In light of todays discussion, we have this paper today. I told you the review (below) was out of date already, but this supports what we have suggested.
Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover.Soresina A, Moratto D, Chiarini M, Paolillo C, Baresi G, Focà E, Bezzi M, Baronio B, Giacomelli M, Badolato R.Pediatr Allergy Immunol. 2020 Apr 22. doi: 10.1111/pai.13263. [Epub ahead of print]
What’s this got to do with MS?
Well here is a genetic condition where the affected individual does not make B cells. They got COVID-19 and recovered therefore B cells and probably antibody are not essential for immune protection against SARS-CoV2. Therefore, if you are taking ocrelizumab and rituximab, you can deal with the infection
Therefore, we evaluated the outcome of SARS-Cov2 infection in patients with inborn errors of immunity (IEI) such as X linked agammaglobulinemia (XLA).
METHODS:When the SARS-Cov2 epidemic has reached Italy, we have activated a surveillance protocol of patients with IEI, to perform SARS-Cov2 search by nasopharyngeal swab in patients presenting with symptoms which could be a manifestations of COVID-19, such as fever, cough, diarrhea or vomiting.
RESULTS:We describe two patients with X-linked agammaglobulinemia (XLA) of 34 and 26 years of age with complete absence of B cells from peripheral blood who developed COVID-19, as diagnosed by SARS-Cov-2 detection by nasopharyngeal swab, while receiving immunoglobulin infusions. Both patients developed interstitial pneumonia characterized by fever, cough and anorexia and associated with elevation of CRP and ferritin, but have never required oxygen ventilation or intensive care.
CONCLUSION:Our report suggests that XLA patients might present high risk to develop pneumonia after SARS-Cov2 infection, but can recover from infection, suggesting that B cell response might be important, but not strictly required to overcome the disease. However, there is need of larger observational studies to extend these conclusions to other patients with similar genetic immune defects.
Now to clarify this further someone has indicated that the people were being treated with immunoglobulin, this would not give neutralising protection from COVID-19, however it could block macrophages and neutrophils and natural killer cell activity and this could be beneficial which is not being done with anti-CD20 therapy, but does not change the argument that B cells are not essential for anti-COVID immunity, which is the point of the post
Successful treatment of plasma exchange followed by intravenous immunogloblin in a critically ill patient with 2019 novel coronavirus infection.Shi H, Zhou C, He P, Huang S, Duan Y, Wang X, Lin K, Zhou C, Zhang X, Zha Y.Int J Antimicrob Agents. 2020 Apr 13:105974. doi: 10.1016/j.ijantimicag.2020.105974
High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019.
Cao W, Liu X, Bai T, Fan H, Hong K, Song H, Han Y, Lin L, Ruan L, Li T.Open Forum Infect Dis. 2020 Mar 21;7(3):ofaa102. doi: 10.1093/ofid/ofaa102. eCollection 2020 Mar.