COVID-19 & MS Treatment: The Long Game

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Omicron variant of the SARS-CoV-2 virus that causes COVID-19 is now taking off in South Africa with scattered cases already in Europe. With over 30 mutations to the spike protein on the surface of the virus, unanswered questions arise. Will the vaccines still be protective? Is this version of the virus more infectious and more lethal? Africa was vulnerable due to only 6% of the population being vaccinated due to global health disparities.

People living with multiple sclerosis deserve highly-effective therapy, which has been shown to prevent future physical and cognitive disability. Many of these medications that prevent the autoimmune attack on the brain and cervical spine are immunosuppressive. Under normal circumstances, the benefits generally outweigh the risks.  During the COVID-19 pandemic, individuals on immunosuppressive MS disease-modifying therapies have had to be extra careful to avoid infection and may be at risk for more serious COVID-19. It’s been a substantial sacrifice for them; missing out on some family gatherings, limited time with friends, remote work or high-risk exposure at work and avoiding critical exercise at classes, gym or the pool. Anxiety and depression in the MS community has been very high during the pandemic.

Sacrifice for 2 years is hard enough, but what if COVID-19 doesn’t go away? COVID-19 could stay around as an “endemic” disease. The best case scenario is that enough people become vaccinated (with regular boosters) or infected naturally that there will be a dramatic decrease in cases over the coming years. An influenza A virus H1N1 caused the 1918 Spanish flu, killing 50 million people globally. Influenza viruses are still around, resulting in 20-60,000 American deaths annually.  However, flu vaccines are not nearly as protective as COVID-19 vaccines and new and emerging treatments for COVID-19 are quite effective.

At some point, each person with multiple sclerosis will need to make a calculated decision with their healthcare providers about their future treatment strategy. I anticipate most people would rather adapt their lifestyle so they can continue on highly effective treatment to prevent future physical and cognitive impairment. Other people living with multiple sclerosis may prefer de-escalation of treatment, using a medication that may be less effective but less or not immunosuppressive. Induction therapy might also become more attractive with temporary immunosuppression followed by “rebooting” the immune system such as with Mavenclad or Lemtrada.  Risk factors for worse COVID-19 disease will need to be considered such as older age and other medical problems like hypertension.

The bottom line:  We will get through this challenging time together as a MS community with open communication between those of you living with multiple sclerosis and the healthcare professionals that show up in a mask everyday to care for you.