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Updated advice for persons with multiple sclerosis and related disorders regarding the COVID-19 pandemic

washing hands
8 April 2020

Background

Since December 2019 following cases emerging in and around Wuhan, China most regions of the world have now experienced cases of a novel respiratory illness (COVID-19) caused by a new coronavirus which has been identified as SARS-CoV-2. The mortality of this infection amongst cases displaying symptoms and confirmed to have the virus is in the order of 1-7%. National and International measures to reduce the risk of transmission of the virus have been implemented in most jurisdictions. It is likely that these measures will slow the rate of transmission, but at this point it is unclear if further spread can be prevented and it is unclear how long the present outbreak will last. At present there is no known effective treatment for COVID-19 and there is no vaccine. Older persons and those with pre-existing medical conditions (respiratory disease, heart disease, diabetes, cancer) have a higher risk of complications from COVID-19 infection. Men may also be at a slightly increased risk. At this stage, there is no evidence that being immunosuppressed increases a person’s risk of being infected with COVID-19 or developing complications, but there is a theoretical risk of both.

In Australia, we are still in a containment phase where it is hoped that the measures being implemented will limit the number of people infected and the present risk of being infected with COVID-19 remains low. The latest data indicate that the number of new cases is declining. This suggests that the present transmission prevention efforts may be working. This is result of two main factors. The first is that the population of Australia has largely followed the recommendations of social distancing and personal protection. The second is the outstanding work undertaken by our Public Health team who have successful traced the source of 80-90% of cases and implemented testing, quarantine and self-isolation as necessary. This has been an amazing achievement and goes largely unnoticed. However, we need to remain vigilant as the situation may still change. We will continue to monitor this and change our advice accordingly.

 

How can I protect myself from getting COVID-19?

In order to minimise the risk of being infected by COVID-19, you should follow the standard precautions advised by the Australian Government. This is the best source of advice on how to keep yourself safe and will be updated daily.

 

What if I develop symptoms of COVID-19 infection or have a confirmed diagnosis of COVID-19 infection?

If you develop symptoms of COVID-19 infection or have a confirmed diagnosis of COVID-19 infection you should:

  • Follow the standard self-isolation advice.
  • Follow the advice of the diagnosing doctor or health care facility.
  • Seek the advice of your neurologist or ask the diagnosing health care team to discuss with them or the on-call neurologist regarding any changes to your treatment.
  • It is extremely important that you advise your neurologist if you become infected with COVID-19 as we will be collectively monitoring the outcomes for people with MS and various therapies. This will assist in providing appropriate advice to all.

 

Who should I contact if I have symptoms of COVID-19 infection?

If you are concerned that you are developing symptoms of COVID-19 you can:

  1. Phone the Coronavirus Health Information Line 1800 020 080.
  2. Phone the Health Direct Hotline 1800 022 222.
  3. Phone your General Practitioner for an appointment (please phone ahead to make an appointment).
  4. Attend a coronavirus testing centre (these are listed for each state by the relevant health department, again please phone ahead to make an appointment).

 

Should I come to my outpatient clinic, infusion, blood test or MRI appointment?

If you have visited a high-risk area, have symptoms of COVID-19 infection or have had close contact with someone who has been diagnosed with COVID-19 please do not attend your outpatient, infusion, blood test or MRI appointment. Please contact your specialist clinic, MRI department, infusion centre or MS Nurse to advise of your need to cancel the appointment and make alternative arrangements. Most neurology clinics have now moved to telephone or telehealth consultations.

It is important to remember that MRI scans and blood test form an important part of the monitoring of your disease activity and potential side effects of medication. In some instances, there may be adverse consequences of delaying or cancelling these investigations. Please contact your neurologist before making any changes to your planned investigations. MRI departments in hospitals and private radiology practices have implemented measures to limit the risk of infection.

Some private pathology services offer a home collection service. Please contact your pathology service for details. This may require the approval of your neurologist.

 

Should I travel overseas?

Current travel advice is available on the Australian Smart Traveller website, but essentially all travel has now been banned.

 

Should I have the flu and pneumonia vaccinations?

It is recommended that all persons with MS and related disorders have the flu vaccination. The Pneumococcal vaccination is also recommended.

 

What if I am a healthcare worker?

At present we have no evidence of an increased risk of COVID-19 infection or its complications in people with MS or related conditions, even in those on treatment. However, as indicated below there are potential, theoretical risks with some medications and it would be sensible for healthcare workers on any of these therapies to avoid work environments that would bring them into direct contact with people either known to be or likely to be infected with COVID-19. If you require any documentation to this effect, please contact your neurologist who will be happy to assist.

 

What should I do about my medication?

If you are on a regular medication for MS or a related condition, then it is recommended that you should continue to take this medication because of the very real risk of relapse when medication is ceased.

With regards to specific therapies:

  1. Self-injected therapies (glatiramer acetate [Copaxone], beta-interferon [Avonex, Betaferon, Plegridy, Rebif]):
    • These medications are not immunosuppressive.
    • You should continue these medications and follow the standard advice regarding prevention of COVID-19 infection.
  2. Intermittent immunotherapies (plasma exchange, intravenous immunoglobulin [IVIg]):
    • These therapies have a minimal impact on immune function.
    • You should continue these therapies and follow the standard advice regarding prevention of COVID-19 infection.
  3. Regular potentially immunosuppressive MS therapies (natalizumab [Tysabri], fingolimod [Gilenya], siponimod [Mayzent], dimethyl fumarate [Tecfidera], teriflunomide [Aubagio]):
    • These therapies are mildly immunosuppressive, there is currently no evidence that they increase the risk of COVID-19 infection.
    • Because of the very real risk of relapse on discontinuing these therapies compared to the currently low risk of COVID-19 infection the present advice is that these medications should be continued.
    • Your neurologist may wish to monitor your immune cell counts more frequently.
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  4. Immunosuppressive therapies (prednisolone, methotrexate [MTX], azathioprine [Imuran], mycophenolate mofetil [Cellcept], cyclophosphamide [Cytoxan]):
    • The level of immunosuppression with these medications is variable and depends upon the dosage and combination of therapies.
    • Because of the very real risk of relapse on discontinuing these therapies compared to the currently low risk of COVID-19 infection the present advice is that these medications should be continued.
    • Your neurologist may wish to monitor your immune cell counts more frequently.
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  5. Pulsed immunosuppressive therapies (rituximab [Rituxan], ocrelizumab [Ocrevus], alemtuzumab [Lemtrada], cladribine [Mavenclad]):
    • These therapies are immunosuppressive to varying degrees and for variable periods of time.
    • Because of the pulsed nature of these therapies there are options to delay courses of treatment.
    • Decisions on whether or not to delay a course of these therapies should be discussed with your neurologist.
    • You should follow the standard advice regarding prevention of COVID-19 infection, in some situations, on the advice of your neurologist, it may be appropriate to take additional precautions.

 

 

Signatories

Simon Broadley
Bill Carroll
Natasha Gerbis
Deborah Mason
Mike Boggild
Heidi Beadnall
Anneke van der Walt
Jeannette Lechner-Scott
Jane Frith
Suzanne Hodgkinson
Stephen Reddel
Richard Macdonell
Michael Barnett
Mark Marriott
Pamela McCombe
Trevor Kilpatrick
Bruce Taylor
Allan Kermode
Ernie Willoughby
Simon Hawke
Mahtab Ghadiri
Tomas Kalincik
Steve Vucic
Ian Sutton
Todd Hardy
Ann French
Mastura Monif
Helmut Butzkueven
John Parratt
Olga Skabina
Caron Chapman
Patrick Aouad
Zara Ioannides
Katherine Buzzard
Nicholas Crump