“Spanish flu,” encephalitis lethargica, and COVID-19: Progress made, lessons learned, and directions for future research.

“Spanish flu,” encephalitis lethargica, and COVID-19: Progress made, lessons learned, and directions for future research.

Publication date: Nov 01, 2024

One hundred years ago, an influenza pandemic swept across the globe that coincided with the development of a neurological condition, named “encephalitis lethargica” for the occurrence of its main symptom, the sudden onset of sleepiness that either developed into coma or gradually receded. Between 1917 and 1920, mortality of the flu was >20 million and of encephalitis lethargica approximately 1 million. For lessons to be learned from this pandemic, it makes sense to compare it with the COVID-19 pandemic, which occurred 100 years later. Biomedical progress had enabled testing, vaccinations, and drug therapies accompanied by public health measures such as social distancing, contact tracing, wearing face masks, and frequent hand washing. From todays’ perspective, these public health measures are time honored but not sufficiently proven effective, especially when applied in the context of a vaccination strategy. Also, the protective effects of lockdowns of schools, universities, and other institutions and the restrictions on travel and personal visits to hospitals or old-age homes are not precisely known. Preparedness is still a demand for a future pandemic. Clinical trials should determine the comparative effectiveness of such public health measures, especially for their use as a combination strategy with vaccination and individual testing of asymptomatic individuals. It is important for neurologists to realize that during a pandemic the treatment possibilities for acute stroke and other neurological emergencies are reduced, which has previously led to an increase of mortality and suffering. To increase preparedness for a future pandemic, neurologists play an important role, as the case load of acute and chronic neurological patients will be higher as well as the needs for rehabilitation. Finally, new chronic forms of postviral disease will likely be added, as was the case for postencephalitic parkinsonism a century ago and now has occurred as long COVID.

Concepts Keywords
100years COVID-19
Covid COVID‐19
Influenza encephalitis lethargica
Neurologists history of neurology
Sleepiness History, 20th Century
Humans
Influenza, Human
Pandemics
Parkinson Disease, Postencephalitic
public health

Semantics

Type Source Name
disease MESH encephalitis
disease MESH COVID-19
disease MESH influenza
disease IDO symptom
disease MESH sleepiness
disease MESH coma
disease IDO contact tracing
disease MESH acute stroke
disease MESH emergencies
disease IDO role
disease MESH postencephalitic parkinsonism
disease MESH long COVID
disease IDO history

Original Article

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