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Are people with hyper/overly active immune systems, such as those with MS, at high risk like those with weakened immune systems?

For patients with autoimmune disorders such as Multiple Sclerosis, treatments often include suppressing some aspects of the immune system. This means that these individuals may be more susceptible to the virus (SARS-CoV-2) that causes the disease COVID-19. Despite this, healthcare providers do not recommend discontinuing treatment regimens for these patients, as this may increase the risk for opportunistic infections.

Patients with MS taking alemtuzumab, cladribine, ocrelizumab, rituximab, fingolimod, dimethyl fumarate, teriflunomide or siponimod are strongly encouraged to take precautions by at least doing the following: 1) social distancing, maintaining at least a 6-foot distance from infected individuals, 2) frequent hand washing for at least 20 seconds, and 3) avoiding touching your eyes, nose and mouth.

The effect of SARS-CoV-2 in patients with overactive immunity not on immunosuppressive treatments has not been investigated. Although, based on our current understanding of the interaction between the related coronavirus SARS and the immune system, hyperactive immunity may be detrimental, leading to overactive inflammation and tissue damage in the lung. Therefore, in these patients the above prevention measures also apply.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517331/pdf/WJCC-3-545.pdf

https://www.msif.org/news/2020/02/10/the-coronavirus-and-ms-what-you-need-to-know/

https://www.neurologylive.com/clinical-focus/covid19-coronavirus-preventive-measures-in-multiple-sclerosis-patients-and-others-on-immunomodulators

https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmv.25685?casa_token=XKPP1DBEfWsAAAAA:6dzVTBP8fLOleED7Mtf3EQ8it_WSu3MU-8OJWaWhlHUS6nNCwYDc8Sh2uU8CX6dcLkwrzDLmPAKG0RY 

Drafted 20 March 2020

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