On March 11^th COVID-19 was declared a pandemic by the World Health Organization (WHO), affecting millions of people worldwide. SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), is an RNA virus belonging to the Coronaviridae family, which was first identified in Wuhan, China, in December 2019 as Coronavirus disease 2019 (COVID-19). Since then it has spread on a global scale, with over 20 million cases and 737,766 deaths, and in Switzerland 36,619 cases and 1,711 deaths (WHO COVID-19 Dashboard). Researchers worldwide are working towards vaccines and treatments against this virus and some of them are already in clinical phase 2-3 to assess their efficacy, safety, and side-effects on humans. In the best case scenario, approved vaccine(s) will be ready in a few months, but the production and supply to the world population is forecasted for late 2021.

The first individuals who should receive treatment are the most vulnerable subjects; older adults, patients suffering from pathologies like diabetes, cardiac deficiencies, and respiratory problems but also patients affected by neurological diseases, such as dementia-related disorders. The latter have been particularly struck by COVID-19 and will benefit profoundly from a vaccine. Demented subjects with SARS-CoV-2 are at greater risk of pulmonary failure, which is a frequent cause of death [1]. As a mild but diffused symptom, a large proportion (30-70%)  of COVID patients manifest olfactory and gustatory impairment [2]. Smell loss also has a strong association with neurodegenerative diseases, such as Parkinson’s and Alzheimer’s disease, implicating a neural dissemination of SARS-Cov-2 and representing a potential risk for brain disability particularly in the elderly segment [3].  Smell loss, confusion and increased risk of stroke in elderly subjects is partially assigned to the cytokine storm and high inflammatory grade typical of SARS-Cov-2 infection, but a direct invasion of the virus has been also speculated [1].

On top of the pathogenesis, social distancing to reduce the viral spread has increased social isolation, further aggravating the conditions of demented patients. Not being able to undergo clinical examinations or to receive family visits has in general worsened mental illnesses, precipitating cognitive decline in these subjects [4]. Social distancing measures also profoundly affected the enrollment of patients in almost all clinical trials for AD therapeutics subtracting the prospect of treatment for these subjects and slowing the clinical developments [5].

Alzheimer’s associations worldwide including Alzheimer Schweiz are providing timely information to dementia patients and their families on the risk posed by the novel coronavirus, the pandemic threat, and the side effects of social isolation. Internationally, with the goal of improving the life and outcome of the most vulnerable, Alzheimer’s Disease International (ADI) and partner Dementia Alliance International (DAI) together with other civil society organisations prepared a statement to the World Health Organization (WHO) on non-communicable diseases during and beyond the COVID-19 response. 

In recent months, BrainFit4Life has refrained from becoming a newsletter provider of COVID, as clinical reports accumulating at unprecedented speed were not always in our opinion scientifically sound. Yet, after more than half a year we wanted to provide a very brief summary of the consolidated evidence to date. 

Useful links about COVID-19 general information and research updates:

World Health Organization: https://www.who.int/health-topics/coronavirus#tab=tab_1

European Commission: https://ec.europa.eu/info/index_en

Living paper: https://rega.kuleuven.be/if/corona_covid-19

Swiss Alzheimer Association, COVID-Support: https://www.alzheimer-schweiz.ch/de/startseite/

Daily Statistics of COVID-19 for Switzerland & the world: https://www.sichh.ch/covid-19/

References

[1] Natoli, S., V. Oliveira, P. Calabresi, L. F. Maia, and A. Pisani. 2020. “Does SARS-Cov-2 Invade the Brain? Translational Lessons from Animal Models.” European Journal of Neurology: The Official Journal of the European Federation of Neurological Societies, April. https://doi.org/10.1111/ene.14277.

[2] Whitcroft, Katherine Lisa, and Thomas Hummel. 2020. “Olfactory Dysfunction in COVID-19: Diagnosis and Management.” JAMA: The Journal of the American Medical Association, May. https://doi.org/10.1001/jama.2020.8391.

[3] Doty, Richard L. 2008. “The Olfactory Vector Hypothesis of Neurodegenerative Disease: Is It Viable?” Annals of Neurology 63 (1): 7–15.https://doi.org/10.1002/ana.21327

[4] Wang, Huali, Tao Li, Paola Barbarino, Serge Gauthier, Henry Brodaty, José Luis Molinuevo, Hengge Xie, et al. 2020. “Dementia Care during COVID-19.” The Lancet 395 (10231): 1190–91.https://dx.doi.org/10.1016%2FS0140-6736(20)30755-8

[5]“Coronavirus Takes Its Toll on Alzheimer’s Clinical Studies.” n.d. Accessed August 18, 2020. https://www.alzforum.org/news/community-news/coronavirus-takes-its-toll-alzheimers-clinical-studies.