Clinical description of the broad range of neurological presentations of COVID-19: A retrospective case series.

BACKGROUND: Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19. METHODS: In this monocentric retrospective case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies. RESULTS: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days. CONCLUSIONS: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.

The global impact of COVID-19 on global and regional hepatitis C elimination efforts

Background: COVID-19 has placed significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination Mathematical models can be used to evaluate the possible impact of programmatic delays on hepatitis disease burden The objective of this analysis was to evaluate the incremental change in hepatitis C liverrelated deaths and liver cancer, following a 3-month, 6-month, or 1-year hiatus in hepatitis elimination program progress Methods: Previously developed models were adapted for 110 countries to include a status quo or “no delay” scenario and a “1-year delay” scenario assuming significant disruption in interventions (screening, diagnosis and treatment) in the year 2020 Annual, country-level, model outcomes were extracted, and weighted averages were used to calculate regional (WHO and World Bank Income Group) and global estimates from 2020 to 2030 The incremental annual change in outcomes was calculated by subtracting the “no-delay” estimates from the “1-year delay” estimates Results: The “1-year delay” scenario resulted in 44,800 (95% UI: 43,800 - 49,300) excess hepatocellular carcinoma (HCC) cases and 72,300 (95% UI: 70,600 - 79,400) excess liver-related deaths (LRDs), relative to the “no delay” scenario globally, from 2020-2030 Most missed treatments would be in lower-middle income countries, while most excess HCC and LRDs would be among high-income countries Under the “1-year delay” scenario, no regions were projected to reach the WHO targets for diagnosis, treatment or incidence, and only the highincome country group was projected to achieve the target for liver-related deaths Conclusion: The impact of COVID-19 extends beyond the direct morbidity and mortality associated with exposure and infection In order to mitigate the impact on viral hepatitis programming and reduce excess mortality from delayed treatment, policy makers should prioritize hepatitis programs as soon as it becomes safe to do so. (Table Presented).

COVID-19 Pandemic: Time to Revive the Cyclophilin Inhibitor Alisporivir

December 2019 saw the emergence of a new epidemic of pneumonia of varying severity, called coronavirus disease 2019 (COVID-19), caused by a newly identified coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-2). No therapeutic option is available to treat this infection that has already killed > 310 000 people worldwide. This Viewpoint summarizes the strong scientific arguments supporting the use of alisporivir, a nonimmunosuppressive analogue of cyclosporine A with potent cyclophilin inhibition properties that has reached phase 3 clinical development, for the treatment of COVID-19. They include the strong cyclophilin dependency of the life cycle of many coronaviruses, including severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, and preclinical data showing strong antiviral and cytoprotective properties of alisporivir in various models of coronavirus infection, including SARS-CoV-2. Alisporivir should be tested without delay on both virological and clinical endpoints in patients with or at risk of severe forms of SARS-CoV-2 infection.