key: cord-0762533-anq15wkk
authors: Ciampi, Ethel; Uribe-San-Martín, Reinaldo; Soler, Bernardita; Fernández, Ramiro; García, Pía; Navarrete-Asenjo, Claudio; Tirapegui, José Miguel; Torres, Rubén; Polanco, Juan; Suárez, Felipe; Cuello, María José; Cárcamo, Claudia
title: COVID-19 in MS and NMOSD: A multicentric online national survey in Chile
date: 2020-07-12
journal: Mult Scler Relat Disord
DOI: 10.1016/j.msard.2020.102392
sha: dfd571768fc2808eec78ab2aedfa3ac906689145
doc_id: 762533
cord_uid: anq15wkk

nan

A myriad of publications addressing COVID-19 and its impact on acute and chronic neurological disorders have been published in the last few months. Special interest has arisen in chronic demyelinating disorders, such as Multiple Sclerosis (MS) and

Neuromyelitis Optica Spectrum Disorders (NMOSD), mainly due to immunotherapy and increased risk of infections 1 . In MS, a multicentric study led by the Italian programme for COVID-19 infection in multiple sclerosis, including 238 symptomatic patients (57 had positive RT-PCR) from 38 centers, seems to reassure that most patients (96%) developed a mild disease. Unfortunately, 5 patients died, all of them with EDSS > 6.5 2 .

An observational study including 8 patients from North America, also highlights the importance of EDSS in the risk of fatal outcome 3 . A more recent multicentric study, including 347 patients from the Covisep French registry, showed that 21% of the patients at least required hospitalization, while 12 patients (3.5%) died. Multivariate analyses determined that EDSS, age and obesity were independent risk factors for hospitalization or more severe COVID-19, while no association between diseasemodifying therapy exposure and COVID-19 severity was observed 4 . In NMOSD fewer articles have been published, also suggesting a similar rate of infection compared to the general population 5 .

On May 16th, our group published a first report addressing the impact of COVID-19 using an online survey completed by 280 patients, highlighting the relevance of early communication for infection prevention measures, and social impact of telemedicine and remote-working. Main results included a high percentage of patients under diseasemodifying therapy (95%), a high percentage of patients reporting at least one comorbidity (60%), 75% stated to be remote working/studying since early March, and 8% declared to be unemployed. Three patients were confirmed with COVID-19, with no fatal outcomes 6 . Unfortunately, over 100 days after the first patient was confirmed in Chile, things have dramatically changed. The number of cases and deaths due to COVID-19 has exponentially increased, with over 300,000 patients diagnosed (1.6% of the total population) and over 6,500 deaths (2.2%) 7 . Therefore, a second online questionnaire was distributed among MS and NMOSD treating neurologists throughout the country in order to assess a national representation of the impact of COVID-19 in their patients' lives, and to improve and update the recommendations given to patients and caregivers, in the event of a confirmed infection. Patients under regular clinical care had already given written informed consent approved by the local Ethics Committee.

Also, before survey completion, patients were asked to agree on an online informed consent. A total of 409 surveys from 9 centers have been completed, 71% women, mean age 41 years, 98% with MS, and 88% receiving immunotherapy. Most prevalent self-reported comorbidities were being overweight/obese (17%), current smoking (14%), insulin resistance/type 2 diabetes (9%), thyroid disorders (8%) and hypertension (8%).

Remote working-studying remains high (74%), but unemployment has risen to 10%.

Compared to our previous study, a similar proportion of patients (16%) reported having any symptom suggestive of COVID-19 (Table 1) Maintaining the connection between the different MS groups at national and international levels will be essential to delineate future directions regarding the changes that COVID-19 is generating in the care of our patients. 

Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic

Italian Study Group on COVID-19 infection in multiple sclerosis. An Italian programme for COVID-19 infection in multiple sclerosis

COVID-19 in MS: Initial observations from the Pacific Northwest

Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis

Naser Moghadasi A. Evaluation of COVID-19 infection in patients with Neuromyelitis optica spectrum disorder (NMOSD): A report from Iran

COVID-19 pandemic: The experience of a multiple sclerosis centre in Chile

Una Mirada Ibero-Panamericana. C. Arriagada y J. Nogales-Gaete (Editores)

We thank our MS care team, our patients, and their families, and Nicole Ciampi for contributing to the development of this information.