COVID 19 in Scotland

C

Our friends from Scotland have reported on the the occurance of Scottish COVID-19 in people in the MS register. You don’t need me to explain this as it is clear in its message but have a read of the paper as you can read the reports of the three referees report on the merits of the post.

Fernandes PM, O’Neill M, Kearns PKA, Pizzo S, Watters C, Baird S, MacDougall NJJ, Hunt DPJ. Impact of the first COVID-19 pandemic wave on the Scottish Multiple Sclerosis Register population. Wellcome Open Res. 2020 Nov 25;5:276. doi: 10.12688/wellcomeopenres.16349.1. 

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on people with multiple sclerosis (MS) is a major current concern, in particular the risk of death. Here we describe the impact of the first wave of COVID-19 infections (Mar 2020-July 2020) on the Scottish MS Register (SMSR) population, a cohort of 4702 individuals with MS, all newly diagnosed in the past decade. Methods: We established a clinician alert system, linking the SMSR with the Electronic Communication of Surveillance in Scotland (ECOSS). This allows identification of patients within this cohort who had a positive SARS-CoV-2 PCR test. The SMSR was also linked to death records from National Records Scotland. Results: Of 4702 people with MS, 246 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR tests were performed, of which 17 were positive. The proportion of positive tests were similar to the general Scotland population (Observed PCR confirmed cases = 17, expected = 17.5, O/E = 0.97, 95% CI: 0.60 – 1.56, p=.90). Between 1 st March – 31 st July 2020 12 individuals on the SMSR died, 5 of which were linked to COVID-19 (1 PCR confirmed, 4 clinical diagnoses without PCR confirmation). This number of COVID-19-related deaths was higher than expected (observed deaths = 5, expected deaths = 1.2, O/E = 4.03, 95% CI = 1.48 – 8.94, p=.01). All COVID-19-related deaths in the SMSR occurred in individuals with advanced disability (Expanded Disability Status Scale ≥7), and no deaths occurred in patients receiving disease modifying therapy (DMT) therapies. Conclusion: In this nationally comprehensive cohort of MS patients diagnosed in Scotland within the past 10 years, we observed similar rates of PCR-confirmed SARS-CoV-2 infection compared to the general Scottish population, but a small number of excess COVID-19 related deaths. These deaths occurred in individuals with advanced disability who were not receiving DMTs.

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6 comments

  • If someone has progressive MS but their only problem is that they are in a wheelchair would this make them more susceptible to severe covid- ?
    Also rather than it being simply that they are perhaps less disabled could those on dmts Simply Be benefiting from a suppressed immune system thanks to the DMT which helps kovid become less aggressive?
    Is this not why they were trailing beta interferon?

    • Beta interferon was initially identified as an anti-viral, way before its use in MS, which is why it was being trialled.

      • I understand that but what I was getting at was that people on dmts do better if they get covid because they are on DMT rather than just because they have an earlier stage of MS.
        As a wheelchair user with MS with no other problems because of my MS surely if someone like me was on on a DMT they would also see a less aggressive effect from covid.

  • Should the question of interest be a comparison of people with EDSS scores higher than 7 with and without MS?
    My mother, now 94, with Parkinson’s told me the well known saying from her consultant, you don’t die of Parkinson’s.
    The existence of the Scottish register is interesting, but I would have thought there should be more interesting things to come out of it than this.
    The US Veterans have records with MS designations which throw up interesting tit bits.
    I am a pwMS rather than a medic.

    • Very good point. And all such studies need to match MSers with cohorts of similar age. Without that it is meaningless.

      However, there have been enough studies from around the world now which all show the same result: progressive MSers and those with the most disability are at much greater risk of serious illness or death from Covid than others (who are on DMTs). But is this due to the older age and comorbidities of the first group, or to MS, or indeed some aspects of the brain for all neurological diseases?
      Does anyone know the answer?

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