United Nations ECOSOC High Level Segment

On behalf of Global Neurocare, Mehila Zebenigus, MD, and James C. Johnston, MD, JD, delivered a presentation at the United Nations ECOSOC High Level Segment on the 7-16 July 2020.  The topic of discussion was entitled Accelerated Action and Transformative Pathways:  Realizing the decade of action and delivery for sustainable development.

Drs. Johnston and Zebenigus discussed the novel coronavirus that originated in Wuhan, China, and rapidly evolved into a pandemic after China failed to provide timely notification of the human to human transmission. 

In recognizing that this pandemic has infected millions, caused hundreds of thousands of deaths, wreaked economic devastation, closed travel and trade, and created global shortages of food and medical equipment, there is no question that a global, comprehensive, multifaceted approach is necessary to provide immediate patient care, and intermediate and long-term global health security, which will necessitate strengthening public health capacity and advancing scientific technology to develop new diagnostics, therapeutics and vaccines.

However, Drs. Zebenigus and Johnston noted with deep concern that addressing this pandemic may divert healthcare funding and support from ongoing programs, potentially derailing decades of progress, significantly impacting the least developed nations of sub-Saharan Africa. This may lead to a resurgence of infectious and noncommunicable diseases, and increase maternal, neonatal and childhood mortality.

The reversal of past gains in the developing regions would force millions of people into poverty, leading to increased vulnerability, marginalization and exclusion, further destabilizing global health security.

It is imperative to secure well-directed funding focused on establishing self-sufficient and sustainable training programs to advance the recruitment, development, training and retention of healthcare workers in these precarious regions, in parallel with funding to effectively manage the ongoing pandemic.

As directors of Global Neurocare, Dr. James C Johnston and Dr. Mehila Zebenigus called upon the High Level Segment to endorse their recommendations, thereby ensuring an integrated, multilateral, multifaceted, cross sector approach to improving health care access in the least developed regions, thus promoting a broad crosscutting impact directly or indirectly across the Sustainable Development Goals.

Neuroimaging techniques including magnetic resonance spectroscopy

James C. Johnston, MD, JD, is a board-certified neurologist and attorney whose current work focuses on global health issues in sub-Saharan Africa. He serves as an Honorary Professor in the Department of Neurology, Addis Ababa University, Ethiopia. In his quest to advance neurological care across the globe, Dr. James C. Johnston also serves as a Partner in Global Neurology Consultants and is the Founder and Director of Global NeuroCare, an NGO with UN Special Consultative Status.

Neuroimaging is an integral part of neurological practice for Dr. James C Johnston, whether in the United States or Africa. Neuroimaging entails the use of various techniques to directly or indirectly investigate the status of the brain or spine, and may include CT scans, MRI (magnetic resonance imaging), PET (positron emission tomography), ultrasonography, and functional imaging modalities. These tests are crucial for the accurate diagnosis and treatment of many patients with neurological diseases or disorders.

Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic test used to detect biochemical or metabolic changes in the brain, particularly for brain tumors as well as to detect tissue changes during strokes or epilepsy and evaluate Alzheimer’s disease and other conditions. This testing is typically performed in conjunction with more conventional studies in order to provide the most accurate diagnosis. For example, MRI may delineate the anatomical position of a brain tumor, while MRS detects the difference in chemical composition between normal brain tissue and the tumor which may, for example, allow differentiation of low grade from high grade gliomas, or distinguish recurrent brain tumor from radiation induced necrosis.

A conventional MRI machine is used to conduct MRS, which aims to analyze molecules such as protons or hydrogen ions. Proton MRS is the most common type of test. The spectroscopy consists of an additional series of tests to measure various metabolites of the metabolic processes, in order to differentiate between the various types of tissue and allow the most accurate diagnosis.

Many of these neuroimaging techniques including MRI are available globally, although scarce in the low resource nations. There are, for example, numerous CT machines and several MRI facilities in Addis Ababa, Ethiopia, but availability in the rural areas is limited to nonexistent, which precludes the accurate diagnosis and treatment of many patients. Dr. James C Johnston and one of his Ethiopian colleagues Dr. Mehila Zebenigus work through Global Neurocare to raise these concerns with various professional organizations, university medical centers, the World Health Organization and the United Nations.

SARS – An Introduction


SARS-CoV-2 is the official name for the virus originating in Wuhan, China in late 2019 and rapidly spreading throughout the world in a devastating pandemic.  It is also referred to as the ‘coronavirus strain responsible for COVID-19,’ or the ‘Wuhan virus.’  The overwhelming impact of this single-stranded RNA virus is compounded by the massive damage attributable to a host of neurological complications.  These latter complications will be the focus of this discussion by neurologists James C. Johnston, MD, JD and Mehila ZebeniguJames Johnstons, MD.


The origin of this virus remains unclear, some purporting it came from a Wuhan, China wet market but recent evidence suggesting it may have originated from the Wuhan biosecurity laboratory.  Laboratory mishaps are well documented.  For example, the 2003 SARS virus – also originating in China – escaped from the Chinese Institute of Virology in Beijing on at least three separate occasions.  Science 2004; 304:659-661.

Perhaps more disconcerting is that the Wuhan Institute of Virology was performing ‘gain-of-function’ experiments, for example by recombining the genome of the bat coronavirus with that of a mouse-infecting coronavirus.  The Wuhan facility reported that the resulting virus could “replicate efficiently in primary human airway cells and achieve in vitro titers equivalent to epidemic strains of SARS-CoV.  Additionally, in vivo experiments demonstrate replication of the chimeric virus in mouse lung with notable pathogenesis.”  Further, “both monoclonal antibody and vaccine approaches failed to neutralize and protect from infection with CoVs using the novel spike protein.”  Nature Medicine 2015; 21:1508-1513.  

The researchers in that paper noted “scientific review panels may deem similar studies building chimeric viruses based on circulating strains too risky to pursue, as increased pathogenicity in mammalian models cannot be excluded.”  Id.  

This type of work, giving pathogens enhanced powers, or ‘gain-of-function,’ is highly controversial, and raises serious questions regarding these Chinese experiments.    

Several of the arguments alleging the virus could not have originated from the Wuhan biosecurity lab are rather tenuous, focus on the lab’s protocols without recognizing the potential for human error, and typically cite reports from unnamed experts or the Wuhan lab itself – for example, concluding that if it was engineered, then one of several reverse-genetic systems available for betacoronaviruses “would probably have been used,” referencing a March 2019 article from the Wuhan Institute of Virology.  Nat Med 2020; 26:450-452; Nat Rev Microbiol 2019 17:181-192.


This SARS-CoV-2 or Wuhan virus has an array of unusual features that have ensured it is highly effective in spreading throughout the world’s population, and indeed rapidly seeded the entire planet.  One distinctive feature is that asymptomatic people can spread the virus, unknowingly infecting large segments of the population.  It is typically spread through the respiratory system, and thus using masks and social distancing reduce spread.

Patients most commonly develop fever, a dry cough and malaise, with a significant portion reporting headache, myalgias, chills and anosmia (loss of smell) with dysgeusia (impaired taste).  Gastrointestinal symptoms are not uncommon.  Recovery is variable, some patients recover in a few weeks, others suffer lingering symptoms such as fatigue, and up to one-third develop severe respiratory problems due to pulmonary inflammation.  Respiratory failure is the leading cause of mortality with SARS-CoV-2, but there are also a host of systemic complications including myocarditis, renal failure, and a coagulopathy that may result in arterial or venous occlusions.     

Professor Mehila Zebenigus and Dr. James C. Johnston will focus on the extraordinarily diverse neurological complications associated with the virus, which can affect the entire central and peripheral nervous systems, and may occur during an active infection or as part of a post-viral syndrome.  

Headache is common, and some patients develop meningitis or encephalitis.  Autopsy studies have demonstrated viral levels in the brains of SARS-CoV-2 patients, not unlike the 2003 SARS epidemic.  The virus may spread to the nervous system through the cardiovascular system or by transneuronal means such as the olfactory nerve from the nasal passages or the vagus nerve from the lungs.  The major cause of death is an atypical Acute Respiratory Distress Syndrome manifest by severe hypoxemia in the face of well preserved lung capacity which may be attributable to invasion of the brainstem respiratory center leading to a form of Ondine’s curse.  Cerebrovascular disease is increasingly recognized with this virus and in fact may be the presenting symptom.  There may also be vascular occlusions of other organs.  Viral and post-viral syndromes include Guillian-Barre syndrome, myelitis, myositis and a host of other disorders including hearing loss.  


This pandemic will continue to plague the world for the foreseeable future, and it is crucial for neurologists and all physicians to recognize the varied and devastating neurological presentations that may occur as a presenting symptom, during the course of the infection, or as a post-viral syndrome.



Neurological Care in Developing Countries

Founder of non-profit NGO Global NeuroCare®, Neurologist James C. Johnston, MD, JD has dedicated significant time and resources to improving neurological care in some of the least developed regions in the world.

Dr. James C. Johnston focuses the NGO on sub-Saharan Africa (SSA), a region plagued by the ‘triple burden’ of ongoing communicable diseases, rapidly increasing non-communicable disorders such as cancer, stroke and heart disease, and escalating problems directly attributable to globalization including increased accidents, climate related health issues, and most notably, the current SARS-CoV-2 pandemic (also known as COVID-19 or the Wuhan virus).

The most significant factor beyond the current pandemic adding to the overall disease burden in SSA is the increasing incidence of non-communicable disorders. Ethiopian neurologist Dr. Mehila Zebenigus and Dr. James C. Johnston discussed these non-communicable disorders at the United Nations High Level Political Forum and last World Association for Medical Law conference, focusing on the neurological diseases which afflict tens of millions of people, typically the young, causing cognitive impairment and physical disability, leading to loss of employment, marginalization, increased vulnerability and exclusion, contributing to a profound impact on the economy. The Global Burden of Disease Study underscored the fact that these neurological disorders are the main cause of disability worldwide. (Global, regional and national burden of neurological disorders during 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurology 2017.).

There must be improved access to neurological care in SSA in order to manage the increasing incidence of these diseases, which mandates addressing extraordinarily complex challenges such as a severe shortage of healthcare workers, poor infrastructure, limited transportation, and a dearth of supplies, equipment and medications, all compounded by abject poverty with food and water insecurity.

Global NeuroCare® focuses on improving healthcare access by establishing collaborative partnerships to increase the number of neurologists in SSA, and has worked with the Addis Ababa University Department of Neurology for the past fifteen years. This autonomous training program has been extraordinarily successful, having graduated over fifty board certified neurologists since inception in 2006. These neurologists not only see tens of thousands of patients but more importantly they train the general physicians to manage some of the common neurological conditions such as stroke, epilepsy and neuropathy. This teaching is an essential means of improving care in SSA, where it is unlikely there will ever be enough neurologists to meet the burden of disease.

Drs. Zebenigus and Johnston will attend the upcoming UN Forum to discuss the importance of maintaining collaborative partnerships, and caution against withdrawing, limiting or redirecting resources from ongoing programs to address the pandemic, as this would lead to increased morbidity and mortality from neurological diseases.

Basic Tips for Avoiding COVID-19

James C. Johnston MD, JD is a Consultant Neurologist with particular expertise in global health. As founder and director of Global NeuroCare, Dr. James C. Johnston has addressed a number of questions regarding SARS-CoV-2 (also called COVID-19 or the Wuhan virus) including the neurological complications of this infection and methods for minimizing the risk of becoming infected.

An obvious step to take in avoiding the infection is to refrain from unnecessary travel, particularly to public areas with high concentrations of people or regions that are seeing a spike in reported cases. Similarly, individuals should avoid direct contact with people who have recently traveled extensively or to destinations like those described above, though social distancing measures should be observed in all person to person encounters and public spaces.

Basic social distancing and hygiene measures include standing at least six feet from other people at all times and frequently and thoroughly washing hands. Hands should be washed with soap and water for at least 20 seconds, especially after being in a public space, after handling a face covering, and before touching the face, handling food or eating. A face cover is recommended when in public. It is also important to clean and disinfect frequently touched areas daily.

Finally, a person demonstrating symptoms of the virus, especially with reason to believe he or she may have been exposed to someone who could be carrying it already, should immediately begin taking the necessary precautions and steps towards isolation and testing, as well as contact his or her physician and employer. Be alert to symptoms including fever, cough, shortness of breath, gastrointestinal symptoms, loss of smell or taste, and virtually any other of a broad array of symptoms as outlined on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.