By:

Louis A. Cona, MD

Reviewed:

Robert J. Hancock

Are people with Multiple Sclerosis more prone to severe Coronavirus related illness? Having a compromised immune system could potentially increase one’s risk of developing severe Coronavirus symptoms. This article aims to answer this question as well as describe the actions MS patients should take to mitigate risk.

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Coronavirus advice for people with MS

The World Health Organization states that while we are still learning about COVID-19, we do know that certain portions of the population are at a higher risk of developing a severe illness than others.

These people include:

  • The elderly

  • People with pre-existing medical conditions such as; high blood pressure, heart disease, lung disease, cancer, diabetes

  • People with compromised immune systems

If you have a weak immune system, you could be at a higher risk.

Having a compromised immune system could potentially increase one’s risk of developing severe Coronavirus symptoms. Many factors could cause a weak immune system these include:

  • Taking immunosuppressants

  • Cancer treatments (Radiation, Chemotherapy)

  • Specific therapies for Autoimmune diseases for Multiple Sclerosis, Inflammatory Bowel Disease, Rheumatoid Arthritis, Lupus  

  • Serious infections such as HIV

  • Organ transplants

Coronavirus has a more significant potential to damage the lungs of people who have weakened immune systems. This damage happens because the virus can infect our immune cells and create confusion.  

Our immune systems are generally in place to keep our bodies healthy by protecting our cells from invaders, such as harmful bacterias.  However, when our immune system is not appropriately regulated, it can cause more harm than good. This phenomenon is typically seen in people with autoimmune diseases and can produce large amounts of inflammation within the body.

Coronavirus causes infected immune cells to overreact and start destroying healthy cells within the lungs.  Over time this can lead to the destruction of the protective cell layer within our lungs.  This destruction can lead to an increased susceptibility to harmful bacterias that can cause pneumonia. 

So, what is a Coronavirus?

According to the World Health Organization, a Coronavirus is a large family of viruses that causes illness in both animals and humans.  In humans, several Coronaviruses cause respiratory infections ranging from the common cold to more severe diseases such as SARS and COVID-19.  The video below does an excellent job of explaining the impact of COVID-19 in detail. (1)

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What is COVID-19?

“COVID-19 is an infectious disease caused by the most recently discovered Coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.” - The World Health Organization (1)

What are the symptoms of Coronavirus?

According to the World Health Organization, the most prevalent symptoms of COVID-19 are fever, fatigue, and dry cough. 

Some patients may have aches and pains, nasal congestion, runny nose, sore throat, or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell. 

Most people (about 80%) recover from the disease without needing special treatment. About one out of every six people who get COVID-19 becomes seriously ill and develops difficulty breathing. 

Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop severe illness. Somebody with a temperature, cough, and trouble breathing should solicit medical attention. (1)

Advice for people with Multiple Sclerosis

People with underlying medical conditions such as high blood pressure, heart disease, diabetes, or persons over the age of 60 are at an increased risk of developing severe illness due to COVID-19.  This group can include people living with Multiple Sclerosis, especially ones that are currently taking immunosuppressants. Some common immunosuppressives include but are not limited to Calcineurin Inhibitors, Tacrolimus and Cyclosporine Antiproliferative agents, Mycophenolate Mofetil, Mycophenolate Sodium, and Azathioprine.

All persons with Multiple Sclerosis should be advised to take extra precaution and follow more stringent social distancing and cleanliness rituals to ensure their chance of contracting COVID-19 is reduced.

According to the World Health Organization, you should follow these guidelines to reduce your risk of contracting COVID-19.

  • Wash your hands frequently with soap and water or an alcohol-based hand rub

  • Avoid touching your eyes, nose & mouth unless your hands are clean

  • Try to keep at least 1-meter distance between yourself and others, particularly those who are coughing and sneezing

  • When coughing and sneezing, cover your mouth and nose with a flexed elbow or tissue

  • Practice food safety by using different chopping boards for raw meat and cooked foods and wash your hands between handling them

Also, the MS International Federation recommends that people with MS should take the following extra precautions (2):

  • Avoid public gatherings and crowds

  • Avoid using public transport where possible

  • Where possible, use alternatives to face-to-face routine medical appointments (for example, telephone appointments).

Advice regarding MS medications

People who are taking Disease-Modifying Therapies for MS should take extra precautions, especially those that may affect the immune system.  People taking these therapies mustn’t stop without speaking with their physician first.  Patients should make sure to call their neurologist or physician rather than going into their clinic.  It may even be possible to schedule a telemedicine appointment so that advice can be given from the comfort of your own home.

Stem cells may be able to help the body resist Coronavirus.

Firstly, stem cells combat viral attack by the expression of specific genes known as interferon-gamma stimulated genes (ISGs). These are expressed in stem cells before their differentiation. (Wu, X, et al., Cell 172: 423, 2018). 

Hence, stem cells are expected to survive even if transplanted into a patient with an active Coronavirus infection. Also, it is known that stem cells rejuvenate and regenerate cells in the body through various processes involving reduction of inflammation, secretion of substances that protect cells, transfer of mitochondria, reduction of cell death, anti-oxidative effects and improvement of immune system function. These effects are likely to increase survival in patients infected with Coronavirus. Also, there is direct evidence of stem cell protection against viral infection. Influenza virus A/H5N1 causes acute lung injury that was reduced by human mesenchymal stromal cells (MSCs) in mice, and the treatment increased survival (Chan et al., PNAS 113:3621, 2016).

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References:

(1) Q&A on coronaviruses (COVID-19). (n.d.). Retrieved from https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

(2) The coronavirus and MS – global advice. (2020, March 24). Retrieved from https://www.msif.org/news/2020/02/10/the-coronavirus-and-ms-what-you-need-to-know/

(3) Wu, X., Dao Thi, V. L., Huang, Y., Billerbeck, E., Saha, D., Hoffmann, H.-H., … Rice, C. M. (2018, January 25). Intrinsic Immunity Shapes Viral Resistance of Stem Cells. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29249360