Q: Avoiding hospital appointments

Should I avoid attending my hospital appointments?

This is something you need to discuss with your own MS team.

However, in general the aim of the public health measures to contain COVID-19 is to reduce your exposure to the virus, i.e. personal hygiene (handwashing, social distancing, social isolation and avoiding travel to high-risk areas). In general, COVID-19 is not a hospital acquired, but a community acquired, infection. This, however, may change as more patients with the disease get admitted to hospitals.

Therefore, it makes sense to reduce the spread of COVID-19 you should avoid attending hospital. This could mean doing telephone or telemedicine follow-up appointments, delaying MRI scans by a few weeks, shifting onto an extended-interval dosing schedule for drugs such as natalizumab, delaying infusions of DMTs such as ocrelizumab, rituximab and alemtuzumab, asking for your blood and urine monitoring to be done at home or at your GP.

For new patients we plan to do an initial triage telemedicine consultation to decide if the patient needs to be seen face-to-face and whether or not investigations can be delayed.

What about MS relapse assessments?

Again there is no reason why relapse assessments can't be done using telemedicine. MS clinical nurse specialists having been doing telephone assessments for decades. It is even possible for your neurologist to do some of the neurological examination by asking you to do things and observing them via a video-link, for example walking heel-to-toe, hopping on either leg unsupported and observing your eye movements. Although a video neurological examination is not ideal it at least allows a cursory neurological assessment to be performed. You can also go online and complete the web-EDSS calculator and other outcome measures, for example the 9-hole-peg test and the timed-25-foot-walk, to provide your MS team with your current level of disability.

When it comes to treating relapses it is advisable to try and not use steroids during the pandemic. Steroids actually make little difference to the final outcome of relapses, but simply speed up the recovery.

Date & Disclaimer: 18-March-2020; please note this information will be time limited and will change as new data emerges.