Nearly nine months into the pandemic, neurologists talk about the most valuable lessons they learned about treating an infection with SARS-CoV-2 and public health management, emergency leadership, care delivery neurologic, and how they should overcome the professional and emotional emergencies that COVID- 19.
Over the past eight months, neurologists have learned a great deal about the detection and treatment of infections with SARS-CoV-2 and public health management, emergency leadership, neurologic care delivery, and the -our amazing medical work. While the number of these lessons will one day be able to fill in textbooks, Neurology today several experts in these fields have called for their most valuable single lesson from COVID-19 to date.
James J. Sejvar, MD, neurologist, and epidemiologist at the Centers for Disease Control and Prevention (CDC)
“The virus is more contagious than we first realized. Many of the COVID-19 release, health effects, and release features we announced in spring 2020 have been relatively stable. It remains that the people most at risk of becoming seriously ill from COVID-19 are people of advanced age (over 65 years); people with co-diseases, including obesity, cardiovascular disease, and diabetes; and those of immunity. There are also some new things we have learned about the virus, and how it has spread, in the coming months.
We now know that this virus, SARS-CoV-2, is much more ‘infectious’ than we first thought – one person with COVID-19 is able to easily spread the virus up to to three or four more. We have also come to understand that children are not completely immune to the adverse effects of the virus, as evidenced by multisystemic inflammatory syndrome in children (MIS-C), which can lead to serious and dangerous infections. cause life in young children.
Finally – as debate continues about sending children back to school, reopening restaurants and bars, and other efforts to return to normalcy – public health professionals are trying to find out how to balance the clear and current risk from the continued spread of the virus from people at lower risk to those at higher risk, by going back to ‘ normal life. ‘ However, approaching the winter season when all respiratory viruses are most likely to be affected, the public health messages remain clear and simple: Wear a mask; avoid social crowds, especially indoor; wash hands frequently; and keep at least six feet between you and others. ”
Kenneth L. Tyler, MD, FAAN, neurovirologist and chair of neurology, University of Colorado School of Medicine
“It’s much more than a respiratory illness, and in fact, it has serious brain problems. In the acute stage, we can divide these complications into effects of systemic disease, including hyper-inflammation, enhanced coagulation, and multi-organ system failure that often leads to ‘encephalopathy’ or cerebrovascular events. We also know that COVID-19 can be associated with encephalitis and that this can lead to direct infection of the brain with SARS-CoV2, but also, more commonly, with an inflammatory condition in which we usually find direct evidence of the virus in CNS.
In addition, the virus can cause a number of post-infectious immune-mediated conditions that may include Guillain-Barré syndrome and its variants, acute diffuse encephalomyelitis, acute necrotizing encephalopathy , and MIS-C, but also, less commonly, in adults. In addition, we are now just beginning to identify and understand the potential long-term neurologic sequelae, as many patients report that they have not returned to normal. -complete to the point of mental activity or continuing symptoms long months after ‘recovery’ from their infectious disease. “
John M. Murphy, MD, neurologist, and president and CEO of Nuvance Health
“We often have to re-evaluate our facts. As we monitored clinical data and reports from around the world, we built protocols and policies based on what we believed were established certifications. It became important for us to recognize that our understanding was evolving, and our communication needed to reflect that. Early in the pandemic, we believed the following statements were correct: asymptomatic people do not spread the virus, children do not become ill with COVID-19, the virus spread directly by droplet spread, steroids should be avoided, and masks only benefit others. As a learning organization, we honestly tried to share what we knew but, at the same time, we invited the idea of questioning without creating unnecessary confusion. Led by a growing and widely believed evidence-based consensus, we quickly established standard clinical approaches across our seven hospitals in New York and Connecticut. We also shared what we learned with others, both nearby. As I look back on the last eight months, I am proud of the many heroes who work in our health system and thank our communities for their support. ”
Steven L. Galetta, MD, FAAN, neuro-ophthalmologist and chair of neurology, NYU Langone Health
“Being on time is critical to communicating guidelines and data that are changing as the pandemic grows. The most important thing I learned during COVID-19 was the need for bilateral communication. It was essential to be a good listener and ask people what they were most comfortable doing in an emergency; playing to people’s strengths was the best approach. Pandemic affected individuals in so many ways, so one prescription was not suitable for everyone.
Conditions were very challenging. Some neurologists had to see patients for meaningful visits while at the same time as mother and father. It was clear that we needed better solutions for childcare going forward. At the same time, the residents, psychiatrists, and stroke specialists saw many people die, and that was sad. The psychiatric aspects of this pandemic have been overwhelming. In the future, I wanted to make sure our teams heard from me and I listened to them. We needed people to know that we were out for them in this time of social and physical isolation. ”
James C. Stevens, MD, FAAN, neurologist and president of AAN
“Never underestimate people’s convenience, creativity and resilience. For a group leader, calm and clear thinking is essential when there is a sudden and unexpected challenge. In my first assessment I was gathering the most reliable information currently available on the potential impact of pandemic on individuals and the group. , then prioritizing the actions required, and changing as more information becomes available.
Communication was equally essential: messages about our planned activities – postpone the AGM, telehealth, personal protective equipment (PPE), financial support opportunities, the latest science, and more – with maintenance ‘communication’ in our physical environment at a distance / quarantine.
This whole group came together to ensure the delivery and support of science and education science, telehealth management, advocacy, PPE, and financial resources through our websites and SYNAPSE and through meaningful meetings. Since the public health crisis was declared in March, I have been impressed by the actions of our staff, committees, volunteers and AAN members on a daily basis. Not everyone’s willingness to adapt and find solutions to our dramatically changed environment has been so amazing and it has always been a profound lesson that I always take with me. . ”
Jennifer Bickel, MD, FAAN, head of headache department in the department of neurology at the University of Missouri and COVID staff wellness officer at Mercy Children’s Hospital
“In these times of crisis we have learned that we have the power to choose how we respond. The first eight months of the pandemic changed our jobs, our communities, our families and ourselves. Many of us were suddenly challenged by the fact that our mission of serving others could endanger ourselves and our loved ones. Some of us worked countless hours on COVID-19 units in positions far beyond our comfort zones. Some of us lost our jobs. Some of us looked at our academic productivity gap as we balanced parenting with being a researcher. And most of us couldn’t spend time together after canceling love conferences one by one. However, we have all used our values and mission to guide how we lead this changed world. We have found inspiration and pride in our colleagues on the front. We have been comforted by the neurologists to find ways to entertain us through virtual reality, Zumba, mindfulness, and much more. We have realized that we need to take care of ourselves to take care of others. None of us know what the next eight months will look like, but we all know that we are stronger than we were before the pandemic. ”
Neil A. Busis, MD, FAAN, associate chair of neurology for technology and innovation and clinical director of the telehealth program for NYU Langone Health
“Telemedicine changed the use of neurology and has been proven to deliver uncompromising care. Conventional wisdom confirmed that the teleneurology study would be a very small subset of the personal neurology study. Moving toward a study with observation, functional testing, and the use of household materials, the neurology study was found to be significantly more complete than you might expect before the epidemic. The old cliché that ‘necessity as a mother of invention’ is true for the isolated general neurological study. Initially the need to adapt to meaningful neurology meetings arose because of the pandemic; next came a collection of creativity that greatly developed what we all thought the meaningful study of neurology could achieve. Future research appears to indicate that the quality of care is similar to the quality of face-to-face visits and, indeed, excels in providing opportunities for the assessment and treatment of social symptoms. health since patients can be examined at home. ”