Introduction: More than a year after the start of the pandemic, the follow-up and face-to-face care of patients with demyelinating diseases has been modified. According to the evidence, patients with a diagnosis of multiple sclerosis (MS), isolated demyelinating syndrome (ADS), Isolated Radiological Syndrome (RAS) or neuromyelitis optica (NMO) spectrum diseases do not seem to be a risk group for COVID19 due to the fact that they have the disease. The presence of certain conditions can make them susceptible to severe infection. A severe course association with anti-CD20 drugs has been described, data on the response to COVID19 vaccines in this population are lacking.
Objectives: To establish clinical-epidemiological characteristics of patients with demyelinating diseases who have suffered from COVID-19 and describe their evolution. Characterize the vaccinated population, evaluate access to medical/therapeutic follow-up during the pandemic. Materials and methods: Descriptive observational study. The medical records of 168 patients with MS, ADS and ARS and 33 patients with NMO corresponding to the Hospital de Clínicas José de San Martin were reviewed. Through a telephone survey, adherence to treatment, clinical evolution, COVID-19 infection, vaccination, and access during the pandemic were evaluated.
Results: 49 patients who developed COVID-19 were found in the MS patient group, and 7 in the NMO group. Of the first group, none required hospitalization, unlike in the second, 2 were hospitalized and one of them died. The most frequent post-COVID complication was: prolonged asthenia and 3 patients presented an outbreak of the underlying disease in the following 3 months. Close to 90% of our population already had at least 1 dose of SARS-CoV2 vaccine. Access to the neurological consultation was questioned and almost 70% of the patients gave the highest score to access to virtual consultations.
Conclusion: Patients with demyelinating diseases who had COVID-19 did not have severe complications from the infection, with only 2 patients having an outbreak in the subsequent 3 months. We did not observe severe post-vaccinal adverse reactions, nor subsequent infection, only 2 patients presented an outbreak in the post-application period. A large number of patients perceived fluid access to their neurologists virtually, which could be related to a high rate of adherence to their treatments despite the limitation to face-to-face consultation.
COVID-19, Demyelinizing Diseases, Isolated Radiological Syndrome
During 2020, a pandemic was developed by COVID-19, infection caused by the SARS-COV2, which produces a severe respiratory infection and high contagion rate. Due to this pandemic, a quarantine was decreed that consisted of insulation at home, only with permission to circulate essential personnel for the care of the population, it lasted for several months in Argentina.
In our country, we registered two large spikes of contagion and Sars-COV2 disease, the first between July and September 2020 and the second between March and May 2021. To counteract serious diseases and hospitalizations by COVID-19, the Vaccination programs at the public level from January 2020, starting with health workers, then by risk people, and finally towards the middle of the year began with the general population.
Demonicizing diseases are entities whose pathology involves inflammatory processes mainly at the level of the white substance of the central nervous system. Among them we can highlight two large groups, multiple sclerosis (including all its variants and isolated and radiological demyelinizer syndromes) and diseases of the optical neuromyelitis spectrum (NMO). Due to its inflammatory nature, its long -term and modifier treatment of the disease, they are based on modular and suppress the immune system.
Several studies from different cohorts of the world have established the relationship between frequency and severity of COVID-19 in patients with demyelinizing diseases [1-8]. Population had a greater frequency of SARS-COV2 infection than the general population. In the Latin American cohort reported by Alonso R, et al. (2021) , within the multiple sclerosis cohort, they found a greater risk of presenting serious pictures in those with an advanced age, high EDSS and long duration of base disease, however, the same according to the modifier treatments of disease or obesity. As for the NMO cohort, they presented a higher percentage of hospitalization and requirement of UTI, also evidencing deaths in a third of it, taking into account the significantly lower sample size for this cohort, other associations were not reached .
Taking into account these data, our objective was to describe how our population of patients with demyelinizing diseases followed at the José de San Martín Clinic, located in the city of Buenos Aires, during the pandemic, the frequency of infections by SARS- COV2, vaccination for it and access to the health system.