By: Dr Asad Abbas, M.D. (Medicine), D.M. (Neurology), Consultant Neurologist, Member American academy of neurology and Indian academy of health care & Sr. Associate Editor-ICN World
LUCKNOW: As we are standing at the crossroad of the spread of corona pandemic world over and its arrival at the doorstep of our country. Every doctor and every specialty will sooner or later have to face the problem of this deadly virus in their patients. As of now a very little is known about the pathophysiology of this virus and involvement of other organs besides the respiratory system.
British neurological society has come up with a detailed dos and don’ts for neurologist as well as patients of neurological disorders in the time of corona pandemic.
In India as we have a large population under treatment of various neurologist for several diseases, this is essential for the neurologists to get updated and to educate their patients.
It is of public interest also to know about the dos and don’ts for the neurology patients so that they should not land up in complications in case of unlucky scenario of a Covid 19 infection.
As we all know and are regularly reading in social media/print media/govt advisories about the methods of prevention of this disease and majority of us already following the concept of social distancing/hand sanitization/avoidance of regularly touching of your face/staying at your home in case of cough and cold/wearing mask/gloves etc.
These are the general advice irrespective of age or comorbid condition. I will just focus on the persons having neurological diseases.
First general information about the virus, Covid 19 is a new virus of corona virus family which primarily affects our airways and lungs. Its infectivity is very high and it effects almost all persons across the age group whosever comes in a contact with a Covid 19 patient.it is being thought till now that it primarily causes complications in elderly population and persons with comorbid condition like diabetes/heart disease/ respiratory disease/chronic kidney disease and some of the chronic neurological disorders.
Another important group of patients at higher risk of getting complicated Covid 19 infection are those on immunosuppression, medical or disease wise. In these subsets of patients their immunity[ability to fight any infection] level is low because of some medication or some disease.
So out of those persons suffering with neurological diseases the 2 subsets of patients are at greater risk
1]the persons on immunosuppressive treatment either steroid alone or in combination with immunosuppressive drugs, being used for chronic neurological disorders like.
Multiple sclerosis/nerve diseases like chronic neuropathies[CIDP/vasculitis] muscle diseases like muscular dystrophies, inflammatory myopathies etc.
This aspect is crucial on neurologist part and the patient and caregiver should take note that if they are on these medication and in case they have fever/cough and other symptoms of Covids 19 infection and had a travel history or history of contact with confirmed Covid patient they should inform their neurologist and follow proper medical advice.
2] out of all patients of neurological disorders the patients having neurological deficit affecting respiratory muscle/muscle of swallowing are at a higher risk of getting complicated Covid 19 infection and a need for ventilatory support. For example patient of motor neuron disease/myasthenia etc.
With this background what should be the advice to our neurology patients to fight this deadly disease and to avoid complication.
Important and common advise to the patients with various neurological problem are as under..
1]Headache/migraine–they are not on any increased risk. Just take all the general precaution. Stress can precipitate your stable headache so avoid stress.do meditation/yoga/don’t see too much of negative news about corona pandemic, talk to your near ones frequently and continue on your medication.
2]Epilepsy– No increased risk except any fever can precipitate your seizure so avoid getting infection. Don’t miss your antiepileptic, take a good 8 hours of sound sleep and don’t get stressed.
3]Stroke—these are subsets of patient on a increased risk because of their age, comorbid conditions and sometimes poor nutrition. Some of them may be bed ridden and on regular physiotherapy at home or at some center. Their caregivers and they themselves should take extra precaution, should self-isolate themselves, withheld assisted physiotherapy, nutrition should be taken care off through Ryles tube or oral route.
They are on increased risk of getting aspiration pneumonia so a 4 hourly schedule of chest physiotherapy, steam inhalation, nebulization done by caregivers. Those caregivers should also follow the rules of corona prevention strictly so that they should not bring infection for this vulnerable group.
4]Nerve and muscle diseases—Those patients who are already having respiratory/swallowing weakness should follow the instruction as for stroke patients.
5] Patient with other neurological diseases like neuralgiform pain/cervical/lumbar radicular pain should follow their medication and continue with their physiotherapy schedule at home.
For stable neurological patients it is also important not to go to the hospitals/clinic for minor ailments. This will lead to overcrowding at those places with increased risk of spreading infection. Try to consult your physician on phone through video call/or whats app. That’s way in this difficult time you will help in controlling this pandemic.
As at this stage our healthcare workers/medical professional are busy playing their part in fighting this pandemic cooperate with them and respect them.
Take away points-
1]Follow government and medical advisory
2]Social distancing/self care
3]Don’t get stressed, stay relaxed
4]Don’t miss your regular medication
5]In case you are on steroid or immunosuppressive take extra precaution
6]Follow all medical advice in case you suspect a Covid 19 infection.
7]Don’t hide anything from your treating doctor
8]Keep a distance from elderly stroke patient or patient with neuromuscular disease at your home
9]Exercise regularly/yoga meditation will help
In the end prevention of this disease is its cure. Stay at your home stay healthy.
I would like to quote a doctor in USA ‘’in the end it will be impossible to know if we overreacted or did too much, but it will be QUITE apparent if we underreacted or did too little.’”
Dr Asad Abbas, Consultant neurologist, Member American academy of neurology and Indian academy of health care & Sr. Associate Editor ICN World