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.
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.
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
