Review of the COVID-19 Risk in Multiple Sclerosis.

The ongoing pandemic of the novel coronavirus of 2019 (COVID-19) has resulted in over 1 million deaths, primarily affecting older patients with chronic ailments. Multiple sclerosis (MS) patients have been deemed particularly vulnerable given their high rates of disability and increased susceptibility to infections. There have also been concerns regarding disease-modifying therapy (DMT) during the pandemic as many DMTs may increase the risk of infection due to some of their immunosuppressive properties. Furthermore, due to MS-related chronic inflammatory damage within the central nervous system, there have been concerns for worsening neurological injury by COVID-19. This has resulted in an alarmingly high level of anxiety and stress among the MS community leading to a lack of compliance with medications and routine check-ups, and even failure to obtain treatment for relapse. However, there is currently substantial evidence that MS and most DMT usage is not associated with increased COVID-19 severity. MS patients who suffer worse outcomes were more likely to be older and suffer from significant disabilities and comorbid conditions, which would also be expected from those in the general population. Likewise, there is little if any evidence demonstrating an increased susceptibility of MS patients to COVID-19-related neurological complications. Therefore, we aim to summarize the most recent findings related to COVID-19 and MS demonstrating that MS and most DMTs do not appear as risk factors for severe COVID-19.

Qualitative review of promising practices for testing vulnerable populations at off-site COVID-19 testing centers.

BACKGROUND: Many off-site COVID-19 testing centers (OSCTCs) are struggling with strategies to serve vulnerable populations who have some of the highest rates of COVID-19 cases, hospitalizations, and deaths. Inter-OSCTC sharing of successful protocols and systems has been hampered by evolving resource constraints, the changing science of testing, and ever increasing COVID-19 case counts. OBJECTIVE: The aim of the present study was to identify promising approaches to testing vulnerable populations. METHODS: We conducted a qualitative study using semi-structured interviews with 26 leaders of OSCTCs and public health departments across the United States between June 8th and August 10th, 2020. All interviews were coded utilizing oral coding via rapid identification of themes from audio recordings, and analysis occurred concurrently with data collection to assess when saturation was achieved. RESULTS: Six main themes emerged highlighting approaches to testing within vulnerable populations including: 1. Expanding services to support health and health-related needs beyond COVID-19; 2. Gaining community trust; 3. Developing and leveraging community partnerships; 4. Promoting clear and creative messaging; 5. Prioritizing patient experience; and 6. Managing patient results. CONCLUSIONS: Testing among the vulnerable not only helps those at highest risk of severe disease or death from COVID-19, but also presents a critical opportunity to control viral spread within and from these communities. Reaching vulnerable populations is challenging and requires multi-sector collaboration, additional funding, and high levels of creativity and flexibility.

COVID-19 in multiple sclerosis patients and risk factors for severe infection.

Multiple sclerosis (MS) patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use; however, there is little data identifying clinical characteristics of MS associated with worse COVID-19 outcomes. Therefore, we conducted a multicenter prospective cohort study looking at the outcomes of 40 MS patients with confirmed COVID-19. Severity of COVID-19 infection was based on hospital course, where a mild course was defined as the patient not requiring hospital admission, moderate severity was defined as the patient requiring hospital admission to the general floor, and most severe was defined as requiring intensive care unit admission and/or death. 19/40(47.5%) had mild courses, 15/40(37.5%) had moderate courses, and 6/40(15%) had severe courses. Patients with moderate and severe courses were significantly older than those with a mild course (57[50-63] years old and 66[58.8-69.5] years old vs 48[40-51.5] years old, P = 0.0121, P = 0.0373). There was differing prevalence of progressive MS phenotype in those with more severe courses (severe:2/6[33.3%]primary-progressing and 0/6[0%]secondary-progressing, moderate:1/14[7.14%] and 5/14[35.7%] vs mild:0/19[0%] and 1/19[5.26%], P = 0.0075, 1 unknown). Significant disability was found in 1/19(5.26%) mild course-patients, but was in 9/15(60%, P = 0.00435) of moderate course-patients and 2/6(33.3%, P = 0.200) of severe course-patients. Disease-modifying therapy prevalence did not differ among courses (mild:17/19[89.5%], moderate:12/15[80%] and severe:3/6[50%], P = 0.123). MS patients with more severe COVID-19 courses tended to be older, were more likely to suffer from progressive phenotype, and had a higher degree of disability. However, disease-modifying therapy use was not different among courses.