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Living with Multiple Sclerosis Amidst a Pandemic

As healthcare facilities continue to flood with COVID-19 patients, concerns are arising about the effects of the pandemic on patients with other diseases. In particular, patients with Multiple Sclerosis, or MS, are believed to be at an increased vulnerability. Though little has been confirmed regarding a direct relationship between MS and COVID-19, here’s a complete breakdown of what we know: 


What is Multiple Sclerosis?


Multiple sclerosis is a degenerative neurodisability that affects the brain and spinal cord. It causes the immune system to attack the protective substance surrounding nerve fibres, called myelin. MS individuals can show a vast range of symptoms depending on the severity of the disease and which nerves are affected. This includes issues with vision, balance, arm and leg movement, and partial paralysis. 


Effects of multiple sclerosis on the nerves (News Medical Life Sciences)


How is COVID-19 affecting MS patients?


Although there is no cure for MS, it can be treated with disease-modifying therapies (DMTs). These processes actively suppress the immune system to reduce or slow the degenerative effects of the disease. However, in the midst of a global pandemic, a weaker immune system puts MS patients at a higher risk for not only contracting COVID-19, but having fatal symptoms if they do.


Coping with the outbreak


Currently, the Canada-U.S MS Society’s Medical Advisory Committee has released several recommendations to help MS patients cope with the outbreak. 

  1. People with MS are asked to wear personal protective equipment (PPE), follow outbreak protocol, limit interactions with other people (as much as possible), and seriously consider their level of risk before going outside.

  2. Individuals should continue DMTs and discuss specific risks with their MS healthcare provider prior to stopping a DMT

  3. Before beginning a cell-depleting DMT or a DMT that warns of severe increase in MS after halting its use, talk to your healthcare provider and discuss the overall benefit of the therapy. 

a. Cell depleting therapies include: Lemtrada™ (alemtuzumab), Mavenclad™

(cladribine), Ocrevus™ (ocrelizumab) and Rituxan® (rituximab). 


b. Potentially severe therapies that can increase MS after stopping their use include:

Gilenya™ (fingolimod) and Tysabri® (natalizumab). 


Lemtrada™ (alemtuzumab), a cell-depleting therapy (News.Law)


Recent research


A recent study in China investigated the relationship between MS and the associated risks of COVID-19. Considering the current dearth of information regarding the effects of DMT use on COVID-19 risk in MS patients, it attempts to prove whether or not there is a true correlation. 


The study involved a survey conducted among patients with MS and neuromyelitis optica spectrum disorder (NMOSD), a disease very similar to MS that also requires DMT treatment. The survey, conducted by the Chinese Medical network for Neuroinflammation, gathered patients from 10 different healthcare centres in 8 different cities. Data from suspected COVID-19 cases were obtained from hospital visits, questionnaires, and patient self-reporting. Furthermore, cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were confirmed through clinical evaluation by a panel of experts, in conjunction with chest CT and viral RNA detection.


Out of the sample, 49% of MS patients and 69% of NMOSD patients were subject to ongoing DMT treatment. In other words, despite the current circumstances, their treatment regimen was not altered due to potential negative effects. Among all those surveyed, only two patients (with NMOSD) contracted COVID-19 and developed pneumonia. However, after treatment, they both recovered and neither patient experienced a worsening of their NMOSD symptoms.

Essentially, the study found that neuro-disabled patients who receive DMTs had no higher risk of COVID-19 infection than those who do not. 

Proportions of patients with MS in 10 centres from 8 cities surveyed who received disease-modifying drugs and methylprednisolone (Neurology, Neuroimmunology, & Neuroinflammation)



Proportions of patients with NMOSD in 10 centres from 8 cities surveyed who received disease-modifying drugs and methylprednisolone (Neurology, Neuroimmunology, & Neuroinflammation)


Conclusion


While DMTs might not increase the risk of contracting COVID-19, having MS can create complications that can make a person more susceptible. For example, individuals with advanced MS may have severe mobility issues. This can increase the risk for COVID-19 because spending the majority of one’s day lying down or in bed can cause respiratory secretions to accumulate. This in turn can cause breathing problems and aspiration pneumonia, which puts the individual directly at risk for COVID-19. 


Overall, patients with MS are advised to take extra precautions to protect themselves. In addition, regardless of whether or not you have health conditions, everyone should be aware of who they’re in contact with and how it affects those surrounding them. It’s especially important to take into consideration those who could potentially be more vulnerable to protect them when they need it most. 


Article contributors: Rahma Osman, Sherilyn Wen

Sources:


MS Society. (2020, May 7). What You Need to Know About Coronavirus. Retrieved July 07, 2020,

from https://mssociety.ca/resources/what-you-need-to-know-about-coronavirus

Fan, M., Qiu, W., Bu, B., Xu, Y., Yang, H., Huang, D., . . . Shi, F. (2020). Risk of COVID-19 infection in

MS and neuromyelitis optica spectrum disorders. Retrieved July 07, 2020, from

https://doi.org/10.1212/NXI.0000000000000787

Villines, Z. (2020, April 9). COVID-19 and multiple sclerosis: Risks and when to see a doctor.

Retrieved July 07, 2020, from https://www.medicalnewstoday.com/articles/covid-19-and

multiple-sclerosis#effects


Featured image courtesy of WebMd.