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[Updated] COVID-19 – Advice for Patients

March 12, 2020 | Support

NOTE: This post was updated on the 27/03/2020, to reflect the requirements of Alert Level 4.

Key updates:

  • At this stage, there is no evidence that MS treatments increase the risk of infection with COVID-19. Theoretically, however, there may be an increased risk of infection (and a possible effect on the course of infection) on some treatments that may have more of an immunosuppressive effect, particularly Fingolimod and Ocrelizumab. There is also potentially an increased risk in those who have had aHSCT.
  • Click here for advice about specific medications.

 

This information and advice has been put together by the Australian and New Zealand Association of Neurologists for patients with Multiple Sclerosis.

Click here for the official release.

 

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 caused by a new coronavirus which has been identified as COVID-19.

The mortality of this infection amongst cases displaying symptoms and confirmed to have the virus is in the order of 1-3%, mainly in older persons with other health problems.

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.

At this stage, there is no evidence that MS treatments increase the risk of infection with COVID-19. Theoretically, however, there may be an increased risk of infection (and a possible effect on the course of infection) on some treatments that may have more of an immunosuppressive effect, however, particularly Fingolimod and Ocrelizumab. Please note that this also applies to Alemtuzumab and Cladribine, although they are not available in NZ. There is also potentially an increased risk in those who have had aHSCT.

In New Zealand, we are currently at level 4, 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 is low. This situation may change. We will continue to monitor this and change our advice accordingly.

 

Frequently Asked Questions:

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 Ministry of Health New Zealand (click here for standard precautions). 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 (click here for a list of symptoms) or have a confirmed diagnosis of COVID-19 infection you should:

  • Follow the standard self-isolation advice (more info).
  • 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.

 

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:

(or for international SIMs +64 9 358 5453).

  • Phone your General Practitioner for an appointment (please phone ahead to make an appointment).

 

Should I come to my outpatient clinic, infusion 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 appointment, infusion or MRI. 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.

 

Should I travel overseas?

Current travel advice is available on the New Zealand Safe Travel website (click here to visit website)

We also suggest if you are planning to travel you contact your travel insurance provider.

 

Should I have the flu and pneumonia vaccinations?

It is recommended that all persons with MS and related disorders have the flu vaccination when it becomes available in April. The Pneumococcal vaccination is also recommended.

 

Medications

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:

  • 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.
  • Plasma exchange, intravenous gammaglobulin [IVIg]):
    • These therapies have a minimal impact on immune function.
    • You will require a blood test before your treatment
    • You should continue these therapies and follow the standard advice regarding prevention of COVID-19 infection.
  • 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 our present advice is that these medications should be continued.
    • Please ensure you are up to date with your blood safety monitoring
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  • Fingolimod [Gilenya] and siponimod [Mayzent]):
    • These therapies are moderately immunosuppressive. Because of this there is a possible increased risk of contracting the COVID-19 infection.
    • However, because of the very real risk of relapse on discontinuing these therapies compared to the current risk of COVID-19 infection our present advice is that these medications should be continued.
    • Please ensure you are up to date with your blood safety monitoring.
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  • Natalizumab [Tysabri]:
    • These therapies have a minimal impact on immune function.
    • Because of the very real risk of relapse on discontinuing this therapy compared to the currently risk of COVID-19 infection our present advice is that these medications should be continued.
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  • 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 treatments.
    • Because of the very real risk of relapse on discontinuing these therapies compared to the currently low risk of COVID-19 infection our present advice is that these medications should be continued.
    • Please ensure you are up to date with your blood safety monitoring.
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  • Ocrelizumab [Ocrevus], Rrituximab [Rituxan]:
    • These therapies are immunosuppressive to varying degrees and for variable times
    • Decisions as to whether or not to delay a course of these therapies should be discussed with your neurologist.
    • You may be asked to go into self-isolation for 14 day following an infusion.
    • Please ensure you are up to date with your blood safety monitoring.
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  • Cladribine [Mavenclad]:
    • These therapies are mildly-moderately immunosuppressive for a limited period.
    • There is currently no evidence that they increase the risk of COVID-19 infection.
    • Because of the very real risk of relapse on discontinuing this therapy compared to the current risk of COVID-19 infection our present advice is that these medications should be continued.
    • Please ensure you are up to date with your blood safety monitoring
    • You should follow the standard advice regarding prevention of COVID-19 infection.
  • Alemtuzumab [Lemtrada], AHSCT:
    • These therapies are immunosuppressive to varying degrees and for variable periods of time.
    • Decisions on whether or not to delay a course of these therapies should be discussed with your neurologist.
    • Please ensure you are up to date with your blood safety monitoring.
    • You should follow the standard advice regarding prevention of COVID-19 infection.

 

Signatories

  • Simon Broadley
  • Bill Carrol
  • Natasha Gerbis
  • Deborah Mason
  • Mike Boggild
  • Heid Beadnall
  • Anneke van der Walt
  • Jeannette Lechner-Scott
  • Jane Frith
  • Suzanne Hodgkinson
  • Stephen Reddel
  • Richard Macdonnell
  • Michael Barnett
  • Mark Marriott
  • Pamela McCombe
  • Trevor Kilpatrick
  • Bruce Taylor
  • Allan Kermode

 

Other Resources

COVID-19.govt.nz

Ministry of Health (MOH)

Barts Blog MS

MS International Federation (MSIF)

MS Society (UK)

World Health Organisation (WHO)

 

Image by Thor Deichmann via Pixabay