In the face of a second lock down Europe is waking up to the realization that COVID19 is now here to say. If something is here to say, the chances are that it would become the norm. For most this will mean wearing face masks, limiting social contact and being careful on a day to day based on background population infection rates. For those with MS and others on regular immunosuppressants, things will need to change.
- A real risk assessment of contracting COVID19. This is easier to do if you haven’t started on an MS therapy than if you’re already on one. Overall, the higher tier drugs have the greatest risk compared to platform treatments, followed by maintenance strategies versus induction strategies. This is a logical assumption, and explains the readout with HSCT (see below) and ocrelizumab.
- The existence of other co-morbidities increases the relative risk with the above, for example heart disease, asthma and diabetes; as does older age.
- Vaccinations will need to be given before start of immunosuppressive therapy, especially with highly active therapies to reduce the risk of other seasonal infections. Namely, the flu vaccine and pneumococcal vaccine (the commonest cause of community acquired pneumonia). The former will need to be given annually and the later 5-yearly. If your treatment affects the efficacy of vaccines speak to your neurologist.
- Risk reduction doesn’t stop with you, but includes your family as household contacts are the commonest mode of spread.
- It is important to maintain good mental health and physical health. Schedule in regular walks (via routes that are less crowded) and other fitness activities into your day.
Hematology. 2020 Dec;25(1):320. doi: 10.1080/16078454.2020.1802931.
Mélange intéressante: COVID-19, autologous transplants and multiple sclerosis
The pandemic of coronavirus infectious disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a threat to global health. During the pandemic changes in how hematopoietic cell transplant are done are suggested such as avoiding the use of immunosuppressive drugs. From June 2015 to March 2020, we autografted 894 persons with multiple sclerosis (MS) using a conditioning regimen of cyclophosphamide, 200 mg/kg and rituximab, 1 g. The first case of COVID-19 in México was diagnosed on 28 February 2020. To determine any interaction between SARS-CoV-2-infection and our program, we studied 13 subjects autografted 2–27 March 2020 during the initial part of the pandemic in México who had negative results of qualitative reverse transcription–polymerase chain reaction (qRT-PCR) tests for SARS-CoV-2 before and after their transplant. We also sent a questionnaire to 894 consecutive transplant recipients, 330 (37%) of whom responded. Four subjects indicated they were infected with the SARS-CoV-2 and developed COVID-19, 6–31 months posttransplant, only 1 of whom was hospitalized for 2 days, not in an intensive care unit. None were treated for COVID-19 (Table 1). Our data suggest, but do not prove, a low risk of developing COVID-19 in autotransplant recipients with MS. We cannot comment on the risk of SARS-CoV-2-infection as most respondents were not tested by qRT-PCR or for anti-SARS-CoV-2 antibodies. Also, there may be a selection bias of respondents.
Table 1: Characteristics of patients with COVID-19
|Interval posttransplant (mo)||31||22||22||6|
|Source of infection||Family member||Work||Family member||Family member|
|Shortness of breath||3|
|Loss of smell||0|