Lessons from a neurology consult service for patients with COVID-19

In March, 2020, the USA watched anxiously as the number of COVID-19 cases rose throughout the country. Yale New Haven Hospital, a tertiary care centre in Connecticut that is less than 80 miles east of New York city, swiftly planned for a large surge in patient numbers. Preliminary reports described frequent and varied neurological complications of COVID-19 (appendix p 1).1, 2 In anticipation, the Yale New Haven Hospital neurology department created a subspecialty consult service led by a neuroinfectious disease specialist, to diagnose and treat an expected wave of patients with novel neurological issues. Although neurologists worldwide have participated in the care of patients with COVID-19 on medical wards and in intensive care units, to our knowledge very few health systems have created services solely to manage the neurological complications of COVID-19.

From April 6 to May 29, 2020, the Yale NeuroCOVID team reviewed 100 cases, unburdening the primary neurology consult service, identified trends in disease presentations and demographics, and provided diagnostic and treatment recommendations based on emerging scientific literature (appendix p 2). In reviewing our NeuroCOVID patients, it was striking to observe that 25 (25%) were Hispanic and 25 (25%) were Black, while Connecticut is demographically 17% Hispanic and 12% Black.³ This disproportionate representation of non-white patients requiring NeuroCOVID consultation parallels racial and ethnic disparities in COVID-19 disease presentations noted in the USA and Europe.⁴ Hispanic NeuroCOVID patients were younger (median age 55 years, IQR 45–68) and had lower in-hospital mortality (16%) compared with white or Black patients (median ages 72 years, IQR 64–81 and 64 years, 58–74, respectively, with 40% mortality). Long-term morbidity related to the neurological effects of acute COVID-19 in surviving patients is unknown.

In The Lancet Neurology, Mark Ellul and colleagues⁵ report neurological complications of 901 patients that might be linked to COVID-19 and outline criteria for categorising the likelihood of association of severe acute respiratory syndrome coronavirus 2 infection with a patient's clinical neurological disease.⁵ In addition to their diagnostic criteria, we propose that a dedicated NeuroCOVID consult team has the unique potential to develop expertise, supplement clinical care, and identify the particular needs of local communities. The underlying cause of racial and ethnic disparities observed in patients with COVID-19 deserves critical investigation from pathogenetic and public health perspectives. Our experience suggests that identifying the populations hit the hardest by COVID-19 and creating policies that address fundamental barriers to disease prevention has the potential to avert neurological disease in at-risk communities.