#MSCOVID19-Italia

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Although much of what we see on the internet has originated in China, we are starting to see some information from Italy.

Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. Onder G, Rezza G, Brusaferro S. JAMA. 2020 Mar 23. doi: 10.1001/jama.2020.4683. [Epub ahead of print] 

Sadly the death rate seems to be higher than has been noticed in China however as you can see in people over 80 this is high and I now suspect this will become even higher, because as the medical system becomes overloaded, people are be triaged for attempted treatment or to recieve no treatment. It is quite possible that we are heading for this problem in the UK. Therefore, whilst you might feel young and invincible, as you are likely to survive, spare a thought for your mum and dads and grans and grandads that may not be so resilient. So keep your distance from them ,

The are reasons why the reported death rate may be different and some of it it may relate to how the deaths were reported.

There are risk factors for doing badly and 30% had ischemic heart disease, 35.5% had diabetes, 20.3% had active cancer, 24.5% had atrial fibrillation, 6.8% had dementia, and 9.6% had a history of stroke. The mean number of preexisting diseases was 2.7 (SD, 1.6). Overall, only 3 patients (0.8%) had no diseases, 89 (25.1%) had a single disease, 91 (25.6%) had 2 diseases, and 172 (48.5%) had 3 or more underlying diseases. The presence of these comorbidities might have increased the risk of mortality independent of COVID-19 infection.

Obviously we are concerned about people on DMT and so keep those stories coming in #MSCOVID19. We have had a case of someone in London 3 weeks post cycle 2 of alemtuzumab, who had mild symptoms for 2 weeks and recovered, so you can’t get much more immunosuppressed than that.

Looking at a case report of the animal and human data, it seems to me that the virus is cleared before there is a significant antibody response. The antibody response will, however, protect you from possible re-infection in the future. This takes a few weeks to kick in. I suspect the innate nervous system is of central importance to virus killing. Most of the high efficacy MS drugs do not really target the monocytes or the neutrophils and this could be a good thing.

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MouseDoctor

12 comments

Leave a Reply to P Singh Cancel reply

  • Thank you, this is very informative.
    However I think there are typos in the last paragraph which makes the meaning not quite clear. Would you mind correcting it please? Thank you very much

    • Essential DMT however cladribine transiently drops NK cells and some people with alemtuzumab drop neutrophil and there is a short drop in monocytes

  • Hi, your posts are reassuring during this time. I currently take Tecfidera and have been on it for over a year with good control of my MS (no new relapses and last MRI showed no new activity). My EDSS is 1 and i feel fitter, stronger and better than i did even 5 years ago. My question relates to those of us that are front line NHS staff (I am an Anaesthetist). What recommendations or advice could you offer. I feel the governments guidance of placing all those with MS in the vulnerable category is a difficult one for me to manage morally at this moment.

    • I will let ProfG make the recommendations but I guess you will not be doing much anesthesia as operations are being canceled left right and centre, but I understand the dilema

      • Many thanks. As an Anaesthetist my role be moved to the Intensive care team, where I will be part of the Intubation teams.

    • As another Doctor (married to a GP) on Tecfidera I’d be really interested in a response to this question. I’m not on the front-line (yet) and will not be anywhere near to it as an anesthetist intubating, but …
      All respect to P Singh

    • It occurs but is rare
      In the active-controlled (RMS) treatment period, a decrease in neutrophils < LNN (belwo lower limit of normal was observed in 14.7% of Ocrevus patients compared with 40.9% of patients treated with interferon beta-1a. In the placebo-controlled (PPMS) clinical trial, the proportion of Ocrevus patients presenting decreased neutrophils was higher (12.9 %) than placebo patients (10.0 %); among these a higher percentage of patients (4.3%) in the Ocrevus group had Grade 2 or above neutropenia vs 1.3% in the placebo group;approximately 1% of the patients in the Ocrevus group had Grade 4 neutropenia vs 0% in the placebo group. The majority of the neutrophil decreases were transient (only observed once for a given patient treated with Ocrevus) and were Grade 1 (<1500 cells/mm3 ) and 2 (between 1000 and 1500 cells/mm3) inseverity. One patient with grade 3 (between 500 and 1000 cells/mm3) and one patient with grade 4(< 500 cells/mm3) neutropenia required specific treatment with granulocyte-colony stimulating factor,and remained on ocrelizumab after the episode. After rituximab administration, antibodies against neutrophils may be produced, resulting in neutropenia. It may also develop due to aberrant B-cell reconstitution after rituximab administration. ... Patients harboring the FcγRIIIa 158 V/F polymorphism were found to have a higher incidence of rituximab-induced neutropenia.

  • If the UK has 1% of population infected or recovered from covid 19 that would be 600000 have had virus
    That seems plausible
    If as some studies suggest, 30% so say 20 million have had or have virus that is a game changer
    We may find out end of next week (or at least develop an informed view in the following days) if phe are satisfied with the antibody test
    If we did a sweepstake what number would you chose between 1 and 30 ?
    I chose 5

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