively attributed to an injury of brainstem centres located in the medulla oblongata.” https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25960 and https://pubmed.ncbi.nlm.nih.gov/32104915/
 
Research has shown that ACE2 receptors used by SARS-CoV-2 is present in the brain, especially in the brainstem and regions responsible for regulating cardiovascular functions.  These regions include the nucleus of the solitary tract and medulla oblongata. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214096/
 
Another study published in The Lancet Microbe has confirmed that SARS-CoV-2 replicates in neuronal cell lines (i.e., cultured cells in a dish). Infecting mice with SARS-CoV-2 via the nose led to high virus replication in the lungs and brain, but the researchers did not analyze the brain regions separately. https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30004-5/fulltext and https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30004-5/fulltext
 
All 6 research groups are proposing Neuro-COVID as a new disease terminology with direct linking towards the brainstem. And another Italian study has also confirmed the correlations. https://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2020N06A0678
 
These Italian researchers had analyzed high-quality specimens from a deceased COVID-19 patient who suffered a loss of smell and taste, headache, fever, and acute respiratory distress syndrome (ARDS). They found SARS-CoV-2 particles concentrated in the olfactory nerve and brainstem, which were also damaged.
 
The researchers concluded that this is the first evidence supporting a direct infection and destruction pathway of Neuro-COVID, from the olfactory system to the brainstem. They said, “The damages of the brainstem could justify the specific respiratory dyssynergia presented by this patient.”
 
German researchers in autopsy studies examined the brain of six Covid-19 victims. Sometimes, Covid-19-associated brain damage is attributed to hypoxia ie insufficient blood flow to the brain. But detailed analyses in this study ruled that out.
 
They said, “We do not attribute these findings to the clinically relevant COVID-19-associated severe hypoxia. Causes of brain damage especially around the brainstem were probably either exaggerated immune response or viral invasion, or both. In summary, in addition to viral pneumonia, a pronounced CNS involvement with pan-encephalitis, meningitis, and brainstem neuronal cell damage were key events in all our cases.” https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31282-4/fulltext#sec1
 
With all the mounting evidence and what we know more about the SARS-C0V-2 mode of actions in the human host body and the various aspects of the COVID-19 disease, it is time to start fragmenting various aspects and start treating Neuro-COVID as a separate disease for better management, treatment and also more awareness.

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