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Contents listsavailable atScienceDirect

Multiple Sclerosisand RelatedDisorders

journal homepage:www.elsevier.com/locate/msard

Commentary

COVID-19 pandemic:The experienceof amultiple sclerosiscentre inChile

Ethel Ciampi

a b,⁎ , ReinaldoUribe-San-Martin a b , ClaudiaCárcamo a aNeurology, Pontificia UniversidadCatólica deChile, Santiago,Chile b Neurology, HospitalDr. Sóterodel Río,Santiago, Chile

ARTICLEINF O

Keywords:

Multiple sclerosis

COVID-19

Telemedicine

Commentary

Several publicationshave addressedmultiple sclerosis(MS) treat- ment considerationsand thecurrent Coronavirusdisease 19(COVID-

19) pandemic.Most consensusrecommendations havehelped in

managing neurologistsuncertainty aboutstarting, changingor post- poning disease-modifyingtherapies (DMT)according tothe underlying mechanism ofaction, potentialincreased riskof infectionand awell balanced risk-benefit assessmentof MSactivity (Brownlee etal., 2020; Carra etal., 2020;Costa-Frossard etal., 2020;Giovanonni etal., 2020). A recentmulticentric studyled bythe Italian programmefor COVID-

19 infectionin multiplesclerosis , including238 symptomaticpatients (57

had positiveRT-PCR) from38 centres,seems toreassure thatmost patients (96%)developed amild disease.Unfortunately, 5patients died, allof themwith EDSS≥6.5 (Sormani etal., 2020). From thepatient's pointof view,the uncertaintyhas beenmanaged by collectinginformation fromonline resources,webinars andin- dividual telemedicinevisits withtheir MScare team.Digital approaches have beenproposed inorder toimprove MSpatients care (Bonavita etal., 2020). Local informationabout MSpatients andthe impactof lock-down measures werea majorconcern forthe Programa deEsclerosis Múltiple

UCprofessionals, ourpatients andtheir families.

In Chile,the first SARS-CoV-2patient wascon firmed onMarch 3rd,

2020. Quarantinewas advisedfor theelderly sinceMarch 15th.On

March 16th,we composeda letteraddressing recommendationsfor patients andfamilies includinggeneral considerationsabout MSrisk and COVID-19infection, standardinfection preventionmeasures, and the advicefor startingsocial-distancing andteleworking. Otherre-

commendations includedin fluenza vaccinationand suggestionsif aCOVID-19 infectionwas suspected(e.g. whento attendthe emergency

department andwhen tostay home).A Stateof Constitutional Exception andCatastrophe wasdeclared onMarch 19th,including measures toprotect thesupply chainlogistics (medicaland first ne- cessities),cordons sanitaires, andallowing measuressuch asquarantines and curfewsto beimposed. OnMarch 21st,a secondletter forneu- rologists wasdeveloped andshared (Cárcamo etal., 2020). Wead- dressed thatMS diagnosiswas probablynot relatedto apoor outcome, but cautionshould betaken especiallyfor patientsover 60years with comorbidities, concernsabout lymphocytedepleting agentsand the general considerationof notstopping MSDMT, especiallyin those therapies witha riskof reboundactivity. Specific considerationsfor each DMT,relapses, andsteroids usewere alsoincluded. SinceMarch

30th, webegan withtelemedicine visits.On April15th, wedeveloped a

short onlinequestionnaire inorder torapidly collectupdated in- formation aboutthe currentstatus ofour patients,with anemphasis on social andCOVID-19-related information.Before completion,patients were askedto agreeon anonline informedconsent. Atotal of551 online questionnaireswere sent,to thedate ofthis report,we received

280 responses,71.1% women,median age41 years(range 20- 81),

88.2% hadprivate healthinsurance, 95.4%were underDMT (27.1%

fingolimod, 20%ocrelizumab, 10.4%interferons, 5.7%teri flunomide,

5.4% dimethylfumarate, 4.7%alemtuzumab, 4.3%cladribine, 3.9%

glatiramer acetate,3.6% rituximab,2.1% natalizumab,8.2% other),

40.3% reportedno comorbidity,while 18.3%reported beingover-

weight orobese, 16.3%were currentsmokers, 9.1%reported hy- pertension, and8.4% hadinsulin resistanceor type2 diabetes.One patient iscurrently pregnant.Relative tothe workingsituation, 51.8% have full-timejobs, 11.8%part-time, 8.2%were unemployed(same as the nationalrate of8.2%) (INE, 2020), 8.2%are homemakers/https://doi.org/10.1016/j.msard.2020.102204 Received 7May 2020;Received inrevised form12 May2020; Accepted14 May2020 ⁎

Corresponding authorsat: NeurologyDepartment Pontificia UniversidadCatólica deChile, DiagonalParaguay 362,5° Piso,Departamento deNeurología,

Santiago, Chile.

E-mail addresses:eciampi@med.puc.cl(E. Ciampi),ccarcamo@med.puc.cl(C. Cárcamo). quotesdbs_dbs10.pdfusesText_16

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