Becker's Hospital Review

80 CMO / CARE DELIVERY 9 things to know about ADEM — a rare inflammatory disorder likely linked to COVID-19 By Erica Carbajal S ince the start of the COVID-19 pan- demic, dozens of acute disseminated encephalomyelitis case reports have deemed the coronavirus as the trigger, NBC News reported Sept. 16. e rare neurological disorder, known as ADEM, is an inflammation of the brian and spinal cord that damages myelin — the protective layer surrounding nerve fibers. Eight more notes: 1. In 50 percent to 75 percent of cases, the condition usually follows a viral infection. 2. It affects both adults and children, though is more prevalent in children. 3. ADEM symptoms typically come on quick- ly and include nausea and vomiting, head- ache, confusion, weakness, sensory changes, unsteadiness, trouble swallowing, trouble seeing and seizures. 4. Most children who develop ADEM re- gain most function within a few months, though some develop a rare, severe form called acute hemorrhagic encephalomyelitis or AHEM. 5. NBC reported on the case of an 8-year- old girl from Minnesota who developed AHEM aer testing positive for COVID-19 in March. She is completely paralyzed and had part of her skull removed due to severe brain swelling. "We're seeing an extreme that is very, very rare, but it's currently something we would want to prevent," said Michael Pitt, MD, the patient's pediatrician at M Health Fairview University of Minnesota Masonic Children's Hospital in Minneapolis. "ere are rare, serious side effects that we can prevent, if we take them seriously," Dr. Pitt told NBC, referring to the vaccine. 6. Dr. Pitt told NBC that there have been dozens of case reports pinpointing COVID-19 as the trigger for ADEM. 7. Currently, there are no official guidelines for treating ADEM, though a course of in- travenous corticosteroids followed by a dose of oral steroids are typically administered to suppress inflammation and speed recovery. 8. A fraction of patients who are initially di- agnosed with the condition may go on to develop MS, "but there is currently no meth- od or known risk factors to predict whom those individuals will be," according to the National Institute of Neurological Disorders and Stroke. n ADEM symptoms typically come on quickly and include nausea and vomiting, headache, confusion, weakness, sensory changes, unsteadiness, trouble swallowing, trouble seeing and seizures. US likely to miss big winter COVID-19 surge, analyst models predict By Erica Carbajal T he U.S. may be spared from a significant surge in COVID-19 cases this winter, according to an analy- sis from the COVID-19 Scenario Modeling Hub — a group of researchers that advises the CDC. NPR obtained the analysis and broke down the models in a Sept. 22 report. The researchers modeled four potential scenarios. In the most likely scenario, where childhood vaccinations rise and no new super-spreading variant emerges, new in- fections would steadily drop from an average of about 140,000 per day in September, to about 9,000 each day by March, NPR reported. This scenario also predicts deaths would fall to less than 100 per day by March — down from about 1,500 deaths per day as of September. "Any of us who have been following this closely, given what happened with delta, are going to be really cautious about too much optimism," said Justin Lessler, PhD, who helps run the modeling hub and is a professor in the department of epidemiology at the University of North Carolina in Chapel Hill. "But I do think that the trajectory is towards improve- ment for most of the country," he told NPR. There's a significant range of uncertainty in the models, and a scenario in which cases rise to as many as 232,000 per day before declining is possible, though very unlikely, according to the NPR report. "We have to be cautious because the virus has shown us time and time again that new variants or people loosening up on how careful they're being can lead things to come roaring back," Dr. Lessler said. There will be regional variation, researchers emphasized, with the surge worsening in some states before it lets up. n

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