#MSCOVID19 The Italian Experience

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An Italian programme on COVID-19 infection in multiple sclerosis Maria Pia Sormani, on behalf of the Italian Study Group on COVID-19 infection in multiple sclerosisThe Lancet NeurologyPublished: April 29, 2020

Italy was the first European country to encounter the effects of the coronavirus disease 2019 (COVID-19) pandemic. The Italian Multiple Sclerosis Society (AISM), the Italian Multiple Sclerosis Foundation (FISM), and the Multiple Sclerosis Study Group of the Italian Neurological Society set up a programme to monitor the events occuring

“They report the results of the pilot phase of an investigation of COVID-19 among people with multiple sclerosis, based on a core set of data collected from treatment providers through a specifically designed web-based case report form”.

“The core data set includes clinical and demographic characteristics, and information on disease-modifying therapies. To be included, patients had to have symptoms and signs of COVID-19 infection, with or without a positive test (RT-PCR on nasal and pharyngeal swabs). On March 14, 2020, they sent the case report form to more than 200 Italian neurologists from about 90 multiple sclerosis centres across Italy”.

They say “As of April 7, 2020, they have collected data on 232 patients from 38 centres, 57 of whom tested positive for COVID-19 and 175 of whom had suspected COVID-19 symptoms but did not have a positive test. Mean follow-up was 12·6 days (SD 7·4). The severity of COVID-19 infection in 232 patients was classified as mild (no pneumonia or mild pneumonia) in 223 (96%), severe (shortness of breath, respiratory rates ≥30 breaths per min, blood oxygen saturation ≤93%, PaO₂:FiO₂ <300 mmHg/%, and an increase in lung infiltrates of >50% within 24–48 h) in four (2%), and critical (respiratory failure, septic shock, and multiple organ dysfunction or failure) in six (3%).2 Of the six critical patients, one recovered and five died; all had a positive swab. 21 patients had undergone a 5-day course of methylprednisolone within 3 months before the onset of COVID-19”.

“These results appear to be slightly reassuring and do not seem to contradict guidelines that the Italian Neurology Socieety and others had already issued on the management of multiple sclerosis treatments in the time of the COVID-19 pandemic.

“These data must be considered only preliminary, however, and there is not enough information to speculate about any susceptibility to protection from COVID-19 afforded by disease modifying therapies. The same is true for the effect of comorbidities, sex, and other medications (beyond just the disease-modifying therapies) that patients with multiple sclerosis might be taking”.

They will “continue to monitor these patients throughout the duration of the pandemic. When a system to record all patients with multiple sclerosis positive for COVID-19 is implemented, more data on the prevalence of these cases can be gathered”.

I am sure ProfG will comment on these data, but at the moment it seems there is nothing particularly special about multiple sclerosis, COVOID-19 creates problems for older people with co-morbidities. 3 of the 5 deaths were in people who were not taking DMT.

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