COVID-19 and MS

MS Ireland has been closely following developments in relation to COVID-19. This is a rapidly evolving situation which we will continue to monitor carefully. We have consulted with neurologists, our friends at MS Trust UK and other patient organisations to ensure we are providing you with up-to-date, relevant and expert information. Below is initial information based on our current knowledge. This will be under continuous review as our knowledge of the virus improves.

If you have specific concerns in relation to your own health or that of a loved one, we would advise that you contact your GP, MS Nurse or Neurologist.

New Diagnosis

People experiencing symptoms suggestive of MS may experience delays in accessing an expert neurologist and appropriate investigations due to the impact of COVID-19. Neurology centers are taking steps to mitigate potential issues to and will where possible, aim to carry out appropriate investigations in a timely manner in line with international guidelines.

Disease-modifying therapies during COVID-19

Those on disease-modifying therapies should remain on their treatment unless they are instructed by their neurologist to stop taking it. Further information on the various medications can be found later in this document.

Relapse management

Relapses should be reported to your neurology team who can provide advice. 

A relapse involves new or returning worsening symptoms lasting more than 24 hours. Tiredness, heat, stress and infection can cause the temporary worsening of MS symptoms and this is not classed as a relapse.

Please see here for information on identifying a relapse can be found here https://www.ms-society.ie/sites/default/files/2019-06/Relapse_Infographic.pdf

Information on the temporary worsening of symptoms can be found here: https://www.ms-society.ie/temporary-worsening-symptoms-and-covid-19

Monitoring

Safety monitoring should continue but the usual timings may be altered as a result of the COVID-19 pandemic. More information on monitoring can be found here https://www.ms-society.ie/msmonitoring-bloods-and-covid-19

Clinic appointments

Telemedicine may be utilised where appropriate. Information on preparing for your tele-medicine appointment can be found here https://www.ms-society.ie/covid-19-ms-and-telemedicine

Hospital delivered therapies

Measures will be taken to ensure that hospital delivered IV therapies will be carried out in a COVID-19 free ward with social distancing measures in place.

Hospital appointments

If you have a hospital appointment and you have a cough, high temperature or shortness of breath, please do not come to the hospital, but contact your neurology team for advice.

MS Medications during COVID-19

Most of the disease-modifying therapies used to treat MS work by suppressing the immune system. This can make a person more vulnerable to COVID-19. As this is a new virus we do not have major information in relation to people on MS treatments who get the virus.

It is important not to stop MS treatments without instruction to do so by your neurologist as this can result in a rebound relapse in the following weeks or months, which can be severe. Individual treatment decisions should be discussed with your neurologist.

If you have a confirmed case of COVID-19 please contact your neurology team for advice on stopping your medicine.


Copaxone, Betaferon, Rebif, Avonex, Plegridy, Tecfidera and Aubagio

These medications should continue as normal. These medications are not believed to have much impact on how the immune system deals with COVID-19. 

Tysabri

Tysabri is not believed to effect the way the immune system deals with COVID-19. Those receiving Tysabri should continue to receive it. When starting Tysabri the first 3 infusions should be administered monthly. After this, the infusion may be given every 6 weeks, this may give further protection from viruses that can enter the nervous system but not affect Tysabri's effectiveness, with appropriate monitoring. Please do not stop Tysabri abruptly as this could cause rebound in MS inflammation after a few months.

Gilenya

Gilenya may have some issues with COVID-19 but there is no detailed information currently available. If you are taking this medication you should continue with it unless you are instructed by a healthcare professional to stop. Stopping this medication suddenly may increase the risk of a rebound relapse in the following weeks and months.

Ocrevus, Lemtrada, Rituximab and Mavenclad

These treatments may make a person more vulnerable to COVID-19. You may be asked to delay your treatment, but this decision is made by the neurologist on a case by case basis. These medications often have a prolonged therapeutic effect and so delaying planned infusions or starting one of these drugs is not a major problem.

It is currently considered safe to start or receive retreatment of Mavenclad or Ocrevus and to continue treatment with Lemtrada and Rituximab, for those who meet the clinical indication of these therapies.

Mayzent (Siponimod) and Arezza (Ofatumumab)_

These medications are not easily available in Ireland. If you have specific queries please contact your neurologist.

Autologous Haematopoietic Stem Cell Transplant (HSCT)

Treatment may be delayed for a number of months. Further discussion with your neurologist is important in relation to this. If you have any queries, please contact a healthcare professional for more detailed advice.

Steroids for MS relapses

Steroids are sometimes prescribed to treat MS relapses. Some relapses do not require steroids as in most cases, symptoms gradually improve however, in some cases where a relapse is causing major difficulties such as walking difficulties or eyesight issues, your doctor may decide to prescribe steroids. The most frequently prescribed steroid is Methylprednisolone.

Steroid use is not recommended if you have a viral infection as they suppress the immune system, reducing the ability to resist infection. You will need to discuss this further with your doctor if you are prescribed steroids while there is a risk of coronavirus.

If you have any concerns, please contact a healthcare professional for more detailed advice.

NEW DMT Risk

Hospital appointments:

If you have an appointment to come to hospital for a review or treatment, and you have cough, high temperature or shortness of breath please do not come to the hospital, but contact your MS team for advice.

Taking extra care

Those taking immunosuppressant medications are advised to adhere to the following advice:

  • Ensure you are washing your hands thoroughly and regularly.
  • Avoid unnecessary travel.
  • Avoid crowded places.
  • Work from home if practical to do so.
  • Ensure family and work colleagues also know to practice avoidance measures.

Symptoms of COVID-19

The symptoms of COVID-19 are:

  • a cough
  • shortness of breath
  • breathing difficulties
  • fever (high temperature)
  • Chills

It can take up to 14 days for symptoms of coronavirus to appear.

Hygiene and prevention

The most important action we can all take to help prevent the spread of Covid-19 is good hand and respiratory hygiene.

MS Ireland encourages everyone to read the HSE’s Coronavirus Information page - https://www2.hse.ie/conditions/coronavirus/protect-yourself.html including the do’s and don’ts:

Do:

  • Wash your hands properly and regulary.
  • Cover your mouth and nose with a tissue or your sleeve when you cough or sneeze.
  • Put used tissues into a bin and wash your hands.
  • Clean and disinfect frequenty touched objects (such as phones, remote controls etc,) and surfaces.

Don’t

  • Do not touch your eyes, nose or mouth if your hands are not clean.

Handwashing

The HSE has also issued the following essential advice on when precisely to wash your hands:

  • After coughing or sneezing.
  • After toilet use.
  • Before eating.
  • Before and after preparing food.
  • If you are in contact with a sick person, especially those with respiratory symptoms.
  • If your hands are dirty.
  • If you have handled animals or animal waste.

Step-by-step guide on how to properly wash your hands and avoid infection:

  1. Wet your hands with warm water and apply soap.
  2. Rub your hands together until the soap forms a lather.
  3. Rub the top of your hands, between your fingers and under your fingernails.
  4. Do this for at least 20 seconds.
  5. Rinse your hands under running water.
  6. Dry your hands with a clean towel or paper towel.

If you have been in contact with a confirmed case

Anyone who knows they have been in close contact with a confirmed case in the last 14 days and has symptoms (cough, shortness of breath, fever) should:

  • isolate themselves from other people - this means going into a different, well-ventilated room, with a phone.
  • phone their GP
  • in a medical emergency (if you have severe symptoms) phone 112 or 999 

If you are displaying symptoms of COVID-19

If you develop symptoms of coronavirus, avoid contact with people by self-isolating (see below) and phone your GP. 

Do not go to your GP’s practice, pharmacy or hospital. Your GP will assess you over the phone. If you do not have a GP, phone 112 or 999.

You must fit specific criteria in order to have a COVID-19 test (see link below).

Your GP will arrange a test and can organize for the National Ambulance Service or other emergency services to deliver the test.  There are also drive-in test centres. If you do not drive please inform your GP.


Advice on self-isolating

Self-isolation means staying indoors and avoiding contact with other people. If there is a chance you could have coronavirus, you may be asked to stay away from other people (self-isolate). This will help to prevent the spread of coronavirus to others.

Information from the HSE on how to self-isolate can be found here: https://www2.hse.ie/conditions/coronavirus/self-isolation-and-limited-social-interaction.html

If you have a confirmed case of COVID-19

If you have a confirmed case of COVID-19 please contact your neurology team for further detailed advice.

MS Ireland Regional Contact

Precautionary measures may be put in place in the coming weeks which may alter the way in which MS Ireland work with our members. The safety of the MS community and our staff is of paramount importance and so precautionary measures may be put in place to prevent the spread of COVID-19. There may come a point where we have to suspend meeting with people however our staff will be contactable via telephone. Regional contact information can be found here.


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