Multiple Sclerosis and COVID-19
5 May 2020
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system. Currently, 130,000 people have MS in the UK. The symptoms are varied: fatigue, optic neuritis, weakness of limbs, balance problems, unexplained pain, etc.
In the context of the current health crisis, is MS a risk factor for complications with COVID-19? Do treatments play a role in coronavirus infection? Can coronavirus make MS worse? We answer your questions!
I have MS, am I more at risk of infection or complications with COVID-19?
The SARS-CoV-2 coronavirus does not appear to worsen MS flares or symptoms. But some people with MS can be at risk of infection if they are taking disease-modifying therapies (DMTs), as immunosuppression therapies. These treatments, like GILENYA or TYSABRI, reduce the immune defences and make you more vulnerable to infection. Therefore, it is essential to respect social distancing and barrier gestures as closely as possible.
Make sure that you do not stop immunosuppressive therapy or any protocol without consulting your doctor or neurologist first! Your MS could progress and cause complications. Continue to take your medications and consult your neurologist or doctor by phone or teleconsultation.
Should I shield at home?
You may have received a letter, text or phone call from the Government recommending that you ‘shield’ (self-isolate at home for a number of weeks). This message has gone to a wide group of people to make sure people at higher risk take action as quickly as possible. If you receive this message, you should self-isolation for 12 weeks from the date the Government contacted you. At the moment, the Government site says shielding will last at least until the end of June. If you’re in England you can self-register for extra help. If you have had a letter you can tick “Yes, my GP or hospital clinician has told me to ‘shield’” on the government form, even if you don’t meet any of the other criteria they list. This is a new feature on the form. You can also call the Royal Voluntary Service to get help from NHS volunteers with shopping and collecting prescriptions: 0808 196 3646.
Can I take corticosteroids to treat flare-ups?
During an episode, you may typically receive high-dose corticosteroid injections over a short period of time (in anti-inflammatory action), such as METHYLPREDNISOLONE. According to Professor Thibault Moreau, head of neurology at Dijon University Hospital, there is no predefined treatment. The choice of corticosteroid injection is evaluated by the doctor and depends on the intensity of the flare-up. During the current health crisis, corticosteroids may be applied orally or by injection and may be given at home rather than in hospital or clinic.
My MS treatment has been stopped because of COVID-19, does this pose a risk for my condition?
For some people, treatment can be temporarily interrupted or postponed in order to reduce the risks of complications of a COVID-19 infection. This can only be done if it does not pose a risk to the progression of your MS. This choice is made on a case-by-case basis with your MS care team.
I think I may have COVID-19 symptoms, what should I do?
If you have a high temperature or a continuous cough, you should self-isolate for 7 days. If you're taking a DMT, you should be able to continue taking it if your symptoms are mild. Do not go to a GP surgery, pharmacy or hospital in person. If you're not in immediate danger but you feel you cannot cope with your symptoms at home or your condition worsens after 7 days, contact the NHS 111 online coronavirus helpline. If you are advised to go to your local hospital, you should inform your MS care team (even if you are not admitted).
Do immunomodulators protect against the “cytokine storm” caused by Sars-CoV-2?
Cytokine storm syndrome (CSS) is a form of systemic inflammatory response that can follow a viral or bacterial infection, an inflammatory disease such as MS or certain gene therapies. This syndrome occurs when white blood cells are activated, creating small inflammatory lesions which release inflammatory cytokines (a type of signalling molecule), which in turn activate more immune cells. A hyper inflammation of this kind can be lethal. It is this phenomenon that is responsible for acute respiratory distress syndromes in patients hospitalised for COVID-19.
In the context of MS, immunomodulators such as COPAXONE, AVONEX and REBIF are administered to regulate these excessive immune responses and reduce the inflammation resulting from damage to the myelin sheath (the insulating layer around nerves). The scientific community is currently examining the usefulness of immunomodulatory molecules to prevent acute respiratory distress syndrome in patients with COVID-19. For the time being, basic MS treatments do not seem to have an influence on this phenomenon.
Is there a specific protocol for people on DMT in the event of hospitalisation?
In the case of a severe form of COVID-19 requiring hospitalisation, patients living with MS and being treated with DMT benefit from the same protocol. This includes close respiratory monitoring by physicians.
I have MS, can I participate in clinical trials for COVID-19?
Guidance on clinical trials will be different depending on what you are testing. So it is always best to talk to your trial team directly.
How can I continue my physical therapy and other treatments while in self-isolation?
MS is a chronic disease requiring multidisciplinary care. Beyond your consultations with your neurologist for your basic treatments, it is particularly important to continue your follow-up with the other specialists (urologists, ophthalmologists, psychologists, physiotherapists, nurses, speech therapists, etc.) to avoid a decline of your overall condition.
MS-UK offers many videos to practise at home: from dynamic stretching and mobilisation, to resistance exercises, balance or aerobic exercises! And if you need someone to talk to, you can contact the MS-UK Helpline: 0800 783 0518.
How can I find support on Carenity?
Carenity currently has thousands of patients and relatives of patients affected by MS. On the platform, you can find support from other members of the community. It is important that we help one another especially in this difficult context of the COVID-19 pandemic. Feel free to join in on the discussions below!
- MS and the Coronavirus - How are you handling the pandemic?
- Progressive MS and the Coronavirus - Should we be shielding?
- Today I feel... A coronavirus special!
- COVID-19 Lockdown and Sleep: How are you sleeping lately?
- Coronavirus: How to keep busy while self-isolating?
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Take care and stay home!
Emission Le magazine de la Santé “Sclérose en plaques et coronavirus” diffusée le 27/04/2020 sur France 5