Jennifer Frontera, MD

"I’ve never seen such sick patients. I’ve never seen so many people dying or deteriorating simultaneously. I probably still haven’t even fully processed the effects of that.”

While the data collected on COVID-19 has primarily been about its pathology and how it may impact those with preexisting conditions, an aspect that has not been subject of much focus has been its effect on the mental state of frontline clinicians. During the heights of the pandemic, hospital staff are commonly overworked, hospital buildings remain overflooded, and clinicians face an increased amount of death with no vaccine or treatments readily available to help.

A recently published dataset from Leah Croll, MD, resident in the neurology department at NYU Langone in New York City, looked at how the pandemic has affected those on the frontline at NYU Langone on specific psychosocial feelings such as 

. The results showed that 79% and 83% of frontline workers and faculty staff, respectively, expressed that they were dealing with fear and anxiety, along with 38% of the total population who suggested they may be struggling with depression.

Croll’s colleague, Jennifer Frontera, MD, professor of neurology, NYU Langone Grossman School of Medicine, and neurointensivist, claims the amount of death she saw was stunning, even as someone accustomed to seeing patients in their weakest stages of disease. In an interview with 

, Frontera discussed her experience even further and touched on aspects such as burnout and long-term mental state for patients who are released from the hospital.

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The professor of neurology at the NYU Langone Grossman School of Medicine detailed the ways the COVID-19 pandemic impacted mental health of frontline clinicians.

Jennifer Frontera, MD: Mental Health Toll of Pandemic on Frontline Workers

"The normal number of people that die and the number of people that died during the COVID-19 surge were certainly different. When you can see that someone died of ARDS related to COVID, it’s easier to ascribe it to that factor.”

As the death toll in the United States has exceeded 200,000, many within the country have speculated the specifics of the count, and whether or not a patient’s death was directly caused by COVID-19 or an underlying symptom. Throughout the year, the data on the associations between the virus and neurologic symptoms have been well documented, with patients who contracted the virus showing slightly increased rates of stroke, encephalopathy, and hypoxic/ischemic injury, among others.

Despite the growing amount of research, questions remain about how COVID-19 affects specific pathologies within the brain. Determining cause of death can sometimes be easy if a patient has acute respiratory distress syndrome (ARDS), but other factors are not as clear cut, according to Jennifer Frontera, MD. Frontera, a professor of neurology at the NYU Langone Grossman School of Medicine, has served on the frontlines during the pandemic, and recently 

 that outlined new neurologic disorders documented in patients with COVID-19.

There are a number of challenges clinicians face when determining whether a patient has died from the virus, a symptom associated, or something that may have been underlying prior to diagnosis. Frontera sat down with 

 to discuss these challenges, and why excess mortality serves as an important statistic when understanding the virus’s surge in particular cities.

The professor of neurology at the NYU Langone Grossman School of Medicine outlined the confusion on whether deaths are related to COVID-19, a symptom associated, or previously unidentified underlying condition.

Jennifer Frontera, MD: Challenges in Determining Death Directly Related to COVID-19

"Can the virus get in the brain? It appears it can, but is it just entering tissue that’s already damaged? I don’t know.”

Throughout the COVID-19 pandemic, researchers have tried to understand whether the virus has a direct effect on the pathology of neurologic disorders. One of the earliest papers published in the 

, prominent agitation and confusion, and corticospinal tract signs. Increased rates of stroke, Guillain-Barré syndrome, and hypoxic/ischemic injury have also been documented among patients with COVID-19.

Recently released data from Jennifer Frontera, MD, and colleagues found that 13.5% of patients with COVID-19 hospitalized during the study timeframe developed a new neurologic disorder. They also found that patients with neurologic disorders were more often male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment scores.

The incidence of stroke, found in 1.9% of study population, has been a topic of discussion after 

 indicated a low risk of stroke. Frontera, a professor of neurology at the NYU Langone Grossman School of Medicine, believes that her research stands in good positioning along with what has published. She sat down with 

to discuss some of the inconsistencies in what has previously been reported and how those compare to her data.

The professor of neurology at the NYU Langone Grossman School of Medicine gave her thoughts on how her recently published data on neurologic disorders in COVID-19 compare to previously reported data. 

Jennifer Frontera, MD: Comparing COVID-19 Neurologic Data

"Toxic metabolic encephalopathy was the most common neurological disorder that we saw in the context of COVID. We know that that's common in general and hospitalized patients, but the severity of it was somewhat surprising to us, I would say.”

Throughout the COVID-19 pandemic, researchers have been trying to uncover more data detailing how the virus may impact neurologic pathology. In contrast to prior retrospective studies that focused on the conglomerate prevalence of non-specific neurologic symptoms along with neurologic diagnoses, Jennifer Frontera, MD, and her colleagues applied rigorous, standardized criteria to identify the prevalence of specific neurologic diagnoses in a prospective fashion.

Frontera, a professor of neurology at the NYU Langone Grossman School of Medicine, and colleagues found that 

 hospitalized during the study timeframe developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. Among them included toxic/metabolic encephalopathy, seizure, stroke, and hypoxic/ischemic injury.

 concerning some of the preliminary data on COVID-19 that had been published. We reconvened for another discussion, this time to get her perspective and thoughts on her study data, and whether the identified levels of new neurologic disorders surprised her.

The professor of neurology at the NYU Langone Grossman School of Medicine gave her reaction to the data she and colleagues published on neurologic disorders in patients with COVID-19. 

Jennifer Frontera, MD

Articles

Jennifer Frontera, MD: Mental Health Toll of Pandemic on Frontline Workers

Jennifer Frontera, MD: Challenges in Determining Death Directly Related to COVID-19

Jennifer Frontera, MD: Comparing COVID-19 Neurologic Data

Jennifer Frontera, MD: Neurologic Implications of COVID-19 Infection