Section 4: Will I Get Seriously Ill from COVID-19?

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Will I Get Seriously Ill from COVID-19?

Serious Illness

MS does not appear to increase your risk of serious complications from COVID-19 infection. However, if your MS causes difficulty breathing or swallowing, this could put you at an increased risk of complications. Talk with your healthcare provider about taking proper precautions.

With regard to people taking an immunosuppressant medication for MS, we are experiencing more favorable outcomes than anticipated. Studies so far are showing that people with MS taking disease-modifying therapies have not significantly differed in terms of complications and recovery from COVID-19. The current recommendation is for individuals with MS to continue taking the medication best suited for them in consultation with their doctor.

At this time, studies do not show that immune modulators can increase protection from COVID-19, but research is ongoing.

As with any other type of infection, a COVID-19 infection may cause a pseudo-relapse. Also known as a pseudoexacerbation, this temporary increase in symptoms is often caused by a fever or warm environment. A pseudo-relapse normally remits once the infection or fever has been resolved, or the individual moves into a cooler setting (when caused by a warm environment).

COVID-19 can also increase the risk of brain and nervous system complications. While not common, examples include deliria, seizure, stroke, and Guillain-Barre syndrome. A number of people report altered smell and taste at the onset, which may continue for an extended period of time.

Some researchers are questioning the classification of COVID-19 as a respiratory disease, as “various reports substantiate its pathogenicity in other organs of the body, including the central nervous system (CNS).”

In a paper published in January 2021 in the journal Alzheimer’s & Dementia, researchers from the University of Texas Health Science Center, Alzheimer’s Association, and Nottingham and Leicester Universities in England announced the launch of an international, multidisciplinary consortium with representatives from more than 30 countries and technical guidance from the World Health Organization to better understand the long‐term residual effects of COVID-19 infection on brain impairment. Researchers are also investigating the relationship between COVID-19 and underlying biology that may contribute to Alzheimer’s and dementia.

In addition, researchers have discovered genetic predisposition to severe COVID-19 infection. The findings could help COVID-19 disease modeling, patient risk assessment, and early intervention.

In an analysis of 906,849 COVID-19 hospitalizations, researchers estimate that two thirds of hospitalizations were correlated with four (4) underlying/pre-existing conditions:

• 30.2% (274,322) were attributable to obesity
• 26.2% (237,738) were attributable to hypertension
• 20.5% (185,678) were attributable to diabetes
• 11.7% (106,139) were attributable to heart failure

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Seniors and Those with Underlying Conditions

Seniors and those with underlying medical conditions are considered most at risk for developing serious complications from the virus.

An analysis of electronic health records for a study published in November 2020 revealed that those with chronic kidney disease are at greater risk of hospitalization for COVID-19 infection.

Blood types may also help determine one’s risk for serious infection. Studies suggest a possible increased risk of complications arising from COVID-19 infection for those with blood type A-positive and a possible protective effect for people with blood type O.

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Children

A July 2020 study reports children under age 5 may carry 10 to 100 times as much COVID-19 viral nucleic acid in their upper respiratory tract compared with adults. While this study did not look at whether children are more likely to spread the virus, an article from Forbes explains that when a young child coughs, sneezes, or shouts, they expel virus-laden droplets into the air. With up to 100 times the amount of virus, it appears logical that infected children would spread the virus more efficiently.

A study published in November 2020 suggests that children may clear the virus faster and might be infectious for a shorter period of time.

Additionally, while children are still considered to be less susceptible to serious complications arising from infection, an article from the Mayo Clinic reports that if children are hospitalized, they need to be treated in the intensive care unit as often as hospitalized adults. In most cases, children have mild symptoms or show no symptoms at all, but a small number develop multisystem inflammatory syndrome in children (MIS-C), a serious condition in which organs or other parts of the body become inflamed (including the heart, blood vessels, kidneys, digestive system, brain, skin, or eyes).

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Fertility

An early study published in November 2020 suggests COVID-19 may impact male fertility. More recent studies support this finding.

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Neurological Symptoms

In January 2021, the National Institutes of Health launched a database to track neurological symptoms associated with COVID-19.

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Long-Term Impacts

An estimated 35% of COVID-19 patients who are not hospitalized are reporting mild to severe long-term symptoms (headaches, fatigue, difficulty breathing, memory problems, etc.). These patients are now being referred to as “long-haulers” suffering from “long Covid.”

The American Academy of Neurology reports that the COVID-related loss of taste and smell may last up to 5 months.

A survey-based study seeking insights about long-term outcomes followed up with COVID-19 patients 60 days after being discharged from the hospital. The researchers found that 6.7% of hospital survivors and 10.4% of those who had been in the ICU had since died. Of the 488 patients who survived, 39% said they were unable to resume normal activities and 12% reported that they had trouble taking care of themselves. Of the 195 patients who were employed prior to COVID-19 infection, 117 were able to return to work, with 57 reporting they could only return to work part-time due to lingering health challenges. Another 45 people surveyed said they could not return to work for health reasons, and 21 survivors had lost their jobs.

A retrospective study of veterans in VA hospitals lends support to the above findings. In this study, the 60 days following hospital discharge, 9% of discharged COVID-19 patients had died and nearly 20% had to be readmitted to the hospital. Moreover, hospitalized COVID-19 patients had a 40%-60% greater risk of needing to be readmitted to the hospital or dying in the first 10 days after hospital discharge, compared with similar patients treated for heart failure or pneumonia at the same hospitals during the same time period.

Physicians and researchers are raising concerns about a variety of heart diseases, including heart inflammation, arrhythmias, and acute or protracted heart failure (muscle dysfunction) associated with COVID-19 infection. In addition to older individuals and people experiencing symptoms, COVID-related cardiac side-effects have even been observed in young, otherwise healthy individuals who experience mild or no symptoms from COVID-19 infection.

Findings suggest a pressing need for long-term support for COVID-19 survivors who were hospitalized with severe illness.

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COVID-19 Risks for Minorities

As the pandemic has grown, so has evidence of racial disparities, particularly in terms of testing outcomes, disease severity, and mortality rates. One report of a study of nearly six million individuals who receive care through the US Department of Veterans Affairs (VA) reveals that “Non-Hispanic Black and Hispanic individuals were twice as likely as non-Hispanic white individuals to test positive for COVID-19.” The report concludes, “Our findings highlight the urgent need for improved strategies to contain and prevent further outbreaks in racial and ethnic minority communities.”

The Kaiser Family Foundation (KFF) provided findings from an analysis of different populations within a large health-record system. It explains that while people of color have an increased risk of exposure to COVID-19 compared to white individuals, they do not have significantly higher rates of testing. However, they are “more likely to be positive when tested and to require a higher level of care” at the time of testing. These findings add to previous studies that have shown higher rates of hospitalization and death due to COVID-19 in people of color. The fact that these differences persist even after controlling for sociodemographic factors (such as where one has lived, income level, available resources, etc.) as well as underlying health conditions, indicates that other factors are involved and more research is needed to fully understand why these racial disparities occur.  

For information specifically relating to COVID-19 and minorities, please see MSAA’s webinar, “Understanding the COVID-19 Impact on MS in People of Color.”

Also see Closing the Gap: Latinos, Health Care, and COVID-19 for an in-depth discussion on how COVID-19 is spotlighting the long-standing race-based health disparities in American communities and our healthcare systems. Speakers include Politico’s Renuka Rayasam, US Secretary of Health and Human Services (HHS) Xavier Becerra, and Congressman Raul Ruiz, MD.

For general information on how MS affects minorities, please read MSAA’s cover story, “Disease Effects and Needs of Minority Populations with MS.”

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