The Norwegian study of nervous system manifestations and sequelae in COVID-19 (NeuroCOVID)

Background:
Corona virus (CoV) may not only affect the respiratory system, but also have deleterious effects on the central nervous system. As the number of individuals infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is increasing, more neurologic, neuropsychological and neuropsychiatric symptoms are being reported in COVID-19 patients. COVID-19 may affect the nervous system via four potential mechanisms; direct viral injury of nervous tissue, an excessive immune response in the form of a "cytokine storm”, unintended host immune response effects after an acute infection or as a result of indirect viral injury results from the effects of systemic illness. In addition, the COVID-19 is a significant psychological stressor an may contribute to neuropsychiatric and neuropsychological sequalae. The long-term effect on neurological and neuropsychological functioning.

Primary objective:
To assess the neurological, neuropsychological and neuropsychiatric manifestations of COVID-19 and identify possible post-COVID neurologic, neuropsychological and neuropsychiatric syndromes at follow-up.

The secondary objectives:
To assess at 6 and 12 months´ follow-up:
The rate of stroke, peripheral nervous affection, myopathy, brain MRI pathology, level of blood specific biomarkers, rate of post-COVID-19 related cognitive and/or neuropsychiatric manifestations, the rate of death.
To assess if there is an association between inflammatory markers and neuropsychiatry/neuropsychology, between neuroimaging and neuropsychiatry/neuropsychology or between neurologic examination and neuropsychiatry/neuropsychology.

Methods
Study design: Multi-center prospective observational study of the occurrence of neurological manifestations and sequelae in patients with COVID-19 at 6- and 12-months follow-up.

Project leader:

Anne Hege Aamodt

EuroECMO-COVID

Prospective and retrospective multicenter observational study of COVID-19 patients who receive extracorporeal membrane oxygenation (ECMO) treatment from 87 European intensive care units

COPSYC-19: Consequences for patients with psychosis from the SARS-CoV-2 shut-down

Background

The SARS-CoV-2 virus was declared a global pandemic by the Worlds Health Organization on March 11th 2020. The next day expansive restrictions were enforced by the Norwegian government to reduce spread of the virus. These included closing down schools, kindergartens, sports, universities, encouraging home office wherever possible, strict border control, home quarantine and expansive social distancing. Mental health services were also affected by the restrictions, and consequently face-to-face consultations were replaced by telephone- or video consultations. Inpatients experienced restrictions in the freedom to leave the wards, visits were not permitted and group activities were limited or closed down.

Individuals with psychotic illnesses are generally considered one of the most vulnerable groups within the mental health services, and they often have several comorbid conditions such as depression, anxiety, substance abuse and cognitive impairment. Despite low prevalence, two thirds of all psychiatric hospital days and half of all psychiatric outpatient consultations are linked to psychotic illnesses. 

Objectives

The main objective of this study is to investigate how the national shut-down enforced due to the ongoing pandemic has affected individuals receiving treatment for psychotic illnesses at Oslo University Hospital. We will examine the individuals’ subjective experiences of changes in psychotic symptoms, depression, alcohol- and drug abuse, traumatic experiences, quality of life, and functioning in terms of employment or studies. We also aim to examine the individuals’ experiences with the mental health services during the shut-down period, both in terms of quality and accessibility. A secondary objective of the study is to examine therapists’ assessment of the quality of care during the shut-down and the impact this has had on the patient group.  

Methods

Participants will be invited to respond to a questionnaire. The questionnaire will be available both online and in paper. Therapists will be invited to respond to an online questionnaire. We will also draw a selection of patient journals to compare the individuals’ responses to what is documented in their journal in order to examine if therapists were able to accurately assess clinical changes in their patients via telephone and video consultations. 


Project leader:

Stig Evensen

Outcome of patients >75 with COVID-19 severe acute respiratory insufficiency (SARI)

Both the preliminary reports of critically ill COVID-19 patients in Wuhan (China) and Italy reported a high risk of dying in patients with multimorbidity. Also, very old patients with SARS-CoV-2 infections suffered from high mortality rates. It is, however, unclear if age alone is an independent risk factor, or if co-morbid conditions and frailty trigger the adverse outcome. In non-COVID-19 elderly patients admitted to the ICU, our European research group found that the co-factors are more important than chronological age itself. In patients with COVID-19, pretreatment with AT-2 blockers and ACE-inhibitors, but also nonsteroidal anti-inflammatory drugs such as ibuprofen were suggested to be associated with adverse outcome. Furthermore, some groups reported a higher death rate in patients with concomitant cardiovascular disease and diabetes. This international multicenter study group, therefore, proposes to study the relationship between age, co-morbidities, pretreatment, frailty, and outcomes prospectively in a group of elderly patients receiving critical care for COVID-19. The results of this investigation will be essential to understand which factors can predict mortality in elderly COVID-19 patients to help to detect these patients early. Furthermore, the proposed study will also be a knowledge base necessary to guide triage decisions in the future. With this pandemic likely to continue for 18 months, it is paramount to identify independent risk factors early to facilitate both risk stratification and substantiate necessary triage decisions. The pandemic begins in all European countries now, and decisive action of the research community is needed.