Lessons from a neurology consult service for patients with COVID-19
Authors: Lindsay S McAlpine, Adeel S Zubair, Jeremy Moeller, Joachim Baehring, Serena Spudich
Journal: The Lancet Neurology (2020)

In March, 2020, the USA watched anxiously as the number of COVID-19 cases rose throughout the country. Yale New Haven Hospital, a tertiary care centre in Connecticut that is less than 80 miles east of New York city, swiftly planned for a large surge in patient numbers. Preliminary reports described frequent and varied neurological complications of COVID-19 (appendix p 1).1Mao L Jin H Wang M et al.Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.JAMA Neurol. 2020; 77: 683-690Crossref PubMed Scopus (4989) Google Scholar, 2Zubair AS McAlpine LS Gardin T Farhadian S Kuruvilla DE Spudich S Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review.JAMA Neurol. 2020; (published online May 29.)http://dx.doi.org/10.1001/jamaneurol.2020.2065Crossref PubMed Scopus (700) Google Scholar In anticipation, the Yale New Haven Hospital neurology department created a subspecialty consult service led by a neuroinfectious disease specialist, to diagnose and treat an expected wave of patients with novel neurological issues. Although neurologists worldwide have participated in the care of patients with COVID-19 on medical wards and in intensive care units, to our knowledge very few health systems have created services solely to manage the neurological complications of COVID-19. From April 6 to May 29, 2020, the Yale NeuroCOVID team reviewed 100 cases, unburdening the primary neurology consult service, identified trends in disease presentations and demographics, and provided diagnostic and treatment recommendations based on emerging scientific literature (appendix p 2). In reviewing our NeuroCOVID patients, it was striking to observe that 25 (25%) were Hispanic and 25 (25%) were Black, while Connecticut is demographically 17% Hispanic and 12% Black.3United States Census BureauQuickFacts Connecticuthttps://www.census.gov/quickfacts/CTDate accessed: June 16, 2020Google Scholar This disproportionate representation of non-white patients requiring NeuroCOVID consultation parallels racial and ethnic disparities in COVID-19 disease presentations noted in the USA and Europe.4Kirby T Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities.Lancet Respir Med. 2020; 8: 547-548Summary Full Text Full Text PDF PubMed Scopus (365) Google Scholar Hispanic NeuroCOVID patients were younger (median age 55 years, IQR 45–68) and had lower in-hospital mortality (16%) compared with white or Black patients (median ages 72 years, IQR 64–81 and 64 years, 58–74, respectively, with 40% mortality). Long-term morbidity related to the neurological effects of acute COVID-19 in surviving patients is unknown. In The Lancet Neurology, Mark Ellul and colleagues5Ellul MA Benjamin L Singh B et al.Neurological associations of COVID-19.Lancet Neurol. 2020; 19: 767-783Summary Full Text Full Text PDF PubMed Scopus (1446) Google Scholar report neurological complications of 901 patients that might be linked to COVID-19 and outline criteria for categorising the likelihood of association of severe acute respiratory syndrome coronavirus 2 infection with a patient's clinical neurological disease.5Ellul MA Benjamin L Singh B et al.Neurological associations of COVID-19.Lancet Neurol. 2020; 19: 767-783Summary Full Text Full Text PDF PubMed Scopus (1446) Google Scholar In addition to their diagnostic criteria, we propose that a dedicated NeuroCOVID consult team has the unique potential to develop expertise, supplement clinical care, and identify the particular needs of local communities. The underlying cause of racial and ethnic disparities observed in patients with COVID-19 deserves critical investigation from pathogenetic and public health perspectives. Our experience suggests that identifying the populations hit the hardest by COVID-19 and creating policies that address fundamental barriers to disease prevention has the potential to avert neurological disease in at-risk communities. SS reports grants from the National Institutes of Health/National Institute of Mental Health and National Institute of Neurological Disorders and Stroke, outside the submitted work, and directs a clinical trial within the international AIDS Clinical Trial group that receives study medications donated by Viiv Healthcare. All other authors declare no competing interests. Download .pdf (.38 MB) Help with pdf files Supplementary appendix Neurological associations of COVID-19