The Coronavirus and MS: What You Need to Know

Latest News March 6, 2020

Reviewed by MSAA Chief Medical Officer Barry A. Hendin, MD

Symptoms and Special Considerations for Individuals with MS

The “coronavirus disease 2019” (COVID-19) is a potentially serious respiratory disease that was first reported in December 2019 in China. As of early March 2020, the illness had made its way to almost 70 locations, including the United States, and has affected more than 90,000 individuals worldwide. Please be aware that these figures are expected to increase on a weekly or even a daily basis.
If exposed to this new coronavirus, symptoms may appear within two days to two weeks. Initial symptoms include:

• Fever
• Cough
• Shortness of breath

According to the Centers for Disease Control and Prevention (CDC), individuals showing signs of the disease should isolate themselves from other people and animals, and immediately contact their physician. Unless a medical emergency, those affected should not go directly to a medical facility. This is in an effort to avoid spreading the illness to others and to enable the physician to be prepared when a patient with this illness arrives at the office.
The majority of individuals who catch the coronavirus will not experience a serious form of the illness and will not need to be hospitalized. Seniors (ages 60 years and older) as well as individuals with certain health conditions such as heart disease, lung disease/respiratory illness, and diabetes, seem to be at greater risk of serious illness.
Those at greater risk also include people whose immune systems are suppressed, such as individuals who take disease-modifying therapies (DMTs) to treat MS, as well as those with other illnesses that compromise the immune system and/or require similar medications. People with MS should not stop taking their DMT, or make any changes to their treatment regimen, without consulting their physician.
Another consideration for individuals with MS is the fact that an illness, infection, or particularly a fever, can cause a temporary flare-up of symptoms, known as a pseudoexacerbation. If ill with a flu or virus, people with MS and their care partners should be aware of this potential complication. A pseudoexacerbation is a temporary worsening of symptoms without actual myelin inflammation or damage, brought on by other influences. Once the illness, infection, or fever is resolved, the flare-up will usually remit within 24 hours.

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For anyone whose illness is more severe, especially if affecting the ability to breathe or if the fever is high, he or she (or the care partner) should immediately contact a medical professional or call 911 and explain the situation. Immediate emergency assistance may be needed.

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How is the Coronavirus Spread?

According to the CDC, the virus is thought to spread mainly from person-to-person. This may occur between people who are in close contact with one another (within about six feet) and respiratory droplets produced when an infected person coughs or sneezes can land in the mouths or noses of people who are nearby. These droplets may also possibly be inhaled into the lungs.
People are thought to be the most contagious when they are their sickest, when experiencing the most symptoms. Additionally, the CDC notes that some spread might be possible before people show symptoms, but this is not thought to be the main way the virus spreads.
The virus may also spread from contact with infected surfaces or objects when someone with the illness has left germs on those surfaces by touching, sneezing, or coughing. When a healthy person touches an infected surface, and then touches his or her own mouth, nose, or eyes, it is possible that the virus may be spread this way. However, it is not thought to be the main way the virus spreads.
Some reports have questioned if the coronavirus may be caught through packages sent through the mail or products imported from areas with high numbers of cases. Several sources, including the CDC, state that germs could not live long enough on a mailed package to be a threat and that the risk is very low.

What to Do if Mildly Sick with the Coronavirus

As noted earlier, the majority of individuals who catch the coronavirus will not experience a serious form of the illness and will not need to be hospitalized. To follow are guidelines issued by the CDC for those who are mildly ill and are able to be isolated at home during their illness. However, a healthcare professional should immediately be contacted to determine (1) an individual’s illness severity and (2) to assess whether the residential setting is appropriate for home care.
Considerations include:

• The patient (with coronavirus) is stable enough to receive care at home
• Appropriate caregivers are available at home
• The patient can recover in a separate bedroom, without sharing immediate space with others
• Resources for access to food and other necessities are available
• The patient and other household members have access to personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to recommended precautions, such as respiratory hygiene, cough etiquette, and hand hygiene
• No household members are present who are at an increased risk of complications from a coronavirus infection; these include individuals who are 65 or older, young children, pregnant women, people who are immunocompromised, or those who have chronic heart, lung, or kidney conditions

The CDC lists the following recommendations if mildly sick with the coronavirus and able to be isolated and recover at home:

• Stay home except to get medical care
• People who are mildly ill and able to isolate at home during their illness should restrict activities outside of the home, except for getting medical care; do not go to work, school, or public areas; avoid using public transportation, ride-sharing, or taxis
• At home, separate from other people and animals
• Stay in a specific room at home and away from other people; use a separate bathroom if available
• Restrict contact with pets and other animals while sick with COVID-19 until more information is known about the virus; avoid petting, snuggling, being kissed or licked, and sharing food
• When possible, have another household member care for the animals; if no one is available, wash hands before and after interacting with pets and wear a facemask
• Call ahead before visiting one’s doctor
• If a medical appointment is planned, call the healthcare provider and explain the situation; this will help the healthcare provider’s office take steps to keep other people from getting infected or exposed
• Wear a facemask when around other people, pets, and before entering a healthcare provider’s office; if unable to wear a facemask, others should not stay in the same room or they should wear a facemask if entering the room

Staying Healthy and Minimizing the Spread of COVID-19

The federal government and the CDC are proactively working to minimize the introduction and spread of this virus within the United States. More time is needed for researchers to gain a greater understanding of the specific virus (SARS-CoV-2) that causes this specific coronavirus (COVID-19), before a vaccine and treatments may be developed. Until these become available, the CDC explains that “Nonpharmaceutical Interventions” (NPIs) are actions that people and communities can take to help slow the spread of illnesses.
Also known as “community mitigation strategies,” and independent of medications and vaccines, examples of these types of actions include disinfecting surfaces, washing hands, staying home when sick, increasing the distance between people at public gatherings, canceling or postponing special events, and closing schools and/or businesses as needed. Avoiding travel to affected countries, as well as keeping a distance from anyone showing symptoms of the coronavirus, is also vital to minimizing the spread of the coronavirus.
Staying healthy and reducing one’s risk is another important factor. The CDC and MSAA recommend the following “healthy habits” for preventing the flu (and other illnesses):

• Get a flu vaccine and help stop the spread of germs (if recommended by one’s doctor)
• Continue taking a disease-modifying therapy (DMT) and do not make any changes to one’s treatment regimen, unless advised by one’s physician; consult a medical professional with any concerns
• Take flu antivirals, if prescribed
• Avoid close contact with people who are sick
• Stay home when sick, but be sure to consult a medical professional
• Individuals should cover their mouth and nose with a tissue when coughing or sneezing, or use the inside of their arm to avoid spreading germs
• Washing hands often helps to protect people from germs; if soap and water are not available, an alcohol-based hand rub should be used
• Avoid touching the eyes, nose, or mouth – an illness may be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth
• Practice other good health habits, such as cleaning and disinfecting frequently touched surfaces at home, work, or school – especially when someone is ill; get plenty of sleep, be physically active, manage stress, drink plenty of fluids, and eat nutritious food
• Anyone in close contact to someone with COVID-19 and who develops symptoms of COVID-19 should immediately call his or her healthcare provider to discuss symptoms and exposure

Coronavirus Background and Overview

As noted earlier, the “coronavirus disease 2019” (COVID-19) is a potentially serious respiratory disease that was first reported in December 2019 in China. As of early March, 2020, the illness has made its way to almost 70 locations, including the United States, and has affected more than 90,000 individuals worldwide. Please be aware that these figures are expected to increase on a weekly or even a daily basis.
According to the Centers for Disease Control and Prevention (CDC), this new virus that causes the COVID-19 disease has been named “SARS-CoV-2,” and is part of a large family of coronaviruses that are common in people and many different species of animals, including camels, cattle, cats, and bats. The CDC explains that although rare, animal coronaviruses can occasionally infect people and then spread between people. Since the outbreak began in an area of China that has large seafood and live-animal markets, an initial animal-to-person spread is suggested. From there, the increasing number of people being diagnosed in areas without exposure to animal markets indicates a change to a person-to-person spread.
The coronavirus ranges from mild to severe. A report from China estimates that 16% of those diagnosed will experience a serious illness, so the majority of those affected will experience a milder form of the disease. The CDC notes that older people and individuals with certain health conditions such as heart disease, lung disease, and diabetes, seem to be at greater risk of serious illness.
According to the CDC, no scientific reports have been published about the susceptibility of pregnant women to the current coronavirus. Pregnant women do experience immunologic and physiologic changes that may make them more susceptible to viral respiratory infections, including COVID-19. No evidence indicates that children are more susceptible to this virus, and most confirmed cases of COVID-19 reported from China have occurred in adults.
Those at greater risk also include people whose immune systems are suppressed, such as individuals who take disease-modifying therapies (DMTs) to treat MS, as well as those with other illnesses that compromise the immune system and/or require similar medications. People with MS should not stop taking their DMT, or make any changes to their treatment regimen, without consulting their physician.
Despite the current warnings, the CDC states, “At this time, however, most people in the United States will have little immediate risk of exposure to this virus. This virus is NOT currently spreading widely in the United States. However, it is important to note that current global circumstances suggest it is likely that this virus will cause a pandemic. This is a rapidly evolving situation and the risk assessment will be updated as needed.”
An illness is considered a “pandemic” when it meets the following criteria: causing an illness that has resulted in death; sustained person-to-person spread, and worldwide spread of the new virus.

Closing Notes

MSAA’s Chief Medical Officer Barry A. Hendin, MD, explains that members of the MS community need to be aware of the risks and take extra steps to minimize their chances of catching the coronavirus. “Although only a small number of individuals in the United States have tested positive for the coronavirus, this number may increase exponentially in the coming weeks. People 60 and older, as well as those with certain health conditions or weakened immune systems, need to be particularly careful.
“Many individuals with MS take a disease-modifying therapy to control disease activity, and as is often the case with these types of disease-fighting medications, the immune system becomes suppressed and may be challenged to combat germs and infections. Even those who are not on a long-term treatment for MS may be more susceptible to infections and less able to fight-off illness. For these reasons, members of the MS community – including patients, care partners, and family members – need to be extra careful during this flu season to avoid catching the coronavirus and giving it to others.
“Strategies such as avoiding crowded public places, washing hands often, and keeping a distance from anyone who may appear to be sick are all vital to reducing your risk of catching the coronavirus. Remembering not to touch your eyes, nose, or mouth when in public and touching the same door handles, chair arms, and other things that multiple people have touched is also important. While we don’t want people to feel they are being held captive in their own homes – and we of course encourage individuals to go outside and be active – it may be wise at this time for people to temporarily avoid the more crowded types of activities and events.
“Unfortunately, this may mean reducing your time doing the things you may truly enjoy, such as shopping, going to the gym, and even attending educational programs. Waiting for things to settle down and become less of a risk may be in your best interest. Of course, if you feel that you have been exposed to someone sick or that you may have symptoms of the coronavirus, please be sure to contact your healthcare professional immediately. I want to wish everyone a very safe and healthy spring season.”

Online Resources

Please visit the coronavirus section of the Centers for Disease Control and Prevention (CDC) website, which provides full coverage of all the details involved with the virus, its risks, and the latest findings.
Please refer to the coronavirus section of the WebMD website for an overview of the coronavirus outbreak along with timely updates on the spread of the illness.

For More Information

For general information or to speak with a trained Client Services Specialist, please call MSAA’s Helpline at (800) 532-7667, extension 154. Questions to MSAA’s Client Services department may also be emailed to MSquestions@mymsaa.org.

Written by Susan Wells Courtney, MSAA Senior Writer
Reviewed by Dr. Barry A. Hendin, MSAA Chief Medical Officer