COVID-19 Neurological Disease: a Global Meta-Analysis and Prospective Case Control Study in Brazil, India and Malawi

Building on our NIHR Global Health Research Group on Acute Brain Infections ("Brain Infections Global" or, "BIGlobal"), which we have recently repurposed to start understanding COVID-19 neurology, we will: 1. Conduct an individual patient data meta-analysis of patients with COVID-19associated neurological disease, identified through the BIGlobal COVID-Neuro Network to define the full spectrum of manifestations. 2. Establish a prospective case control study of hospitalised COVID-19 patients in Brazil, India and Malawi, comparing those with neurological disease to those patients without neurological disease, focusing on risk factors which may be modifiable. 3. Examine outcomes of hospitalised patients with COVID-19 associated neurological disease, looking for prognostic factors associated with a poor outcome. 4. Building on our strong Patient, Public and Community Engagement and Involvement Programme, and close relationship with WHO and national policymakers, use the information from 1, 2, and 3, above to develop national and international clinical care guidelines to improve patient outcomes and reduce disability. 5. Strengthen capacity for emerging brain infections research in partner countries. The case control study will test the primary hypothesis that among hospitalised patients with COVID-19, acute neurological disease is associated with hypoxia. The meta-analysis, case control study, and work with policymakers will run in parallel, to ensure rapid delivery of the changes needed to impact on practice. The study builds on 25 years of research on brain and emerging infections from the Liverpool group, much of which has been translated into new policy and practice.