2023 Update: COVID-19 and Parkinson’s Disease

In March 2020, COVID-19 unexpectedly entered our lives, and over the past three years, we have navigated a roller-coaster of events and consequences. Thankfully the development of vaccines and treatments has changed our relationship with COVID-19 and decreased the burden of the virus.

woman wearing covid mask

We will likely never be free of COVID-19. While vaccination substantially lowers the risk of severe illness, most of us have probably been infected with it by now. It now lives among us much like other infectious illnesses for which there are effective vaccines, such as the flu and certain types of pneumonia.

Therefore, it is a good time to review current information on COVID-19 infection and vaccines and the relationship between COVID-19 and Parkinson’s disease (PD).

In this article, we will cover:

Further reading: Past Review of Medical Research Concerning COVID-19 & Parkinson’s.

COVID-19 vaccine review and update

The primary series of vaccination consists of one of the following:

  • Two Pfizer-BioNTech vaccines given 3-8 weeks apart
  • Two Moderna vaccines, given 4-8 weeks apart
  • One Johnson & Johnson vaccine
  • Two Novavax vaccines, given 3-8 weeks apart

At least two months after the primary series, a booster is recommended. Currently, the recommendation is to receive the newly introduced Pfizer-BioNTech or Moderna bivalent boosters — meaning the vaccines have been adjusted to protect against two strains — the original virus as well as Omicron variants. If you have had a recent COVID-19 infection, you may delay receiving your next vaccine or booster dose by three months, but this is not necessary.

If you already received a booster, but it was before Sept 2022, the booster was likely not a bivalent booster. You may benefit from receiving a fourth vaccination with the newest type of booster. Talk with your primary care physician about whether this is best for you.

Although this has not yet been determined by the CDC, moving forward it is possible that there will be a recommendation that people receive an annual COVID vaccination, similar to an annual flu shot, that has been adjusted for whatever the prevalent current strain of the virus is. We will update you if and when any official guidelines are publicized.

The Center for Disease Control and Prevention (CDC) is a great resource for COVID-19-related vaccination information.

COVID-19 testing

Over this winter, there have been three major illnesses circulating in the US that all share similar symptoms – COVID-19, influenza, and respiratory syncytial virus (RSV). There are also numerous other viruses that cause the common cold and other respiratory illnesses that are currently causing disease. Based purely on symptoms, it would be impossible to know which one you have. However, there are specific treatments for both COVID-19 and influenza that are recommended for people who are elderly or have medical illnesses that increase their risk of severe illness from these infections. Therefore, it may be important for you to know which of these illnesses you have so you can get the right treatment. Talk with your healthcare provider about testing for these infections. Rapid antigen tests and more accurate PCR tests are available to help determine what infection you have.

Home antigen tests for COVID-19 are available at your local pharmacy. These tests will generally detect about 70-80% of people with COVID-19. 20-30% of people who have COVID-19 will register as negative on an at-home test. This number will vary depending on many factors including how symptomatic you are (the more symptomatic with COVID-19, the more likely the test will show a positive result) and how carefully you follow the instructions in performing the test. On the flipside, if the test comes back positive, then you almost definitely have COVID-19 (false positives are very unusual). Talk with your healthcare provider to determine if you should do a home test to determine whether you have COVID-19.

COVID-19 treatment update

The Food and Drug Administration (FDA) has authorized three medications for people with mild to moderate COVID-19 who are at increased risk of developing more severe illness. Because the treatments work best earlier on in the disease course, talk with your healthcare provider as soon as you have symptoms so that testing can be performed. If you do have COVID-19, and you are at risk for severe illness, you may be prescribed one of the two available oral anti-viral medications: Nirmatrelvir with Ritonavir (Paxlovid) or Molnupiravir (Lagevrio). There is also an intravenous medication that is given at a healthcare facility on three consecutive days called Remdesivir (Veklury).

Many people have expressed concern about potential interactions between COVID-19 medications and PD medications. This COVID-19 drug interactions checker allows you to check whether the medication combination that you are on is problematic or not. For example, one of the most common combinations asked about is Paxlovid and carbidopa/levodopa. It is reassuring to know that these two medications can be taken together.

Commonly Asked Questions: PD and COVID-19

Does contracting COVID-19 make PD symptoms worse?

Multiple studies across the world analyzed people with PD who contracted COVID-19. The basic conclusion is that people with PD who contract COVID-19 often report new or worsening motor and/or non-motor symptoms in the setting of their illness. This is consistent with an expected worsening in symptoms that a person with PD develops with any intercurrent medical illness. When this occurs, it is typical for PD symptoms to return to baseline when the medical illness resolves.

Should I be taking precautions such as wearing a mask?

Anyone over 50 or who has a medical co-morbidity is at increased risk for more severe COVID illness. It therefore makes sense to continue to take steps to reduce the risk of infection. However, everyone will find their level of comfort in the amount of infection risk that they are willing to take. Some people will continue to always wear a mask in public. Some will wear a mask only in large, unventilated crowds. Others will not want to wear a mask at all and instead will rely on their vaccinations. All people, however, should be mindful of the public’s health and stay home if they are not feeling well.  

Does PD make COVID-19 symptoms worse?

Multiple studies from across the world also looked at this question and concluded that:

  • Severe illness, hospitalization, and mortality due to COVID-19 among people with PD correlate with more advanced disease and increased medical co-morbidities
  • PD in and of itself likely does not increase the risk of more severe COVID-19 illness

Can having been infected with COVID-19 contribute to future risk of developing PD?

There have been some articles in the medical literaturesuggesting that COVID-19 may be a risk factor for developing PDThis paper reviewed the medical literature and found 20 cases of people who developed parkinsonism in the setting of severe COVID-19 infection (which is a very small number considering that, at this point in the pandemic, billions of people worldwide have been infected with the virus). It must be emphasized however, that since COVID-19 remains a new illness, and PD is known to be a disease that develops slowly over years, the relationship between COVID-19 and PD may yet unfold over time. This review article nicely explains many of the issues to consider when thinking about the relationship between COVID-19 and PD.

New research has shed some light on whether COVID-19 can increase the risk of PD. It is well established that the pathologic hallmark of PD is the abnormal aggregation of alpha-synuclein which can be found in the cerebrospinal fluid (CSF) of people with PD, even very early on in the disease course. The laboratory of Un Kang (an APDA Scientific Advisory Board member) was not able to isolate any abnormally aggregated alpha-synuclein from the cerebrospinal fluid of patients hospitalized with COVID-19.

Although this research is reassuring, the relationship between COVID-19 and Parkinson’s disease may yet evolve over time as we learn more.

How can I tell the difference between long-COVID and PD?

Long-COVID is defined as the persistence of symptoms greater than 12 weeks after COVID-19 infection that are not explained by an alternative diagnosis. This phenomenon has been well described in the general population and the more common neurologic symptoms reported are “brain fog”, or a decrease in concentration and/or memory issues, fatigue, decreased mobility, and sleep disturbances. All of these symptoms are also common in people with PD (who have not been affected by COVID), so it can be difficult to sort out if these symptoms are occurring as part of long-COVID or not.

This study looked at people with PD who had COVID-19 infection and found a high prevalence of long-COVID symptoms. The study acknowledges that although long-COVID is likely playing a role in the persistence of symptoms, other factors are also relevant including baseline PD symptoms, decreased access to PD healthcare, and decreased rehab efforts during the infection period.

Read previous Q&As about COVID-19 & Parkinson’s

Tips and Takeaways

  • COVID-19 vaccines are readily available and decrease the risk of severe infection, hospitalization, and death from COVID-19. They are especially important for those over 50 and for those who have a chronic medical condition, such as PD
  • COVID-19 testing and treatment are also now readily available, further changing how we respond to COVID-19 symptoms
  • COVID-19 can make motor and non-motor symptoms of PD temporarily worse
  • Symptoms of advanced PD can increase the risk of severe illness from COVID-19
  • Symptoms of long-COVID overlap with many symptoms of PD which in some situations makes it difficult to distinguish between the two

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