COVID-19 in spinal cord injury patients at a veterans administration hospital: A case series

Objective: To describe the clinical features and disease course of COVID-19 in veterans with spinal cord injury (SCI). Design: Case series of consecutive veterans with SCI treated at a single center. Setting: SCI Unit at an urban Veterans Administration hospital at the epicenter of the COVID-19 pandemic in the US. Participants: Seven SCI veterans with confirmed COVID-19 infection by PCR; all veterans were male, mean age was 60.6. Five had cervical level of injury, and five had complete injury (AIS A). Six veterans had a BMI > 22; three had chronic obstructive pulmonary disease; three had chronic kidney disease. Interventions: None. Outcome Measures: Presence of co-morbidities, diagnostic values, and clinical findings. Results: Each case presented differently; the most common presenting sign was fever. In the three individuals with critical and fatal infection, pre-existing comorbidities were more common and inflammatory markers were markedly elevated. Conclusion: Level and completeness of SCI did not appear to correlate with COVID-19 severity, as mild and asymptomatic illness was noted in persons with high grade SCI. As has been shown to be the case in the general population, pre-existing comorbidities are the most reliable predictors of severe SARS-CoV-2 infection currently available for persons with chronic SCI. Contrary to concerns that SCI may mask the cardinal signs of COVID-19, such as fever and cough, by way of compromised thermoregulation and thoracoabdominal musculature, such signs were common in our series. To facilitate early detection, prompt treatment, and minimized viral spread, the implementation of preventive strategies by SCI units is recommended.