Mass General Neurologists Research Effects of COVID-19 on the Brain
In This Article
- Massachusetts General Hospital is distributing a free smell test in hopes that presymptomatic detection of anosmia might prompt PCR testing at a time when high SARS-CoV-2 viral load is present, improving the sensitivity of PCR
- A longitudinal study will examine the prevalence and duration of SARS-CoV-2 antibodies in people with multiple sclerosis (MS) who previously tested positive by PCR, and investigate how the antibodies relate to MS subtypes and therapeutic agents
- With a focus on essential workers, a multidisciplinary collaboration will respond to the brain health needs of COVID-19 patients who survive the ICU and work to develop preventive and therapeutic measures for neurologic complications
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Alongside the drug trials clinicians and researchers from Massachusetts General Hospital have been leading and joining, there are also multiple COVID-19 studies underway through collaborations in numerous departments. Members of the Department of Neurology at Mass General discussed their research related to COVID-19 at a virtual Grand Rounds presentation on April 30, 2020.
COVID-19 Smell Test
Mark W. Albers, MD, PhD, a neurologist and investigator at the MassGeneral Institute for Neurodegenerative Disease, discussed the COVID-19 smell test.
Anosmia (loss of smell) and ageusia (loss of taste) are so common in COVID-19 that the CDC has added them as screening symptoms. However, self-reporting is unreliable. In a study of 60 COVID-19 inpatients published in the International Forum of Allergy & Rhinology, only 34% reported anosmia or ageusia, but a 40-item objective test showed 98% had a smell deficit.
There was no significant difference in performance on the test between the patients who reported smell loss and the 66% who did not. This suggests objective testing might identify many patients with asymptomatic COVID-19.
COVID-19 anosmia is apparently a problem of the nose, not the brain, and seems to be transient. The receptors for SARS-CoV-2, notably ACE2, are on 2% of olfactory epithelial cells and are not on olfactory neurons. However, research in mice at Mass General suggests viral infection produces a profound interferon response in the epithelium that spreads to neighboring cells and turns off olfactory neurons. When inflammation resolves, the neurons turn on again.
To investigate this hypothesis and explore whether smell testing has clinical applications, Dr. Albers and colleagues created an odor test card in English and Spanish that is being distributed to patients in COVID-19 screening tents, respiratory illness clinics and community health centers. Patients can use a smartphone to go to a website and follow prompts to take an odor identification test and odor discrimination test using the card.
The hope is that presymptomatic detection of anosmia might prompt PCR testing at a time when high viral load is present, improving the sensitivity of PCR. Smell testing might also help with prognostication. In a UC San Diego study published in the International Forum of Allergy & Rhinology, people who self-reported anosmia were 10 times less likely to be hospitalized for COVID-19.
SARS-CoV-2 Antibodies in Multiple Sclerosis (MS)
Eric C. Klawiter, MD, director of the Multiple Sclerosis and Neuromyelitis Optica Unit at Mass General noted that there continues to be many unknowns about how MS and its treatment affect the risk and outcomes of COVID-19. Are patients with MS who use disease-modifying therapies at increased (or decreased) risk of severe COVID-19?
To investigate, Dr. Klawiter and colleagues will begin recruiting for a longitudinal study of SARS-CoV-2 antibodies in people with MS. Their aims are to:
- Compare the prevalence of SARS-CoV-2 antibodies in people with MS who live in Massachusetts (n=500) with their cohabitants (n=400–500), people with MS in New England who previously tested positive for SARS-CoV-2 (n=200) and other Massachusetts residents (n=7,000)
- Examine the prevalence and duration of SARS-CoV-2 antibodies in people with MS who have previously tested positive by PCR and investigate how the antibodies relate to various MS factors such as subtype and therapeutic agent
Many patients with MS are rightly cautious about entering a health care setting, so recruitment, consenting and data collection will be done remotely. Mail will be used to send the participants a blood spot collection card and lancet for the return of the samples.
Information on demographics, MS history, smoking, comorbidities, and COVID-19 precautions, exposure, symptoms and treatment, will be collected at baseline and months 3, 6 and 12.
Brain Health of ICU Survivors
Mechanical ventilation and prolonged periods of sedation, delirium and immobility are risk factors for post-intensive care syndrome (PICS), which is characterized by new or worsening impairment in any of three domains—cognition, physical function and mental health—that persist beyond hospital discharge. PICS-family refers to impairments in mental health among family or caregivers of ICU patients. Both syndromes can last for months to years. Jonathan Rosand, MD, co-director of Mass General Neuroscience presented on the topic.
A real-time database at Mass General shows that of the 254 COVID-19 patients who required ventilation between April 15 and 24, Blacks and Latinos were overrepresented. Thus, severe COVID-19 is having a disproportionate impact on communities already deeply affected by disparities in health care and whose health care needs are understudied.
To support these patients, the Henry and Allison McCance Center for Brain Health at Mass General has envisioned a program similar to Home Base, which is a multidisciplinary collaboration between the hospital and the Red Sox Foundation that provides high-intensity care to veterans of war who have brain complications. Components of the new program are expected to include:
- Inpatient contact/assessment and preventive interventions for patients and family caregivers (with the aid of translators as necessary)
- Outpatient clinical follow-up
- A longitudinal natural history study with nested intervention studies
- A focus on the improvement of central nervous system symptoms
- A focus on essential workers and their families
- Linkage to electronic health records and biobanks
Home Base for COVID-19 aims to measure the impact of severe COVID-19 on the brain health of patients and families, identify and respond to their brain health needs quickly and develop successful preventive and therapeutic measures.
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