Advice from MS TRUST & MS Society
What is COVID-19?
COVID-19 is a new strain of coronavirus first identified in China. As a group, coronaviruses are common across the world. In general, they cause mild respiratory or sometimes gastric symptoms.
The symptoms of COVID-19 are:
- a cough
- a high temperature
- shortness of breath
These symptoms are very similar to other illness which are much more common, such as a cold or flu. If you do develop these symptoms, it’s very unlikely to be COVID-19 unless you have been in close contact with someone with confirmed COVID-19 or if you have visited one of the high risk countries in the last 14 days.
What’s the risk of catching COVID-19?
The UK government has said the risk to individuals remains low and is taking measures to prevent the spread of the virus.
If you have MS, you have the same risk of getting an infection as anyone else. People with MS are not at a greater risk, your immune system is not weakened by MS.
The exception to this is if you are taking one of the more effective disease modifying drugs, such as Gilenya, Mavenclad, Tysabri, Ocrevus or Lemtrada. One side effect of these drugs is a greater risk of infection; they work by suppressing parts of the immune system. If you are concerned, do check with your MS nurse or neurologist. You should not stop treatment or miss appointments until you have spoken to a health professional.
What can I do to avoid catching COVID-19?
The NHS recommends these simple measures to avoid catching or spreading infections
- cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
- put used tissues in the bin immediately
- wash your hands with soap and water often – use hand sanitiser gel if soap and water are not available
- try to avoid close contact with people who are unwell
- do not touch your eyes, nose or mouth if your hands are not clean.
What’s the risk if I do catch COVID-19?
For most people, COVID-19 is a mild infection. Treatment aims to relieve symptoms while your body fights the infection. There is no specific medication for COVID-19.
If you have MS and get an infection, be it COVID-19, flu, cold, a bladder infection, stomach upset or any other bug or virus, the way your body deals with the infection (for example a fever) can cause a temporary worsening of MS symptoms. Once you’ve recovered from the infection, your MS symptoms will settle down.
If your MS is more severe, you may have a higher risk of developing complications from COVID-19 or other infections. If you find it difficult to clear your lungs, there’s an increased risk of a cold or flu developing into a more serious chest infection such as pneumonia.
Find out more
The NHS website has further advice on COVID-19, which covers the risk of catching it, simple ways to avoid catching or spreading it, and what to do if you are worried you might have caught it.
Government information and advice on COVID-19.
Foreign Office advice on travel to affected regions.
Barts MS Research blog has further discussions on disease modifying drugs and COVID-19.
The MS Society’s medical advisors have today (6 March 2020) released the following statement concerning coronavirus COVID-19. This advice may change as new information becomes available.
MS Society statement
The MS Society’s medical advisors, a group that includes some of the leading neurologists in the UK, have agreed the following joint statement on the COVID-19 coronavirus and MS:
“We have been closely following developments around the COVID-19 coronavirus. This is a rapidly evolving situation with a lot of uncertainty. We have set out below our initial advice based on what we know currently, but we will keep this under continual review as events progress and our knowledge of the virus improves.”
“In line with general public health advice, people with MS should ensure that they wash their hands frequently and where possible avoid being within 1 metre of people who are coughing and sneezing.
Those with other health conditions in addition to MS (such as cardiovascular disease or diabetes) should be especially careful to observe these recommendations.
“If you believe you may have been exposed to COVID-19, in the first instance you should contact the NHS 111 coronavirus service. If you remain concerned you can speak to your GP or neurologist.”
DMTs and coronavirus
“As of today (6 March 2020) our assessment is that people with MS would not normally need to stop taking a disease-modifying treatment (DMT) as a result of the threat of the virus.
As with many features of MS care, risks can vary widely from person to person and will depend on a range of factors including the clinical features of your MS, your general health, and any other long-term health conditions you have.
We have set out below an assessment of specific risks regarding different DMTs, as general guidelines to helpful people make an initial assessment of their own risk and decide when to contact healthcare professionals for more detailed advice.”
Copaxone, Aubagio, Tecfidera, beta interferons, and Tysabri
“Glatiramer acetate (brand name: Copaxone), teriflunomide (brand name: Aubagio),dimethyl fumarate (brand name: Tecfidera) and beta-interferons (various brand names) are generally likely to be safer than the other DMTs as they are not considered to be generalised immunosuppressive therapies. We likewise recommend that people with MS who are taking natalizumab (Tysabri) continue as normal, noting that we will be closely monitoring the developing situation.
Lemtrada, Mavenclad and Ocrevus
“If you are taking a course of alemtuzumab (brand name: Lemtrada), cladribine (brand name: Mavenclad), or ocrelizumab (brand name: Ocrevus) you and your neurologist should consider delaying this as these treatments can hamper your immune system. The case for waiting could be particularly strong if you are scheduled for a second or third course of treatment of one of these DMTs, where a delay of a few months is relatively unlikely to affect the clinical progression of your MS. Before cancelling a course of treatment it is important to first discuss this with a neurologist or other healthcare professional – it may be that having understood the risks you feel it is best to continue, or there may be an alternative DMT that would be more suitable for the time being.
“It is important to note that fingolimod (brand name: Gilenya) may increase your chances of having more severe viral and other infections, including COVID-19. However if you are already taking fingolimod, stopping can lead to rebound MS disease activity, which in many cases would outweigh the risks of the virus. If you are considering beginning a course of fingolimod in the near future, you and your neurologist could consider an alternative DMT for the time being.”
Siponimod, ofatumumab, rituximab and stem cell therapy
“Other important points to note regarding specific disease-modifying therapies:
- Siponimod (brand name: Mayzent), ofatumumab (brand name: Arzerra) and rituximab (various brand names) are not currently available on the NHS, but are available by private prescription in the UK. These could also affect your risk regarding COVID-19 and should be discussed with your neurologist or healthcare professional.
- Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells. This treatment greatly hampers your immune system for a period of time and you and your neurologist or healthcare professional should consider delaying this treatment.
If you are concerned please contact your neurologist or other healthcare professional for more detailed advice.”