Parkinsonism as a Third Wave of the COVID-19 Pandemic?

Authors: Beauchamp, Leah C.^{a; b} | Finkelstein, David I.^a | Bush, Ashley I.^{a; c} | Evans, Andrew H.^d | Barnham, Kevin J.^{a; b; c; *}

DOI: 10.3233/JPD-202211

PDF: https://content.iospress.com/download/journal-of-parkinsons-disease/jpd202211?id=journal-of-parkinsons-disease%2Fjpd202211

Abstract

Since the initial reports of COVID-19 in December 2019, the world has been gripped by the disastrous acute respiratory disease caused by the SARS-CoV-2 virus. There are an ever-increasing number of reports of neurological symptoms in patients, from severe (encephalitis), to mild (hyposmia), suggesting the potential for neurotropism of SARS-CoV-2. This Perspective investigates the hypothesis that the reliance on self-reporting of hyposmia has resulted in an underestimation of neurological symptoms in COVID-19 patients. While the acute effect of the virus on the nervous system function is vastly overshadowed by the respiratory effects, we propose that it will be important to monitor convalescent individuals for potential long-term implications that may include neurodegenerative sequelae such as viral-associated parkinsonism. As it is possible to identify premorbid harbingers of Parkinson’s disease, we propose long-term screening of SARS-CoV-2 cases post-recovery for these expressions of neurodegenerative disease. An accurate understanding of the incidence of neurological complications in COVID-19 requires long-term monitoring for sequelae after remission and a strategized health policy to ensure healthcare systems all over the world are prepared for a third wave of the virus in the form of parkinsonism.

“For too long medical science has tended to relegate the 1918 influenza/encephalitis lethargica/parkinsonism puzzle to an intellectual ash heap – apparently on the assumptions that these pandemics are past and of little and dwindling importance to current and future health. But failure to identify the 1918 influenza virus as the cause of encephalitis lethargica and parkinsonism has crippled progress towards the understanding of influenza pathology and epidemiology needed to fuel and guide prevention of these elusive yet exceedingly important diseases.”

Reimert Ravenholt, 1982 [1].

In December 2019, pneumonia caused by a novel coronavirus, SARS-CoV-2, was reported for the first time in Wuhan, China [2]. On March 12, 2020, the World Health Organization (WHO) officially declared coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, a pandemic. At the time of preparing this manuscript, 23.7 million people had been infected, and >800,000 people had died from COVID-19 according to data from the WHO [3]. The presentation and nature of symptoms in COVID-19 appear to be ever-increasing, with new case-reports appearing daily. Extrapulmonary complications have been reported in many instances of infection, including neurological symptoms.

https://content.iospress.com/articles/journal-of-parkinsons-disease/jpd202211