CORONAVIRUS, COVID-19 and NMOSD
What is coronavirus and COVID-19?
The coronavirus is a family of viruses that can cause respiratory and intestinal infections in humans and animals.* Coronaviruses are typically very common causes of colds. COVID-19 is a disease caused by a new coronavirus termed SARS-CoV-2 or 2019-nCoV, which has infected humans. It has been declared a pandemic by the World Health Organization.**
What are the symptoms?
Image obtained from Ohio Department of Public Health.
The CDC has now added 6 symptoms to their initial list posted (fever, cough and shortness of breath): chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell.***
How is it spread?***
Predominant proposed mechanism of spread of the virus (transmission):
Coronavirus is thought to spread predominantly person-to-person. This can occur between people who are in close contact, within about 6 feet. This person-to-person transmission can occur through respiratory droplets when someone infected coughs or sneezes. It’s thought that people are most contagious when they are the sickest, or most symptomatic.
Other potential mechanisms of transmission:
It’s possible that people can spread the virus when they’re asymptomatic, or before they are showing symptoms. The virus may also be able to be spread by contact with contaminated surfaces and objects, but this is most likely very negligible.
The virus that causes COVID-19 seems to be spreading easily in the community in affected areas, giving the term community spread. This means that people have been infected in an area and aren’t sure how or where they became infected.
What’s the risk?***/*****
Reported cases of COVID-19 have ranged from no reported symptoms or very mild to severe, including fatality. Based on available data, COVID-19 cases are mostly mild, however about 20% have been deemed severe. People who are at greatest risk of severe infection are those in high risk groups, including: those with older age, heart and lung disease and the immunocompromised (impaired or weakened immune system). COVID-19 can lead to development of pneumonia and in severe cases, acute respiratory distress syndrome (ARDS).
What about NMOSD treatments?
Many treatments for NMOSD work by suppressing the immune system. In general, people with NMOSD who are treated with immunosuppressants have an increased susceptibility to infections.
If you are an NMOSD patient receiving treatment and have concerns about your risk for COVID-19, do not stop your treatment without discussion with your NMOSD care clinician. If you have symptoms suggestive of COVID or have been in close contact with a person known to have COVOD-19 or believe to have COVID-19, stay home and contact your NMOSD clinician team right away.
What can we do?***
- Get a Covid vaccine when available to you! Check with your doctor about any questions or concerns first.
- Practice social distancing, meaning avoiding/reducing contact with others to help reduce the rate of transmission of the virus.
- Wear a mask!
- Keep good hygiene- wash your hands and avoid touching your face (eyes/mouth/nose).
Those in the high risk group, including NMOSD patients receiving immunosuppressant treatments, are strongly recommended to strictly follow these precautions.
Ways to stay safe:
Stock up on supplies including medications
If you work and can work from home, do it!
Wash your hands frequently and thoroughly, using 20 seconds as a standard
Sneeze or cough into the crest of your elbow- the ‘dab’
Avoid contact with known infected
Practice social distancing
What if I'm a family member or living with someone who is at risk, like an NMOSD patient receiving immunosuppressant treatment?
Those living or in daily close contact with a member of a high risk group should behave as if they are in the high risk group.
The CDC has guidelines for family members and caregivers. Below are the guidelines directly pulled from the CDC's website***:
- 'Know what medications your loved one is taking and see if you can help them have extra on hand.
- Monitor food and other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan.
- Stock up on non-perishable food items to have on hand in your home to minimize trips to stores.
- If you care for a loved one living in a care facility, monitor the situation, ask about the health of the other residents frequently and know the protocol if there is an outbreak.'
What are considerations for NMOSD and Covid vaccines?
Vaccines work to train your immune system to recognize and fight against and prevent disease. The currently FDA-approved vaccines for Covid include genomic (mRNA, Pfizer/Moderna) vaccines and viral vector vaccine (J&J). The mRNA vaccines can NOT integrate into human DNA, and the viral vector vaccines are not capabable of viral replication. Each of these FDA-approved Covid vaccines have been shown to be safe and effective in large phase 3 clinical trials, preventing hospitalization and death.
These types of vaccines do NOT contain active virus and so pose no theoretical safety concerns to NMOSD patients, including those on immunosuppressants. However, there have been no data from clincial trials or studies of these vaccines in NMOSD patients or those on immunosuppressants. It remains to be seen how effective these vaccines will be in use with immunosuppressive treatments, and it is likely that some may attenuate efficacy. However, it is still being recommended overall to receive the Covid vaccines when available, as the benefit-risk profile is favorable to reduce and/or prevent Covid and Covid-related complications. Please talk with your healthcare team about your decisions regarding vaccines.
Until herd immunity is reached, we must still wear masks and physical distance when in public- we are in this together! The CDC has issued recommendations around what you can do once you are vaccinated.
Listen to the episode on 'Vaccine Preparedness' on our pod Demystifying NMO, which neuroimmunologist Mary Rensel, MD of the Cleveland Clinic Mellen Center here.
Do we have any data specific to COVID19 outcomes and NMOSD?
There are multiple ongoing registries around the world that are recording cases of COVID19 in people living with demyelinating diseases, including multiple sclerosis and NMOSD. The goal is to understand COVID19 disease outcomes in these patients, based on a number of factors, including treatments for their demyelinating diseases. One regisry is COViMS- a collaboration between the National Multiple Sclerosis Society and the Consortium of MS Centers. CBJF has supported ongoing research in the NMO Covid Project with the Cleveland Clinic Mellen Center to investigate outcomes to Covid in NMO patients. Overall, non-treatment related risk factors include older age, increased disability, smoking and co-morbidities including diabetes, hypertension, obesity, heart and lung disease.
Multiple guidelines have been shared from various MS/NMOSD clinicians and patient advocacy organizations. All decisions regarding NMOSD treatments need to be discussed between patient and clinical care team.
What are potential treatment approaches to COVID19?
There are a few key strategies currently being studied to combat the virus:
- Prevention: vaccine designs.
- Anti-virals: stop/reduce the spread of infection, or viral replication.
- Anti-inflammatory/Immunomodulation: aim to decrease the immune-mediated inflammation that results in severe COVID19 infection.
- Other approaches that aim to help the immune response, potentially decrease ability of virus to infect cells and/or help with oxygenation.
You can learn more about these treatment approaches here, and find ongoing clinical trials for COVID19 at clinicialtrials.gov.
Are there any lifestyle tweaks that can help with the immune system?
In general, living a well-balanced lifestyle helps support your immune system. This includes getting adequate, well-rested sleep, exercising, and maintaining a nutritious diet.
There are some studies that support maintaining a good level of Vitamin D, which has been associated with immune system regulation and autoimmune disease.
Anxiety and related-stress can hamper your overall immune response, which suggests that practicing calming activities and mindfulness could be helpful.
You can learn more about these wellness/lifestyle factors on our 'Wellness' tab:
Suggestions for how to cope and manage your time while social distancing:
Check out the list of resources put together by the CBJF and our friends at The Sumaira Foundation
What are good resources for more information and updates?
Centers for Disease Control and Prevention:
World Health Organization:
Follow your state public health department on social media and find their website for more local information and updates.
For information related to COVID-19 and rare neuroimmune disorders, including NMOSD, visit the Siegal Rare Neuroimmune Association's site for more information and access to other related resources.
* Cui J et al, Nature Reviews Microbiology, 2018.
*** Coronavirus Disease 2019 (COVID-19), Center for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov
**** Wang H et al, Cell Discover, 2020, https://www.nature.com/articles/s41421-020-0148-0
***** Guan W et al, NEJM, 2020.
Top image of coronavirus is from Nature.com