Coronavirus: Guidance for Better Mental Health
We encourage reviewing a discussion about guarding mental health during the COVID-19 pandemic prepared by Rehab 4 Addiction from UK.
We encourage reviewing a discussion about guarding mental health during the COVID-19 pandemic prepared by Rehab 4 Addiction from UK.
COVID-19 and people with neuromuscular disorders:
World Muscle Society position and advice
The category of neuromuscular disease (NMD) covers a wide range of different diagnoses with widely varying levels of disability even in people with the same diagnosis. It is difficult, therefore to make specific recommendations that apply generally. The following are recommendations that apply to numerous neuromuscular disorders. These recommendations are designed primarily for patients who have been diagnosed with a neuromuscular disorder, their carers, general neurologists and non-specialist medical providers. They are also intended to inform neuromuscular specialists particularly regarding frequently asked questions and basic service requirements. In-depth reference links are provided.
Note: COVID-19 is a rapidly evolving field. The advice in this document is subject to regular revision. Please ensure that you are using the most up to date version of the document.
1. Are people with neuromuscular disease (NMD) at higher risk?
So far, there is no evidence that hereditary neuromuscular disorders confer a higher risk of infection by the SARS-CoV-2 virus. However, neuromuscular diseases and their treatments may influence the patient’s ability to cope with infection or its systemic effects.
National neurological associations and neuromuscular networks (Association of British Neurologists, European Reference Network EURO-NMD, others) have produced guidance on the impact of COVID-19 on neurological disorders and their management. These documents define the risk of a severe course of COVID-19 as high or moderately high in all but the mildest forms of NMD. Features conferring a high or very high risk of severe disease include, for example:
2. What do people with NMD need to do to avoid infection?
COVID-19 spreads through droplet infection when an infected person coughs, sneezes or talks, or potentially via touching a surface carrying infectious droplets. People with NMD and a high risk of a severe course of COVID-19 infection, as defined above, should undertake the following precautions:
3. What consequences does the risk of COVID-19 infection have for treatments used in people with NMD?
4. What needs to be done to assure ventilatory services when isolating (LVR bags, home ventilators etc.)
5. When should people with NMD seek admission if they develop symptoms of infection?
Inpatient admission should be avoided if possible, but should not be delayed when necessary. This can be a difficult decision. People with NMD need to be aware that:
6. What applies to immunosuppressive treatment in patients who have suspected or proven COVID-19 infection?
7. Can treatments for COVID-19 have effects on neuromuscular disease?
8. What should neuromuscular specialists do to assist Emergency Medical and Intensive Care decisions on admission to units, escalation of treatment, and ceilings of care in neuromuscular patients?
Decisions on patient admission to Intensive Care may be affected by anticipated or existing capacity problems. Triaging may have been instituted. This can have practical and ethical consequences.
9. What patient support should neuromuscular centres provide?
Neuromuscular centres and specialist services should aim to provide the following:
10. De-escalation of shielding measures – “Déconfinement”
Since the last update of these recommendations, a new discussion is emerging, concerning the safe de-escalation of some aspects of shielding and self-isolation to allow people with neuromuscular disorders to resume social interactions and education, work, or attend scheduled medical appointments.
Currently, there is considerable variation in the way national restrictions and the relaxation of restrictions are evolving, and this impacts on people with neuromuscular conditions, their families and carers, who seek advice from their neuromuscular services.
Despite the range of national approaches to this issue, the WMS agrees on the following considerations regarding risk stratification:
Experience so far (15-06-2020): Based on an unpublished survey among WMS members, we urge particular caution in some patient groups, despite their being ambulatory and socially active. These may include patients with conditions that are likely to exacerbate through febrile illness, and those with prominent nasopharyngeal weakness. In our case observations worldwide, Myasthenia gravis and Myotonic dystrophy have featured prominently in this group.
Further information links:
https://www.theabn.org/page/COVID-19
https://neuromuscularnetwork.ca/news/COVID-19-and-neuromuscular-patients-la-COVID-19-et-les-patients-neuromusculaires/ (updated version April 3rd 2020)
link https://ern-euro-nmd.eu/
https://www.enmc.org (European Neuromuscular Centre website) WMS COVID-19 advice V5 15th June 2020
https://www.aanem.org/Practice/COVID-19-guidance (American Association of Neuromuscular and Electrodiagnostic Medicine AANEM website)
https://www.apta.org/telehealth (American Physical Therapy Association advice on telehealth)
https://filnemus.fr (French neuromuscular reference centres network with extensive advice on medical and social issues around Covid19)
Authors of this document:
Collated by Maxwell S. Damian, PhD, FNCS, FEAN and the members of the Executive Board of the WMS (www.worldmusclesociety.org) in cooperation with members of the Editorial Board of Neuromuscular Disorders, official journal of the WMS
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