A #MSCOVID19 reality check

A

Are you aware of how the COVID-19 pandemic is going to play out?

People are being lulled into a sense of security that over the next 2-3 months the pandemic and mini-epidemics in each country and region will be over and things will start to return to normal. This is not correct. 

The current strategy is to flatten the curve and extend the tail of the epidemic. What this means is that the COVID-19 epidemic will last many more months and is likely to extend into next year. The purpose of flattening the curve is simply to manage limited NHS resources, i.e. ventilators, CPAP (continuous positive airway pressure) machines, ITU and hospital beds, supplies of PPE (personal protective equipment) and staff. At present, it is estimated that 25% of NHS staff are off ill and/or self-isolating because another family member is ill.

By flattening the curve it will keep the stream of patients with severe COVID-19 infection to a manageable level. Instead of them arriving at NHS hospital in a 3 month window they will now arrive over a 6 to 9 month window. 

If the lockdown is very extensive and prolonged as it has been in China you can stop the spread of infection in the community, but there will still be flares of infection and hence further lockdowns will be required. These flares will be triggered by asymptomatic viral shedders or people returning to China from outside its borders who are infected.  I am almost certain that China is not telling us their whole story. We are not hearing about the COVID-19 flares, which according to basic epidemiological principles has to be happening. 

I think it is highly unlikely that the UK will take the Chinese approach to our epidemic. This means that COVID-19 will move from being an epidemic, i.e. an increasing number of cases, to becoming endemic. The latter means the number of new cases becomes stable and at a level, the NHS can cope with. Eventually, herd immunity will occur that will slow down the spread of infection to very low levels. For herd immunity to occur it is estimated that at least 80% of the population, and possibly more, will have to get infected with SARS-CoV-2 so that it will ring-fence people who are susceptible to infection and stop the person-to-person spread, which has driven the epidemic. 

How quickly herd immunity occurs depends on how soon the government relaxes or stops the lockdown and start letting people socialise and to start spreading the virus again. If the government removes the lockdown at the end of June as some commentators have suggested then I would estimate it would take about 18 months for the British population to acquire herd immunity. 

One strategy that is likely to be employed is for high-risk people to be screened for immunity to SARS-CoV-2 by testing for the presence of antibodies in their blood and only letting them out of self-isolation if they are immune. This strategy is in anticipation that there will be an effective vaccine for SARS-CoV-2. I personally think this is a high-risk strategy. Vaccines for respiratory infections are notoriously difficult to make. Immunity from a vaccine may not be lifelong and the virus will mutate and drift, which will make the vaccine less effective. Importantly, the logistics of getting a vaccine tested and deployed globally makes it highly unlikely that we will see a vaccine deployed at a population level before 18 months. Just maybe a vaccine may be ready for very high-risk patients towards the end of 2021.

What does this mean for people with MS and the general population? It means that you really need to prepare yourself to be infected with SARS-CoV-2 and to possibly get COVID-19. I predict at 80% of us, yes 4 out of 5 of us, will be infected with SARS-CoV-2. The good news is that it looks like at a population level the proportion of people who get asymptomatic infections may be higher than previous estimates. The CDC (Centre for Disease Control) estimates asymptomatic infection rates as being 25% and higher. This means that when we get the real denominator of people infected with SARS-CoV-2 we will find that the proportion who get severe COVID-19 will be much less than 5% and the mortality or death rate from the infection will be much lower than the 2-5% that is currently being quoted. 

Another possibility that I think is more likely than a vaccine is the emergence of effective antivirals and immunotherapies for treating COVID-19 and severe COVID-19. There are a lot of ongoing trials with repurposed drugs. I predict that when one or more of these trials are positive the registration of the drug, and adoption of the drug, into clinical practice will be very rapid. This means COVID-19 will be treatable and the proportion of people needing ITU and ventilation will drop and the mortality rate will improve. I predict that such a drug discovery is only months away. 

You also have to realise that the ‘suits’ (yes, they tend to be men in grey suits) or the ‘Whitehall economists are frantically working away at their various economic models and will be weighing up the economic costs of the COVID-19 epidemic versus the health of the population. At some point in the near future, they will decide that GB Inc. has to to get back to work and the consequences of doing that will be the loss of lives due to severe COVID-19. The decision will be based on four competing factors (1) is the NHS now in a position to cope vs. (2) the mental health of the population (will they continue to adhere) vs. (3) the cost of a continued lockdown to the British economy vs. (4) the number of lives that will be lost. This is the harsh reality of being in charge of a country.

So, in conclusion, please don’t be lulled into a sense of false security; the COVID-19 pandemic is far from over, you are likely at some point to get COVID-19, don’t hold your breath expecting a vaccine to save you, but be optimistic and expect an anti-viral and/or anti-inflammatory to change the prognosis of COVID-19 soon. Please don’t believe China’s figures and take our politicians comments for what they are; political spin to manage expectations (unrealistic expectations). 

CoI: I am about to leave the trenches to start fighting the war and I am very anxious.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

78 comments

  • I’m being treated with tysabri. If there are drugs to block covid19, will I be able to take them? Thanks professor g

      • Thank you very much Mouse Doctor!
        Can I ask you if I will be able to take it even for the future vaccine even if I am being treated with tysabri? Thank you

        Massimo

        • Anti-viral drugs won’t affect the action of natalizxumab and natalizumab should probably not affect the anti-viral drug. Can you make a vaccine response on natalizumab…I would say yes because if people can make an anti-drug response which about 10% of people do one could make an anti-viral response, however they may be abit blunted in some studies

          Humoral immune response to influenza vaccine in natalizumab-treated MS patients.
          Vågberg M, Kumlin U, Svenningsson A. Neurol Res. 2012 Sep;34(7):730-3.

          Natalizumab treatment shows no clinically meaningful effects on immunization responses in patients with relapsing-remitting multiple sclerosis. Kaufman M, Pardo G, Rossman H, Sweetser MT, Forrestal F, Duda P.J Neurol Sci. 2014 Jun 15;341(1-2):22-7

          Antibody response to seasonal influenza vaccination in patients with multiple sclerosis receiving immunomodulatory therapy.
          Olberg HK, Eide GE, Cox RJ, Jul-Larsen Å, Lartey SL, Vedeler CA, Myhr KM.Eur J Neurol. 2018 Mar;25(3):527-534. doi: 10.1111/ene.13537. Epub 2018 Jan 6.

          • Sorry Doctor Mouse if I ask you another question on this topic: in Italy they are also using the drug TOCILIZUMAB to treat Covid19. Can I use this medication if I am being treated with Tysabri? Thanks and sorry again for stealing your time.

            Massimo

          • Tocilizumab blocks the interleukin 6 receptor, this is unrelated to natalizumab and again there is not reason why you could use this but obviously I hope this never happens. It is been used to try and block the cytokine stor that seems to contribute to the severity of COVID

          • I don’t speak perfect English. I did not understand your answer well. Can doctors use Tocilizumab even if I’m taking Natalizumab? Yes or no? Thanks again and sorry.

  • Sobering article Prof G. People are comparing this virus to the Spamish flue pandemic. In reality it will be much much more worse. With instant international travel, and over 5 billion more people crammed together. Can you imagine the horror this viris will create in a slums of india/south america? It will rage like inferno till all those susceptible are dead. God help us all! Human tragedy and misery of unimaginable horror is about to unfold as this world changing event takes hold. That will echo in history for.generstions to come. Caused no less than by human greed and contempt for the ecosystem by biting the hand that feeds us. Remember self protecting is your duty and not option when you go into the trenches. Albeit using diy masks/suits.. Our doctors and nurses are the most precious commodity we have during this world changing event. On the up side at least world co2 levels would of dropped for better. Good luck to you and your team and remain safe.

  • Thanks Prof… I think here lies the rub, it is difficult to keep the motivation to self-isolate for 12 weeks when you have read the imperial papers which will lead you to the conclusion that getting Covid is inevitable. I was asked to go and work on the ICU trials this week; Im going to have to say no, but it does make you feel like you aren’t doing your bit and in order to justify it Ill have to disclose the closet health condition which is also frustrating.

    Take care of yourself on the battle lines. I can only imagine how terrible it feels in the London hospitals. Im worried for the more mature clinicians, as looking at the odds ratios I think you are in a worst place than me, but you don’t get the bubble wrap and cotton wool that people with a health condition have been given. Do, take care.

  • Of course lots of uncertainty, but I think the clearest and most balanced summary of the likely future I’ve read. Many thanks. Take care Prof G and the team and thanks for your support and all you are about to do!

    • Amen to that. Between being a PwMS and originally trained as an economist (wearing dark not grey suits and track suits these days 😉), I am acutely aware of both sides. Some of the economists come across callous even to me but keeping lockdown for too long will cost lifes for other, potentially less visible reasons…

      I really don’t envy the people in charge.

  • But don’t worry about going out the front door again anyway because there won’t be any jobs to go to as all the businesses will shut down and the economy will collapse. Therefore no taxes therefore no NHS. We are just going to have to face up to the fact that we can’t play God, and accept a small percent of the population will not recover. This ridiculous lockdown is ultimately going to mean people starving and becoming weaker leaving them more susceptible to the virus anyway. And don’t even get me started on the crime levels which are already rising, but at least we save the nhs so it can stumble on to its next crisis.

    • Hmm I guess nurses dying while helping the sock and leaving their children in pain for the rest of their lives is your definition of NHS stumble on to its next crisis. You know what is happening in the world without NHS and India? Where likes of Trump use this crisis to give family members jobs!

    • 2 ways why this will not happen:

      1) quantitative easing i.e. treasury printing uncollateralised money
      2) issuance of long term debt to fund public service and infrastructre.

      Who would lend the state? Pension funds and the like will buy sovereign bonds at the right yield.

      But what you can expect is is (hyper) imflation for a few years to come.

      Nonetheless, there is nowhere besides the UK where I and my family would want to be in the coming years….

  • A very honest read. I agree with you totally. As a fairly fit 58 year old on fingo I’d take my chances against this virus. My worry is my mother. At 77 years old with copd and an enlarged heart, she wouldn’t fare so well and if Boris says she’s allowed to resume her normal life again, I don’t know how I would be able to persuade her to continue personal lockdown.
    However, we’ll cross it as we come to it.
    Thanks for the heads up Prof

  • Worrying to read about the actual reality of this pandemic and how it is actually being handled and how it’s leading the population into a false sense of security 😢 I honestly believe that after the peak has been flattened and people will be allowed out into the community again, we will see a second peak but this will be much greater than what we are currently experiencing 😢 Our only hope at this time is to slow this raging virus in it’s tracks, with the release of antivirals that can minimise the severity of the infection 🤞 A vaccine will come along in time this I’m sure but what is worrying is how many lives will be lost in the meantime.

    I can only imagine the anxiety & fear that must be coursing through your mind at these very uncertain times as you are being called upon to work on the frontline, in the fight against Covid-19, this being totally outside your field of expertise.
    I pray you stay safe & well.
    Gillian

  • Best Wishes Prof G. Thanks so much for everything you have done and everything you do. We are learning to value what is important and also, where future dangers will come from.
    Keep us all in touch if you get a chance.

  • Along with the other comments I send good luck and thanks to all of you at this awful time
    As an Mser awaiting either a potential trial of cladribine which may now not happen I suppose or siponimod which again may not happen I worry for those already on treatment as how will they be monitored?
    I hear at my London hospital that tysabri has been completely stopped how can this be right?

    • Look at the times they and comments are posted and it may explain as MrsMouse says you won’t be saying I wish “I worked harder on my deathbed”

  • “I predict at 80% of us, yes 4 out of 5 of us, will be infected with SARS-CoV-2.”

    It’s hard to tell though, isn’t it? I don’t think I’ve ever caught flu, not since I was a child anyway, haven’t caught the swine flu, H1N1, which does the rounds every year at least. I don’t get the flu jab either.

    Think it’s all speculation right now? Might be a lot better than anyone imagines in the end, might be a lot worse.

    • If you are severely infected needing ventilation then it is very worse, if you need oxygen then it isnt good either. The data from china imply 80% were asymtomatic or unnoticbly symptomatic. I like you do not remeber having the flu, cold yes, but incapacitating flu no and have never been vaccinated. Whilst in isolation, I have had a snivel for a day..I suspect this is just a cold, I await being tested. I think every Londer who uses the tube should be tested and we may get a pleasant surprise that the number with asymtpomatic covid exposure is high, as the 2m rule is out for that.

      • I just wonder/worry if asymptomatic really is necessarily asymptomatic. Because a person I was living with and in a relationship with many years ago got a bad flu-like illness and I never got it. They were incapacitated with it. But me – no symptoms, nothing. And that was just prior to when my MS kicked off.

    • RE: “80% of the population will be infected with SARS CoV-19….” if so then the spread of the virus will be stopped as about 50-60% of the population needs immunity before t

    • RE: “80% of the population will be infected with SARS CoV-19….” if so then the spread of the virus will be stopped as about 50-60% of the population needs immunity (R value between 2-3). As for your decision to pass on the flu vaccine, the idea is to have as many individuals immune to the influenza virus as possible for the same reason as SARS, to prevent widespread infection.

  • Prof G

    You seemed much more optimistic about a vaccine at some points. I believe I read even as quick as 6 months at one point of time. What has changed your thinking around this?

    Wishing you and your colleagues the best during this situation. You are truly a legend and I am very grateful for this site.

    • The vaccine will come and come soon, they are already in human trials for some of the variants. This is not the issue the question whether it will work well. Vaccines make antibody responses and they will be designed to stop the virus infecting cells, but the issue is will it make some people worse? We already know that high anti viral levels coorelate with the disease severity and from past experience some anti-lower respiratory tract infections make some people do worse. Astra zeneca sent half a billion dollors developing an antiviral antibody, it made some people worse an the approach was terminated. they will have to be tested but prepare for some set backs along the way.

    • I am optimistic about vaccines going into trials. But I am less optimistic about showing they work, showing they are safe, getting them through the regulatory process, scaling-up production, getting governments to buy them and then getting them to general population before the tail of the curve. Science takes time even when you speed-up the process as much as possible.

      • Team G, and especially clinicians that will be on the front lines, we are so incredibly grateful for your courage and dedication! Indeed, this gratitude existed well before this nightmare but has exponentially increased in light of current circumstances. How do folks feel about “challenge trials?” Many experts reasonably cite ethical concerns. Others argue we are in unprecedented times and a risk/benefit analysis may tilt in favor of conducting such trials so as to expedite the discovery of a safe and effective vaccine. Scale up, of course, is a separate dilemma….

    • “Prof G

      You seemed much more optimistic about a vaccine at some points.”anti

      Yeah..same thing with an EBV vaccine for MS…and yes antivirals don’t work on EBV at all…so don’t expect them to work on this thing.

  • Hi Prof G, I wish you well and please ensure that you have the right equipment in place before you deal with patients. I appreciate your honest and factual information. The reality of this virus has hit home to me as I’ve lost 2 member of my family, albeit that autopsy confirmation for cause of death to follow, and they both had underlying health conditions. I find that dealing with grief or I should say, being unable to grieve properly for a family member is taking its toll but I’m more able to cope if there’s honesty, transparency and some ‘light at the end of the tunnel’ narrative, that gets you through the day!

    If only the media (and that includes everything) would stop reminding and treating us like blimming idiots then you might well see people take their own path and start to rebel! I know we all need a little reminder about our social graces now and again, but there’s overkill and complete moronic harping on! We understand about the herd immunity, about the potential length of time that this virus will or will not peak or evolve but we do need a whole new way of getting the public behind the rules and regs, at this time. The global economy has and was a greedy bunch of shareholding fat cats who wanted more out of us humans in terms of work rate, achievements and profits. You were and are no longer looked upon as a person, in most global companies and jobs will be lost as we’ve locked-down but the business is still running even with a small team. Does that mean all the data that seems to drive business – is not a relevant as they’d have you believe! There are those who will try and claim compensation, when they are already billionaires and the companies will blame this crisis on why they’ve laid people off – or if you’ve been put on furlong leave! Does that mean your job is there at the end of the term!?! Lots of superficial lifestyles that can now come back to earth and reality. Does anyone need to spend £500.00 plus for trainers or bags! (Please do watch the world according to Jeff Goldblum – fascinating!).

    We need more people out there supporting what we can do differently – how we can engage with our children more. If you work full-time – this is not always an option. Cherish our time and invest in how to eat and live a healthier lifestyle. We don’t need to eat certain things – that trends and advertising tell us we do. This time could be used to show people how to change and use their time, as we engage with our neighbours (or not if you wish) – but help support them if they are elderly. Something you’ve probably never done before as you’re too busy! Worry less what people think and go with your gut instinct – you could decide to start your own business. Most importantly – make changes, don’t over eat with all those homemade cakes and end up with another health problem. Think about the environment – no noise, so peaceful y’day morning when I opened my back door – no road noise, no airplanes (well the odd one) no noisy delivery trucks and no tree cutting! (So sorry, I sound like Victor Meldrew 🙂

    Make some homemade masks for your family and front-line workers, if they haven’t been given any. Consult with University students who are sitting waiting to help and have the ambition, want and stamina to support lab testing – if they are 3rd year and studying medicine/science. Most of all try and stay positive – as things will seem dire and yes, people will die (I can vouch for that) and yes, you might get sick but keep fighting and keep your spirits up!

    I hope my rant resonates a bit with – “I just wish they’d stop treating us like idiots” and if you want to take your elderly mother who has Alzheimer to see the sea, in a car, with no other passengers – then that’s okay! Assuming you are in the same household and a million other people aren’t there too! Be sensible, of course!

    Positive thoughts and re-think how we do things – This could be what we can focus on and if another, radio or tv presenter or interviewee – says that we have to stay indoors and not go out. I’m going out and I will wear a mask and gloves and I will blimming get my exercise. And I might do it twice a day!

    Only joking – just in case I get a visit from my local SPC! I’ll just go out once a day – I promise. And I’m well aware of my immune-suppressed state too!

    God Bless – and I wish you all well and your families too.

    Jane

  • Dear Prof G, you always talk so much sense! Thank you so much for everything you do! Withing you the very best o luck for the difficult times ahead. We’re all thinking of you and rooting for you. Thank you!

  • Thank you for your direct, honest, and clear voice. It is rarer than one would hope during this crazy time. MS makes my life uncertain enough, I appreciate all you are doing to share your knowledge and well informed views. from across the pond, Suebee , Houston TX

  • We’re gonna miss you whilst you’re on the battle front ProfG and the reason we’re gonna feel your absence is because of the invaluable contributions you make to our lives as PwMS.
    Those of us who spent a few mins every day on the Blog know we will continue to benefit from MD posts, but the lack of your contributions and the connection you thereby make with us won’t go unnoticed.
    Please stay safe. Take good care. We will warmly anticipate and then welcome your return to this site at a future date.

  • It is no-brainer that mortality rate is much-much lower than 4%(0.4..0.04?). The direct impact of lockdowns on economies will cost much more lives then retrovirus itself.

  • Thank you so much, Dr. G. Given the likelihood that this will continue for months, if not years, what is your advice for continuing shielding? I’m a 36 yo female on Ocrevus (last infusion Jan 2020). Other than MS, I’m very healthy. Should I plan on isolating myself until an antiviral treatment is developed? Until herd immunity is achieved? I know it’s early days yet, but I’d love to hear your thoughts at this point. Thank you!!! (I’m American, as you can tell by the excessive exclamation points).

  • Judy says

    Honest. Comprehensive. Sobering. Magnanimous. Frankly, this is the best portrayal I have seen of what faces us in this pandemic. Please take care of yourself on the front lines. PwMS need you. Your staff needs you. So does your family. And on and on, not the least of which is yourself.

    Thank you deeply and Stay Safe!

    P.S. MD here. remove it from Gravitar.

    • MD aren’t we allowed to use Gravatar? Was so pleased when got mine back. It feels more personal to connect to a photo or picture than anon icons.

  • Prof G,
    As so many have already said, thanks for taking the time to write an honest, clear and carefully considered view of the situation.
    We will miss you badly. Your family need you and pwMS everywhere need you.
    Please stay as safe as you can and look after yourself 😊

  • “For herd immunity to occur it is estimated that at least 80% of the population,”

    This statement is incorrect

    herd immunity threshold (HIT) for COVID-19
    (2019–20 coronavirus pandemic its between
    50%- 60% assuming an Ro between 1.4-3.9

    That level of HIT is for Ro of 10

    “For example, the HIT for a disease with an R0 of 2 is theoretically only 50%, whereas with disease with an R0 of 10 the theoretical HIT is 90%”

    • It’s based on incomplete data from incomplete testing regimes.
      Until we have a quick, reliable, cheap antibody test we’re just estimating and plucking numbers out of thin air.

      • I agree. The current R0 is based on symptomatic and more severe cases. Some epidemiologists have predicted that up to 80% of cases may get very mild or asymptomatic diseases. Until we get the seroprevalence data in we should be sceptical about the current R0 estimates.

        Similarly, we can’t extrapolate the SARS R0 to SARS-CoV-2 because the infectivity of the latter is clearly much greater in humans. Even the WHO has said they expect the R0 to be higher than the original estimates. The question is how large will the SARS-CoV-2 R0 be when we get the seroprevalence data in?

        • Can you please explain where you get your estimate of 7 from for R-zero? I am interested in the science. Thanks.

  • Good luck Prof G 🙂 Stay strong, safe and patient – things will get better!!
    Best wishes and thank you for your constant dedication.

  • Should all people be encouraged to be vaccinated for flu and pneumococcal?
    And if so how long after a Ocrevus infusion do you need to wait before having the vaccines?
    Thanks

  • I’ve recently heard that China experienced a 7.5 million decrease in mobile phone users recently. Definitely food for thought. Of course the stats they’re giving us cannot be trusted in any way.
    Stay safe Prof G and all NHS employees!

  • Thank you Prof. G.

    Just wanted to document a few of my observations on BCG vaccine and COVID-19.

    Based on various accounts (direct, anecdotal & reported data), it appears that those countries that have a policy of mandatory BCG vaccine administration have least number of cases and least number of deaths due to COVID-19. The efficacy of BCG for TB may be checkered, but its effect on helping to boost the immune system seems to be well appreciated – even before the COVID-19 pandemic. Just a back of the envelope calculation indicates that hundreds of millions of people around the globe have been administered this vaccine in the past and continue to be administered presently and therefore its safety is not major concern.

    Looking at China where this all started – initially it was reported that COVID-19 only affects older adults. Correlating this with BCG policy of China, it restarted (BCG) vaccination after 1979 after pausing it during cultural revolution times. India has had the vaccination policy in effect since 1948 and it continues till today. I was looking at few other countries (Vietnam, Taiwan, UAE, Russia, South Korea) with low number of cases and deaths due to COVID-19, they all seem to have a BCG vaccination policy and some having a 2nd or even 3rd booster mandate – at least until a few years ago as per http://www.bcgatlas.org/

    On the other hand, if you look at the countries (Italy, USA, Spain, UK, France) with most number of cases and deaths, one thing that is very common is that they do not have BCG policy – which makes perfect sense due to the fact that TB is not very prevalent in these countries.

    Although it may not apply directly in this case; I understand the term “Correlation is not Causation” – . But, its hard to see that while some in “power” are promoting drugs that haven’t been proved – as a magic potion to cure COVID-19, I’m surprised to note that the same amount of attention is not being given to BCG – except for a few articles here and there.

    Thanks

    • If we look who are dying alot in the UK it is the over 55year olds and I believe it was every one in the UK of that age would be BCG vaccinated we were given Polio booster and manntoux tested (5-6 pins in the wrist) at school when we were about 13 or 14, and got vaccinated if negative or a chest X-ray (to see if we had tuberculoisis) if positive, but happy if you are right I got a massive blood blister at the injection site and still have the scar. I’m also of the small pox vaccination generation. I believe BCG vaccination was stopped in 2005.

      I know of the belief that the BCG vaccination boosts an anti-COVID response. It surely juices up the macrophages, which I think are important in destroying SARS-CoV2. Not sure the historic vaccination is whats claimed for protection

    • I am aware of the BCG hypothesis. The Australians have started a trial of BCG in healthcare workers to see if reduces their chances of getting COVID and/or severe COVID. I await the results with interest.

      There is a large literature of BCG’s effects on the immune system, including data supporting it as a potential treatment for MS. Does the latter support the viral theory of MS?

      • Very interesting, I was not aware of the BCG-MS studies; I will be reading up further on that!

        As a matter of fact, I’m sure I’ve had BCG Vaccine at/around my birth, since I’m originally from Chennai, India, living in Chicago for the past 25 years. I was dx with MS in 2014; M/49; JCV+ and currently on Ocrelizumab.

        Thanks

  • I enjoy your blog – always interesting!
    We need more facts coming out from the hard hit areas and the registries. It all comes down to statistics – then reccomendations follow.
    I am on Ocrevus after years on Tysabri. I’m scared of the next Infusion which i have been postponing (48 weeks). Could Tysabri be an Option during the corona pandemic?

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