A recent paper¹ suggested the absence of epidemiologic association between COVID-19 and Guillain-Barré syndrome (GBS). Previously, we had published the lack of national increase in GBS hospitalizations during Dengue² and Zika virus³ outbreaks in Singapore. Using similar methodology, we asked if GBS hospitalizations have changed in 2020 during the COVID-19 outbreak. All hospitalization episodes coded with discharge diagnosis of GBS (ICD-10: G61.0) from January 2019 to October 2020 were extracted from the Singapore Ministry of Health's inpatient administrative database, taking into account patients who were recorded more than once because they were transferred from another hospital. COVID-19 notification data were obtained from the Ministry's surveillance system on infectious diseases. Like Zika and Dengue, COVID-19 is a legally notifiable disease under Singapore law. Association between monthly GBS hospitalization episodes and monthly number of COVID-19 notifications was examined by calculating Spearman's correlation coefficient, after adjusting the time series data for stationarity. 57 985 COVID-19 infections were notified from January 2020 to October 2020. Compared to 2019, there was a significant decrease in the number of GBS hospitalization (figure 1), from an average of 9 per month in 2019 to 4 per month in 2020 (P < .005). There was no association between GBS hospitalizations and COVID-19 (Spearman's correlation coefficient = −.03). To date, we have had only one patient with probable COVID-19-related GBS, as defined by Ellul et al.⁴ It was a case of acute motor sensory axonal neuropathy, diagnosed in a patient approximately 1 month after admission for critical COVID-19 infection that required prolonged ventilation.⁵ Spinal fluid SARSCoV2 real-time polymerase chain reaction was negative.

Our data suggest that COVID-19 may not be a significant antecedent infection of GBS. The decrease in GBS hospitalizations may be partly related to mild cases not being hospitalized during the pandemic. A few Singapore hospitals also restricted non COVID-19 admissions during the second and third quarter of 2020. However, these cases would likely have been admitted to other hospitals and therefore captured in the national data. Overall, we believe the period of national lockdown, the social and physical isolation, emphasis on hygiene measures and mandatory mask-wearing were the main factors behind the general decrease in GBS cases.

最近的一篇论文¹表明 COVID-19 与吉兰-巴雷综合征 (GBS) 之间没有流行病学关联。此前，我们曾发表过登革热²和寨卡病毒³期间 GBS 住院人数在全国没有增加的情况新加坡爆发疫情。使用类似的方法，我们询问了 2020 年 COVID-19 爆发期间 GBS 住院人数是否发生了变化。2019 年 1 月至 2020 年 10 月，所有以 GBS（ICD-10：G61.0）出院诊断编码的住院事件均从新加坡卫生部的住院管理数据库中提取，并考虑到因转诊而被多次记录的患者来自另一家医院。COVID-19 通知数据来自卫生部的传染病监测系统。与寨卡病毒和登革热一样，根据新加坡法律，COVID-19 是一种法定通报疾病。通过计算 Spearman 相关系数来检查每月 GBS 住院事件与每月 COVID-19 通知数量之间的关联，调整时间序列数据的平稳性后。从 2020 年 1 月到 2020 年 10 月，共报告了 57 985 例 COVID-19 感染。与 2019 年相比，GBS 住院人数显着减少（图 1），从 2019 年的平均每月 9 人降至 2020 年的每月 4 人(P  < .005）。GBS 住院与 COVID-19 之间没有关联（Spearman 相关系数 = -.03）。迄今为止，我们只有一名患者可能患有 COVID-19 相关的 GBS，如 Ellul 等人所定义。⁴这是一例急性运动感觉轴索神经病，患者在入院大约 1 个月后被诊断出患有严重的 COVID-19 感染，需要长时间通气。⁵脊髓液 SARS CoV2 实时聚合酶链反应呈阴性。

我们的数据表明，COVID-19 可能不是 GBS 的重要先行感染。GBS 住院人数的减少可能部分与大流行期间未住院的轻症病例有关。一些新加坡医院还在 2020 年第二和第三季度限制非 COVID-19 入院。但是，这些病例可能已被其他医院收治，因此被纳入国家数据。总体而言，我们认为国家封锁时期、社会和身体隔离、强调卫生措施和强制戴口罩是 GBS 病例普遍减少的主要因素。