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Neurology in the time of COVID-19
  1. Hadi Manji1,
  2. Aisling S Carr1,
  3. Wallace J Brownlee2,
  4. Michael P Lunn1
  1. 1 MRC Centre for Neuromuscular Disease, National Hospital for Neurology, UCLH Foundation Trust, London, UK
  2. 2 Multiple Sclerosis Centre, National Hospital for Neurology, UCLH Foundation Trust, London, UK
  1. Correspondence to Dr Hadi Manji, MRC Centre for Neuromuscular Disease, National Hospital for Neurology, UCLH Foundation Trust, London WC1N 3BG, UK; hadi.manji{at}nhs.net

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Epidemics and pandemics in human history are not the exception but the rule. Bill Gates was prophetic in 2015 ‘if anything kills ten million people in the next few decades, it is likely to be an infectious virus rather than a war. Not missiles, microbes’.

The Black Death (1347), the Great Plague of London (1665) and the Spanish Flu outbreak which killed 50 million people occurred in 1918. In 1997, the H5N1 bird flu epidemic occurred and was followed, in 2002, by the coronavirus outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. These were followed by the re-emerging pathogen epidemic; Ebola virus, unexpectedly, exploded in West Africa in 2013. While the world was celebrating the success of victory over Ebola, in 2015, the Zika epidemic reared its head. Significant neurological complications only featured in the Zika outbreak: congenital microcephaly, Guillain-Barre syndrome, myelitis and meningoencephalitis.1

Coronaviruses

The most well-studied coronavirus is the betacoronavirus, mouse hepatitis virus, that has provided model systems for the study of encephalitis and multiple sclerosis. In humans, coronaviruses usually cause common cold symptoms. However, the emergence of two zoonotic betacoronaviruses, SARS-CoV and MERS-CoV, revealed their full pathogenic potential.2

In December 2019, Zhu et al 3 described patients with pneumonia epidemiologically linked to a seafood and wet animal market in Wuhan, China. A novel coronavirus, SARS-CoV-2, was identified. WHO labelled the disease as COVID-2019. Further genomic analysis reveals that SARS-CoV-2 is similar to the betacoronavirus detected in bats but is a distinctly separate clade from SARS-CoV and MERS-CoV.

A metallopeptidase, angiotensin-converting enzyme 2 (ACE2), has been identified as the functional cellular …

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