Medicine & Research

The coronavirus, COVID-19, is a respiratory virus that is transmitted from person to person. The virus began in Wuhan, China, in December 2019 and has since spread worldwide. Symptoms can vary from mild to severe and can include fever, cough, and difficulty breathing. The virus spreads through direct contact with other individuals who have been infected, particularly through coughing and sneezing. When the virus lands on hard surfaces and an individual touches that surface and proceeds to touch their nose, face, or mouth, they are at risk for transmission. The virus is more likely to spread in group settings, so it is recommended to avoid gatherings or groups of 10 or more. 

Having multiple sclerosis does not increase the risk of developing COVID-19; however, certain factors associated with MS could increase the risk of infection. These factors include taking certain disease-modifying therapies, having lung disease or heart disease, significantly restricted mobility (spending most of your day seated or in bed), or being older than the age of 60. Oftentimes, when the body is responding to infection, there may be a worsening of MS symptoms. For example, patients with MS may experience worsening fatigue, numbness, difficulty thinking, and/or vision problems if they become infected. 

In an interview with Dr. Ben Thrower, director of the MS Institute at the Shepherd Center, Thrower stressed that “patients should not discontinue taking any DMT product and encouraged patients to contact their prescriber with questions.” Dr. Thrower’s recommendations echo those of other MS professionals, in that, the decision to continue or discontinue disease-modifying therapies should be made exclusively between the patient and their MS healthcare provider. 

Dr. Thrower went on to explain that certain DMTs could pose increased risk of infection from viruses, such as COVID-19. According to Dr. Thrower, DMTs that deplete immune cells and/or that restrict the ability of the immune system to fight infections could pose the most risk of infections such as COVID-19. These DMTs include:

• Alemtuzumab (Lemtrada)
• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Diroximel fumarate (Vumerity)
• Fingolimod (Gilenya)
• Ozanimod (Zeposia)
• Ocrelizumab (Ocrevus)
• Rituximab (Rituxan)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio).

It is important to note that many DMTs do not suppress the immune system and should not pose any increased risk from infections, such as COVID-19. These include glatiramer acetate (Copaxone, Glatopa, Glatiramer Acetate Injection), and the interferons (Betaseron, Rebif, Avonex, Extavia, Plegridy). 

The CDC has released specific guidelines for people at risk for serious illnesses from COVID-19. These include: stocking up on necessary supplies, taking everyday precautions to keep space between yourself and others, keeping away from others who are sick when going out in public, limiting close contact and washing hands often, avoiding crowds as much as possible, avoiding cruise travel and non-essential air travel, and staying home as much as possible to further reduce your risk of being exposed. 

All individuals should follow the World Health Organization’s recommendations for dealing with COVID-19. These recommendations include: washing your hands frequently with soap and water or an alcohol-based rub, avoid touching your eyes, nose, or mouth, maintain at least six feet of distance between yourself and others, particularly those who are coughing or sneezing, cover your mouth when coughing or sneezing using a flexed elbow or tissue, avoid public gatherings greater than 10 people, avoid using public transport when possible, use alternative face to face routine medical appointments, such as telephone or video-call appointments. 

This is a challenging time for everyone, especially those with chronic illnesses, such as MS. Mental health is just as important as physical health and should also be prioritized. When stuck inside, make time for phone calls with family and friends, develop a new hobby, do a puzzle, or read an uplifting book. Remember to stay positive, thankful, and encouraged during this time. Address any disease-specific concerns with your MS healthcare provider and MS Focus: the Multiple Sclerosis Foundation website for updates on guidelines associated with COVID-19. 

General Recommendations for Patients with MS:

• Do not stop DMTs without speaking to your healthcare provider. 
• Stopping a DMT increases risks of relapses and disease progression. 
• Patients recently diagnosed with MS and prescribed a DMT, should start therapies as directed by prescribers. 
• Although some DMTs can increase the risk of infections such as COVID-19, this risk must be weighed against other factors such as MS activity, age, other medical conditions, and other factors that could impact the DMT. 
• Temporarily or permanently stopping a DMT is challenging decision and should involve in-depth discussion between patients, caregivers, and prescribers.

For more information, visit Get Ready for COVID-19 at the Centers for Disease Control and Prevention.