COVID-19 Self Lockdown

At first I was going to put a caveat at the beginning of this post that for the reader to beware that this was a non-political post but then I remembered that “everything is politics” as Thomas Mann observed. I will then lead off with a caution to my political brethren. Please do not continue to politicize the COVID-19 outbreak to your own benefit. A day of reckoning will come; if not from the voters then from Providence. If you think that I am talking about you, then I am. 

Having spent a lot of time around physicians in the last few years, I am acutely aware of the threat posed by COVID-19 to my health condition and those of my family and friends. Kidney transplants, heart conditions and Parkinson’s Disease could be listed as my next of kin. During my 15-year war with Parkinson’s Disease (and I realize that it is a war of containment) I have realized that good information is foundational to good strategy. What follows is for informational purposes and should not be considered medical advice as I did only manage a “C-” in my high school biology class.

Since my fight with Parkinson’s Disease has raised my awareness of all thing neurologic, I ran across a report from physicians in Italy currently treating patients who are COVID-19 positive. The report suggests that COVID-19 can present with neurological symptoms before the patient manifests the more common fever and cough that the general population has been warned about. 

Alessandro Padovani, MD, professor of neurology and director of the Institute of Neurology at the University of Brescia stated “The recent onset of the pandemic caused by COVID-19 has rekindled attention to the possible neurovirulence of this virus and the possible involvement of the CNS and peripheral nervous system. Neuro-invasion usually occurs by hematogenous route or by retrograde axonal transport through some cranial nerves, such as the olfactory nerve, the trigeminal nerve, the glossopharyngeal nerve and the vagus, or peripheral nerves,”

I will admit that I don’t understand all of the details of his statement but I can get the gist of it. Not everyone presents the same way and you have to ask yourself how many patients are not  being tested because no one is mentioning the possibility of these other presenting symptoms. If you are neuro-compromised then beware.  

One term in particular caught my eye. The term “olfactory nerve” suggests that the virus can affect your sense of smell and by extension your sense of taste. The news media recently reported that South Carolina Congressman Joe Cunningham announced that he was COVID-19 positive and said that loss of his sense of smell was the first symptom that he noticed. (The medical term for the loss of sense of smell is hyposmia. The loss of taste is termed hypo-ageusia). 

The neurologists in Italy have noticed more symptoms. They recently reported “Neurological symptoms in patients with COVID-19 infection fall into three categories: neurological expressions of the symptoms of the underlying disease (headache, dizziness, disturbances of the state of consciousness, ataxia, epileptic manifestations and stroke;) symptoms of neuro-peripheral origin (hypo-ageusia, hyposmia, neuralgia;) symptoms of skeletal muscle damage, often associated with liver and kidney damage.”                                  

A symptom is defined as physical or mental manifestation of an underlying disease. In the case of COVID-19 we have been told repeatedly that coughing and fever are the primary symptoms. Coughing indicates an attack on our pulmonary system. Those with weak hearts and lungs are considered vulnerable. Fever indicates an infection. Those with weak immune symptoms are also considered vulnerable. Coughing and fever – typical symptoms of a cold or flu.

The neurological symptoms noted by the Italians are not typical of a cold or flu. 

The fact is that we just don’t know what we are dealing with. Yet. Until then, we should voluntarily lockdown even if our political leaders are not inclined to make us with the force of law. 

Why does a lockdown work? Studies from Italy and South Korea suggest that 50% to 75% of people who test positive showed no symptoms yet were highly contagious. Isolating those who tested positive drastically decreased the number of new patients over a 10-day period. Since we are short of testing kits, we don’t know how many people are COVID-19 positive. That’s why a two-week lockdown was initially suggested – we should assume that all of us are until proven otherwise. 

I will close with another observation about politics generally attributed to Tip O”Neill who said “all politics is local”. So is COVID-19.