I’ve posted before regarding the Coronavirus, but wanted to address some questions I am getting from my MS patients who are taking medications that suppress their immune system and what is their risk and what should they do?
Remember, this virus upon us is not “a bad flu.” It kills more of its hosts, and it will spread farther unless we take aggressive steps to slow it down, because no one is yet immune to this disease. It will be quite some time before the virus runs out of new patients.
No one should be making light of this pandemic that is spreading like wildfire across the globe . This is serious everyone, but together we can move beyond this challenge. In times like these the invisible threads of the interconnectivity of all living things becomes palpable and visually illuminated.
Where can I find updated data and information about the current situation?
The best source for the total number of COVID-19 global cases in real-time is by the Johns Hopkins Center for Systems Science and Engineering, https://coronavirus.jhu.edu/map.html, where you can find interactive maps and other helpful information in their Coronavirus Resource Center.
What are the symptoms of COVID-19?
Symptoms that may appear two to 14 days after exposure include fever, cough, shortness of breath. Other mild symptoms that you may or may not have are a runny nose, headache, fatigue and/or sore throat. If you have been exposed to someone in whom the infection has been confirmed, please call your primary care physician (PCP) right away for guidance as to how to proceed.
How may I or my family be affected?
Although the coronavirus is not the most infectious or lethal of viruses, it is still very high in both categories. The case fatality rate (percentages of confirmed cases that die) varies by age group:
Under 50 years: <0.5%
Ages 50-60 years: 1.4%
Ages 60-69 years: 3.6%
Ages 70-79 years: 8.0%
Ages 80+ years: 14.8%
The higher case fatality rate among older age groups does not mean younger people can ignore any signs of illness. People of any age group that have comorbidities (more than one disorder) or who are immunocompromised all have an elevated case fatality rate:
Cardiovascular disease: 10.4%
Chronic pulmonary disorders: 6.3%
Note: About 60% of all US adults have at least one of these underlying co-morbiditiesResearch suggests that people with COVID-19 can shed a small amount of virus before symptoms appear and up to 20 days after they recover. The same research study found that when people are infected with COVID-19, they shed A LOT of virus into their surroundings. It is extremely important to isolate yourself if you experience any symptoms.
I have MS, am I more at risk of getting COVID-19?
Having multiple sclerosis (MS) doesn't necessarily increase your risk. However, everyone’s MS is different and the risk varies from person to person including people who have no preexisting condition at all.
If you are taking a MS drug that can suppress your immune system (e.g. Tecfidera, Aubagio, Gilenya, Tysabri, Lemtrada, Ocrevus, Mavenclad, etc.) then you are more at-risk of infection in general and including the Coronavirus. which is highly contagious.
I am not recommending a patient stop their MS medication as this can cause sudden worsening of their symptoms and disease. BUT…if you are diagnosed with COVID-19, I do think you should consider stopping the MS treatment temporarily.
We will review and adapt this or any recommendation on a case-by-case basis with all patients so please call us should you have questions regarding your individual health status.
The “Lily Pad Effect” and the case for self-quarantine.
We can expect a doubling of cases every six days, according to several epidemiological studies. Confirmed cases may appear to rise faster (or slower) in the short term as diagnostic capabilities are ramped up (or not), but this is how fast we can expect actual new cases to rise in the absence of substantial mitigation measures. Please note that there are many variables about which we don’t yet know so we will likely see adjustments to reported figures.
But it is when our health care system becomes overwhelmed with the rapid rise of cases that we reach a threshold effect. At that point there are no more ICU beds and this is a significant reason why so many are dying from this virus. We saw this unfold in China, Italy and Iran and its why other countries now such as France and Spain have quickly moved to closing everything to attempt to contain the spread of disease.
We cannot ignore this Lily Pad Effect, when something dangerous is growing exponentially, everything looks fine - until it doesn’t. In the early days of the Wuhan epidemic, when no one was taking precautions, the number of cases appears to have doubled every four to five days.
What do we ALL need to know now?
My biggest advice is that we ALL adopt measures for self-quarantine now. This means no travel on airlines, no going out to restaurants or bars, no kids’ playdates or soccer practice, work from home if at all possible, and no social gatherings larger than 10 people among other generally advised recommendations – for more details please see our previous blogs about best-practice approach to limiting the spread of this disease too.
Sadly, our government has had an anemic response to this now-pandemic and still is not giving the American people the necessary hard line precautions. So it is up to the medical community to convey to our patients as much accurate information as we have and what we recommend right now and going forward.
If you need to shop for groceries or basic supplies, go early or whenever you can identify are less-crowded times and wipe down everything you bring home from the store. Avoid lines of people that are less than six feet from one another, which is also the recommended distance to maintain between individuals if you are out in public. We understand this all sounds extreme and social distancing is a new concept for us - but it really is the ONLY and best measure we have to slow down the spread of this potentially lethal virus.
Everyone should be tested if they want to be tested and certainly if they have symptoms. We recommend you contact your primary care provider for their instructions regarding testing or refer to the metro health departments in the city where you live. In San Antonio, that website can be found at https://www.sanantonio.gov/HEALTH.
Hopefully, the tests will be widely available soon, but like many health care practitioners, I am concerned that this is unfortunately “after-the-fact” when it is now that we need this information about those who may be asymptomatic carriers. That doesn’t mean testing won’t be of value so please don’t delay contacting your provider for their guidance if you are ill or have any concerns.
Remember we are all in this together. I think we need to remind ourselves of that so we don’t feel alone in our concerns. Ideally this will make us less inclined to panic. I believe that collectively we can work together – even at a distance – and make this time at least feel like it’s passing more quickly!
In health, hope and healing,
Dr. Suzy Gazda
“Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality.”
--Martin Luther King, Jr.
Some lifestyle recommendations and guidelines:
1. Stay at home; this means teenagers, kids and young adults, too. Children are important drivers of virus transmission in the community. If you absolutely must travel on a plane, you should self-quarantine at least two weeks upon return. We all need to realize we are putting our family and others at risk with domestic travel. Our office can provide a work excuse if you need it or a “work from home” recommendation.
Keep in mind, the self-quarantine period that is advised for all of will likely last 4-8 weeks. We realize not everyone can self-quarantine for this extended time frame, but MANY OF US, and certainly our children, can. And if you are at all sick, you must stay home…please!
2. Eat real food. Limit sugar and processed foods and get back in the kitchen to try out those great recipes you’ve been saving and sending yourself!
3. Sleep 7 to 8 hours as much as that’s possible.
4. Lower stress through mindfulness practices like meditation, breath work, Heart Math and focus on all the love that abounds in your life. Practice gratitude.
5. Movement: Get out for a walk, keep moving outdoors (just keep a healthy distance between you and any others who are also out in nature).
6. If you drink alcoholic beverages please stick to the suggested limits: for women this is no more than two to three glasses of wine per week, for men it would be four to six per week.
7. Wash your hands frequently for approximately 20 seconds each time and regularly wipe down contact surfaces with a disinfecting solution.
8. Increase your Vitamin C to 2-4 grams/day; VIT D3/K2 to 10,000 IU/ day.
Please see my How to Beat the Flu downloadable PDF in our Medical Resources section for more information regarding supplements.