**Table 2.**

*Autoimmune diseases of the nervous system have been reported in the context of COVID-19.*



*ACE, angiotensin-converting enzyme; COVID-19, coronavirus disease 2019; JAK, janus-kinase; IL-1R, interleukin-1 receptor; IL-6R, interleukin-6 receptor.*

#### **Table 3.**

*Treatment options to counteract viral replication or/and viral virulence or organ damage caused by a viral infection or virus-mediated secondary tissue damage.*

Dexamethasone has been shown to have beneficial effects in COVID-19 since it leads to reduction of the host immune response against the virus [70]. This host immune response can lead to catastrophic outcomes for the body. Beneficial effects of dexamethasone are mainly seen in the case of severely ill patients requiring mechanical ventilation. In non-severely affected COVID-19 patients not requiring oxygen supplementation, increased mortality is observed [80]. Tocilizumab an anti-interleukin-6 receptor (IL-6R) directed monoclonal antibody (mAb) has been shown to have some beneficial effects in COVID-19 patients reducing the risk of mechanical assistance [71, 72]. Also, another mAb against IL-6R, Sarilumab, improved the outcome and survival of COVID-19 [73]. Early start of treatment with anakinra a mAb against the interleukin-1 receptor (IL-1R) guided by levels against soluble urokinase plasminogen activator receptor (suPAR) significantly reduced the risk of worse clinical outcome at day 28 and reduced the length of hospital stay compared to placebo in patients hospitalized with moderate and severe COVID-19 [74]. Various mAb directed against the SARS-CoV-2 spike protein have demonstrated beneficial effects in patients with COVID-19 [76, 77, 79]. Malnupavir has anti-RNA polymerase activity and the risk of hospitalization or death in at-risk, unvaccinated adults with COVID-19 was reduced in patients treated early with this novel compound [78]. The protease inhibitor PV-07321332/Ritanovir of SARS-COV-2 3-chymotrypsin-like protease resulted in the reduction of risk of hospitalization and death compared to placebo in adults with a high risk of poor outcome of COVID-19 [79]. Much effort is done to identify compounds with beneficial effects in COVID-19 patients including repurposing of drugs from other indications [73, 81]. Importantly, serum from patients recovered from COVID-19 has been used successfully to reduce mortality in patients with active COVID-19 disease [82]. Higher anti-SARS-COV-2 titers of the transfused plasma led to a lower risk of death in non-ventilated patients with COVID-19. So far, besides symptomatic treatments no specific treatments for COVID-19- related neurological conditions have been introduced. Nevertheless, the beneficial effects of treatment on COVID-19 precipitation and severity will also result in reduced neurological disease burden.

### **9. Vaccination**

Vaccination is of paramount importance to counteract the further spreading of SARS-CoV-2 and COVID-19 [83]. The first vaccines were introduced at the end of 2020 [84] and the beginning of 2021 [85–87]. Since then, a major vaccination effort has been undertaken with the fastest vaccination campaigns in Israel and Great Britain. The vaccines also have shown efficacy against mutated variants of SARS-CoV-2 even though breakthrough infections have been observed [88]. Societies

*Neuroimmunology and Neurological Manifestations of COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.103026*

with high numbers of vaccinated individuals have gained better control over the COVID-19 pandemic compared to societies with low vaccination rates. Repetitive vaccination strategies have increased vaccination efficacy and have provided more protection from novel virus variants [89]. Presently as of the end of January 2022, mRNA vaccines and adenovirus vectors with inserts of sequences coding for the spike protein of SARS-CoV-2 and protein-based vaccines have been introduced [84–87, 90, 91]. Vaccination efficacy is much dependent on booster vaccination regimes [89, 92, 93]. All currently approved vaccines are given by intramuscular injection [94]. Muscle cells that take up the mRNA vaccine or the adenovirusvector-based vaccine are used subsequently to produce SARS-CoV-2- derived spike protein. This protein is recognized as `non-self` by the immune system and a strong T-and B-cell derived immune response is generated. This immune response leads to protection from SARS-CoV-2. The protein-based vaccines lead to the generation of a T- and B-cell response against SARS-CoV-2. There are vaccination-related cases with neurological symptoms [95–97]. In general, vaccination-related side effects were increased in patients with preceding COVID-19 [98].
