If you live in the UK and have MS you may receive a letter from the NHS stating that you are potentially in the ‘extremely vulnerable group’ in relation to COVID-19. The reason for that is they are using GP databases and other sources of information to identify patients who may be on immunosuppressive therapy. If you receive one of these letters don’t be alarmed and please contact your MS Team for specific advice.
In my opinion, the only pwMS who should be classified as ‘extremely vulnerable group’ are those who have had HSCT and alemtuzumab in the last 3-6 months and are still immunodepleted or patients with severe disability who have swallowing problems and/or a history of recurrent chest infections.
You will have seen the UK Government have updated its guidance and is now “classifying people on immunosuppression as being extremely vulnerable, which probably includes pwMS on immunosuppressive DMTs. There are three reasons for this. (1) To protect you from potentially getting infected with SARS-CoV2 and (2) potentially getting more severe COVID-19 that needs hospitalisation and a potential ITU bed and ventilation. (3) There is also a potential risk of creating a population of super spreaders, which increases the risks to the general population. Immunosuppressed people may not be able to clear the virus quickly and hence shed more virus and for longer.
The current list of what is an immunosuppressive therapy is incomplete and was not drafted from an MS perspective. This is despite being a member of the subcommittee that was meant to help draft this guidance. I think it important to liaise with your own MS team about your own situation.
What about if you have MS and are an essential worker? If you can work from home, please work from home. If your job involves no contact with people then you may be able to continue working; however, please clear this with your organisation. If your job entails coming into contact with people and particularly people infected with SARS-CoV2 then you are going to have to self-isolate. This advice may seem harsh, but this is a war, a war against a virus, and it demands extraordinary sacrifices at an individual level for the good of society. This is not only about looking after your own health, but the health of the country.
The above may be relevant today and may change by tomorrow. If we don’t adhere to the Government’s advice, it will become a diktat tomorrow.
I have put together some slides to show how we think immunosuppression may affect the disease severity curve of COVID-19. Please note it is a may and not a definite as we don’t have evidence to back up these claims. I hope this is self-explanatory.
I predict that NHS letters will create a lot of anxiety so this is a warning not to panic. I am still collating this information on my COVID-19 & MS microsite.