HA COVID-19 Update March 15, 2020
An issue of great concern to our members is whether hydrocephalus is considered a risk factor for severe disease with COVID-19. As a follow up to our previous post, Dr. Michael A. Williams, Chair of the HA Medical Advisory Board, has reviewed published medical research that addresses such risks factors (available as of March 15, 2020) and found that hydrocephalus has not been mentioned as a specific risk factor in adults or children.
The CDC appears to give conflicting information with respect to the risk associated with underlying neurological conditions. A CDC document on mitigation strategies for communities with local COVID-19 transmission includes “Neurological and neurologic and neurodevelopment conditions” in a list of underlying medical conditions that may increase the risk of serious COVID-19 for individuals of any age. The list specifies “disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury”. This document does not say why these conditions are included or how they increase the risk of severe disease with COVID-19.
Other CDC web pages and documents have a more limited list of risk factors for severe disease, including age ≥ 60 years and underlying conditions such as cardiovascular disease, diabetes, chronic respiratory disease, hypertension, cancer, and immunocompromising conditions. Neurologic disorders are not mentioned on these pages.
A review of the medical literature for adults shows that the identified risk factors for severe COVID-19 disease across all of the papers includes age ≥ 60 years, diabetes, hypertension, and cardiovascular disease. Other risk factors included in individual papers include chronic obstructive pulmonary disease (COPD), cerebrovascular disease, hepatitis B, cancer, chronic renal disease, and immunodeficiency.
- New England Journal of Medicine
- JAMA Internal Medicine
- Lancet Respiratory Medicine
A review of the medical literature for children provides limited information. One paper does not list risk factors. Another states that “7 of 20 patients had a previous history of congenital or acquired diseases, which may indicate that children with underlying diseases may be more susceptible to COVID‐19 infection”; however, the article does not describe what the underlying diseases were.
What does “severe COVID-19 disease” mean?
Nearly all patients with severe COVID-19 have had pneumonia as a direct effect of the virus, and many have then developed acute respiratory distress syndrome (ARDS), which requires support from a ventilator and treatment in an ICU. Many of the patients also experience other complications associated with critical illness, including shock (very low blood pressure requiring treatment with intravenous medications), abnormal coagulation, and effects on the function of the liver and kidneys.
What does this mean for persons with hydrocephalus?
- Hydrocephalus by itself has not been identified as a risk factor for severe COVID-19 disease.
- Persons with normal pressure hydrocephalus (NPH) should consider themselves at high risk for severe COVID-19, but not because they have NPH. Persons with NPH are at risk because they are over age 60 years, and many have coexisting conditions, such as hypertension, diabetes, cardiovascular disease, and other conditions that can make it more difficult to survive the viral pneumonia, ARDS, and complications of critical illness that are seen in severe COVID-19 disease.
- The risk factors for severe COVID-19 in children are uncertain at this time. The medical literature shows the children are either less likely to contract COVID-19, or that they generally have milder disease. The American Academy of Pediatrics offers guidance at their Healthy Children web site.
- Persons with hydrocephalus of any age can try to estimate their risk for severe COVID-19 disease by assessing whether they have other chronic health conditions, as well as the nature of their health conditions.
- Because severe COVID-19 primarily affects the lungs, persons with lung disease or medical conditions that can affect breathing should be cautious. Lung disease includes asthma, COPD, emphysema, the need for supplemental oxygen, the need for chronic ventilator support, the presence of a tracheostomy, as well as other lung disorders.
Recommendations for the hydrocephalus community at large
- Many persons of all ages with hydrocephalus have coexisting health conditions, and those individuals should consider themselves in the higher-risk population, as described by the CDC, which includes older adults or those of any age with serious long-term health problems, such as heart disease, diabetes, or lung disease, as well as other ongoing serious health conditions.
- If you are in doubt or unsure about your risk category, we recommend that you follow CDC guidance to stay at home as much as possible, to avoid crowds if you leave home, to practice social distancing (keeping space between yourself and others), to wash your hands often, and to avoid non-essential air travel or cruise ship travel.
- Avoid travel to hospitals, clinics, or physician offices, especially in high-risk areas, to prevent exposure to COVID-19. If you have a scheduled appointment with your physician for a routine visit that could be safely delayed, we recommend you speak with your physician’s staff to see if the physician agrees that your appointment can be safely delayed.
- Do not let fear of COVID-19 keep you from seeking necessary care for your hydrocephalus. If you are experiencing symptoms that are concerning for shunt malfunction or another issue that could be harmful to you if not addressed promptly, please contact your physician’s office to confirm that you will come to the appointment, or if there is an emergency, call 911 or emergency services in your community to be seen in the emergency department.
- Obtain information about COVID-19 from reliable resources, including the Centers for Disease Control, Health Canada, the World Health Organization, state or provincial health boards, and the Hydrocephalus Association. Please be careful not to respond to information on the internet that may be untrustworthy, or that may try to sell you bogus advice or treatments for COVID-19, i.e., scams.
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