Do persons with Parkinson’s have a higher risk of dying from COVID-19 infection?
We have been inundated with questions about COVID-19 and Parkinson’s. Perhaps the most important one is whether COVID-19 infection increases mortality in this neurodegenerative disease. We had the pleasure to sit down with Drs Narayanan and Zhang from the Department of Neurology and Parkinson’s Foundation Center of Excellence in Iowa. We picked their brains on this question and we discussed their newest publication (in Movement Disorders) and their data on COVID-19 and Parkinson’s mortality.
Who are Drs Narayanan and Zhang?
Drs Narayanan and Zhang from the University of Iowa Department of Neurology
Dr. Nandakumar Narayanan is the vice chair of Neurology for Basic and Translational Research at the University of Iowa. Dr. Narayanan specializes in Parkinson’s disease. Dr. Qiang (Johnson) Zhang is a neurologist specializing in Parkinson’s disease at the University of Iowa. Drs Narayanan and Zhang had the idea of applying statistical methods to the COVID pandemic dataset to estimate the risk of COVID in Parkinson’s disease. They extracted medical datasets from the TrinetX platform, and worked with other data specialists (Dr. Simmering / Dr. Schultz) and another neurologist, Dr. Aldridge— to analyze the data. You can reach them on Twitter for any questions or discussion @narayanan_lab, @johnsonpumc, @aldridge_lab, @iacobus42, @schultz_lab!
Picture by Jonny Acheson MD (with permission)
How does one determine if there is an increased
risk of “coming down” with COVID-19 with
Parkinson? Why is it so hard to study?
Persons with Parkinson’s (PWP’s) have all kinds of reasons that may predispose them to respiratory diseases such as COVID-19. Before the COVID era, diseases such as pneumonia and the flu were known to be huge contributors to mortality (death) and morbidity (developing another medical issue in the setting of Parkinson’s). However, we have as a field lacked data on COVID infection and Parkinson’s disease. What we can obtain are data on hospitalizations and death— especially if the data are entered into a healthcare data management system or online medical record.
Is it possible to determine if there is increased
morbidity and mortality with PD plus COVID
infection?
Elevated case fatality rate for COVID + Parkinson’s
We found a 30% increase in the risk of mortality compared to a demographically matched population. Our work clearly showed that PWP have a greater risk of dying from COVID, compared to people without Parkinson’s disease. We are working on obtaining access to a larger and “richer” dataset— one with more detailed comorbidity data ( what other diseases the patients have along with their PD) and other information.
Increased case fatality rate of COVID+Parkinson especially over age 50
How did you decide to study this question?
Dr. Zhang, Dr. Narayanan and Dr. Aldridge were all working hard to keep PWPs safe during the worst of the pandemic. We were watching with interest all the early reports, and we were curious to see if we could use our data analysis skills in to address this problem— and to answer this question.
Did you find PD plus COVID infection increased
morbidity and mortality when compared to the
population?
We found an increased risk of mortality (at 1.3 X ) compared to a demographically matched population. This analysis took into account age— which is the primary risk factor for PD. So the bottom line is that PWP were 1.3 times more likely to die if they got COVID than people without PD.
What should be the take home points for PD
patients and should this data influence the prioritization of who should get the COVID vaccine?
We recommend, based on this data and other information in the literature, that PWP socially-distance, wear masks, and get any vaccine as soon as it is available. We are hopeful that by working together, we can turn the tide on the pandemic and keep all of our PWP safe.
Also listen to the Facebook live on Parkinson’s disease and the COVID-19 vaccine provided free by the Parkinson’s foundation. It is important to keep in mind that although the mortality rate is higher for COVID +Parkinson’s, that these data do not account for vaccine use. We advocate that everyone with PD get the vaccine.
To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside
He also serves as the Medical Advisor for the Parkinson’s Foundation.
To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.