Senior clinician Benedict Michael hasn’t slept more than four hours a night since February. While many in the field would say science is a slow process, the opposite is true for Michael since he started leading groundbreaking research into the neurological complications caused by Covid-19.
“When it became apparent the virus had taken hold in Italy, I said to the guys, ‘We’ve got to get something up and running’,” Michael, from the University of Liverpool, tells NR Times.
Michael led a similar programme during the H1N1 epidemic over a decade ago, when he noticed that, while the number of people who developed neurological complications was low, they were often the most severe cases.
Michael wanted to find out: what is Covid-19 doing to the brain, how is it doing it, what makes a person more at risk of these complications, and how do these patients recover? And so, the National Surveillance Programme for Neurological Complications of COVID-19 was born – just in time for Covid-19 coming to the UK.
Michael and his team developed a way for doctors to record the symptoms of patients experiencing neurological and psychiatric complications through their membership organisations, collaborating with the Association of British Neurologists, British Paediatric Neurology Association, British Association of Stroke Physicians and the Royal College of Psychiatry.
Michael applied for permission to use the data, so he could see complications doctors were seeing, and developed a series of online portals that members of the four bodies could access, to fill out a form.
“We needed something quick and easy to use for busy doctors who are running around,” Michael says.
When the Spanish flu took hold 100 years ago, there were reports of patients developing neurological symptoms, Michael says, but they didn’t have the tools to understand what was going on in the patients.
They didn’t know, for example, if the virus was directly affecting the brain, or if it was the body’s immune response to the virus.
“This is our first opportunity as a neuroscience community to understand the role of the virus and the immune response,” Michael says.
The researchers first excluded easily recognisable causes for conditions, such as older patients with several existing conditions, who might already be confused and agitated.
The data, published in the Lancet journal, has revealed that 50 percent of patients with alterations in their mental state were under the age of 60, which Michael says are cases of unexplained neurological and psychological complications.
The most common reported brain complication was stroke, experienced by 77 of the total 125 cases researchers looked at. Most of these strokes were caused by a blood clot in the brain, while nine were caused by haemorrhage and one was caused by inflammation in the blood vessels of the brain. Seven patients showed inflammation in the brain (encephalitis).
There could be several mechanisms at play in cases where Covid-19 affects the brain in this way.
“We currently think the chances of the virus getting into the brain are rare We do see inflammation when looking at MRI brain scans, but no virus in the spinal fluid,” Michael says.
“We also don’t know to what extent the psychological pressures of being hospitalised during the context of the pandemic,” Michael says. “They can’t see their family, and doctors are gowned up and wearing masks. What does this do to the mental state of a person already at risk of developing a mental health disorder?”
While this is the first nationwide study of neurological complications associated with Covid-19, it’s important to remember that the findings are based only on cases that are serious enough to need hospitalisation.
However, Michael’s work is ongoing. Alongside his team, he plans to focus on looking at patients’ immune response, and carrying out geometric testing to try to understand genetic differences in patients who experience more severe symptoms.
The team also hopes to collaborate with other parts of the world.
“I’ve been contacted by patients and clinicians around the world, thinking about how to bring data sets together,” Michael says.
“The number of cases seems to be coming down in the UK, but colleagues in the US might be seeing a second peak and might be able to identify other patients, to help understand this mechanism.”
