You would have to assume that if you got COVID and then three days later, you start to get symptoms of ATM (acute transverse myelitis), that the link is there. — Dr. Gustavo roman, texas a neurology expert on a rare spinal Disorder that may be linked to

At least one case could be tied to getting vaccine

A new scientific review has suggested the existence of a link between COVID-19 and a rare spinal disorder that can cause paralysis and quadriplegia and that has affected adults and a few children in several countries.

Researchers in the United States and Panama have found at least 43 cases of acute transverse myelitis (ATM) — among a global total of 86 million COVID-19 cases in 21 countries — that they say has been linked to a previous COVID-19 infection.

Three of those cases were found in trials conducted to test the Astrazeneca vaccine and researchers say one of those three cases may be directly linked to the vaccine.

The team had reviewed all previously published scientific literature on ATM, using search terms to find mentions of the neurological condition with any connection to the COVID-19 virus.

Acute transverse myelitis — an inflammation of the spinal cord — is rare, the review points out, and in any given year normally occurs in about 1.36 to 4.6 cases per 1 million people.

However, between March 2020 and January 2021, the review found 43 reported cases of ATM linked to COVID-19 infection, spread among countries such as the United States, Belgium, India, Italy, Australia, Mexico, Spain, Turkey, Indonesia, Panama, Moldova and Switzerland.

Seven cases were reported in Iran, the highest incidence among all the nations, followed by Italy and the U.S., which each reporting six cases.

No cases of Covid-linked ATM have been reported in Canada, according to the review.

By the time the search ended in January, close to 86 million cases of COVID-19 had been counted globally. Scientists used this figure to calculate that the rate at which the condition occurred among COVID-19 patients alone was a minimum of 0.5 cases per 1 million people.

“It’s certainly much higher than what we would expect,” said Dr. Gustavo Roman, a neurology expert with the Houston Methodist Hospital in Houston, Texas.

The rate, he said, could be even higher depending on how many Covid-linked ATM cases remain unreported. After the review was published on April 26, two more cases have been recorded in Egypt, Roman said, bringing the total known number of Covid-linked ATM cases to 45.

The recorded minimum incidence also makes COVID-19 the most common cause of the condition right now, Roman added.

The review can be found in the online journal, Frontiers in Immunology.

Normally, the condition can develop due to a host of factors ranging from infections, external or internal trauma, internal blockages, a family history of neurological disorders such as multiple sclerosis, reactions within the body’s immunity system and, in some cases, even vaccines.

However, in the case of COVID-19, “we are dealing with an inflammatory process that is secondary to infection,” Roman said, which mean the condition could have been caused by the virus directly attacking the spinal cord or by mimicking components of the body’s immune system to trigger a self-attack.

Of the 43 cases reported in the review, 23 were found in men and 20 in women, all of whom ranged in age from three to 73 years old.

In 68 per cent of the cases, the condition appeared anywhere between 10 days to six weeks after COVID-19 symptoms were observed, which according to the review could indicate “post-neurological complications mediated by the host’s response to the virus.”

The condition showed up much quicker in the remaining 32 per cent of observed cases, anywhere between 15 hours to five days after the onset of COVID-19 symptoms, which could suggest a more direct link between the virus and the condition.

It’s hard to say whether ATM could be used to identify a COVID-19 infection, Roman said, as it depended on how long the condition took to show up POST-COVID.

“You would have to assume that if you got COVID and then three days later, you start to get symptoms of ATM, that the link is there,” Roman said. But if the condition were to show up weeks after the infection, doctors would first need to rule out any other factors that could cause the disorder.

Those diagnosed with ATM will commonly experience symptoms such as body pain, sensitivity, muscle weakness, loss of bladder control and, in severe cases, either partial or total paralysis.

In the review, 58 per cent of the patients were reported showing tetraparesis, in which an individual’s four limbs suffer from muscle weakness, as well as total paralysis of the arms and legs, i.e., quadriplegia.

The percentage includes the youngest patient in the group, a three-year-old Navajo girl from the United States who developed quadriplegia as a result of ATM, Roman said. Her condition was one of the “most severe,” he explained.

The remaining 42 per cent showed paraparesis and paraplegia, which involves a loss of sensation and movement in the lower body.

It’s unclear how long these patients have suffered from the condition and what their recovery has been like. But in general, those who suffered severe ATM “may never recover fully,” Roman said.

It’s also hard to predict whether someone who has COVID-19 can develop ATM in the future, Roman said.

“Probably a predisposition in your genes, (where) you tend to respond to or attack the nervous system in your body because of whatever your genes are,” he said.

Any family history or background of other neurological disorders that attack the central nervous system could also potentially increase the likelihood of someone developing ATM after being infected with COVID.

However, of all the patients analyzed in the review, only one had a previously undiagnosed history of multiple sclerosis, Roman said.

The others, he said, did not appear to have any medical background that could suggest a likelihood of developing ATM prior to being infected with COVID-19.

Of the 43 cases reported in the review, three had also been found in vaccine trials testing the safety and efficacy of Astrazeneca vaccine in Brazil, South Africa and U.K.

Researchers suspect that the vaccine may have caused the development of ATM in one of the cases.

The other two were dismissed after one was found in a person who was given a different vaccine as part of a control group. The third was the same person found to have an undiagnosed history of multiple sclerosis, which the review stated could be a factor in developing ATM.

Last year, a global hold was put on all clinical trials testing the vaccine after a woman in the U.K. was hospitalized after showing neurological symptoms consistent with ATM.

CEO Pascal Soriot told investors last September that the woman’s condition at the time “was improving” and she was discharged from the hospital.

Its uncommon but several vaccines in the past have on occasion induced ATM, such as vaccines for polio, influenza, rabies, measles, hepatitis B, rubella etc.

Scientists have hypothesized that the vaccines could — via a mechanism called molecular mimicry in which the injected foreign substances may resemble something in the body — trigger an immune reaction that damages the body’s cells.

The Astrazeneca vaccine includes a chimpanzee adenovirus, which carries the COVID-19 antigen into the body’s immunity system, that “may induce immune mechanisms leading to the myelitis,” the review states.

“The short answer is we don’t know,” Roman acknowledged. “But the Astrazeneca vaccine is the only one that uses a chimpanzee adenovirus as an enhancer.”

More research needs to be done to determine whether there is a definite link between the vaccine and the disorder, but Roman called the number of cases found “a concern”.

“One case per million people who received the vaccine, that would be a normal situation, but here, three cases in 11,000 people (the test group in the vaccine trials) is too much,” he said.

IT’S CERTAINLY MUCH HIGHER THAN WHAT WE WOULD EXPECT.