​COVID 19 PANDEMIC AND MULTIPLE SCLEROSIs - What we know, think we know and don’t know at all

During the past 2 weeks we have witnessed a transformation of society and our health care system unlike anything observed for almost 75 years, since the upheaval of WWII. The stress created by our response to all the uncertainties surrounding current events can have a negative impact on our relationships and our health, if we let it. So how do we minimize this stress? In many ways this is an existential question. None of us have as much control over our lives as we imagine. Any day something bad could happen to a friend or a love one and we never know when our own time will be up. You may be thinking, Wow, that’s a downer thought. Instead, it is meant to be liberating. If you consider and embrace this idea, you will live each day more fully and learn to appreciate and interact with those around you in a more positive light.

If you can do this--and for many I’m sure your faith or religion helps-- then you can turn your mind away from uncertainty, fear, blame and other negative thoughts and focus on events you can control. If you do this, you will also realize there are many people out their, even in your own community, who may need your help; help with supplies and food delivery or simply a friendly and kind voice to call and check on them. It is with these thoughts in mind that I offer you a three-part blog on what you, as people with MS, need to know about COVID 19 with an emphasis on those things you can control. The advice in part I apply to almost anyone with chronic health conditions, but part II and III will focus more specifically on MS.
 
The best strategy for dealing with a pandemic of a highly contagious, incurable infectious disorder is to close down all activity, isolate us from human contact to prevent the rapid spread of the illness and thus avoid overwhelming the health care system. You’ve all heard the term repeated on the news: “flatten the curve” or slow the rate of infection so there are enough hospital beds at any point in time to care for those with severe illness. For those with chronic medical conditions there is a unique concern; namely, will the health system be available to help you with your condition if overwhelmed with the care of COVID 19 infected individuals. The answer is yes but you must get used to doing things differently and adjust expectations for the time being.
 
Part I: What we know (for sure):
1. We must slow the spread of infection to save lives, including the lives of people with MS, by switching to Video Visits or Telephone Visits instead of in person visits: case fatality rates (deaths) are 5 % or greater when the health system is overloaded and about 1 % when the system can handle the volume of infected patients; For those with or without MS or other chronic diseases, this means avoiding contact with individuals potentially exposed to COVID19, paying attention to social distancing, frequent hand washing and cleaning of any surface potentially contaminated. One of highest rates of infection is currently among health workers and one of the best places to get infected is in a hospital, emergency room, urgent care center or doctor’s office. THEREFORE, YOU MUST PHYSICALLY STAY AWAY FROM THE HEALTH SYSTEM AS MUCH AS POSSIBLE DURING THE PANDEMIC. This is only difficult if no one knows what is causing your medical problem. For those with a known or suspected diagnosis of MS it is now essential to use video and telephone visits to keep social distance from the health system. There are few reasons for anyone with MS to see a doctor in person until they’ve had a video or telephone visit. Even if you think you’ve been infected with COVID19 or are displaying COVID-like symptoms (fever, dry cough, headache, runny nose, sore throat, fatigue, and muscle aches) you do not need to see a health care worker in person unless you are experiencing difficulty with shortness of breath, difficulty keeping down food or fluids or experience significant worsening of your MS that does not respond to lowering your temperature with Tylenol (Acetaminophen). Find out how to do video visits with your doctor and insist on this type of interaction unless a visit is necessary or the pandemic is over.
 
2. The experience in China tells us that the people at highest risk of complications from COVID 19 are those greater than 50 years old, men and people with hypertension, diabetes and heart disease. There is no reason to believe this is different in MS patients. People with any of these risk factors should be particularly cautious; but remember, the vast majority of people with these risk factors, even if you have all three risk factors, WILL NOT experience severe disease. Furthermore, the disease can be severe even if you do not have these risk factors. As an example, 40 % of current COVID 19 admissions to US hospitals involve people under the age of 40. Make sure your family members or contacts are aware of this information. This information should not be used to create either fear or complacency. Use this information instead when deciding whether you plan to relax any of the current restrictions associated with the pandemic. As the number of cases begins to fall and life starts to normalize, it may be prudent for those with greater risk factors for serious illness from COVID 19 to maintain their vigilance and restrictions a little longer than the rest of the population.
 
So that is what we know so far. It is not a lot but it is very helpful information. In part II of this series, I will address what we think we know about the effects of COVID 19 in different MS patient scenarios. This is also important information but it is not written in stone and could change as we learn more. Stay tuned.

​Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

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