A universal worry for people with any long-term disease at present is whether they are at increased risk of Covid-19 infection (how likely they are to catch it) as well as increased risk of complications from it (how likely they are to suffer seriously from it). Both factors are important. For example, a weak immune system due to treatments can increase the chance of Covid-19 being able to infect someone. In someone who has muscle weakness affecting their breathing muscles, Covid-19 is more likely to cause critical lung damage needing ventilation in an intensive care unit. To help decide the risk for common neurological conditions, the Association of British Neurologists (of which I am a member) has released advice for each condition, available here. Some examples are summarised by me below:
- Alzheimer’s disease: Low risk unless mobility or swallowing impaired, or potentially higher risk if in care homes.
- Epilepsy: Low risk unless there is severely reduced mobility as a result of frequent seizures.
- Motor neurone disease (ALS): High risk especially if breathing assistance is needed.
- Multiple sclerosis: Low risk unless taking certain disease-modifying drugs or unless a person has difficulty swallowing or breathing.
- Parkinson’s disease: Low risk but similar to Alzheimer’s disease above.
- Stroke: Low risk if there are minimal symptoms, but can be high risk due to immobility or swallowing difficulty, for example.
Certain drugs also put people at high risk of serious Covid-19 infection and some of these that are used in neurology are:
- Mycophenolate mofetil
- Prednisolone (more than 20mg per day)
Nobody with a long-term neurological illness should stop medications without discussing with his/her neurologist first. Sometimes the risks of the neurological disease itself outweigh the risk of Covid-19 illness. Most people in the high risk category will received letters advising them to ‘shield’ from others indoors for now, but those who are not sure should contact their GP or specialist. Please continue to practise social distancing in the meantime (away from Barnard Castle!).