CORONAVIRUS (COVID-19) UPDATES
Stay up-to-date on Bend Neurological Associates response to COVID-19
The health and safety of our patients and team members is our top priority. As your caregivers, we want to ensure that we are able to meet your needs during the Coronavirus (COVID-19) pandemic.
WHAT CAN I DO TO PROTECT MYSELF?
Masks are still strongly recommended for all individuals. However workers, patients and visitors in health care settings will no longer be required to wear masks starting April 3.
IF YOU OR ANYONE IN YOUR HOUSEHOLD HAS FEVER, CHILLS, BODY ACHES, FATIGUE, HEADACHE, COUGH, SOAR THROAT, CONGESTION, RUNNY NOSE, DIFFICULTY BREATHING, SHORTNESS OF BREATH, LOSS OF SMELL OR TASTE, DIARRHEA, VOMITING OR HAVE BEEN EXPOSED TO PERSON WITH CONFIRMED COVID-19 DO NOT COME INTO THE CLINIC!
Here are some actions you can take to protect yourself:
Wash your hands frequently, and before and after eating. Use soap and water if available, wash for 20 seconds. Use hand sanitizer when soap and water are not available.
Wear a mask or face covering whenever in public settings or if you are unable to socially distance yourself from others.
Avoid touching your eyes, nose and mouth. Cough or sneeze into a bent elbow.
Avoid contact with individuals who appear sick or have symptoms.
Practice social distancing.
WHERE CAN I GET MORE INFORMATION ABOUT CORONAVIRUS (COVID-19)?
Call 2-1-1 for information from the Oregon Health Authority or go to their site here:
Centers for Disease Control and Prevention:
MULTIPLE SCLEROSIS AND VACCINE INFORMATION
Updates from Laura J. Schaben, MD
January 2023 - Evusheld
Update: On January 6, 2023, the Food and Drug Administration (FDA) again updated information on the effectiveness of Evusheld, addressing COVID-19 subvariant XBB.1.5. The agency noted that although laboratory data is still in process, the similarity of XBB.1.5 to XBB in the areas of the virus that are targeted by Evushelds antibody mix makes it unlikely that Evusheld is effective against XBB.1.5. As of December 17, 2022, only about 24% of COVID-19 infections nationwide were from variants that have been shown to be neutralized by Evusheld like BA.5 and BN.1.
Responding to the alarm of immunocompromised individuals who relied on Evushelds protection, AstraZeneca announced clinical trials of a second-generation antibody mix for COVID-19 prevention. The new formulation retains one of the two original Evusheld antibodies, cilgavimab, and adds a second long-acting monoclonal antibody that is broadly neutralizin. That is, it neutralizes many different COVID-19 variants, including the subvariants of Omicron that Evusheld does not neutralize. The company hopes to make its new protective product available in the second half of 2023.
November 2022 - Evusheld
If you received Evusheld last spring as added protection against COVID infection, please be aware you are eligible for repeat dosing 6 months out from the initial injection date. You can contact my office for referral to Saint Charles Bend for that next set of injections. This FDA has released information that some of the circulating COVID variants are now resistant to Evusheld. At this point in time, I still recommend getting repeat Evusheld dosing given the overall excellent safety of Evusheld and evidence that most of the circulating variants are not resistant. Currently, Evusheld is the only option for preexposure prophylaxis of COVID-19 in patients who are immunocompromised.
March 2022 - Evusheld
Evusheld is now available through SCMC Bend on a limited basis as a preventative monoclonal antibody against COVID infection. It is administered as two intramuscular injections. If you have received Ocrevus, Rituxan, Kesimpta, Gilenya, Mayzent, or Lemtrada in the last year, you may be eligible for this therapy. If you wish to be considered for this treatment, please contact my office. Ultimately, SCMC approves and schedules the treatment depending on supply availability.
Additional information can be reviewed here:
With the new Omicron COVID-19 variant, the monoclonal antibody treatment has changed, and as of today (1/6/2021), monoclonal antibody therapy is in very short supply. Because of this, the criteria to qualify has been made more stringent in the St. Charles health system. Please be aware that people who have been treated with Ocrevus, Rituxan or Lemtrada within the last year DO QUALIFY for outpatient monoclonal antibody treatment at this time. Treatment will be limited to those within 7 days of symptom onset and a positive lab test result is required. If you become sick with covid, please contact your primary care provider or proceed to the SCMC urgent care to coordinate monoclonal antibody treatment if you are on one of these immunosuppressive treatments.
In light of the rapid spread of the Omicron variant of COVID-19, please consider changing your visit to telehealth if you are higher risk for COVID-19 illness and you have an appointment with me between now and the end of January, 2022. I would recommend patients on immune supressing therapy (Ocrevus, Kesimpta, Rituxan, Gilenya, Lemtrada) and anyone over 65 to please consider taking advantage of our telehealth option to help limit your exposure to this variant. If you do elect to come to clinic for your visit, please be vigilant in keeping your mask on at all times.
August 2021 - Patients on Ocrevus/Rituxan/Kesimpta/Gilenya or Lemtrada
If you are on Ocrevus, Kesimpta, Rituxan, Gilenya or Lemtrada, you are eligible for the COVID vaccine booster being offered for immunosuppressed individuals. You do not need an order or a doctor’s note to be able to get this, and it should be available wherever vaccines are being offered (pharmacies, PCP offices, vaccine fairs, etc).
For patients on ocrevus or rituxan therapy, I would recommend getting the booster shot in the latter half of your infusion cycle.
If you have any further questions please contact us to discuss.
To patients who take immunosuppressive therapy for MS such as Ocrevus, Rituxan/rituximab, and Kesimpta: Immunosuppressive therapy reduces the effect of the COVID vaccine. It is still recommended that you get the COVID vaccine, because some benefit exists, but it is not going to be as effective.
The effect (production of protective antibodies) is likely reduced by one third to one half compared to those not on immune suppression. If you have an option to select which vaccine you get, starting with the highest efficacy vaccine you can make sense. This means Pfizer or Moderna (rather than Johnson and Johnson).
With this in mind, please continue to follow careful COVID precautions even after vaccination (masking, handwashing, social distancing) and also encourage consider asking those you are in close contact with to get vaccinated for your benefit.
The National MS Society now has COVID vaccine guidelines available on its website. You can link to the full document here:
Open the link then scroll down and open "COVID-19 Vaccine Guidance for people living with MS
The expert panel included MS specialist physicians from top University MS centers as well as from the NIH and MS International Federation. In short, the panel does view the vaccine as safe for use in MS and recommends patients get the vaccine as soon as possible. They also advise that the risks with COVID infection is much higher than risks associated with the vaccine.
This document does not give specific guidance for timing of vaccine on Ocrevus and Rituxan (these MS treatments are thought to reduce the effect of the vaccine), and at this time I continue to recommend that patients on those therapies time their vaccines in the last two months of the 6 month infusion cycle.
If you have any further questions please contact us to discuss.
Many of you have been asking about the safety of vaccinations for people with MS. The vaccines that have been approved for use do look safe and effective for use in MS. I DO EXPECT to recommend to almost all of my patients that they get vaccinated. I think the benefits of the vaccine greatly outweigh the risk for most patients. MS as an illness is not likely to be a priority group, as it has NOT been found to be a high risk condition with COVID. Those with advanced age or advanced disability (not ambulatory) are likely to be prioritized. As of right now I expect it will be weeks to months for most people to have access to the vaccines.
If you are not on MS therapy you can get vaccinated. If you are on an injectable therapy (shots like Copaxone or Avonex) you can get vaccinated. If you are on Aubagio you can get vaccinated. If you are on Tysabri you can get vaccinated.
If you are on Tecfidera or Gilenya/Mayzent you will need to check with me as to your immune system lab numbers but you will very likely be able to get vaccinated. I would wait to call until the vaccine is actually available to you, as your lab numbers may change over a few months and it may be months before the vaccine is available.
If you are on Rituxan or Ocrevus we will want to time your first dose vaccine 2-3 months before your next infusion date. If you start the vaccine process (2 doses for the current approved vaccines will be given 3-4 weeks apart), you will need to finish it and have at least 2 weeks time before we infuse ocrevus/rituxan. We want to avoid vaccination in the first 2-3 months AFTER the infusions.
My recommendations may change as more information becomes available, and if so I will send out an update. If you have additional questions, feel free to call. I suggest calling once the vaccine is made available to you as this is an evolving issue.
Happy New Year! Please keep masking and washing your hands, and stay safe!