EDITOR’S NOTE: Information contained in this article is current as of the time of printing, Nov. 25, 2020.
Despite months of precautions, warnings and official guidelines, the COVID-19 pandemic is in the midst of an upswing in Colorado and around the United States. At the time of this issue’s publication (late November), it’s well understood that we are experiencing a third wave of COVID-19 infections — the first being the initial U.S. wave in March and April, and the second being the mid-summer wave.
“The numbers continue to go up around the country,” says Dr. Enrique Alvarez of the RMMSC at CU, “and they continue to go up in the state of Colorado. So I think being particularly careful becomes more and more important.”
“Wearing masks — we’re seeing more and more data that they protect the wearer, as well as helping to protect others,” said Alvarez. “I really try to emphasize wearing masks, washing your hands, and social distancing.”
One positive piece of data to come from recent cases and infection rates is that while the current number of infections is skyrocketing, we have not yet seen a similar rise in COVID-related deaths, and the death rates at this stage of the pandemic do seem to be significantly lower than in the early days of March and April. Nonetheless, medical professionals are stretched thin, hospitals are becoming crowded again, and numbers remain on very concerning upward trends.
Still, the largest risk factor for poor outcomes with COVID-19 continue to be a patient’s age and existing medical conditions, which has caused great concern among people living with MS.
Risks for MS Patients and Immunosuppression
Age and other illnesses (comorbidities) remain the top predictors of bad outcomes when a patient contracts COVID-19. The elderly (especially >70), and people with cardiovascular disease, diabetes, chronic respiratory disease, hypertension, cancer and physical disability experience the most severe cases of COVID-19 and are at risk for worse outcomes.
While MS itself does not seem to be a risk factor for contracting COVID-19 or for experiencing a more severe disease course, the fact is that many MS patients are also living with one or more other health conditions that could put them at increased risk.
Many patients are fighting MS with disease modifying therapies (DMTs) that act as immunosuppressants, which has been an area of concern since the beginning of the pandemic.
A study published over the summer in Journal of the American Medical Association (JAMA) looked at a number of MS patients being treated with common MS drugs, and showed these patients had slightly less risk of poor COVID-19 outcomes, indicating that MS drugs may actually have a small protective effect.
However a similar study conducted in Italy during that country’s severe COVID-19 outbreak in the Spring notably showed a higher risk of negative outcomes in those MS patients on anti-CD20 medications (commonly, ocrelizumab and rituximab) in the order of 2.5 fold.
“This is why it’s helpful to look at many different studies,” said Alvarez. “The end results are sometimes different, and the more data you get together the better it allows you to explain and understand what the factors are.”
The bottom line is that data is still being collected, but there’s no debate that COVID-19 is a serious matter, and all precautions possible should be taken to avoid exposure and infection.
Developments in COVID-19 Vaccines
Some promising news in the fight against COVID-19 is that four potential vaccines have shown great initial results in trials, from pharmaceutical teams involving Pfizer, Moderna, AstraZeneca, and Russia.
“The first two are a different type of vaccine than what we’re typically used to in the sense that they involve mRNA,” said Alvarez.
Messenger RNA (mRNA) is a single-stranded RNA molecule that can lead to production of certain protein found on the surface of COVID-19, and trains the immune system to recognize and attack it.
“The great news that came from Pfizer’s study is that there was a 95% decrease in number of cases,” said Alvarez. “I would emphasize that these are preliminary data, but very promising data.”
The Moderna vaccine study reported similar data of a 94.5% decrease in cases. For a point of reference, the annual Flu vaccine, depending on the year, is usually between 50% and 70% effective.
The mRNA vaccine approach is a relatively new technology that’s been pushed into rapid development thanks in part to the COVID-19 pandemic itself. These new vaccines require some special handling and procedures as they make their way out to the public.
“This affects the logistics of shipment and delivery of the vaccines,” says Alvarez, “because they both must be kept at extremely cold temperatures.” Shipments must be kept on dry ice or other very cold refrigeration, not only while in transit, but also while in storage at their destination.
“Both vaccines are two shots,” said Alvarez. In one version, shots are three weeks apart; in the other, they’re four weeks apart.
“It’s likely we won’t hear the full results of the study until the end of December or early January,” said Alvarez. “There’s still a lot more information to come such as the safety data, and that’s the reason why we haven’t seen the vaccine yet.”
More promising news for those living with MS is that the nature of mRNA vaccines shouldn’t pose any problems for MS patients on immunosuppressive medications.
More recently, we’ve heard preliminary data from AstraZeneca/Oxford and a Russian vaccine that involved another novel vaccine technology called non-replicating viral vectors. Here, proteins from COVID-19 are made by another type of virus called an adenovirus which cannot multiply and go on to divide other cells. The efficacy varies from 70-95% depending on the report, vaccine, and its dosing and we will need more information to better understand their efficacy. However, these are still very good results and should again be safe in MS patients on disease modifying therapies. Their advantage is that they are easier to store and ship and can be much cheaper.
“That’s our main takeaway: Get vaccinated, once it’s available,” says Alvarez. And in the meantime, continue to be safe, smart and responsible.
“Social separation and wearing your mask really has a huge effect,” says Alvarez. “Just wear your mask, be careful, wash your hands, and follow all safety guidelines.”
For more information on COVID-19 and MS, please see Dr. Alvarez’s presentation from the MS Center’s recent Fall 2020 Education Summit. Video and slides can be found in our online archive, available at mscenter.org/edsummit.
View the MS Center’s latest COVID-19 updates any time at https://mscenter.org/covid.
