Coronavirus disease 2019 (COVID-19) is a new viral respiratory illness which has been detected around the world, including the United States. Spread of the disease has been closely documented in the media, but for the most accurate information about the virus, please focus on reliable websites such as the Centers for Disease Control & Prevention (CDC). Many people with Parkinson’s disease (PD) may be wondering if this virus will affect them any differently because they have Parkinson’s disease.
It is very clear from the data emerging from the ongoing pandemic that the risk of complications from COVID-19 rises steeply with age and with co-morbid medical conditions such as diabetes, heart disease and lung problems. We do not have similar data yet for people with PD. Although some small studies have been conducted that probe the relationship between COVID-19 and PD, there is much more information that we need to learn.
PD is a very variable disease. Some people who are young and have very mild PD may not have any increased risk from COVID-19. However, we don’t know that for sure. We do know that there is no evidence that having PD makes you immunosuppressed and more susceptible to becoming infected with the virus. However, if you do get infected with the virus, it can make your course more complicated.
What features of PD could increase complications from coronavirus?
Although we do not have enough data regarding COVID-19 and PD specifically, we can extrapolate from experiences of people with PD and other viral respiratory illnesses.
PD and other viral respiratory illnesses
PD motor- and non-motor symptoms can be exacerbated by any medical illness, including a viral respiratory illness. This means that in addition to the respiratory symptoms of the virus, people with PD may feel that they are slower and stiffer than usual and that their medications don’t seem to be working as well. Hallucinations may start in a person who never experienced that symptom before. Recovery from the illness can be more drawn out. Since COVID-19 is a viral respiratory illness, it would be reasonable to assume that someone with PD who contracts COVID-19 could experience these complications as well.
In addition, some people with PD may have restrictive lung disease which refers to an inability of the lungs to fully expand with air. Restrictive lung disease can occur in PD because of rigidity of the muscles of the chest wall, as well as bradykinesia, or slowness of the muscles responsible for chest wall expansion and contraction. People with PD may also have abnormalities in the posturing of their trunk including head drop, stooped posture, tilting of the trunk and bending at the waist. These postures can restrict the amount that the lungs can fill up with air. PD can also predispose a person to dysfunction of swallow and difficulty clearing secretions from their airway. These issues could contribute to development of complications during a respiratory illness.
Because of these reasons, people with PD are always strongly encouraged to protect themselves from any infection as much as possible. Vaccines such as the flu vaccine and the Pneumovax vaccine (for bacterial pneumonia) are strongly recommended. (COVID-19 does not yet have a vaccine, but many are already in clinical trial).
People with moderate PD also may start to experience decreased mobility, with more risk of falls. As PD advances it can cause additional problems including urinary dysfunction and weight loss. All of these elements can contribute to general frailty and increased risk of infection, including increased risk from COVID-19.
All things considered, it is good practice for those with PD, because of age and because of their underlying PD, to consider themselves at increased risk of complications from COVID-19.